Research into the mental health needs of asylum seekers and refugees has revealed that they are likely to experience poorer mental health as well as higher levels of exclusion and vulnerability than native populations. This paper reports on data drawn from semi-structured interviews of 21 refugees and asylum seekers that describe the complexity experienced by those living in exile, and the necessity for a more integrated and holistic approach in the planning and delivery of services to support mental health. Incorporating a perspective from service users will encourage providers to take account of the multitude of practical, social, cultural, economic and legal difficulties that can influence the long-term mental health of this population. The implications highlight a need to shift from a simple biomedical model of the causes and effects of ill-health to a social model, which will require reorganisation not only in healthcare but in welfare, housing, employment and immigration policy.