Although it has declined in the past decade, the highest percentage of immigration to the U.S. comes from Mexico. Additionally, rates of migration from Central American countries including Guatemala, Honduras and El Salvador have increased in recent years due to systemic challenges of poverty, political persecution and organized crime, and large-scale destabilization from hurricanes, floods, earthquake and volcanic eruptions.
As Hispanic/Latinx people continue to migrate to the U.S. and become a larger and more diverse segment of our population, it is important to understand the internal diversity, experiences and needs of these communities.
Mental Health Factors For Immigrants
In addition to the wide range in national origin and ethnicity, Hispanic/Latinx immigrants come from diverse socioeconomic and educational backgrounds and have arrived under different documentation statuses. The community includes documented immigrants who have received permanent residency or citizenship status, undocumented immigrants, U.S.-born children of undocumented immigrants and young people eligible for temporary protected status granted under DACA (Deferred Action for Childhood Arrivals) and the DREAM (Development Relief and Education for Minors) Acts.
Depending on their reasons for migration, and the way in which they migrated to this country, members of this community may experience significant stressors — including severe physical, emotional and mental health trauma — that can increase their risk of poor mental health, worsen an existing mental illness or result in a new chronic condition.
Trauma Among Refugees and Asylum Seekers
Refugees and asylum seekers are a significantly vulnerable population at risk for worsened mental health outcomes. Many are seeking asylum due to trauma, violence and other social injustices unaddressed in their home countries. Additionally, the migration journey itself, and the relocation in a new country, can involve physical and emotional trauma.
The process to be granted refugee status is long, usually lasting years, while the individual awaits resettlement at a refugee camp or a secondary country. When it comes to mental health and trauma, unaccompanied minors, children and adolescents who migrate to the U.S. without the company of an adult or a caregiver, or have been separated from their parents at the border, are a specific population of concern.
These children face significant mental health challenges as they often face mistreatment and lack social support. The results of trauma endured by separated families have not been fully measured or reported, but the impact of mental health as a result of adverse childhood experiences is well documented.
For people who arrived in the U.S. without documentation, or those who are awaiting formal recognition of permanent residence or citizenship, everyday experiences of finding work, housing and medical care are fraught with uncertainty and risk. Young people eligible for DACA and DREAM Act status may face prolonged stress and anxiety during the application process and while their status is pending renewal. Mixed-status families, those with undocumented parents and U.S.-born children, can face significant stress and many barriers when accessing care. In addition to the challenges of stigma, language barriers and lack of insurance, family members may not seek care or may not be fully forthcoming about immigration-related stress or status due to fear of deportation.
Undocumented individuals often must navigate systemic challenges with limited social support, placing them at high risk of mistreatment or discrimination in their homes, work environments and broader society. Mental health providers working with these vulnerable populations benefit greatly from additional education about their mental health needs, as well as from partnerships with community organizations who support the social needs of these individuals.
Immigrants can feel an intense pressure to “assimilate” into U.S. culture, adopting mainstream social and cultural practices at the expense of losing traditional ones. This includes expectations that they learn and primarily speak English, consume mainstream American media, and dress, act and eat according to mainstream American standards.
The pressure to assimilate into U.S. culture can be a risk factor for poor health. One way to decrease these risks is to promote biculturalism, the understanding and appreciation of belonging to two cultures. Collectively, we can enhance our understanding of intersecting identities — valuing and respecting different cultures and their worldviews as part of a stronger and diverse society.
Mental Health Factors For Second-Generation Immigrants
Although trauma and stress are common in first-generation immigrants, children born in the U.S. to immigrant parents have even higher rates of mental illness than their parents — an experience known as the “immigrant paradox.” This is an area that continues to be studied, but several possible explanations have been explored.
People choose to immigrate to the U.S. for many reasons, but undocumented immigrants are often motivated by violence, political or religious persecution, poverty and other traumatic experiences in their country of origin. These experiences can directly affect mental health, resulting in personal struggles and difficulties for the individual and longer-term impacts that affect the next generation.
