The Mental Health Needs of Immigrants

Some recent immigrants face difficulty adjusting to their new home in the United States for a host of reasons, including coping with trauma experienced in their native country, overcoming cultural and language barriers, and encountering discrimination. The effects of immigration on psychological and social well-being are especially profound for certain populations, including children, women, individuals with disabilities, and those with limited financial resources. Despite the critical need for mental health services, immigrants face significant obstacles to receiving quality mental health care.

• Many immigrants experienced traumatic circumstances in their native country, including extreme poverty, human trafficking, exposure to war, and natural disasters. For instance, the U.S. Department of State's 2003 Trafficking in Persons Report revealed that the practice of human trafficking exposed women and children to rape, torture, HIV/AIDS and other sexually transmitted and infectious diseases.

• Many immigrants have difficulty acculturating to their new environments in the U.S. , which is exacerbated by experiences with prejudice and discrimination. Acculturation, the process through which immigrants adapt to the culture and institutional systems of their new country, transcends all aspects of their lives (e.g., school, work, and community life).

• To support their families, immigrants are often forced to take jobs in manual labor, even though they may have the training and education for professional jobs. Thus, many immigrants cannot sustain their former economic and social status, which can lead to psychological distress.

• Learning and academic success can be challenging for children and adolescents when the curriculum and teaching methods of the U.S. differ from those in their native country. Also, many immigrant youth whose parents are migrant farm laborers often leave school to join their parents in the workforce, causing frequent disruption in their education and potential emotional and behavioral problems.

• Immigrants may feel torn about where to draw the line between fitting into American society and into their own ethnic community, and preserving their original way of life. Children and adolescents often acculturate more quickly than their parents, which can lead to significant family conflicts and lack of family cohesion. Feelings of isolation often emerge with family conflict and the struggle to develop a tight social network.

• Exposure to traumatic conditions, coupled with difficulties in acculturation, can lead to severe and long-lasting psychological and behavioral problems, including depression, anxiety, posttraumatic stress disorder, and a high risk for suicide.

• Access to quality culturally and linguistically appropriate mental health services is critical for immigrant populations.

• The U.S. Department of Health and Human Services asserts the need to develop multiple health and mental health treatment approaches addressing the needs of diverse, multicultural and multilingual populations.

• Immigrants have less access to, and lower utilization of, mental health services. Immigrants face many barriers to receiving care, including financial difficulties, t he lack of culturally- and linguistically-appropriate services, and mistrust of mental health providers. The rate of uninsurance for foreign-born children under the age of 18 is 36.8 percent, more than triple the rates for U.S. citizen children.

• Medicaid and State Children's Health Insurance Program (SCHIP) play an important role in providing health insurance coverage for low-income immigrants. However, federal legislation restricts many immigrants, particularly recent immigrants, from qualifying for critically important services. Immigrants, including pregnant women and children, arriving after August 22, 1996, are restricted from federally-funded health care coverage for their first five years in the U.S.

The American Psychological Association strongly recommends:

• Comprehensive, coordinated, and continuous health and mental health services for immigrant populations.

• Development of culturally and linguistically competent programs and services for immigrants.

• Enactment of the Immigrant Children's Health Improvement Act, which would:

• Allow states to lift the five-year ban for children and pregnant women who arrived in the U.S. after August 22, 1996;

• Give states the option of providing health coverage to eligible, lawfully present, pregnant women under Medicaid and children under either Medicaid or the SCHIP.

• Cultural competence training for service providers and efforts to increase the members of ethnic minority mental health professionals and those fluent in diverse language.