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.

A formulation is an attempt to understand an individual’s predicament. In contrast, a psychiatric diagnosis is a way of categorising difficulties.Making a formulation or diagnosis is not a straightforward task, especially given differences of culture and power.It is helpful to think of both as constructed narratives.

With people seeking asylum, both present specific benefits, disadvantages and challenges.They can powerfully affect the person themselves, determine what help is offered and influence third parties, such as asylum decision-makers. A helpful approach to formulation and diagnosis depends on the therapeutic relationship and the clinician’s skill in working with differences in culture and power. Clinicians need tobear in mind how formulations and diagnoses depend on the quality of assessment and the cultural context in which they are embedded.

Formulations for people seeking asylum need to pay particular attention to culture, family, and physical health, and to the impact of the asylum process, of being a refugee, and of discrimination. Diagnoses should be made only after discussing formulation and considering the potential additional impacts of a diagnosis.