This paper describes the development of clinical programs for the psychiatric needs of refugees. It begins with a discussion of the known psychiatric epidemiology of immigrants and refugees: the increased likelihood of depression, schizophrenia, reactive psychoses from trauma, and organic or psychophysiological disorders. Barriers that refugees experience in receiving services are next discussed, along with the basic issues that clinical programs must address to meet refugee needs. The staffing needed for an effective program is considered, including the psychiatrist, the bilingual mental health workers, and other therapists, while program content should include cross-culturally valid psychiatric assessment, regular program evaluation, and medical evaluation of refugees. After a hypothetical discussion of the ideal program and the barriers to achievement of such an ideal, the psychiatric program for Southeast Asian refugees at the Oregon Health Sciences University is described to illustrate various approaches to providing refugee mental health services. Other clinical services in other settings are briefly reviewed, and the paper concludes with a discussion of training needs for counselors and bilingual staff. References are included. (TE)