The effects of minority and undocumented immigrant status combined with poverty pose a set of unique psychiatric risk factors. Restrictive legislation and policy measures have limited access to health care and other basic human services for undocumented immigrants and their children. Despite the need for mental health support, undocumented immigrants underutilize mental health services as well as other social services and supports. Undocumented status results in an invisible class of people who suffer from significant challenges combined with limited access to services that can assist them.
Most undocumented immigrants come to this country for economic opportunities or to reconnect with a family member who is a US resident or citizen. Many endure traumatic experiences while emigrating that put them at psychological risk.
Once in the US, undocumented immigrants face multiple psychosocial stressors. Experiences of discrimination are associated with increased risk of depression and anxiety.1 In a study of Hispanic immigrant patients at a mental health program in New York City, undocumented patients had a significantly greater number of psychosocial stressors than legal residents and US-born citizens.2 They were more likely to have psychosocial problems related to occupation and access to health care and the legal system. They also had a lower mean number of total mental health appointments in which to address stressors.
Families and children
The mental health of undocumented immigrants is a family issue. Approximately 5.5 million children in this country have at least one parent who is undocumented. About 1 million of these children are also undocumented, while about 4.5 million are US-born citizens; approximately 9.5 million people live in “mixed status” families that include American citizen children and undocumented immigrant parents.3
Undocumented children and US-born children of undocumented parents are at risk for long-term detrimental effects on their social development, sense of belonging, educational achievement, economic well-being, and mobility. Fear and vigilance are key issues in the home lives of undocumented immigrants: parents are significantly less likely to engage with teachers or be active in school or to access health services. Parents’ fears of deportation lead to lower levels of enrollment of their US-born children in public programs for which the children are legally eligible. These include child care subsidies, public preschool, and food stamps.
Many undocumented immigrant children and youths are subject to racial profiling and ongoing discrimination. They are exposed to gangs, immigration raids in their communities, arbitrary stopping of family members to check their documentation status, being forcibly taken or separated from their families, returning home to find their families have been taken away, placement in detention camps or in the child welfare system, and deportation. These experiences lead to anxiety, fear, depression, anger, social isolation, and lack of a sense of belonging.
The impact of having parents who have been detained or deported can result in severe mental health problems, such as PTSD, chronic depression and anxiety, acting out behaviors, and difficulties in school. Many immigrant parents work long hours in low-wage jobs and often work in more than one job. Even when children who are undocumented succeed and complete college or advanced degrees, they are likely to continue working low-wage jobs like their parents because of barriers inherent in their legal status. This leads to further frustration and hopelessness as these young people work to escape this perpetual “outsiderness.” Legislation such as the Development, Relief, and Education for Alien Minors (DREAM) Act has been proposed to help support undocumented youths who came to the US before age 16, which allows them to study and/or serve in the military as a path to citizenship.
What new information does this article provide?
This article provides several recommendations and outlines approaches for mental health treatment for undocumented immigrants, derived from the first author’s extensive clinical work with this understudied population.
What are the implications for psychiatric practice?
Psychiatrists and other clinicians interested in better serving undocumented children and adults can do so by addressing the many barriers to care that may be present in their practice, by providing trauma-informed and culturally sensitive care, and through collaborative work with the community.
Dr Fortuna practices adult and child psychiatry with a specialization in immigrant and refugee populations. She is also a researcher in the field of mental health service research and is currently participating in a National Institute of Drug Abuse International Collaborative study of dual diagnosis treatment with Hispanic immigrant populations. She is a researcher at the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, Mass. Dr Porche is Associate Director and Senior Research Scientist at Wellesley Centers for Women, Wellesley College, Wellesley, Mass. Her research focus is on socio-emotional factors that impact on academic achievement for children and adolescents. The authors report no conflicts of interest concerning the subject matter of this article.
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