The chapter considers essential components of any effective treatment or intervention, and the need to adapt standard approaches for people seeking asylum, how this may be done, and the limitations of the ‘evidence base’. Barriers to accessing intervention are discussed, and the need for services that address the complexities of interpretation and cultural differences.

Therapeutic relationships are reviewed, andcollaborative work is emphasised.

Therapeutic organisation is also important: early intervention, a conducive setting, continuity of care, and minimising pitfalls of onward referral. Mental and physical health care should be integrated as far as possible, with attention to communication with other professionals and feedback to the client. Consideration is given to how to identify starting points for an intervention. Interventions for specific groups are reviewed, including gender and sexuality, and related to torture, trafficking and sexual violence. Work in inpatient settings and immigration removal centres isconsidered. Remote working is reviewed, as is the possible therapeutic role of medicolegal assessment. Ways of ending treatment constructively are discussed.

This chapter shows that COVID-19 death rates were more than twice as high in areas of high deprivation as in less deprived areas. This is due, firstly, to a greater likelihood of contracting COVID-19 and then, secondly, to a greater vulnerability to its effects. Those with lower incomes are more likely to be key workers and to use public transport, exposing them to greater risk. This is compounded by a greater vulnerability to serious illness as underlying health conditions linked to deprivation – cardio-vascular disease, obesity and diabetes – interact with the virus. These co-morbidities often affect whole families, including those living in multi-generational households, increasing disease transmission. The higher death rates of the BAME population are discussed, alongside the structural discrimination and potentially direct racism that may have played into this.

The chapter continues with an analysis of the inadequacies of the benefit system as an insurance against hard times, and the likely long-term consequences of the poverty and destitution that will follow, especially in more deprived northern regions. It then focuses on the ‘COVID generation’ scarred by the loss of education and work, by unequal access to home learning, and carrying a mental health burden into the future.