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.
In the waiting room of the Mexican Consulate in downtown Los Angeles, 500 people per day pass through, most of them seeking legal help. Two days a week, while they wait, licensed clinician Paula Helu-Brown stands up and asks whether anyone they know is “nervios” — a Spanish term for anxious. She tells them that if they know anyone who is fearful or having trouble sleeping, she knows where they can find help.
In public spaces throughout Los Angeles County — in the parks, at the libraries and during festivals — social worker Miriam Brown and her staff from the Department of Mental Health discreetly take their places behind information tables as part of the Office of Immigration Affairs, handing out fliers to let immigrants know that the county offers counseling services to residents, regardless of immigration status.
In 20 schools surrounding Washington, D.C., full-time Spanish-speaking counselors from Mary's Centeropens in new window, a community health center, are available to help immigrant children cope with a world full of bullying and confusion, as well as with their fears that their parents may not be there when they get home from school.
Connecting with clients
Throughout the United States, people who offer counseling services to immigrants have found one way to reach a population that does not necessarily want to be found: To overcome their distrust of authorities, you have to go where the people are.
Once you find these clients, you have to not only speak their language, but connect with them on a cultural level as well.
“One word comes up: confianza,” said Helu-Brown, assistant professor of psychology at Mount Saint Mary's College and clinical coordinator for Modula de Salud Mental at the Mexican Consulate. “It's like comfort and trust and familiarity. A place you can be yourself and let go.”
During her outreach at the consulate, she collects 10 names a day. In its first two years, the programopens in new window has served about 350 people. After Helu-Brown makes her announcements in the waiting room, counselors are available on-site to talk with people immediately. She also offers two group counseling sessions a year for six- to eight-week periods. In all these sessions, she said, the sense of “confianza,” a sense of being at home, is absolutely critical.
The term figured prominently in research findings for a recent articleopens in new window about the program in the journal Research on Social Work Practice. The research was conducted with the School of Social Work at the University of Southern California.
The study concluded that “the participants' accounts underscored the need for service providers to not only possess Spanish linguistic proficiency but also a cultural sensitivity that helps create a sense of familiarity and trust resulting in confianza (trust), which in this study led to an openness to services and destigmatization of mental illness and was instrumental in addressing several of the barriers that had previously kept participants from seeking services.”
In the article, one participant said: “An American won't really know our Latinx customs. They don't know our way of talking...Us Latinxs have a particular way of talking, a particular way of acting, we have a double meaning with words. And all of that affects us in some way...And that is why I feel more identified here at the Consulate of Mexico. Because I have heard the way the therapists speak, and they speak exactly like they do in Mexico. That really helps mentally, because it feels like a more direct help, that is why I feel comfortable here, and there is confianza.”
Helu-Brown said that a critical component in treating these clients is “referencing things back home. Knowing the city they're from. Saying, ‘I'm from a similar place.'“
Understanding that place, she said, is a catalyst to discussing the grief of leaving home behind.
Marisa Parella, director of the School Based Mental Health Programopens in new window at Mary's Center in Washington, said that immigrant families are “absolutely” feeling more duress in the current environment of high-profile news about raids and deportations.
“When there would be a raid,” she said, “there would be an enormous drop in attendance in the high schools. Schools really suffer as well.”
Around the 2016 election, she said, “there was a lot of bullying toward immigrants, along with crying, anxiety, fear that parents would not be home when they got home.”
Parella's program, which places full-time counselors in schools, started six years ago in five public schools. Since then, it has expanded to 20 sites — including elementary, middle schools and high schools – and now, 10 more schools want to join. The program employs 36 people, of whom 25 are bilingual.
“Schools are attractive to immigrant populations that need behavioral services,” Parella said. “The families were not taking that next step of going to a clinic...You can get them over a crisis more quickly in a school setting.”
Part of the program's mission, she said, is to help craft a message so that families know that immigration enforcement authorities are not allowed in schools. In a one-year period starting in April 2018, the program served 944 participants in family, group and individual therapy.
Much of the work for the program starts before the school year begins.
