Undocumented migrants in the United States — a majority of whom are Latinx — face high rates of mental health problems but receive little or no formal support. In an exclusive interview, Prof. Luz Maria Garcini, an expert in the healthcare needs of Latinx families, tells us more about this issue, and why it is so important.
There are an estimated 11,300,000 undocumented migrants living and working in the U.S., most of whom come from regions of Mexico and Central America.
The reasons why these individuals emigrate without going through the typical legal processes are manifold, including financial precarity and exposure to violence.
Past experiences of adversity and trauma, as well as present worries stemming from their undocumented status, can fuel struggles with mental health issues, such as depression or anxiety.
Prof. Luz Maria Garcini, who is an assistant professor at the Center for Research to Advance Community Health at the University of Texas Health Science Center San Antonio, as well as a faculty scholar at the Baker Institute for Public Policy at Rice University, has been studying the issues confronting Latinx migrants for many years.
In a study in the Journal of Consulting and Clinical Psychology in 2017, Prof. Garcini and her collaborators report that undocumented Mexican migrants who live in high risk neighborhoods face a greater risk of anxiety and depression than the general U.S. population.
Medical News Today has spoken to Prof. Garcini to find out more about the causes behind undocumented migrants’ mental health troubles, as well as what prevents them from accessing formal support, and how decision-makers could improve this situation.
We have lightly edited the interview transcript for clarity.
‘The […] resilience they have is impressive’
MNT: Why would you say that you saw such disproportionately high rates of anxiety and depression among Mexican migrants with undocumented status compared with the general population? What kind of experiences might lead to that effect?
Prof. Luz Maria Garcini: One of the first things that I would like to emphasize is to try to avoid stigmatizing these populations. They’re highly resilient within the context of the many chronic and compounded stressors that they’re living [with].
So, the amount of resilience that they have is impressive. However, because they have endured so much trauma over a long time and in many different areas of their lives, you know, it is expected, obviously, that they’re going to present with symptoms of depression [or] with symptoms of anxiety.
And these experiences have not only happened within a certain amount of time, but they started premigration before they left their countries [of origin]. That’s why they left because they did not feel safe because many did not have resources; many had to be separated from their families, so the stress comes from a very, very long time [before].
And we have differences in those populations because, if you think about it, we have people migrating from Central America; they have to cross two borders — and the border between Central America and Mexico is brutal.
If we think of the border between the U.S. and Mexico, even that southern border is even more terrifying, and having to cross to Mexico within the current conditions — it’s terrifying. So you can imagine also the stress and the trauma of having to risk your life.
And then, one of the other things that we have found is that there is a lot of trauma in migration, really, that lasts [even] once they live in the U.S., which is very sad. Because, if you think about it, they thought [they were] reaching [a] safe haven, and they didn’t; because they have to live hidden; because they cannot denounce exploitation; because they’re living in constant fear of being separated, of being deported.
You know, they’re abused all the time. Think about women who are preys of domestic violence situations that can’t go get help.
And now, right now, with the current pandemic that we’re facing, it is terrifying, because they’re the ones at the forefront, doing a lot of the [essential] jobs, but they don’t have access to healthcare.
So, if you get sick, you can’t get treatment. How [much] more life threatening can it get than that?
And that is a constant, living with your life [in] constant uncertainty. And being willing to risk it. That, I think, is why we’re seeing a lot of this [trauma].
Now, one caveat is [that] the research that you mentioned [Prof. Garcini’s 2017 study] — that was done previous to the current administration, so you can only imagine that with the current administration and with the current pandemic, those numbers [of migrants with depression and anxiety] are probably skyrocketing.
And, it’s very concerning, because their access to mental health services, and their knowledge about what mental health services mean, is very limited.
MNT: Can you tell us a little about which aspects of the current administration are the ones that are likely to jeopardize the health and safety of undocumented migrants?
Prof. Luz Maria Garcini: One of them is the rhetoric. Undocumented immigrants have been labeled as an undesirable community, have been stigmatized as criminals, […] [portrayed as] taking away jobs, which we know by evidence that it’s not true, because the kind of jobs they do, you know, we have trouble finding other populations that will do [them].
