Refugees and asylum seekers are at an increased suicide risk, and this is particularly so amongst younger men and those confined in mandatory detention. In most instances, refugees and asylum seekers have experienced high levels of loss and grief, stemming from the loss of their homes, being forced to leave their country and losing people they love. Many have witnessed the death of family members, friends or fellow refugees or asylum seekers.

The losses experienced by refugees and asylum seekers can accumulate when immediate concerns about safety leave little space to grieve. As a result, their mental health can deteriorate significantly over time. It is important to be aware that severe and repeated exposure to violence and traumatic loss has a significant impact on mental health, and that the cultural background, personal experience and way refugees and asylum seekers are treated when they reach Australia can influence how their mental health problems are expressed.

Although refugees and asylum seekers share many of the same risk factors for suicide, there are some differences between the experience of being a refugee and that of being an asylum seeker that can lead to different mental health outcomes. These differences are explained below.

A refugee is a person who has fled their country of origin owing to fear that they will be harmed or persecuted there on the basis of their race, religion, cultural or social group membership or political beliefs. At the end of 2017, approximately 68.5 million people were displaced globally due to conflict, violence, persecution, and human rights abuses. Of these, approximately 28.5 million were refugees and asylum seekers who had fled their country of origin.

Resettlement in a country like Australia represents an opportunity for refugees to begin a new life. However, it is important to note that the journey towards resettlement can result in serious and lasting trauma.

For many refugees, the conditions faced in their country of origin may have involved witnessing or experiencing violence, fear or human rights abuses. In turn, the process of leaving may have involved significant chaos, danger and loss. During displacement, many refugees face conditions that continue to diminish their mental health, including periods of uncertainty, deprivation and separation from those they love. The process of resettlement can bring additional challenges, as refugees face cultural dislocation, social isolation, financial hardship and difficulties associated with language and access to services.

Asylum seekers are people who do not have refugee protection when they enter Australia but lodge claims upon arrival. For this reason, they face additional and complex hardships. For asylum seekers who arrive by boat, the journey to Australia is likely to have been perilous and traumatic, and on arrival they will be placed in detention facilities while their application for asylum is processed.

The experience of detention can be devastating for asylum seekers already suffering the impacts of trauma and grief. The prolonged uncertainty experienced while their claims for refugee status are adjudicated can re-traumatise them, and contribute to mental deterioration and despair. As asylum-seekers are questioned during the assessment of their refugee claim, reliving past events can trigger or exacerbate symptoms of post-traumatic stress disorder.

If refugee protection is granted it will almost always be temporary protection without family reunion. This often leads to significant distress and uncertainty. At the same time, asylum seekers – including those living in the community – have limited access to social and financial support services, and may be reluctant to access them owing to feelings of shame, guilt or fear of stigma. In turn, a sense that they feel trapped by their circumstances, powerless and unable to plan for the future can contribute to feelings of hopelessness, and place asylum seekers at significant risk of suicide and self-harm. This risk can increase if they receive a negative determination decision to their asylum request.

Providing safe and accessible supports for refugees and asylum seekers at risk of suicide and self-harm is essential. When a refugee or asylum seeker dies by suicide, the impact upon their communities – often already facing multiple griefs– can be both deeply felt and complex.

Professionals supporting refugees and asylum seekers around mental health and suicide prevention indicate that it is important to approach service provision within a ‘trauma-informed’ approach. This requires an understanding of the impact of trauma on the physical, emotional and social wellbeing of the individual, and indeed on themselves as helping professionals. It means working to avoid re-traumatisation by empowering refugees and asylum seekers and those who support them in decision making, safety, trustworthiness, choice and collaboration while building of strengths and skills.

Trauma-informed approaches are based on the understanding and belief that action, behaviour and experiences related to trauma are coping strategies developed to manage traumatic experiences. At a practical level this means working with transcultural experts, and co-developing safety plans with the refugee/asylum seeker that are culturally meaningful and safe.

Other factors that can help refugee wellbeing include:

• supporting the development of culturally and gender appropriate social groups
• supporting the maintenance of cultural identity
• rebuilding a sense of trust, emotional safety and security
• identifying safe ways of communicating past experiences of trauma
• identifying ways to understand individual conceptualisations of distress, preferred help and support