This paper argues for a re-examination of mental health responses to refugee youth seeking asylum in high-income countries. Reviewing international literature related to mental health and social care services for refugee children and youth and drawing upon Foucault’s concepts of power, truth and discourse, we explore and question the predominance of the bio-medical model in responding to refugee children’s distress. We demonstrate that, despite notable initiatives and developments in social work theory and practice, the bio-medical model has, in many ways, become a ‘regime of truth’, with the power to define refugees’ problems and thus shape the policies and services that affect their lives. While not denying that many refugee youth and their families may benefit from such therapeutic interventions, it is our contention that working with this population requires a significant expansion, diversification and transformation of the current paradigm informing social work practice to incorporate the multiple and unique cultures and contexts of this population. We conclude with a discussion of promising practices and interventions with refugee youth and families.