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Refugees as Survivors New Zealand

A selection of the team - for the full team photo please read our story.

What:A multidisciplinary mobile refugee mental health team.

Why:To provide culturally competent mental health care, and increase the responsiveness of mainstream services for refugee communities.

How:Providing multidisciplinary mental health and practical support to refugees at community venues or in their own homes.

Target:Refugees with mental health concerns.

Where:Greater Auckland region.

...the community link person is the key person here. The work of the psychologist is very important. But the follow-on support which links the client into services provided in New Zealand is really important for helping the client engage and improve his/her self esteem..." Senior doctor interviewed during the evaluation  

The profile

The Auckland Regional Refugee Mobile Team provides a mobile mental health service, including early clinical intervention and preventive care, to people who are refugees. Services are available free of charge to refugees who experience mental illness and live in the Auckland region. Asylum seekers who have experienced torture are also eligible to attend the service.

The mobile team is made up of psychiatrists, psychologists, body therapists, social workers, a nurse and six permanent refugee community link workers. Team meetings, referral information and/or psychologist assessments are used to decide what combination of psychological assessment, intervention, counselling, social work, body therapy and community support work would be most beneficial for each client.

The community link workers deliver practical and social support to refugees such as assistance to access English lessons and interact with other service providers. The community link workers also provide cultural advice to the mobile team and to mainstream mental health services. They are all professional interpreters and lifeline counsellors. Currently the community link workers come from Afghan, Burmese, Somali, Iraqi, Ethiopian, Sudanese and Kurdish communities. Interpreters for other languages can be accessed when necessary.

Clients are seen at local community venues or in their own homes. Between November 2007 and September 2009 the team has worked with around 200 clients. Wherever possible the mobile team engages in shared case work with mainstream services so these services develop greater competence around working with refugee clients. The mobile team also provides training and education to build the capacity of the mainstream services.

Four evaluators have been contracted to monitor and evaluate the mobile team’s work. The first stage of the evaluation prompted the service to increase their office space and hire additional administration support. The final evaluation provided more detailed information on service performance and identified strategic needs for the service.

The beginnings

The refugee mobile team initiative was set up in November 2007 to address a serious gap in community-based mental health services for refugees. Currently groups of 120-140 new refugees from around the world enter New Zealand every eight weeks. For the first six weeks following arrival they receive comprehensive assessment and orientation from various agencies based at the Mangere Refugee Resettlement Centre.

Once resettled in the community, refugees had no access to refugee-specific services. Access to mainstream services was limited by transport difficulties and knowledge of the services. In addition, staff of mainstream services are not always trained to deal with the specialist needs of refugee mental health and NGOs that provide non-acute mental health support do not have funding for interpreters.

The Refugees as Survivors New Zealand (RASNZ) Mangere Centre received many phone calls from mainstream mental health services and primary health providers expressing concern about refugee clients in the community. The centre recorded the number and types of calls to support their funding applications, demonstrating the need for a community-based initiative.

Gary Poole, the RASNZ chief executive officer, and RASNZ Board deputy chair, Hon Aussie Malcolm (former Minister of Immigration and Health) worked on service specifications for the new mobile team and approached multiple funding bodies – multiple funders were needed to achieve sufficient sustainable ongoing support.

Currently, the clinical team is funded by the Northern District Health Board Support Agency (NDSA), with the community link workers funded by the ASB Community Trust. This funding is supplemented by donors and corporate funding. RASNZ also receives United Nation funding to work with victims of torture.  

"We take services to people rather than expecting them to come to our offices.",
RASNZ Mobile Clinical Team Leader

The process

The team aims to provide culturally competent care using a holistic approach to mental health. The community link workers provide practitioners with advice on culturally appropriate treatment, monitor client wellbeing and provide clients with regular follow up and practical assistance. Practical assistance has included taking clients to the Mosque, regular home visits, assistance to understand bills and advocacy during interactions with other service providers.

Transport to mental health services is a key barrier for many refugees. The mobile team works to overcome this barrier by using multiple centres around Auckland and visiting refugees in their homes if necessary. The RAS mobile team works with Refugee Services Aotearoa settlement staff and social workers to help refugees to build their transport independence, teaching them how to use the bus system if they do not have access to a car.

