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Immigration

Emotions and Politics: A Social Work Response to the Mental Health of Immigrants

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Some of my clients have called their immigration journey, the immigration nightmare. One noted, “everyone talks about the American dream but nobody talks about the American nightmare.” This nightmare has become a real every day experience for many of them.

Children crying and terrified after a stranger, an immigration agent, separates them from their parents when they arrive at the US border. Young adults living in limbo in a life that feels uncertain to them, not knowing whether in a few years they will continue working where they are or studying their university programs because of the nature of their temporary Deferred Action for Childhood Arrivals (DACA).

Parents worrying that if they get deported to their countries of origin their children will become foster kids because they will have to make a hard choice to leave them behind in the United States rather than to bring them back to countries plagued by violence, poverty, and hunger. Scholar and social worker Dr. Luis H. Zayas refers to these children, impacted by immigration policies of family separations, as the forgotten citizens.

These are just of the few stories that represent the plight that immigrants who are undocumented or have temporary status face in the United States. In the last year, we have seen increased political efforts to seize migration and punish immigrants who chose to migrate in the only way they could, creating feelings of insecurity, trauma, depression among community members affected by these policies.

As social workers, it’s crucial we become well-versed on the challenges that existing immigrants and a new generation of newcomers face and that we follow our National Association of Social Workers (NASW) code of ethics to support them and treat them with dignity and worth of a person regardless of how they arrived to this country, nor our political views.

Going Beyond the Headlines, Facts about Immigration

Over the last year, we have been inundated with countless stories of immigrants arriving in record numbers through the Mexican border. Some of the media stories have focused on the illegality of migrating through the border; other outlets have reported on the reasons why immigrants are knocking on our doors but with little emphasis on why immigrants “choose” to come through the border. Reasons for coming include fleeing violence, political unrest, and persecution among others.

From testimonials of lawyers, service providers, and human and immigrant’s rights organizations who are working profusely on the ground at border towns, we know that most of the immigrants who are arriving can qualify as refugees. Noting this difference is important because refugees seeking asylum have a right to seek asylum in the United States and have certain protections. The UN Refugee Agency defines refugee as “someone who has been forced to flee his or her country because of persecution, war or violence. A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. Most likely, they cannot return home or are afraid to do so. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries,” (UN Refugee Agency, 2019).

We often hear questions like “Why can’t they come the right away?” or “They need to get in line?” The reality is that our immigration system is broken. To come to the United States legally, individuals have to either have a family member who is a Citizen or US Resident petition for them, or be sponsored by an employer through a work visa, most employment visas are usually for high skilled workers, or apply to a lottery system, for the “lucky” opportunity to obtain a visa. It sounds simple, right? Just apply and you should be fine. Not so much!

There is a restriction of the numbers of visas granted each year. According to the Migration Policy Institute, there are about 140,000 work visas per year and family sponsored preferences are limited to 226,000 visas per year. There are currently two types of backlogs impacting the issuance of US Resident cards, which allows people to come to the United States and stay permanently.

“The first is due to visa availability, not enough to go around and meet the demand. The second is due to processing delays of applicants’ documents. A brief illustration of that is that in February 2019, the U.S. government was still processing some family-sponsored visa applications dating to August 1995, and some employment-related visa applications from August 2007,” (Migration Policy Institute, 2019).

This means that a mother who is concerned that gang members have infiltrated her neighborhood, and are looking to extort her each month for a sum of money that she does not have or she and her family will be killed, who may not have a US Resident or Citizen family member or an employer to sponsor her, has no other way to enter the United States as a refugee seeking asylum. She and scores of others do not have another choice.

Clinical Implications

When working with immigrants is important to remember that while there are some similarities in the immigration journey for some, not two stories are alike. This is our opportunity to allow the client to be the expert of their story and have them guide us in their experience.

Community members who are in the United States without an immigration status or a temporary status or are seeking status may face many challenges as they adjust to a new environment or simply work towards surviving it. But their distress or trauma may not be new or their first trauma. Clinical psychologist Dr. Cecilia J. Falicov reminds us of the pre-trauma, during trauma and post-trauma immigrants can experience during their journey. Trauma sometimes begins before people leave their countries of origin. Understanding what their experience was prior to coming to the United States is critical during clinical or initial assessment or throughout work with clients.

Immigrants may experience trouble with acculturation, getting used to new norms, traditions, food, and language. Most importantly and often overlooked is the grief and loss they may experience for having left (or lost) a place they knew, friends, family members and things they are familiar to.

