Migration and mental health: the great unknown of asylum policy

On 22 January 2025, two people were killed in a knife attack in a park in the city of Aschaffenburg in Germany. The suspect was a 28-year-old Afghan man with a history of violence. The tragedy instantly brought to mind previous attacks in Solingen and Mannheim, against the backdrop of tensions exacerbated by an election campaign. The origin of the alleged perpetrators has fueled an increasingly popular narrative in Germany, in which the tragedies are the inevitable consequence of large-scale uncontrolled immigration of fundamentally violent foreigners.

That sentiment is in turn fuelled by the belief that there is a general correlation between migration, crime, religion and violence. These well-known tropes have already been investigated by Voxeurop. But one factor seems to have escaped the notice of the mainstream media and short-sighted politicians: the obvious potential for a link between aggression and poor mental health.

The online outlet Infomigrants interviewed several experts shortly after the attack in Aschaffenburg. It points out that the attacker “suffered from mental disorders, according to the authorities, and was interned after his arrest. An Afghan man who attacked a far-right candidate in Mannheim in May, killing a policeman, was also diagnosed with a mental disorder.”

According to Ulrich Wagner, a professor of social psychology at the University of Marburg, the aggressors may be suffering from “extensive psychological problems, irrespective of their migrant background”. While he does not condone the acts, Wagner believes that we need to identify the root causes. One such cause might be the perpetrators' living conditions in Germany, which “obviously favored such mental disorders”. The individuals in question faced numerous challenges, including poor access to outpatient therapy, financial hardship, accommodation with little privacy, and forced indigence that made it impossible for them to give structure to their lives through work or social interaction.

Clearly there is no intention to excuse the aggressors. But the lack of consideration given to their psychological vulnerability raises a whole other question: that of the trauma of migration itself.

In Tagesspiegel, Nora Ederer interviews Meryam Schouler-Ocak, a doctor and professor of intercultural psychiatry, about the mental health of refugees in Germany. She agrees on the scale of the problem, citing the language barrier, discrimination and bureaucratic red tape as aggravating factors. Moreover, the costs of reception are unevenly distributed. “Interpreters are not part of the system. In our outpatient clinic, we pay for them out of our own budget”, she says. “This is also one of the reasons why some therapists, when they have the choice, prefer to accept patients who are less of an effort for them.”

For many displaced people, the journey itself plays a major role in the deterioration of their mental health. In a long and exhaustive analysis, the Center for Strategic and International Studies (CSIS, quoted here by iMEdD Lab) examined the issue of the “bottleneck” between Tunisia and Italy. Here, many exiles find their journeys held up by, among other things, the EU’s outsourcing of its border security. In this case the consequences are anything but trivial. “Stuck in a vicious circle between Tunisia and [the Italian island of] Lampedusa, with no safe alternative on the horizon, many migrants and refugees suffer further trauma.” Citing a 2019 study on the mental health of refugees in Tunisia, the analysis notes that “while migration does not automatically lead to further trauma, it is a profound life transition that requires significant adaptation on the part of the migrant. The impact of a migrant's life on his or her mental health evolves over time, with migration characterized by periods of relative stability and others of stress.”

The link between precarious living conditions and mental health is now well established. In terms of depression, for example, an analysis by Eurostat revealed that in 2019, “people in the first income quintile (the 20% of the population with the lowest incomes) were the most likely to report depressive symptoms”. 10.6% of them were affected, a figure “just over three times higher than that of people in the fifth, and highest, income quintile”.

The psychosocial consequences of migration are still poorly understood. The simple act of fleeing one's country for an indeterminate period of time, and leaving one's entire life behind, could result in “migratory mourning” which in turn can lead to reactive stress. In the Spanish magazine Ethic, Ana Mangas calls this the “Ulysses syndrome”, using the term coined by psychiatrist, professor and author Joseba Achotegui.

Mangas explains that the syndrome is not currently considered a mental disorder, and so is distinct from pathologies such as depression. Achotegui, whom Mangas interviewed, observes that it can be triggered by “forced solitude, fear, powerlessness and lack of opportunity”. Symptoms are varied: sadness, anxiety, insomnia, muscle pain, digestive problems, memory problems, and so on.

The conditions of arrival can also contribute to this stress: the strain caused by bureaucratic red tape, the need to recount traumatic experiences over and over again, discrimination, and so on. According to Mangas, tackling the Ulysses syndrome means understanding the links between migration and mental health, establishing decent universal healthcare and, ultimately, “humanizing” migration.

While studies do exist of the mental disorders suffered by certain migrant communities, the cases are scattered in time and place. Yet it is still possible to paint a general picture of the situation.

In a review of 21 studies on the subject, Farah Abdulrahman, Mary Birken, Naomi Glover, Miranda Holliday and Cornelius Katona of University College London demonstrate how the conditions of short-term accommodation influence the mental health of migrants. The specific challenges are manifold: the need to acclimatize to a new environment; feelings of imprisonment; the lack of an occupation; an eroding sense of security and trust. For the researchers, all these factors explain the cumulative burden of forced migration, and thus the health consequences it can bring.

Even if (as these studies suggest) a large proportion of displaced people suffer from mental-health disorders (anxiety, depression, PTSD) resulting from trauma, this fact naturally does not imply that all migrants are potential aggressors. But the link between these high-profile attacks and the mental health of the suspects is worth exploring.

All too often, such attacks have been explained by the personal, ethnic and religious profile of the perpetrators. That narrative overlooks the crucial consideration of their social, psychological and economic vulnerability. Ultimately, it has obscured the profoundly systemic nature of the suffering experienced by displaced people.