Step by step

  1. Clients are referred by RASNZ at the national refugee centre in Mangere, mental health services, general practitioners, primary health organisations, community agencies, refugee organisations, family members, lawyers and social workers. Self-referrals make up 20-30 per cent of the referrals. Initial information about the needs of potential clients is recorded on a referral form.
  2. Referrals are discussed at clinical team meetings. Decisions are made about which psychologist should conduct a screening interview and whether a refugee community worker should attend.
  3. Once the psychologist conducts a screening interview, the team will review the case. Decisions are then made about the most appropriate type of support for the client. Support services include assessment, intervention, counselling, social work, body therapy and other clinical therapies.
  4. Treatment and clinical support is supplemented with follow up support by the community link workers. Community link workers may visit clients in their homes every 1-2 weeks and phone clients as often as every week.

Capacity building in mainstream services is provided through consultation/liaison work, developing and delivering training, presentations and sharing interpreters and case workers.


 "Even those who speak good English said that having someone from their own ethnic group present at the Centre gave them confidence in the RMT. ",
From the mid-term monitoring report
RAS mobile team<

Pictured from left: Sangita Wadenerker, Team Leader Surpreet Cheema, Dr Grant Galpin, Dr Fahima Saeid (Afghan Community), Andrew Duirs, Priscilla Dawson (Burmese Community), Dr Ibrahim Kadir (Somali Community), Fetiya Mohammad (Ethiopian Community) and Santino Deng (Sudanese Community).

The unique approach

  • Permanently employed refugee community link workers provide interpreting services, cultural advice, social and practical support to clients. All the community link workers come from refugee backgrounds and many are recognised leaders in their communities.
  • Community link workers facilitate access by directly linking and building the credibility of the mobile team with refugee communities.
  • The service addresses pressing practical concerns, not just mental health concerns.
  • The service is holistic and aims to address trauma and torture. For example, body therapy is available.
  • The team provides support in local community centres and/or service users own homes.
  • Over time clients are encouraged and supported to attend the community offices to improve their independence.
"...There have been a lot of benefits. A lot of changes in my life. Before I didn't know where to go and ask for help. I didn't know who to talk to and who to trust. Before I only sat at home and cried to myself because I didn't know what to do. Now my life is peaceful with my two children... Now there is no fear...",
Refugee survivor

The results

Evaluation methodology

A team of four evaluators, led by an independent contractor, conducted an evaluation assessing the use and quality of the mobile team’s work. Quantitative and qualitative evaluation methodologies were used. Information on service user numbers, ethnicity, time in New Zealand and referral sources was used to evaluate whether the team is reaching the right people, and areas of the community who may have been missed. Key informant interviews with service users and members of other mental health organisations provided information and perceptions about service quality from service users and community leaders. Data on outcomes was collected from 18 clients using the General Health Questionnaire (GHQ). The GHQ was selected because of its wide translation and application in the international literature. The team’s own views on progress and areas for improvements were also collected.

Evaluation information was collated and evaluation reports developed for the end of year one and year two (see the links in the ‘more information’ section below). Findings from the evaluations were fed back to the team in learning and reflection workshops.

"... [The RASNZ mobile team] are invaluable. I deal with a particularly stressed group of people. The mental health services can not deal with the workload. They fill an absolutely necessary gap. They also meet the psychological needs of the client group which I don't always find in other mental health services.", Peer professional interviewed during the evaluation

Evaluation findings

  • Statistically significant improvement post-treatment were noted for GHQ total scores, general illness, somatic symptoms, anxiety, depression and sleep disturbance showed (n=18). Please see the report in the ‘more information’ section below for further detail.
  • Service users and community leaders expressed positive feedback about the service.
  • Other services expressed positive feedback about the work of the mobile team.
  • Community link workers were considered to be a very important part of the service delivered.
  • Information on service’s strengths, potential service improvements and service gaps was discovered. For example, in their evaluation feedback service users emphasised the value of the practical support that was provided alongside the therapeutic support.
  • Changes to the service were made following the interim evaluation report to improve the service.
  • The service may need to think about adapting its service delivery if it is to meet the needs of the community within the resources available. One idea was to provide group training around issues that impacted on mental wellbeing in refugee communities.

The lessons learnt

  • Service users, mental health services and community representatives noted it was important to provide both practical and therapeutic support to the refugee clients.
  • Strong links with the refugee communities made it easier to set up the mobile team, recruit staff and encourage people to attend and refer themselves to the service.
  • Conducting evaluation requires staff commitment. Information can be hugely beneficial but does add another factor for staff to think about, and some extra work to carry out.
  • Evaluation information was useful for demonstrating the value of the service to funders, as well as improving the quality and direction of the programme.
  • The team have found that some refugees would rather have ‘touch’ therapy through body work than talk about their feelings. The body therapies may in turn increase open-mindness towards more conventional mental health treatments.

More information

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Refugees as Survivors New Zealand mobile team story (PDF)

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Page last updated: 7 November 2008