Aside from the trauma, kids who are separated from their parents may experience, attachment to their parent or caregiver may suffer, making it harder for them to have a healthy reunification at a later time.

Furthermore, immigrants may face discrimination, racial profiling or bullying in their community, at work or school, which can lead to stigma about immigration status or passing to hide their immigration status. They can experience abuse at work or exploration, such as earning low wages while working long hours. Perpetrators of abuse can threaten victims who are undocumented to call immigration authorities on them. Often times victims do not call for help out of fear of being deported and what they may not know is that there are actually certain protections for victims of violence or crime who are undocumented.

Immigrants may realize the limitations of their immigration status such as not being able to obtain driving licenses (some states do grant licenses to immigrants who are undocumented), not being able to obtain in-state tuition (some states have passed in-state tuition laws for students who are undocumented), not being able to travel and little or no access to services, resources or benefits.

These and other challenges can lead to depression, anxiety and post-traumatic stress disorder (PTSD), which are the three main diagnoses that impact immigrants. And media news about immigration policies that may impact their life may exuberate symptoms.

While someone’s immigration status can represent a social determinant of health, not all immigrants want to address challenges regarding their status in their work with social workers right away or sometimes ever. Teenage immigrants sometimes just want to talk about dating; parents want to talk about parenting, DACA recipients want to talk about their dreams and aspirations. We must be mindful and respect the client’s self-determination and not impose our own agenda to address what we think the client “should” address and meet the client where they are at in their journey.

The Social Work Response
I propose a comprehensive approach to meeting the needs of our immigrant clients composed of clinical, psychoeducation or supportive services, mezzo (support groups) and advocacy. In my work with immigrant clients whose goal is to address their distress connected to their immigration status, I use a psychoeducational, skills building and processing approach where I incorporate:

Psychoeducation on the impact of politics in everyday life such as anxiety, depression, and PTSD; identifying feelings, emotions, behaviors, thoughts, and overall mental health symptoms.

Processing emotions, verbalization of feelings, normalization and validation through empathy, reflective listening, etc.

Skills building including stress and anxiety management, behavioral activation to combat depression, self-care, cognitive behavioral therapy, mindfulness (focusing on present moment and grounding). Strengths assessment and positive qualities. This activity entails helping clients re-discover or discover their strengths by reviewing all they have accomplished so far, including getting here. For many, the journey of getting here is a demonstration of determination, risk-taking, and survivorship.

Fostering a sense of safety, building safety plan (to address fears like “what if I get deported,” etc.)

Empowerment: gaining control over what we can control.

Building Awareness: providing know your rights information, connecting clients to local resources, and providing information analysis.

In addition to the work we can do through our own agencies or places of work, effective interventions include providing services for community members at their schools, churches, and community based organizations.

This requires us to partner with entities and cross collaborate. Not too long ago, several colleagues and I were going to schools to talk to immigrant parents about stress management. The local school system and the organization I worked at then formed a partnership to bring awareness during “drop off kids and coffee time.”

The clinical response and mezzo responses are just some ways of helping clients address their distress. But we know that our client’s distress is connected to environmental issues and as long as there isn’t a solution to that can aid the millions of lives impacted by the broken immigration system, our immigrant community currently in limbo will continue to suffer. This is when micro becomes macro. We have plenty of opportunities to engage right now on important fights including the passage of the DREAM and PROMISE ACT and decrying the family separations that are impacting children and are a form of children neglect and abuse. This is when we join together to fight for social justice as our NASW code of ethics calls us to do.

REFERENCES

Falicov, C. J. (2014). Latino families in therapy (2nd ed.). New York, NY: The Gilford Press.

Zayas, L. H. (2015). Forgotten citizens: deportation, children and the making of american exiles and orphans. New York, NY: Oxford University Press.

Zong, J., Zong, J. B., Batalova, J., & Burrows, M. (2019, March 14). Frequently Requested Statistics on Immigrants and Immigration in the United States. Retrieved from https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states

What is a Refugee? Definition and Meaning. Retrieved March 15, 2019, from https://www.unrefugees.org/refugee-facts/what-is-a-refugee/

Cheryl Aguilar is a licensed clinical social worker, LICSW, LCSW-C, founder and lead therapist of Hope Center for Wellness, LLC, a multicultural behavioral health and training consulting practice serving DC metro area residents and organizations. She founded and co-leads Social Workers United for Immigration, a DC based network of social workers committed to the well-being and the advancement of immigrants and immigrant rights. She can be contacted at caguilar@thehopecenterforwellness.com.

          
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