Updated
Original VAYEMA symptom and impact self-check – not a validated scale
Cultural adjustment and wellbeing
Answer the symptom statements below to see which experiences and areas of daily life you report as most affected. These are original VAYEMA questions, not a validated diagnostic scale. No clinical severity or probability score is calculated.
Answers are processed only in this page by this assessment. They are not submitted, monitored or automatically saved. No name, email or account is required. Use a private device and clear your answers when finished.
For adults aged 18 and over. This self-check cannot diagnose or rule out a condition. Concerns about a child require an age-appropriate professional assessment.
Thinking about the past four weeks, how well does each statement describe your experience?
Additional context – not included in any questionnaire score
These are original VAYEMA questions, not a diagnostic instrument or a validated severity scale. They summarise the experiences you select and do not predict a diagnosis or future harm. Background condition information; this source does not endorse this self-check.
Understand the purpose of the appointment
A wellbeing or mental health assessment explores symptoms, context and support options. It is different from an immigration interview, employment assessment or a formal report for another organisation. Ask the service what role it is providing, who receives information and what consent arrangements apply. Do not assume that all appointments described as assessments have the same purpose or privacy rules.
This worksheet is for personal preparation only. It does not establish eligibility for services, confirm a diagnosis or supply evidence for an administrative process. You can ask a clinician for support without providing a complete migration history in advance. A brief account of your current concern may be sufficient to arrange the appropriate first conversation and clarify what information is actually needed.
Describe the change without having to justify it
You may have moved for work, study, relationships, family needs, safety or reasons that are difficult to summarise. The assessor should not require a positive or traumatic narrative to take your distress seriously. Explain what changed in daily life and what feels difficult now. You can say that some aspects of the move were chosen while others were outside your control.
Avoid comparing your experience with someone whose circumstances appear more severe. Different pressures can create different support needs. WHO describes the relevance of experiences across different stages of migration. An individual assessment should use that context to ask better questions, not infer symptoms or diagnoses from your background.
Identify symptoms and functioning in your own words
Note changes in sleep, mood, concentration, appetite, social contact or ability to manage tasks. Include when the changes began and whether they were present before the move. This can help a clinician consider several explanations without assuming that every difficulty is culture shock. You do not need to decide whether the problem is an adjustment reaction, depression or something else.
Give a few practical examples: difficulty attending work, making essential appointments or maintaining routines. Also mention what remains manageable. The purpose is a balanced account, not a score of successful adaptation. Persistent or worsening symptoms deserve assessment even when the move is recent, and serious physical symptoms need medical attention rather than being attributed automatically to stress.
Explain language and communication needs early
You may be able to manage everyday conversation but find emotional or medical language more difficult. Tell the service which language and format would help you understand and express yourself accurately. Ask whether a trained interpreter, translated information, extra time or written questions are available. These are access considerations, not signs of poor effort.
Clarify the interpreter’s role and confidentiality before discussing sensitive material. A family member may not be appropriate, especially when relationships or safety are part of the concern. Children should not be responsible for translating adult mental health information. You can ask to change the arrangement if it prevents you speaking freely or leaves you unsure what the professional has understood.
Separate practical barriers from emotional questions
Consider whether housing, work, money, transport, documentation or unfamiliar systems are contributing to distress. Write the category of need rather than entering identifying records. A question about where to find reliable local advice is different from a symptom requiring treatment. Both can matter, but they may need different professionals.
WHO identifies practical and structural barriers to care. An assessment should not label those barriers as a personal inability to cope. Ask which service can address each issue and whether a referral has actually been made. A list of suggestions is not the same as accessible support or a confirmed appointment.
Describe culture and identity without an integration score
You can explain what feels familiar, what feels misunderstood and which values or relationships you want the service to respect. There is no requirement to choose one cultural identity or show that you have adopted a new way of life. A person may feel at home in some settings and disconnected in others, and that complexity can be relevant to care.
If the professional’s language does not fit your experience, say so. You may prefer another way of describing distress or a different explanation of what would help. UCL’s settling-in guidance discusses familiar routines and available support; these are possible resources, not universal requirements. Your assessment should identify what is meaningful and practical for you.
