The UK asylum processat the time of writing is described in detail to illustrate more general practices and effects. Claim handling and the role of immigration detention are discussed.Legal representation is important but hard to find. Asylum claim interviews are described.The decision-making process is outlined. Tribunals, appeals, appeals rights exhaustion, and fresh claims are described.The National Referral Mechanism for people who have been trafficked is outlined.Claiming asylum has a human context.People are excluded from society.Shame can be induced, and ‘retraumatisation’ can occur. Detention without limit of time can distress and destabilise individuals who were mentally stable on arrival.Fear and uncertainty prevail.

Possible reactions of the host society are reviewed; suspicion and disbelief, and deprivation and demands as part of the ‘hostile environment’.

The key themes of medical care and the role of medical evidence are introduced.Forms of recognition as a refugee are described, and some of their practical and psychological consequences.

It is likely that those planning, managing or commissioning mental health services will be able to create changes that make them more effective for people seeking asylum. There are some recurrent themes in publications about what changes are needed. However, priorities are different in different situations and from different perspectives.One approach to choosing how to use limited resources is to consider what guiding principles are most important.We consider the implications of adopting each of six principles: anti-racist and anti-discriminatory practice;‘first do no harm’; a human rights approach; evidence-based care; using public health principles; working with organisational values. An alternative approach to deciding on what actions to prioritise is to identify specific goals.We discuss what might be done towards the following nine goals: involving people seeking asylum; improving interpreting; removing barriers to access; using training, supervision and support to enable staff to provide good care; working with community groups and other agencies; working to guidelines, standards or checklists; creating alternative services; prevention; making a difference quickly.