integrated mental health care for refugees
Introduction
About the Project
The Integrated Mental Health Care project is a multi-year research program examining how mental health services can better integrate to support refugees and people with forced migration backgrounds in British Columbia and beyond.
People with forced migration experiences often face complex mental health challenges related to trauma, resettlement stress, language barriers, and the social determinants of health. At the same time, services across health care, settlement, and community sectors are often fragmented and difficult to navigate. Improving coordination and integration across these systems is essential to ensure equitable, accessible, and culturally responsive care.
Project Purpose
This research aims to understand what works, for whom, and in what contexts to support integrated mental health care for refugees and people with forced migration.
The project uses a participatory realist approach and engages settlement organizations, health care providers, community agencies, policy makers and people with lived and living experience. Through working dialogues, deliberative discussions, and collaborative knowledge-sharing activities, the project is co-developing a theory to guide integrated mental health services.
Project Activities
Key activities include:
- Deliberative dialogues with service providers and community partners
- A World Café event to identify priorities for refugee mental health
- Development of an initial theory that explains how integrated mental health care services work (or not)
- A review of the literature, an evaluation of the initial theory and implementation strategies to bring the theory to life
- Knowledge mobilization through publications, presentations, and community engagement
Project Information
Lead Investigator: Dr. Nancy Clark
Institution: University of Victoria, BC
Collaborating partners: Community, health, and settlement organizations across BC
Timeframe: 2023–2028
Funding: Michael Smith Health Research BC Scholar Award; Health Research BC Convene and Collaborate (C2) Grant
Ethics approval: Research ethics approval obtained through the University of Victoria and partner institutions.
Current stage: Realist review to refine the initial theory developed in Phase 2
We welcome collaboration and inquiries from researchers and students, healthcare and settlement organizations, community groups and policy makers. Please contact the research team to learn more or explore partnership opportunities.
Phases of Work
A Realist Approach to Understand Integrated Mental Health Care
This project uses a realist approach to understand how integrated mental health care works, and why it sometimes does not, for refugees and people with forced migration backgrounds.
Mental health services do not work the same way for everyone. People who have experienced forced migration often face complex challenges such as trauma, language barriers, unfamiliar health systems, housing and employment stress, and cultural differences in how mental health is understood. At the same time, services are often delivered across multiple organizations and sectors that may not be well connected. Because of this complexity, integration may work well in some situations but break down in others. The realist approach helps us understand these differences and identify the conditions that support effective coordination across services.
This approach recognizes that integrated care does not happen simply because services exist. Integration occurs when the right supports and relationships activate positive responses within specific social, cultural, organizational, and policy environments. Understanding and explaining these dynamics helps identify not only whether integration is happening, but how it can be strengthened and where systems are breaking down.
To develop this knowledge, the project uses multiple methods, including working dialogues, community engagement activities such as World Café events, and collaboration with settlement organizations, health care providers, policy makers, and people with lived and living experience. By bringing together diverse perspectives, the research aims to understand real-world challenges and opportunities for integration.
The goal of this work is to develop a theory that explains and supports stronger coordination across sectors, more culturally responsive and accessible services, and evidence-informed policy and practice so that mental health systems work together more effectively to meet the needs of refugees and people with forced migration.
Articles
This section includes peer-reviewed publications and manuscripts related to the Integrated Mental Health Care project. Publications are listed with the most recent work first.
2026
Clark, N., Argüelles Bullón, A., Huq, M., & Mukumbang, F. C. (2026).
Integrated Mental Health for Refugees: A Realist Theory Building Study.
PLOS Mental Health
This open-access article presents the initial theory developed through participatory realist research with stakeholders across settlement, health care, and community sectors.
Programme Theory (Academic version)
Programme Theory (Accessible version)
Under Review
Clark, N., Argüelles Bullón, A., Huq, M., & Mukumbang, F. C. (Under review)
Understanding how integrated mental health care works for people of forced migration in global contexts: A realist review protocol.
Argüelles Bullón, A., Clark, N., Huq, M., & Mukumbang, F. C. (Under review)
Bringing together linked coding and realist thematic analysis: A worked example for initial [programme] theory elicitation.
Presentations
This section includes conference presentations, invited talks, and knowledge-sharing activities related to the Integrated Mental Health Care project. These presentations share emerging findings with academic, professional, and community audiences.
2026
Community Presentation – Victoria Coalition for Survivors of Torture (VCST)
February 27, 2026 | Virtual (Zoom)
Integrated Mental Health Care for Refugees: What works, for whom, and why?
Presenters: Dr. Nancy Clark and Alejandro Argüelles Bullón
This community session focused on practical insights for service providers, highlighting system challenges, coordination needs, and strategies to support integrated and culturally responsive care based on the theory building publication.
26th International Conference on Integrated Care
April 13, 2026 | In person (Birmingham, UK)
Integrated Mental Health for Refugees: A Realist Theory Building Study
Presenters: Dr Nancy Clark and Alejandro Argüelles Bullón
This presentation shared findings from the 2026 realist study examining what supports effective integrated mental health care for refugees and people with forced migration backgrounds.
