When we talk about justice in healthcare, two words often surface for the ones who understand the basics of a social system: equality and equity. While equality means offering the same resources to everyone, equity acknowledges that some groups—such as refugees—face unique barriers and therefore need adapted, tailored support. In psychotherapy for refugees, especially in Austria, this difference is more than a semantic nuance: it can determine whether people with urgent mental health needs actually receive effective help.
Why Equity Matters in Refugee Mental Health
Around 26–31% of recent refugees in Austria suffer from moderate to severe mental distress, particularly women, young people, and refugees from Afghanistan (Buber-Ennser et al., 2020; Vidovicová et al., 2023). Contributing factors include past trauma, ongoing uncertainty, discrimination, and economic insecurity (WIIW, 2021). Simply granting “equal access” to the same psychotherapeutic system available to Austrian citizens is not sufficient, because systemic, cultural, and linguistic barriers prevent refugees from benefiting equally from these services.
Refugees face a variety of barriers despite limited financial resources (~200 Euro per month for all supplies needed) when seeking psychological support, for example:
- Language barriers remain one of the greatest challenges. While interpreter services and multilingual programs exist, provision is patchy and inconsistent (ReHIS Project, 2021).
- Limited availability and waiting lists reduce access, with demand far exceeding available services, especially for trauma-informed psychotherapy (WIIW, 2021).
- Information gaps mean that many refugees, especially women, do not know where or how to seek psychotherapy (ReHIS Project, 2021).
- Discrimination and stigma increase distress and undermine trust in healthcare providers, sometimes discouraging refugees from seeking support at all (Vidc, 2023).
These obstacles mean that equality of formal access (everyone is entitled to psychotherapy) does not translate into equity (everyone being able to benefit from psychotherapy).
In Austria several NGOs therefore have developed specialized programs to address these challenges professionally within the last 20 years. Organizations and projects such as HEMAYAT, ZEBRA, ANKYRA, AFYA, and HIKETIDES offer culturally sensitive, trauma-informed psychotherapy, often with interpreter support and a focus on particularly vulnerable groups such as refugee women (Sozialministerium, 2021; AFYA, 2020). Evaluations of AFYA’s intercultural programs, for example, show positive impacts on refugees’ well-being and illustrate the importance of adapted approaches (AFYA, 2020).
Public funding and low-threshold access remain central issues: experts emphasize that sustainable, widely accessible psychotherapy requires greater public investment and reduced bureaucratic barriers (Sozialministerium, 2021). Gender-specific approaches are also essential, since refugee women are both more vulnerable to distress and less likely to access care (Vidc, 2023).
From Equality to Equity: Policy Recommendations
To ensure psychotherapy for refugees in Austria is equitable, several steps are consistently recommended:
- Expand interpreter services and multilingual psychotherapy programs.
- Reduce waiting times by increasing funding and training for psychotherapists with intercultural expertise.
- Improve outreach and information campaigns, especially targeted toward women.
- Support community-based and NGO initiatives that combine practical support with mental health care.
- Strengthen advocacy roles for psychotherapists, helping address not only individual distress but also systemic inequalities.
Lastly, many of these projects not only provide essential services for refugees but also create opportunities for young psychotherapists in training. They are learning to work in multicultural, trauma-sensitive contexts, thereby building the foundation for a more inclusive psychotherapeutic profession in Austria. However, political decisions can undermine this progress. In Salzburg, for example, the current deputy governor (FPÖ), responsible for the social affairs portfolio for three months, recently announced funding cuts for refugee mental health projects after only a few months in office. Such measures stand in stark contrast to the evidence on refugees’ disproportionate mental health needs and the documented success of specialized programs (ReHIS Project, 2021; WIIW, 2021). For sure, equality is not among the FPÖ’s political concerns—but one would expect economic reasoning to be. Cutting roughly €30,000 per year may look like a budget saving, yet the long-term costs of untreated mental distress—ranging from higher social welfare expenditures to healthcare costs and integration challenges—will amount to a multiple of that sum. By the time these costs manifest, the responsible politicians will likely already have secured their next position, shielded from accountability. Such short-sighted cuts not only threaten equity in psychotherapy but also risk dismantling the very structures that could secure equality in the future.
Equity in psychotherapy for refugees in Austria means more than ensuring the same rights on paper. It means recognizing the lived realities of trauma, displacement, and cultural difference, and creating systems that respond to those realities. Equality is a starting point; equity is the goal. By investing in culturally sensitive, accessible, and sustainable care, Austria can ensure that refugees not only survive, but also have the opportunity to heal and thrive.
AFYA. (2020). Evaluation of the intercultural mental health promotion program (Executive summary). https://afya.at/media/files/ev…
Buber-Ennser, I., Kohlenberger, J., Rengs, B., Al Zalak, Z., Goujon, A., Striessnig, E., … & Testa, M. R. (2020). Human capital, values, and attitudes of persons seeking refuge in Austria in 2015. PLoS ONE, 15(9), e0237392. https://doi.org/10.1371/journal.pone.0237392
ReHIS Project. (2021). Refugee Health and Integration Survey. Vienna Institute of Demography, Austrian Academy of Sciences. https://www.oeaw.ac.at/vid/research/re…
Sozialministerium. (2021). Survey of psychosocial programmes and additional support services for refugees and people with migrant background in Austria. Federal Ministry of Social Affairs, Health, Care and Consumer Protection.
Vidc. (2023). Refugee Women as Agents for Peace: Study on the situation of refugee women in Austria. Vienna Institute for International Dialogue and Cooperation (VIDC). https://www.vidc.org/fileadmin/user…
Vidovicová, L., Hammer, T., & Kytir, J. (2023). Development of mental distress among refugees in Austria. WIIW Policy Notes and Reports. Vienna Institute for International Economic Studies.
WIIW. (2021). Mental distress of refugees: A challenge for social and labour market integration in Austria. Vienna Institute for International Economic Studies.
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