Share difficult experiences only through an appropriate process
Some people have experienced frightening or harmful events before, during or after a move. Others have not. Do not assume that a detailed account is necessary for every first appointment. You can tell the clinician that there are experiences you may need help with and ask how the discussion will be paced. The worksheet is not a place to conduct trauma treatment.
Avoid recording graphic details or identifying information about other people. A professional can explain what information is clinically relevant and how it will be protected. You should be able to ask for a pause, clarification or a different format. If there is immediate danger now, the priority is an appropriate local response rather than completing a history of what happened previously.
Prepare questions about ongoing healthcare
Mention any interruption in your own treatment or difficulty finding a local clinician. You can note that prescription continuity, records or follow-up need attention without entering a full medical file. Ask who is responsible for reviewing medication and how relevant information can be transferred securely. Do not change treatment on the basis of this worksheet.
For remote care, tell the provider where you will be physically located and ask whether they can work with that location. Clarify confidentiality, professional arrangements and the plan for urgent help. An existing relationship with a clinician elsewhere does not automatically resolve all cross-border questions. The assessment should help establish a practical route to care where you are now.
Ask for a clear and manageable plan
At the end of an appointment, ask what the professional understands, what remains uncertain and which next step is recommended. Does the plan involve counselling, assessment of a particular condition, medical review or practical support? What are the alternatives, and when will the plan be reviewed? You can correct misunderstandings before agreeing to ongoing work.
A manageable first step may be more useful than a long list of activities. NHS guidance on change encourages breaking demands into smaller parts. Apply that principle to access as well as personal action: who will arrange an interpreter, make a referral or explain costs? Responsibilities should be clear rather than left entirely with someone already navigating unfamiliar systems.
Privacy and urgent help remain separate from the worksheet
The tool does not send answers, monitor distress or create an appointment. A downloaded copy remains on your device and may be accessible through shared accounts, employer systems or backups. Keep only what is useful and safe, clear the notes when finished and share selected information through an appropriate secure channel. Do not enter documents or identifiers simply because you are preparing for an assessment.
For immediate danger, inability to stay safe or a medical emergency, use the appropriate services where you are located. Do not wait for a reply from a distant provider or assume a completed form has alerted anyone. For routine support, the companion treatment guide can help you compare the roles of counselling, clinical care and practical assistance without treating the worksheet as a diagnostic result.
Frequently asked questions
Does this assess immigration status or eligibility?
No. It is not connected to an immigration or administrative process and does not determine access to services. Ask the relevant organisation directly about any formal assessment. Do not enter passports, legal documents or other identifiers into a wellbeing preparation worksheet.
Is there a score for how well I am adjusting?
No. The tool has no score and does not judge cultural identity, belonging or integration. It helps you identify support needs. A professional assessment should consider your circumstances and health rather than rank how successfully you fit an assumed model of adjustment.
Must I talk about traumatic experiences?
Not in this worksheet. You can say that there are experiences you want to discuss privately or gradually. A clinician should explain the purpose of questions and consider pacing. Immediate safety needs should be addressed directly, without waiting to provide a detailed history.
Can I ask for an interpreter even if I speak some English?
Yes, you can explain that important emotional or medical conversations require additional language support. Ask what the service provides and how confidentiality is handled. Everyday fluency does not necessarily make a complex assessment easy to understand or express accurately.
Can the assessment help continue treatment from another country?
It can identify the need and help clarify next steps, but a suitable clinician or pharmacist must review prescribing and continuity arrangements. Remote providers should confirm whether they can work with your location. Do not assume that completing this worksheet transfers records or renews prescriptions.
Are the notes shared with anyone?
The tool does not transmit answers to VAYEMA or another organisation. A downloaded file remains on your device and may be accessible to people who can use that device or account. Contact a service directly for help; the worksheet is not monitored or an emergency channel.
Resources and references
[1] WHO: Refugee and migrant mental health
[2] WHO: Refugee and migrant health