Defining Competencies for Language-Discordant Care in Migrant and Refugee Mental Health: An International Modified e-Delphi Study

Background Migrants and refugees experience a higher prevalence of mental disorders than host populations, and language discordance undermines care from help-seeking through diagnosis, adherence and outcomes. The WHO Refugee and Migrant Health: Global Competency Standards for Health Workers set broad behavioural expectations for individual health workers but do not operationalise language-discordant care, leaving clinicians and administrators without measurable standards. Objective To develop an international, consensus-based competency framework for healthcare professionals working in language-discordant mental health care, paired with a priority-versus-feasibility gap analysis to direct policy investment. Methods We conducted an international modified e-Delphi study between May and October 2025, reported in accordance with the ACCORD and CONFERD-HP guidelines. Evidence-derived items, organised into five domains and stratified for healthcare providers and administrators, were rated for priority and feasibility; consensus required at least 75% "Mandatory" agreement. Results In Round 1, 101 experts from 24 countries participated; 51 (50.5%) completed Round 2 with non-differential attrition, and 16 ratified borderline items in Round 3. Seventy-six items reached consensus across People-Centred Care (19), Communication (27), Collaboration (6), Evidence-Informed Practice (7) and Personal Conduct (17). The widest gaps fell in systemic, infrastructure-dependent competencies, including 24-hour interpreter access and interpreter-coincident scheduling (mean gap 29.6 percentage points; 33 items >30 points). Conclusions This first international competency framework defines the reciprocal behaviours clinicians and administrators must meet in language-discordant (mental) health care. Paired with a gap analysis, it offers a behaviourally specific basis for training and accreditation and shows where policy investment is most needed.