Compassion fatigue: A side effect of the immigration crisis

APA has been closely following the recent and ongoing threats to immigrants and refugees living in the United States. These groups are “at risk of psychological harm due to factors including the stress of starting a new life away from family and culture, as well as prejudice and discrimination.” This article series takes a look at some of the ways psychologists are working to help immigrants, the communities where they live and the resources that are available to clinicians who want to help these at risk groups.

Several years ago, immigration attorney Nora Phillips was chatting with a friend. She told her that she was sick, exhausted and couldn't stop thinking about work.

Her friend, Annabel Raymond, is a licensed marriage and family counselor.

“I thought, ‘This isn't burnout,' ” Raymond said. “ ‘This is secondary post-traumatic stress disorder.' “

At that moment, Raymond identified a little-talked-about component of the nation's immigration crisis: Compassion fatigue among professionals who are trying to help.

The work with the victims of terrorism, war and domestic violence among immigrants is different from the challenges of, say, working with victims of a natural disaster.

“This trauma treatment is different because there's no end in sight,” Raymond said.

She and Phillips started a therapy group for immigration attorneys in Los Angeles. Six attorneys routinely attend.

Phillips, the legal director of Al Otro Ladoopens in new window, a nonprofit legal services organization, has been doing legal work at the border since 2011. The work was never easy, she said. But policies enacted since 2017 have left attorneys — and judges — with no wiggle room to help people. In the past, deportation cases could be terminated. The government could apply prosecutorial discretion as to whether to proceed. People who were brought to the United States as children could apply for citizenship. But now, those tools are gone or are under threat by an administration that wants to curtail immigration.

Because she has lost so many legal tools to help clients, Phillips' sense of powerlessness can be overwhelming. She said she throws up in the shower before work. She's never free of the sense that when she loses immigration cases, her clients could face violence or death when they return to their home nations.

“I refer to myself a lot as a depository of human sadness,” said Phillips, who sobbed throughout the interview and then joked that she cries through every interview.

It was clear to her friend Raymond that Phillips was going to need more than a few days off.

“You're not getting the right support, because you're treating it as a burnout issue,” she said.

Treating attorneys, Raymond said, presents its own challenges.

“You're looking at a population that's already vulnerable, but they don't want to tell you they're vulnerable.”

Raymond said that the monthly group in Los Angeles works on trauma resolution skills and mindfulness.

The goal of the therapy, she said, is “keeping you upright, because you're on the front line of an international humanitarian crisis....The best we can do is to trust that our bodies and brains can keep going.”

“You're not going to be able to dictate how these events land on your nervous system,” she added.

The attorneys who attend the group, she said, are doing well. They've gone from feeling overburdened to managing their boundaries. They decide how heavy a caseload to take, depending on the levels of other stresses in their lives.

“Some of these people were talking about getting out of the field,” Raymond said, “and now they're staying.”

Keeping attorneys in the field is a big achievement.

A strong feeling of helplessness is common among professionals who advocate for immigrants, said Gabriela Livas Stein, a psychologist and associate professor of psychology at the University of North Carolina at Greensboro.

“Compassion fatigue is very real,” Stein said. “In talking personally with providers, it is clear that they feel helpless advocating for folks and knowing the unpredictability that they face.”

Seeing ever-more-restrictive national policies and an oppressive political climate for immigrants exacerbates the sense of helplessness, she said.

“A lot of folks who are doing this work are also identified as immigrants or Latinx,” Stein said. “Folks that have this profile are showing heightened symptomology,” she said, particularly if they or members of their families are at risk of detention or deportation.

She recommends two types of action for frontline immigration professionals:

• Build social support.
• Engage in social justice activities.

Stein herself has gotten involved; she stepped up to present data on the psychological effects of deportation on families to the Governor's Council on Latino Affairs in North Carolina.

State and local officials are divided over whether local law enforcement agencies should work with U.S. Immigration and Customs Enforcement on raids and deportations.