So, there is a lot of stigma. They’ve been labeled as criminals, as thieves. That has damaged this community. You can only imagine what that does for your self-image as an immigrant.
The other one is the actions, the constant threat against the community, and we saw that with the action around the DACA [Deferred Action for Children Arrivals] recipients, where they’re being held in a limbo about their temporary protected status being taken away in the midst of a pandemic.
Now, within the pandemic, when they closed borders, they’ve been seized and labeled as disease carriers. So there are so many layers.
Just seeing what they do to your community and the people when they’re held in cages [in detention centers], the family separation, […] the deportations… I mean, within this pandemic, there was a time when there were 10,000 deportations that happened in the midst of [it].
So there is a lot of damage, and there is a lot of mistrust in the community, particularly when, all of a sudden, they [the migrants] start hearing that they’re essential to the workforce.
So that dichotomy is like, “Oh, so now they want me to go out there and pick up food and do service jobs, and now I’m essential, but I’m not worthy of your country.” So it creates a lot of hurt, a lot of confusion, and that’s what, I think, is causing a lot of damage.
Services ‘not tailored’ to migrant needs
MNT: In your experience, what are some of the key reasons that stop undocumented migrants from seeking the formal mental healthcare that they need?
Prof. Luz Maria Garcini: Well, the first one, I think, [is that] there’s not a lot of knowledge about where to go and how to access [formal support] that would be available at a cost that is reasonable to them. Many of them don’t have insurance; the majority won’t have insurance.
So that’s one: The access and the delivery of services that are not tailored to the needs [of the migrants].
Some of the people that I talked about [might think]: “I go to talk to someone who doesn’t understand my experience, and if I’m going to have to spend one or two sessions telling them who I am and paying for it, you know, I can’t do it.”
I would say the other one is the stigma. There’s a lot of mental health-related stigma in Latino immigrant communities, particularly, but I would say among other undocumented communities [as well].
We have a growing Asian community of undocumented immigrants who also see mental health as very stigmatized, [i.e.] “There must be something wrong with me.”
[It’s] not seeing mental health as [the fact that] you’re living under constant, constant stress, under stigmatization and discrimination, and [that] we have strength-based approaches that can help you endure those and cope with that adversity better, but rather, they’re seen as “there’s something wrong with me, I’m not going to go [seek help] because people are going to start [to] label and stigmatize me.” So, that’s another big barrier that we have.
And the other one is [that] they live such complex and busy lives. Many of them have more than one job; they have families to take care of. A lot of them don’t have transportation.
So it’s really difficult for them to come every week to a session, and speak to a treatment when their life is compounded with so many things [such as]: “I don’t have a car today;” “I have [to look after the] kids;” “Today, I’m helping my neighbor with the kids;” “I have to cover extra hours.”
It’s almost like they have to live on a day-by-day basis, and it’s so hard to plan [in advance], which most of the time is required for mental health treatment.
MNT: What about something like the Public Charge rule, which can be a big stumbling block when it comes to seeking care?
Prof. Luz Maria Garcini: At this point, there’s a paranoia. I’m also doing a lot of [research on] COVID-19-related information, knowledge, and testing.
In [undocumented] communities, [people are] paranoid — they don’t trust anyone. [They think,] “What’s going to happen with my information? Are they [healthcare providers] going to breach confidentiality?”
And, we already know what happened with the DACA recipients. [U.S. Citizenship and Immigration Services] have [all the] information [about DACA recipients, so] that if they decide to terminate DACA, they know where [the recipients] are; they could be easily deported overnight.
People don’t trust [the authorities], and this extends beyond undocumented immigrants. I talk to a lot of different communities, and even legal, permanent residents are afraid now that for any type of service they seek, even if they test positive for COVID-19, [this information] is going to go [on their] record and, at some point, it is going to backfire.
[They worry that] they’re going to [take their] residence, their permit away, and if they’re undocumented that that’s even worse.
So, there’s the instability, the uncertainty, and the rhetoric that has been used, and the actions that have happened are creating a lot of distrust in the community, so people are not willing to risk it.
‘Educating community health workers’
MNT: What do you think would be some ways of addressing some of these issues that are holding people back from seeking support?
