p e e r - r e v i e w e d p e e r - r e v i e w e d 5 The Challenge of Simple Questions: Positioning Refugee Mental Health in the Global Health Agenda Alastair Ager Professor of Clinical Population and Family Health, Mailman School of Public Health, Columbia University, USA International Journal of Migration, Health and Social Care Volume 1 Issue 1 December 2005 © Pavilion Publishing (Brighton) Ltd Introduction Two very personal milestones shape my approach to this paper. First, it is just over ten years since the World Mental Health report (Desjarlais et al, 1995) appeared.As part of the development of that report I was commissioned to review the global literature on refugee mental health available at that time (Ager, 1993).Writing that review – which highlighted a crucial agenda for research and policy development – shaped my involvement in academic, clinical and humanitarian discussions for much of the subsequent decade. Second, for the last 12 months I have been working in the much broader context of the global health strategy of the UK Department for International Development, determining priorities for health research within developmental assistance efforts to low-income countries. Assuming the latter role has cast some very interesting perspectives on my previous objectives, and indeed those of all who are committed to the social and emotional well-being of the displaced. There is currently a very strong drive in global health research for greater attention to be paid to influence on policy (DFID, 2004; REACH, 2005; Ager, 2005). Although this can be understood as part of wider moves to the establishment of evidence-based practice, it also reflects an appreciation of the way in which health and related policy is formulated and implemented by governments. ‘Dissemination’ – particularly if focused on writing scientific papers for peer-review journals – is generally too passive and ill-targeted a process to create significant policy influence. In consequence, communication specialists are increasingly engaged with major research programmes to ensure more effective communication of key messages to – and generally more effective interaction with – policy-makers. Two key principles govern much of this communication work (Lavis et al, 2002). One is the engagement of policy-makers with research right from the outset, including the process of formulating research questions.The other is the distillation of research findings into statements that can be readily assimilated by policy- makers. Neither of these principles sits particularly comfortably with the traditional model of research. The former requires discussions with policy-makers when ideas are poorly articulated and – particularly where such discussions are actually linked to the commissioning of research – gives policy-makers a role in defining research Abstract To position refugee mental health more effectively on the developing global health and humanitarian agendas requires effective communication in policy-making processes.The capacity to answer three simple but demanding questions arguably determines the readiness of those working in this field to seek such influence. Reviewing current knowledge on the global context of refugee mental health with respect to the questions ‘What is the need?’, ‘What can we do about it?’ and ‘Will it work?’ suggests significant conceptual advance in this area over the last decade, and increasing consensus on broad intervention strategy. It remains important to document impact more effectively,however,if policy-makers are to be persuaded to invest more resources in promoting mental health interventions with displaced and war-affected populations. Key words refugee; mental health; policy; dissemination; assessment; intervention; evaluation