Sir: Derek Summerfield's editorial (Psychiatric Bulletin, May 2001, 25, 161-163) shows how apparent mental health problems of asylum seekers/refugees must be seen in the context of disrupted social lives, and the importance of such practical issues as employment.

One practical issue not mentioned was housing. Those with no established right of abode experience special difficulties in securing accommodation.

For the hospital, this causes a danger of bed blocking if the patient ought not be discharged without an address to allow appropriate follow-up. Normally referrals are made to social services or to the Salvation Army. However, the social services has no duty to house an illegal immigrant, and the Salvation Army cannot help as it cannot recover costs via the benefits system. The Home Office does have a duty to house immigrants whose status is being investigated. However, faced with a detention centre, the patient may withhold consent to inform the Home Office. The stand-off can persist until a stage is reached in an asylum application when the applicant becomes eligible for benefits, and can be brought into the normal support system.

Even for an experienced doctor knowing the system, the process is difficult and extremely frustrating. How much harder must this be for someone trying to deal with a foreign language. As Derek Summerfield and others (for example, see Reference Burnett and PeelBurnett & Peel, 2001) note, symptoms of psychological distress are common among refugees but may not signify clinical mental illness. Other cultural and social factors may contribute to psychological distress (for a recent analysis see Reference Bhugra and JonesBhugra & Jones, 2001). Surely, the difficulties of finding accommodation must be one such contributing factor.