Prof. Luz Maria Garcini: I think the best [solution] is to give the tools to the community to educate themselves [about mental health].
[This means providing] nontraditional sources of service delivery — educating community health workers that can go to the community and give them educational resources about mental health, [including] how to recognize symptoms, how to validate emotions, how to have coping skills to deal with stress, and how to recognize when symptoms have gotten so severe that they actually need to seek professional help before it’s too late.
The other [solution] is training the mental health workforce that we have. [Recently, there was] the second [webinar] of a series of three that Dr. Germán Cadenas put forward to train mental health professionals at the American Psychological Association (APA) on what it [means] to work with DACA recipients and their families, for instance.
We’re trying to gather a directory, along with Dr. Manuel Paris, Dr. Alfonso Mercado, Dr. Melanie Domenech Rodriguez, Dr. Michelle Silva.
We’re a big network of Latino psychologists that are trying to put a mental health directory and train [other mental health professionals] on the specific needs of these populations, so that when they want people, at least we can refer them to someone that already has started to walk the path.
But, I would say, [part of the solution is also] working closely with faith-based communities, because the [undocumented] community trusts a lot of faith-based networks.
And, a lot of the time, the pastors and the priests have done an incredible job with them, but it’s a lot for them, and, many times, they say “we don’t have the training to field the cases when they get severe.” So, many [of them are] working in collaboration with some of these agencies to deliver [support in] nontraditional ways that could help us as a community.
MNT: For the time being, what would you advise undocumented migrants in terms of helping them seek mental health help without fear?
Prof. Luz Maria Garcini: We have several resources. We create pamphlets, with 10 key points for immigrants and mental health, but a lot of what we do is trying to build support groups within the community, so we orient them [toward] social support.
Editor’s note: Prof. Garcini also indicated the toolkits and resources page of United We Dream, a nonprofit, immigrant youth-led network that provides support for young people in the U.S. regardless of their immigration status.
Social support is an essential strength, so we recommend that they find someone that they trust, that they talk about how they feel, that they learn to express their needs. But, most importantly, that they learn to recognize the symptoms.
And, we understand that symptoms are an individual experience, but if we guide them, and if we guide them to also learn what impairment might be happening in their lives, and to reflect on that, [it can help].
There are some wonderful immigrant organizations in the U.S. that do a lot of advocacy work and have resources, so, recommending them to go and join those local immigrant organizations will be a first step.
‘Use whatever platform’ to change the rhetoric
MNT: Do you have any final remarks, as we draw to a close?
Prof. Luz Maria Garcini: If you’re not a mental health provider, if you’re listening to these […] podcasts or blogs [about mental healthcare issues faced by migrants, you might ask yourself]: “What can I do? What can I do as a citizen; what can I do as a person that [is] not in touch with immigrants, that [doesn’t] provide mental healthcare, but still wants [to] help?”
And, I always tell people: Use whatever platform you have, anything — think about it — whether it’s media, whether you teach people, whether it’s in your community, in your organization, even your own families, to try to change the rhetoric. Educate yourself about this immigrant community, and fight the stereotypes. You can fight them in the way you talk about them.
You encounter these immigrants everywhere you go, treat them with kindness, treat them with respect, show how grateful you are. [This is] a thing that can [bring about] a lot of change.
Start creating avenues for dialogue, which we haven’t had in our country, which is very sad, because we lost [such avenues]. So, I think, those are huge first step that anyone can [take].
Learn more about the community, talk about this community in respectful ways that are more valid; and support efforts. There are many organizations that take volunteers across the board. You know, everybody has a talent or a skill. Use them to support [the community].
If you have the possibility of funding of donating [that would also be useful, because] we do our research with very little funding, because, unfortunately, federal funding is not available for the kind of research that we do. For people who [are affiliated with] organizations that want to put their funding in the right place: Find people who do this type of work [to support migrant communities], and help sustain those efforts.
There are many things that people can do. But, I would say, you know, they label undocumented immigrants as essential, and I would say [that] each of us is essential to protect [these migrants], and to keep up building the America that we know, that is great, and, lately, seems to be falling apart.
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