Realist definitionsa.

People with forced migration backgrounds, such as refugees, experience disproportionate mental health conditions related to complexities associated with acculturation, separation from family, traumatic events due to war or persecution and precarious journeys in their effort to find protection and care. Intersecting social determinants of refugee mental health include navigating and finding health care resources, employment, housing and social support. Because of the complexity of health and social needs that refuges experience, there is a need for robust integration of mental health services across services such as settlement organizations and primary health care services. Robust service integration to address mental health for refugees can benefit from a theory-driven approach to understanding integrated mental health service delivery. This study engaged in deliberative dialogues with multidisciplinary interest group holders from settlement services, primary health care, mental health, a survivor advocacy group and a policy analyst (N = 24) to understand how services work to promote refugee mental health in a Canadian context. Adopting a participatory realist approach, we developed an initial program theory on the integration of refugee mental health across services. We found trust, connection, proactivity and moral commitment to be key mechanisms that enabled better integrated mental health care across refugee clients, providers and services. Mechanisms which hindered integration included alienation, stagnation, burnout and fragmentation. Findings indicate that, when funding is allocated to settlement programs, supports like cross-cultural brokers, community health workers and navigators can then be implemented. These resources then address social determinants of refugee mental health and trigger positive mechanisms for equitable, just policy approaches to integrate services for refugee mental health.拥有被迫移民背景的人群（如难民），因文化适应、与家人分离、战争或迫害引发的创伤事件，以及为寻求保护与照料而历经的艰险旅程等复杂因素，罹患心理健康问题的比例远高于普通群体。影响难民心理健康的交叉社会决定因素涵盖医疗资源获取、就业、住房与社会支持等环节。鉴于难民群体所面临的健康与社会需求具有高度复杂性，亟需在安置服务机构、基层医疗卫生服务等各类服务体系中强化心理健康服务的整合。针对难民心理健康问题开展高质量服务整合，可借助以理论为导向的方法来理解整合式心理健康服务的提供模式。本研究与来自安置服务、基层医疗、心理健康领域、幸存者倡导团体及政策分析师（共24名）组成的多学科利益相关方开展了协商式对话，旨在探究加拿大语境下各类服务如何助力难民心理健康状况改善。本研究采用参与式实在论（participatory realist）方法，构建了关于跨服务体系整合难民心理健康服务的初步项目理论。研究发现，信任、联结、主动性与道德承诺是推动难民服务对象、服务提供者与各类服务体系之间实现更优质整合式心理健康照料的核心机制；而阻碍服务整合的因素则包括疏离感、停滞状态、职业倦怠与服务碎片化。研究结果显示，当为安置项目拨付专项资金后，可推行跨文化协调员、社区卫生工作者与服务导航员等支持举措。此类资源可针对性解决影响难民心理健康的社会决定因素，并为构建公平、正义的难民心理健康服务整合政策路径提供正向机制支撑。