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It is estimated that around 450 million around the world live with a mental illness, yet only a third will ever seek treatment (Anxiety and Depression Association of America, 2019).
This week’s blog is dedicated to Mental Health Awareness Week (May 18th-24th), forwarding the mission to #BreakTheStigma associated with seeking support for mental health. While research suggests that immigrants (with the exception of refugee populations) are no more likely than the general population to experience mental illness (Alegría et al., 2006), the challenges this population faces often differ from the general U.S. population as they stem from the immigration experience. However, with these unique challenges come unique strengths and sources of resilience.
There are unique stressors associated with the immigration process that can test adaptability and exacerbate underlying mental health conditions. These stressors can include disconnection from networks of support, challenges adapting to a new physical environment, and often the task of learning a new language.
Another challenge is the notion of acculturative stress. This term refers to stressful life events associated with the acculturation process (i.e., the process of adapting to a new culture) that lead to psychological difficulties (Berry, 1997). An immigrant’s experience of acculturative stress may be particularly severe if there are significant differences between their home country and new country in terms of values, behaviors, and customs. These challenges risk exacerbating mental health difficulties, such as anxiety, substance abuse, and depression.
Many clients seeking mental health support or an immigration evaluation have undergone traumatic life events. Sometimes, these events are at the root of a person’s wish to immigrate to the U.S., such as when a person is persecuted in their home country and seeking asylum. Other times, traumatic events in the new country form the source of trauma, such as when a client experiences abuse, exploitation, discrimination, or poverty in their new country (Garcini et al., 2016). Either way, the experience of trauma is often a factor leading to diagnoses of posttraumatic stress disorder (PTSD), anxiety, and/or depression.
When working with trauma and subsequent diagnoses, it is important to discuss the implications of psychological testing and diagnosis on an individual basis. While mental illness is gradually being destigmatized in the U.S., your clients may have concerns about being labeled with a mental health condition based on prevailing attitudes in their home country. So, be sure to discuss these implications thoroughly on a case-by-case basis.
Guidelines for Effective Treatment
There are several important factors to keep in mind to ensure the effectiveness of treatment for immigrant patients.
First, clinicians should maintain an ecological perspective, which recognizes that the human experience involves a complex interplay between the individual and their context (American Psychological Association, 2012). When contexts change (i.e., when one enters a new culture, new location), individual responses will also vary. So, it is important to remember that your clients’ experiences do not occur in a vacuum.
Secondly, the American Psychological Association (2012) notes the importance of drawing upon a blend of evidence-based practice (EBP) and practice-based evidence (PBE) when working with immigrant populations. This means using approaches to psychological diagnosis and treatment based in research, while also knowing when to adapt these approaches based on your wisdom and experience as an immigration evaluation therapist to ensure their efficacy and appropriateness. You may also want to look for opportunities to make connections with community-based organizations that offer specialized support for migrant communities. That way, you can link your clients to additional sources of culturally relevant support.
I feel it is important to acknowledge the remarkable resilience I’ve seen in my office over the years. This observation is backed by research, which suggests that immigrants today are learning English more quickly than previous generations and are highly engaged in the labor market. They also tend to do better than their counterparts remaining in the country of origin across a range of psychological and behavioral indicators (American Psychological Association, 2012). Factors that contribute to this success include high levels of optimism, clear aspirations (Fuligni, 2001; Kao & Tienda, 1995; Portes & Rumbaut, 2001), the support of traditional family networks (Escobar, Nervi, & Gara, 2000), and supports from within one’s ethnic community. All of these factors can contribute significantly to resilience.
These positive indicators should serve as a reminder as to why immigrant populations add to the fabric of our country, and why we can be optimistic in our role as immigration evaluation therapists to make a positive difference in their lives.
To learn more about all the different types of immigration evaluations, check out my free quick-start guide.
Alegría, M., Canino, G., Stinson, F., & Grant, B. (2006). Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans and non-Latino Whites in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67, 56-65. https://doi.org/10.4088/JCP.v67n0109
American Psychological Association (2012). Crossroads: The psychology of immigration in the new century. Report of the APA Presidential Task Force on Immigration. Washington, DC: Author.
Anxiety and Depression Association of America (2019, May). Mental Health Awareness Month. https://adaa.org/mental-health-awareness-month
Berry, J.W. (1997). Immigration, acculturation, and adaptation. Applied Psychology: An International Review, 46, 5-34. https://doi.org/10.1111/j.1464-0597.1997.tb01087.x
Garcini, L.M., Murray, K.E., Zhou, A., Klonoff, E.A., Myers, M.G., & Elder, J.P. (2016). Mental health of undocumented adults in the United States: A systematic review of methodology and findings. Journal of Immigrant and Refugee Studies, 14(1), 1-25. https://doi.org/10.1080/15562948.2014.998849
Escobar, J. I., Nervi, C. H., & Gara, M. A. (2000). Immigration and mental health: Mexican Americans in the United States. Harvard Review of Psychiatry, 8, 64-72. https://doi.org/10.1093/hrp/8.2.64
Fuligni, A. J. (2001,Winter). Family obligation and the achievement motivation of adolescents from Asian, Latin American, and European backgrounds. New Directions in Child and Adolescent Development, 94, 61-76. http://dx.doi.org/10.1111/1467-8721.ep10774731
Kao, G., & Tienda, M. (1995). Optimism and achievement: The educational performance of immigrant youth. Social Science Quarterly, 76, 1-19. https://doi.org/10.4324/9780203621028-25
Portes, A., & Rumbaut, R. G. (2006). Immigrant America: A portrait. Berkeley, CA: University of California Press.
I’m Cecilia Racine, and I teach therapists how to help immigrants through my online courses. As a bilingual immigrant myself, I know the unique perspective that these clients are experiencing. I’ve conducted over 500 evaluations and work with dozens of lawyers in various states. Immigrants are my passion, I believe they add to the fabric of our country.
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