Barriers to Accessing and Negotiating Mental Health Services in Asylum Seeking and Refugee Populations: The Application of the Candidacy Framework

J Immigr Minor Health. 2020 Feb;22(1):156-174. doi: 10.1007/s10903-019-00929-y.


This review brought together research investigating barriers asylum seekers and refugees (AS&R) face in accessing and negotiating mental health (MH) services. The candidacy framework (CF) was used as synthesizing argument to conceptualize barriers to services (Dixon-Woods et al. in BMC Med Res Methodol 6:35, 2006). Five databases were systematically searched. Twenty-three studies were included and analyzed using the CF. The seven stages of the framework were differentiated into two broader processes-access and negotiation of services. Comparatively more data was available on barriers to access than negotiation of services. The Identification of Candidacy (access) and Appearances at Services (negotiation) were the most widely discussed stages in terms of barriers to MH care. The stage that was least discussed was Adjudications (negotiation). The CF is useful to understand inter-related barriers to MH care experienced by AS&R. A holistic approach is needed to overcome these barriers together with further research investigating understudied areas of candidacy.

Keywords: Asylum seekers; Candidacy framework; Mental health services; Refugees.

Publication types

  • Systematic Review

MeSH terms

  • Communication Barriers
  • Cultural Characteristics
  • Environment
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility / economics
  • Health Services Accessibility / organization & administration*
  • Humans
  • Mental Health Services / organization & administration*
  • Negotiating*
  • Patient Acceptance of Health Care / ethnology
  • Prejudice
  • Refugees / psychology*
  • Refugees / statistics & numerical data*
  • Social Environment
  • Socioeconomic Factors