Digital Mental Health Tools and Migrant Populations in the UK: Are We Designing for Inclusion or Exclusion?

Category: Health and Healthcare

Digital Mental Health Tools and Migrant Populations in the UK: Are We Designing for Inclusion or Exclusion?

15/11/2025

Main author: Isatou Touray

Contributing researchers and editors: Dr Nadia Musa, Dr Mikael Leidenhag

Background

A migrant is defined as a person who moves away from their regular residence, whether within a country or internationally, for various reasons, typically to escape wars or to seek a better life elsewhere (Anderson and Blinder, 2024). In 2020, the global population consisted of around 281 million international migrants (International Organization for Migration, 2024). Migrants frequently encounter health challenges such as infections, mental health illnesses and accessing healthcare services during and after their migration (Wickramage et al., 2018). Due to pre- and post-migration stressors such as trauma, violence, separation, and loss, migrant communities, including refugees and asylum seekers, endure an increased risk of mental health disorders, including anxiety, depression, and post-traumatic stress disorder (Chen et al., 2017).

These health disparities intersect with broader structural changes in healthcare delivery. As healthcare services become more digital, especially in the West (Matlin et al., 2024), online referrals and remote consultations are common in the NHS. Their purpose is to make services easier to access and utilise; however, it often forgets the hurdles and barriers that migrant groups face (Jama, 2022). Barriers such as low digital literacy, language issues, and limited health literacy can hinder access to these services (Whitehead et al., 2022). This is important because the United Nations research (2024) showed that Europe has the highest number of international migrants (82 million), thus indicating the significant challenge of designing digital mental health services in the UK in ways that can serve diverse and disadvantaged migrant groups (Marchi et al., 2024). Without fixing digital exclusion, millions of people will be at a disadvantage in accessing mental health services, which could result in their symptoms and mental conditions worsening (Torous et al., 2025).

NHS Digital Mental Health Tools: Who Are They Built For?
NHS digital mental health tools, such as the NHS app, IAPT online referral systems, and remote consultation platforms, were created to improve accessibility. However, data show these tools are disproportionately adopted by populations who are already relatively advantaged, suggesting they are not designed for those most at risk of exclusion (Kc et al., 2024). Large studies have investigated and found that people from lower socioeconomic areas and certain ethnic groups are less likely to sign up for or utilise and access the apps as frequently, demonstrating that the app’s ‘digital front door’ did not work equally for all (Kc et al., 2024). A qualitative study by Berry, Lobban and Bucci (2019) further showed limitations in these apps, due to their embedded assumptions about language, digital literacy, and UK health systems. Users and staff say reported that key functions (e.g., booking an appointment, repeat prescriptions, and self-referral) are helpful to those who are digitally literate but can be confusing, inaccessible, and culturally inappropriate for others, especially recent migrants, refugees, and asylum seekers (Islam et al., 2024). Research on refugee and asylum-seeker groups shows that digital mental health interventions are promising; however, they lack inclusivity and show low effectiveness within vulnerable groups. They are not well-suited to local cultures, they have few language choices, and people may lack access to electronic devices such as phones and the internet (Whitehead et al., 2022).

Existing Evidence and Policy Gaps
As the number of research projects investigating the use and impact of NHS digital tools grows, there is more evidence to showcase the disparities in the way different groups utilise and access such tools. For example, a study by Kc et al., (2023) found that utilisation was 'dramatically lower' in most deprived areas and ethnic minority groups. They also identified issues with digital literacy and language barriers. This was exacerbated by a limited understanding of NHS systems. This indicates that the individuals who could gain the most from improved service access are actually those who are least able to utilise it tools. Research on migrants, refugees, and asylum seekers shows that health gaps increase due to unequal digital health access in the UK. Mabil-Atem et al., (2024) find in their integrative literature review that digital mental health tools for refugees are promising but face constant barriers like language, no cultural fit, and low trust in digital. Matlin et al., (2024) also show that most of the available interventions are not well funded, are poorly monitored, and are not based on migrant groups' experiences. The British Red Cross (2023) found that asylum seekers in England often have a hard time getting GP appointments, referrals, and prescriptions because of digital-only systems. Many are left out of vital health care.

These findings show that NHS digital mental health services have been built on assumptions that are not consistent with the needs of marginalised populations. This highlights an important policy gap; while national digital health strategies focus on operational efficiency and scaling up, they do not focus on making structural inclusion a key part of their work. If no targeted ways of breaking down language, literacy and access barriers are put into place, digital mental health services will only deepen health inequalities.

Conclusion and Recommendations
This paper has investigated the links between migration, mental health, and digital healthcare access in the UK. It found that while the NHS promotes digital mental health tools as ways to make them easier for everyone to use, their design and roll-out actually exclude many of those most in need. Migrants, refugees, and asylum seekers face many hurdles, including language barriers, digital skills, and a lack of trust in digital tools. Studies show that migrants and minority groups are less likely to use NHS digital tools, while other publications explain how asylum seekers are often left out of even basic health care through digital-only systems. All of this makes it clear that health policy is leaving out a key part of the picture; digital health strategies focus on more people and quicker ways of doing things, but they fail to prioritise inclusivity.

To avoid exacerbating exclusion and inequalities amongst users, several reforms and targeted actions are required:

1. Multilingualism – all NHS digital tools should have translated interfaces and culturally appropriate resources.

2. Digital skills training – train community workers to support migrants and refugees to use NHS digital tools.

3. Retain non-digital options – paper-based, phone and in-person routes should always be an option for those who cannot or do not want digital routes.

4. Culturally responsive designs – work with migrant and refugee communities to co-design digital mental health tools.

5. Evaluation and care – include equity markers in the design of national digital health strategies to see if there are gaps in who is using the tools.

References

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