In training sessions, trainers take teachers through empathy-building exercises. They start by reflecting on life in a country where children routinely hear about relatives and neighbors being killed and kidnapped, then spend months walking to the United States to escape.
During exercises, they “imagine living in a country where every day you hear about someone being murdered,” Parella said. “What it's like to have walked for three months, with hunger, thirst. And now they're in your chair.
“I think that's a real wake-up call.”
How teachers can help
The organization trains teachers to take several steps to help immigrant students:
- Build a classroom that's a safe environment.
- Hand out information cards for parents to find out why they may not be responding to you.
- Build parents' capacity to advocate.
- Understand, particularly on the high school level, that the trauma of migration may be a factor in a student's acting out.
“The overlay is, how do you do that with a population you don't have a lot of experience with, or you don't understand?” Parella said.
“We think very clinically about the work we do. We are committed to being part of the school. We are committed to skill-building and knowledge building.”
Using understanding in services
For Luis Flores, the key to treating immigrant populations is “personalismo,” which translates not just as using the personal touch, but as a sense of warmth as well.
Flores is executive vice president of Serving Children and Adults in Need (SCANopens in new window), a community-based nonprofit social services organization on the border in southwest Texas. With 35 programs in 16 counties, the organization provides intervention, prevention and treatment services to a population that is 95 percent Mexican American.
“We need to make a connection instead of providing the service,” he said. “We speak the language and are part of the culture. The greatest thing you can provide to somebody is to understand them through the experience.”
For the resident population near the border, Flores said, “I have seen an increase in the level of distress in the population that already lives here. There's stress in being detected, stress in kids when caregivers are not calling.”
For the Los Angeles County Department of Mental Health, the first step in effective outreach to immigrants was to remove the label “mental health” from outreach services.
“We've tried to set it up so it wasn't through mental health,” said Miriam Brown, deputy director of outreach, engagement and triage for the county department.
For the past two years, her outreach to immigrants has been conducted through a new umbrella called the Office of Immigration Affairs, which oversees public health, mental health and legal services.
Many clients first make contact with county offices when they're seeking legal aid.
If someone mentions having trouble sleeping or anxiety, he or she is connected to a mental health worker within 24 hours.
The department also recently held an event on Facebook Live. The English version received 1,000 viewers, and the Spanish version received 300 viewers. Mental health staff were also available during a two-hour immigration help session televised by Telemundo and the local NBC affiliate.
But Brown noted that a county helpline where people can use text messaging has been more active than the phone line. She said that aside from cultural resistance to seeking mental health services, the county's No. 1 obstacle is to convince people who need help that county clinics are safe spaces.
“The fear of giving information is really high,” Brown said. “We tell them about the services we offer, that we're a safe location, that we're not allowed to disclose information.”
In fact, the department has established a protocol to bring in immediate help from the county counsel's office in the event that immigration enforcement officers show up in a county clinic.
The good news?
“It's never happened,” Brown said.
In addition to services at county clinics, which include group and individual counseling, Los Angeles County has started offering grants to community clinics to help them serve immigrant populations.
“This is a societal problem for all of us,” said Mimi Martinez McKay, deputy director for strategic communications for the department. “The fear and the anxiety out there...even people who are documented feel they should walk around with their passports.”
Counselors and administrators who are working with immigrants said that psychologists who want to help can assist in a variety of ways.
Helu-Brown said that her program at the Consulate has a dedicated space with room for more counselors. (Professionals can reach the program through this web pageopens in new window). Also, she said, nonprofit organizations welcome cash donations, and she is always looking for community partners.
Informed Immigrantopens in new window, a collective of nationally recognized legal and service organizations that assist immigrants, set up a searchable web pageopens in new window where volunteers and donors can look up nonprofits that help immigrants. These organizations include local chapters of Catholic Charities and Lutheran Social Services. State and county health departments also maintain lists of agencies that assist immigrants and refugees.
Flores recommended reaching out to nonprofits. If you have refugee families nearby, he said, check whether local nonprofits need training. Do they need support evaluating clients or help with programs for post-release families?
For Flores, the notion that psychologists far from the border might want to help was a revelation.
“The warmth,” he said. He paused a moment. “I'm feeling emotional. The warmth comes across.”
