As fellow human beings uproot their lives in search of protection, and for those who survive to reach European shores, many countries are faced with an unprecedented, highly complex challenge of managing huge and immediate need. Clearly, immigration agencies are front line in this scenario, but they are closely followed by accommodation, subsistence, community and health agencies. It is widely recognised that the mental health burden of asylum seekers is large and the stir of growing interest at a clinical level in addressing that burden is encouraging. Mental health services have been aware of asylum seekers and refugees for decades but we have grappled with our role, been confused by the relevance of a political dimension and overwhelmed with how to manage diverse need, in the face of endless competing demands. Mental health services for asylum seekers and refugees have largely evolved in many and varied ways, dependent on local need and interest.