BMC Public Health 2009, 9:214 http://www.biomedcentral.com/1471-2458/9/214 The lack of utilisation of mental health services should be further investigated to discover if patients should be referred to these services or if immigrants are satisfied that their mental health problems are being adequately addressed by GPs. Health policy recommendations The provision of interpreters and training of health service providers to promote cultural awareness, particularly within the mental health service and GP settings would facilitate the utilisation of these services by refugees and asylum seekers. While education programmes within direct provision centres on Irish culture, available health services and life skills required for the new environment would also help in narrow the gap in communication and cultural differences. Our results suggest that living within direct provision cen- tres adversely affects mental health; it isolates asylum seekers from the local community, and limits their inte- gration and understanding of the society they wish to join. In addition, preventing asylum seekers from working is known to lead to mental health problems and issues of self esteem [28]. Conclusion Asylum seekers have a higher level of self reported PTSD and depression/anxiety symptoms compared to refugees. However, residence status appears to act as a marker for post migration stressors. Compared to refugees, asylum seekers utilise GP services more often. Despite the higher level of mental health problems in asylum seekers, no dif- ference was found between these groups in the utilisation of mental health services. The findings of this study illustrate the need for preventa- tive measures or coping strategies in addition to psycho- logical and psychiatric treatment. Addressing pre migration traumas with psychological support, should be combined with a strategy to increase coping or reduce post migration stressors, as they are a strong predictor of mental health problems in these vulnerable groups. Competing interests The authors declare that they have no competing interests. Authors' contributions MT and TF were involved in the design of the study. MT carried out the fieldwork for the study, performed the sta- tistical analysis and drafted the manuscript. KOB was involved in the statistical analysis and along with MT and TF redrafted the manuscript. All authors read and approved the final manuscript. Acknowledgements We would like to acknowledge all the refugees and asylum seekers who enthusiastically participated in this research. KOB was funded by the Health Research Board of Ireland through the HRB Centre for Primary Care Research under grant HRC/2007/1. References 1. 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