Professional Webinar – CAMH
June 11, 2026 | Virtual (Zoom)
Integrated Mental Health for Refugees: A Realist Theory Building Study
Presenters: Dr. Nancy Clark and Alejandro Argüelles Bullón
This practice-focused webinar explored key findings from the realist theory building study, including the system conditions that support or hinder integration.
Downloads
Resources, reports, and knowledge materials developed through the Integrated Mental Health Care project are available below. These materials provide an overview of the research, key concepts, and the ongoing phases of work.
Upscaling Integrated Mental Health Services and Systems for People of Forced Migration
Open Access Government article
This feature article highlights the need for coordinated, system-level approaches to integrated mental health care and outlines the broader goals and policy relevance of the project.
Read online: Open Access Government (OAG42)
Faculty of Health (OAG42)
This article introduces the Integrated Mental Health Care research program and its focus on improving collaboration across health, settlement, and community services for refugees and people with forced migration.
Read online
Phases of Work
This presentation outlines the key stages of the project, including stakeholder engagement, theory development, knowledge mobilization, and future research activities.
PowerPoint (132 KB)
Meet Our Team
Nancy Clark
Principal Investigator
Dr Nancy Clark is an Associate Professor at the School of Nursing at the University of Victoria in British Columbia. Her research focuses on social and structural inequities experienced by underserved populations, including groups negatively affected by displacement (i.e., refugees and other groups that experience displacement and structural vulnerabilities due to war, environmental change, and political persecution). She examines how age, sex/gender, ethnicity/race, class/poverty, and other social identity categories shape and are shaped by structural determinants of mental health, and how health and social systems respond to build resilience and adapt to the needs of these population groups.
Alejandro Arguelles Bullon GMBPsS MRSPH
Graduate research assistant
Alejandro is a mental health researcher and PhD candidate in Mental Health at Lancaster University, where he received the Dean’s Ben Booth Award for Outstanding Contribution. His research focuses on a wide range of mental health topics, using realist approaches to understand what works, for whom, and why across different contexts and populations. He places a strong emphasis on inclusion, lived-experience roles, and health system responsiveness. He is currently affiliated with Lancaster University, the University of York and the University of Victoria as a mental health researcher. He has participated in several realist research projects collaborating with teams in Canada, Spain, Colombia, India, the UK and other global contexts.
Dr Ferdinand C Mukumbang
Assistant Professor
Dr. Mukumbang is an Assistant Professor at the Department of Global Health. He is a Public Health scientist specializing in health policy and systems research with a specific focus on implementation sciences. Regarding methodological advancements in implementation sciences, he is particularly interested in the development and adoption of realist-informed research methods – critical realist theorizing, realist evaluation and realist synthesis and reviews – for evidence-based theorizing in health care and global health to unpack implementation outcomes. He has published several methodological papers in this regard.
Neelam Dhakal
Graduate research assistant
I am a healthcare researcher with over five years of experience in clinical and public health research across national and international settings. I currently work as a Research Assistant on an integrated mental health care project at Faculty of Health, School of Nursing, University of Victoria, supporting data extraction, data analysis, and knowledge translation. My background includes multidisciplinary research, research ethics submissions, and the use of both qualitative and quantitative methods to support policy-relevant health research.
World Cafe Event
The World Café brought together settlement organizations, health care providers, community leaders, policy representatives, and people with lived and living experience of forced migration to share perspectives on how to improve mental health services for refugees in British Columbia. The event created a collaborative space for dialogue, reflection, and collective learning about the challenges and opportunities for integrated mental health care.
Participants discussed the barriers refugees face when seeking mental health support, including language and cultural differences, stigma, system complexity, and difficulties navigating multiple services. Conversations also highlighted the importance of trust, relationship-building, and culturally responsive approaches to care.
The event reinforced that collaboration across sectors, along with sustained funding and policy support, is critical to reducing service fragmentation and improving access to care. These discussions directly informed the development of the project’s initial program theory and ongoing research activities.
The photographs capture moments from the World Café and reflect the collaborative and participatory nature of this work.
Partners and Collaborators
We gratefully acknowledge the partners and collaborators who have contributed their time, expertise, funding and lived experience to this project. Integrated mental health care cannot be understood or improved without strong collaboration across sectors. This work has been shaped through the knowledge, insights, and ongoing engagement of community organizations, health care providers, policy partners, researchers, and people with lived and living experience of forced migration. We sincerely thank our partners for their commitment to improving mental health services and outcomes for refugees and people with forced migration.
Contact
For collaboration, research inquiries, or student opportunities:
Email: Dr. Nancy Clark (nancyclark@uvic.ca) or Alejandro Arguelles Bullon GMBPsS MRSPH (aarguellesbullon@uvic.ca)
Institution: University of Victoria, BC, Canada
Copyright © 2026