Stein reviewed literature and reported findings to the governor's council, including a 2017 studyopens in new window in the International Journal of Epidemiology that found that Latina women, one year after a massive immigration raid in Iowa, had a 24 percent greater risk of having babies with low birth weight, compared with the same date one year earlier. Stein also drew on a survey (PDF, 483KB)opens in new window of research in Social Policy Report on how the “chronic uncertainty” surrounding families' stability compromises immigrants' physical and mental health.

Stein said that many immigration officials believe the best policy change would be to make health-care services accessible for immigrants.

“It's hard for people to even pay for services,” she said. “As a society, we benefit a lot from the work of undocumented workers. Policies need to help people not live in the shadows.”

For Phillips, recruiting young attorneys to immigration law has lifted her spirits.

“God, we need reinforcements,” she said. “So many people have closed their practices.”

She has recently spoken to law schools at Loyola, DePaul and Northwestern Universities to encourage students to consider immigration law.

“Through this chaos, we have gotten incredibly good at organizing people,” she said. “Once we come out of this, we're going to have tools that would only have come out if we had been at war.”

Phillips tries to stay strong as an example to her own staff of 25 people. Also, she prepares them for the work.

She said that she tells them that “the pain is never going to stop. There will never be a shortage of clients. You need to take care of yourself.”

The attorneys who are least prepared to handle the trauma of the job, Phillips said, are solo practitioners who have no support or preparation from an organization.

Elizabeth Carll, a trauma and health psychologist and chair of the Refugee Mental Health Resource Networkopens in new window, said that professionals who work with immigrants and refugees need training before tackling the job.

“I see the long-term effects,” she said. “First responders, they're under chronic stress...The worst thing you can do is have no training.”

At a minimum, she said, organizations should talk about trauma with the workers before they go to detention centers or conduct evaluations.

The Refugee Mental Health Resource Network, which is partially subsidized by APA, maintains a database of psychologists and other mental health professionals who want to volunteer to help with evaluations and support services for refugees and asylum seekers. The organization has also produced a series of webinars for volunteers.

Carll, who has trained workers who respond to disasters for many years, recommended that professionals who work with immigrants receive strong mentoring. A mentor, she said, can help them limit their vicarious trauma.

“Someone new should be mentored,” Carll said.

She gave an example of how a mentor can help. In 1996, after the crash of TWA Flight 800 off the coast of Long Island, she led a team of psychologists to help families. In mentoring the group, she recommended that the psychologists not accompany families into the room where people were identifying bodies, but to stay in the back of the room or outside the door to offer support, if the families requested it.

Unlike other emergency personnel, mental health counselors do not typically have the ongoing experience and training for viewing bodies, she said. Without training, that process may trigger trauma from the past.

By sparing themselves that trauma, she said, counselors would be in a better position personally to help families.

Because of the scope, the technical nature and the never-ending timeframe of the immigration crisis, Carll made a bold prediction: that immigration psychology would become a new specialty in the field.

“Immigration psychology will be another specialty,” she said, “just like trauma psychology division became after it started.”

That prediction is worth noting. Carll was a founding member of APA's Division of Trauma Psychologyopens in new window.

APA Policy and Advocacy Efforts

• APA Calls on Government to Ensure Immigrants and Refugees Can Access Health, Mental Health Services | Official Statement (PDF, 50KB)opens in new window
• APA CEO: Administration Decision to Penalize Immigrants Who Rely on Public Programs Will Harm Vulnerable Populations
• APA Calls for Action on Border Crisis
• APA Services Advocacy on Immigration

Recently Published Research

• Middle-School Latino Children Report More Depressive Symptoms After Family Member Arrested, Study Finds
• Psychological Research on Immigrants and Refugees
  

Further Reading and Resources

• Book: Mental Health Practice With Immigrant and Refugee Youth
• Podcast: On the Front Lines of the Immigration Crisis
• The Dire Consequences of Family Separation for Refugee Mental Health
• LGBTQ Asylum Seekers: How Clinicians Can Help (PDF, 534KB)opens in new window
• Div. 43 Presidential Initiative on Social Justice
• Psychologists Help Youth Who Return to Mexico Because of Deportation Threats
• Immigration and refugees topic page