The Norwegian Directorate of Social and Health Affairs has asked the Norwegian Health Services Research Centre to clarify the possibilities for a pilot project on systematic identification of need for psychiatric help among asylum seekers.

The general need for psychiatric help among asylum seekers in not well understood. Studies of refugees indicate that the need is larger than in the general population. Asylum seekers are in a more uncertain situation than expatriated refugees, which could indicate an even larger need. However, not all asylum seekers are victims of mass violence or persecution, and among these the need could be lower.

Today, there is insufficient help available for psychiatric problems that have been recognized. The systematic identification of further unmet needs for psychiatric help will put greater pressure on the health services. It is considered unethical to identify illness or disease by a screening procedure if no treatment can be offered.

The situation does not satisfy generally accepted criteria for a screening program. The type of disease is not suitable, because there is no well described course of the illness from latent phase to manifest disease. The lack of such a description means that it has not been possible to develop a well validated test. There is also no clearly described treatment option that improves the prognosis.

We have undertaken a review of the literature for three commonly used instruments, the Harvard Trauma Questionnaire, the Hopkins Symptom Checklist-25, and the Post Traumatic Symptom Scale-16. Without further research, we cannot be sure if these instruments are well suited for the purpose.

If a project is undertaken, it should be designed as a research project. The planning of such a complicated project will demand a senior researcher for 1/2 year. We expect the project to meet great difficulties related to the heterogeneity of the population under study, the selection and definition of relevant psychiatric conditions to uncover, and considerable uncertainty regarding the choice, definition, and registration of outcome variables.

If a research project nevertheless is launched, and proves to be successful, a national program will cost at least NOK 7 000 000 per year. The calculation is based on the number of asylum seekers arriving in Norway in 2004. No cost-benefit analysis has been undertaken. Such an analysis should be undertaken alongside the research project.

From a medical point of view, we cannot recommend the routine large scale systematic identification of psychiatric problems among asylum seekers.