This paper engages with the critique that mental health social work with asylum seekers requires urgent attention, as current practice is inadequate. Four key issues are discussed in the paper. First, I briefly interrogate key aspects of the UK’s current asylum policy: poverty, dispersal and detention. I elaborate on the mental health implications of each of these and argue that these policies replicate known risk factors in mental ill health. Second, much of the psychiatric literature relating to asylum seekers and refugees draws on post-traumatic stress disorder (PTSD) as the key diagnostic category. The paper argues that PTSD has to be problematised and highlights the importance of maintaining a social model of understanding mental distress and developing it further to include insecure immigration status in our models of understanding mental distress. Third, I consider the specific issues facing women asylum seekers and illustrate how an analysis at the intersection of gender, mental distress and asylum is essential. Lastly, I argue that, to respond more effectively in this complex area of work, interventions at a practitioner, organisational and societal level are required if the espoused values of social work are to be more than mere rhetoric.