Differing Cultural Beliefs
A person born in the U.S. to immigrant parents may experience conflict between the attitudes, beliefs and values of the parents’ culture and those that are more prevalent in the U.S. Parents will often try to preserve their cultural roots through maintaining beliefs and practices from their home country, while their U.S.-born children may separate or dissociate from their parents’ beliefs due to a lack of strong connection to the country of origin or a desire to be “more American.” Because cultural beliefs and practices have deep roots and are often fundamental to a person’s identity, it can be hard to discuss and resolve differing perspectives and viewpoints within the family.
Seeking Mental Health Care
The decision to immigrate and the ensuing experiences of migration and acculturation require great strength and resilience. Although many are able to rely on this personal strength and the protective factors of community and culture, the stress involved in immigration may cause significant challenges.
Differentiating between “natural” or expected responses to the stress of immigration and the presence of a mental health issue that requires treatment and professional support can be difficult, and often requires seeking support from friends, family and the community. Primary care doctors, counselors, religious leaders and community organizations supporting immigrants can all be great resources to discuss any concerns about your mental health.
However, if your sleep, eating, daily mood, relationships, and ability to function at work or school are affected, it is likely time to seek the help of a professional. Mental health treatment can include dialogue-based or behavioral therapy, medication or a combination of both. Increasingly, no cost or low-cost practices like mindfulness and breathing exercises are being used to address mental health conditions such as anxiety and PTSD. A culturally competent mental health provider can help you understand and navigate the specific challenges you may be facing, and determine what type of treatment and support is best for you.
Mental health providers may or may not have additional education or training in working with immigrant patients. It may be helpful for you to prepare ahead of time with information you think is important to discuss with your mental health provider, including:
- Concerns about financial cost of treatment, including visits, medications and therapy.
- Concerns about insurance coverage. Your documentation status may affect your ability to receive services, as most mental health providers require insurance coverage. If you do not have insurance, it may be helpful to ask faith leaders or community center workers for mental health providers who may offer free or low-cost mental health services. Be aware that emergency services are generally covered for undocumented immigrants.
- Concerns about privacy, especially regarding documentation status. Be aware that your mental health provider is not required by law to share your medical records with government authorities.
- Cultural beliefs or practices that may affect your mental health treatment. For example, some families strongly believe that mental illness does not need to be treated with medications. If you or your family believes this, do not hesitate to discuss this with your mental health provider so they can incorporate this important information in your treatment plan.
- Concerns about having a bilingual practitioner or the use of interpretation services.
Disclosing Your Status and Migration History
A culturally-competent mental health provider will appropriately and respectfully discuss your immigration status and your migration history to determine how to best provide treatment and support. They may ask questions about how long you have lived in the U.S., what led to your decision to migrate and your life experience living in the U.S. — but they should not take up time during appointments to give any opinion or judgment about your experience and choices. Your provider should use open-ended questions and allow you to provide however much information you feel comfortable sharing.
Providers should make it clear that the information you share is confidential and will not affect your access to medical treatment. You should see signs or receive a notice that outlines their confidentiality policy and the measures they will take to protect their records from scrutiny by immigration agencies. If you don’t see a notice, feel free to ask and get assurances that your documentation status information will be protected.
When finding a provider, it may be helpful to inquire about their use of interpreter services. Interpreter services should be available during phone calls when making an appointment, when you are evaluated by the medical provider and by any other staff member who interacts with you at the doctor’s office.
Whether you seek help from a primary care doctor or a mental health professional, you should finish your sessions with health professionals feeling heard and respected.
Please note: The resources included here are not endorsed by NAMI, and NAMI is not responsible for the content of or service provided by any of these resources.
American Psychological Association-Immigration
This website offers information for mental health providers and educators regarding the mental health needs of immigrants.
American Psychiatric Association (APA)
Stress and trauma toolkit for treating undocumented immigrants in a changing political and social environment.
A tool to connect with mental health professionals serving immigrant patients.
This website offers multiple resources for Latinx, immigrants, DACA recipients and undocumented individuals.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Find contact information for mental health services for refugees.