Migration has become a cornerstone of Portugal’s economy, yet the psychological wellbeing of many newcomers is severely tested by the trauma of displacement, perilous journeys, and a rising tide of racism fueled by far-right rhetoric. Compounding these issues, access to mental health care is frequently obstructed by profound cultural and linguistic barriers.
At the Ismaili Centre in Lisbon, a dedicated team prepares for community outreach as part of the “What Health” project, an initiative focused on assessing the mental health and wellbeing of migrant populations. Their strategy involves direct engagement on the streets and at diaspora festivals, where they distribute questionnaires designed to gather crucial data.
“Mental health is an exceptionally complex subject and remains a deep-seated taboo for many,” explains Sofia Peyssonneau, a community development officer at the Aga Khan Foundation involved in the project. “We cannot simply host events labelled ‘mental health’; we must employ alternative strategies. For instance, at a diaspora festival, we set up a stand offering general health check-ups with our medical team, after which participants complete a mental health questionnaire.”
These outreach efforts are largely driven by migrants themselves—individuals hailing from Nepal, China, India, Bangladesh, and Pakistan. Many are qualified professionals, including doctors, who leverage their expertise to improve living conditions for their peers through data collection and awareness campaigns.
“There is a pressing need for improvement because migrants in Portugal struggle to access healthcare services, and mental health remains a major taboo,” states Pabitra Neupane, a cultural mediator for the Nialp organisation and a contributor to the What Health project.
Partially funded by the European Union, What Health will conduct extensive research into migrant mental health through 2029. Following the collection of personal testimonies, researchers collaborate with physicians to identify systemic gaps and train them in culturally informed approaches. These practitioners then engage directly with migrant communities to raise awareness and clarify available care pathways.
From Emigration to Labour Shortage
Since the late 1990s, Portugal has shifted from a nation of emigrants to a destination for immigrants.
“Initially, the country primarily welcomed migrants from Portuguese-speaking nations, such as Brazil and Cape Verde, followed by citizens from Eastern Europe,” says Mário Ribeiro, a PhD candidate and coordinator of the Migration Observatory, which monitors migration flows for the government’s integration agency.
From the mid-2010s onward, the demographic profile diversified to include Syrian and Afghan refugees, workers from the Indian subcontinent, and European retirees—arrivals driven by an ageing domestic population and a growing demand for labour.
“We rely on migrant workers for agriculture, tourism, and elderly care,” Ribeiro notes. “In the fields of Alentejo or Ribatejo, the vast majority of harvesting is performed by migrant labour.”
The emergence of these new communities necessitates the adaptation of services, particularly in mental health.
Many arrive carrying deep psychological scars, whether from the conflicts that forced their flight or the dehumanising, often dangerous journeys to safety.
In Almeirim, a town 80km east of Lisbon, Cátia Sequeira manages Claim, a local centre for migrant support and integration. She frequently works with Syrian and Ukrainian refugees traumatised by war.
“Some individuals would jump at the mere sound of a toilet flushing because it reminded them of bombing raids,” she recalls.
Claim has developed Cuidar+, a psychological and social support programme designed to help individuals regain stability.
“We needed to create a space where we could truly listen. We also encounter significant domestic violence and complex trauma. By establishing a climate of trust and fostering close relationships with service users, we can intervene effectively when sensitive situations arise,” Sequeira explains.
The healthcare system has also been forced to adapt to a surge in non-Portuguese speakers, with Ribeiro identifying the language barrier as the primary obstacle.
Telephone interpreting services and intercultural mediators have been deployed, coordinated by the What Health project and organisations such as the Portuguese Council for Refugees (CPR).
Cultural Differences
In Loures, the CPR reception centre provides a critical gateway to healthcare for asylum seekers.
Upon arrival, applicants receive accommodation and support during the initial phase of their asylum process.
“They are assessed within the first 48 hours via a psychosocial evaluation covering physical health and an initial mental health screening,” explains Catarina Baptista, the centre’s director and a psychologist. This immediate screening allows for the rapid identification of urgent cases.
“Our psychology team then conducts a more in-depth assessment, either individually or in groups, depending on the person’s circumstances.”
The CPR maintains a partnership with the Júlio de Matos Psychiatric Hospital in Lisbon to expedite specialist consultations for its users.
For Baptista, delivering care within a familiar, culturally sensitive setting is paramount.
“The support here is designed to be culturally attuned. In many mainstream hospitals, difficulties persist in accessing translation services or understanding culturally specific behaviours. This lack of understanding impedes diagnosis and continuity of care, despite the Asylum Act mandating guaranteed healthcare access.”
Political Context Takes Its Toll
While frontline workers intensify their efforts, Portugal’s shifting political and economic climate is exacting a heavy toll on migrants’ mental health.
Since a 2025 reform took effect, undocumented individuals face hospital fees exceeding €100—a prohibitive cost for many recent arrivals.
“The requirement for these people, who are in the process of regularising their status, to pay often causes them to abandon treatment altogether,” says Sequeira.
“Many stop seeking hospital care because they’ve heard of friends receiving bills after visiting A&E. They wait until they are in crisis, and by the time they reach us, we often have to call emergency services immediately.”
The ascent of the far-right Chega party and the normalisation of anti-immigration rhetoric are further damaging psychological wellbeing.
“Racism is increasing. When I arrived in 2022, people were welcoming. Now, if you wear a headscarf, you face discrimination. I have already been refused entry onto a bus,” says Sabera Parvin, a doctor and field researcher for the What Health project.
“We felt the local community had gradually accepted these new residents. Then we were forced to combat prejudice and misinformation all over again. The Chega party ultimately undermined the progress we had made,” echoes Sequeira.
Baptista from the CPR emphasises that hate speech uniquely impacts refugees.
“A process of re-traumatisation sets in: I leave my country because I do not feel welcome, only to arrive in another where I feel equally unwelcome. It adds a new layer of trauma to a pre-existing one. Trust in the institutions and people designated to help erodes, rendering people even more vulnerable.”
The CPR is running a project titled “From Care to Self-Care,” aimed at disseminating its mental health expertise to other professionals within the asylum system.
“This project has two core objectives: to train teams in cultural sensitivity and trauma-informed care, and to protect them from the secondary traumatic stress inherent in exposure to suffering,” explains Baptista.
The organisation asserts that caring for migrants requires supporting those who support them, ensuring the entire reception system remains humane.
