After DACA victory, attention turns to mental health needs

The U.S. Supreme Court decision that the Trump administration cannot immediately end the Deferred Action for Childhood Arrivals (DACA) program has spurred a wave of relief and victory in the DACA community—as well as a complex mix of emotions ranging from sadness, to anxiety, to resolve. 

The June 18 decision on the DACA program was a major win for DACA recipients and their loved ones, who have been living under a cloud of uncertainty since the administration tried to end the program in 2017. DACA enables undocumented immigrants to remain within the United States, as long as they arrived before 2007 and were under age 16 when they came into the country, provided that they meet educational, work, and conduct requirements. 

The program directly benefits approximately 700,000 people, including an estimated 27,000 essential workers within the health-care field. But DACA does not provide a path to citizenship, nor are its protections permanent, since recipients must apply to renew their eligibility every two years. In part because of this instability, psychologists recognize a huge unmet mental health need among DACA recipients, and in the undocumented immigrant community more broadly.

To meet this need, the National Latinx Psychological Association (NLPA), APA and immigration policy advocacy organizations such as United We Dream and FWD.us are working together to train mental health professionals on this community’s needs, to create a directory of therapists who are willing and able to work with undocumented immigrants on a sliding scale or pro bono basis, to conduct research on this population’s complex needs, and to raise awareness of the legal challenges still ahead. As part of this collaborative effort, APA is offering a free, three-part Continuing Education series that began June 21. The first installment features presentations on the context and impact of immigration policy and COVID-19 for undocumented communities. Registration for the webinar reached the 1,000-attendee limit within hours. Recordings of the series will be available for those who are unable to attend live.  

“This is a time for us to build up, to prepare, because the community’s needs might have even become more complex after this decision,” says Luz Garcini, PhD, MPH, a clinical psychologist at the University of Texas Health Science Center San Antonio, and a faculty scholar at Rice University. “DACA recipients, their families, and their communities have been under constant and chronic stress for a very long time.”

This pent-up stress was evident on a pair of community calls on June 18 hosted by United We Dream’s UndocuHealth initiative, Garcini says. Members of the community felt emotions ranging from elation to numbness following the Supreme Court decision. It’s important for psychologists to help people understand that this mix of emotions is valid in response to a high-stress situation, Garcini says. “One of the things that is important for us as mental health professionals is to provide them with skills helpful to take care of themselves so that they can step back and get some rest, because the fight is not over.”

The fight itself can be a coping mechanism in the face of uncertainty and discrimination, says Germán Cadenas, PhD, a counseling psychologist at Lehigh University whose work focuses on the psychology of undocumented immigrants. Cadenas and his colleagues have found that undocumented immigrants experience race-based discrimination and have higher psychological distress than those with citizenship or legal protections such as lawful permanent residence (Journal of Latinx Psychology, In Press). 

Critical consciousness—the ability to analyze and challenge systems of privilege and oppression—is a coping mechanism that protects against some of this distress, the researchers found. Critical consciousness is also associated with a greater intent to persist through college for DACA recipients, Cadenas has found ( Cultural Diversity and Ethnic Minority Psychology opens in new window, 2018). “Getting involved in activism gives people an outlet to deal with all of these awful things, like family separations, police brutality, and incarceration,” he says. 

Wins like the Supreme Court decision can be highly motivating. “It’s incredible to see that justice can still prevail, that it matters to fight,” says Norma Ramirez, a doctoral candidate in clinical psychology and one of the plaintiffs on the Supreme Court case. 

The activist community has long taken steps to combat the burnout that can come with extended legal battles and relentless advocacy work. UndocuHealth, the United We Dream program, has developed a mental health toolkitopens in new window with mindfulness exercises and information on stress and healing. In collaboration with the NLPA and the Center for Research to Advance Community Health (ReACH) at the University of Texas Health Science Center at San Antonio (UTHSC-SA), the program also holds monthly themed group support meetings through the Extension for Community Healthcare Outcomes (ECHO) platform. These sessions are designed to connect community members with mental health professionals, says Jenifer Garcia Mendoza, the health program coordinator for United We Dream.

But access to mental health care for the undocumented and immigrant communities still lags. Many DACA recipients report that when they do seek therapy, they have to explain to the therapist what DACA is and what that means for their immigration status, Garcia Mendoza says. Issues of insurance, cost, and trust are also barriers. 

“As psychologists we have a lot of power, especially in the therapy room,” Ramirez says. “We need to be able to take our values and live them, for policy change and to make mental health access accessible.”

United We Dream and NLPA are collaborating to recruit providers and agencies to provide culturally competent services on a pro bono basis or on a sliding scale. The directory they are building is especially in need of mental health providers in California’s Central Valley; the Washington, D.C., Virginia, and Maryland area; New York; Seattle; southern Florida; Connecticut; and Oklahoma City. (Providers who are interested should contact Carmen Caneda, Jenifer Garcia Mendoza, or Walter Barrientos with their names, addresses, emails, and phone numbers.)

Another collaborative effort is a new training guideopens in new window authored by Cadenas and colleagues, which was published April 20, prior to the DACA decision. The guide was convened by the Informed Immigrant platform spearheaded by FWD.us. It includes recommendations for providers and resources to become informed about DACA, immigration policy, and the impact of the COVID-19 pandemic on undocumented immigrants. APA‘s free Continuing Education series is based on the guide. 

Therapists need to take care not to pathologize undocumented immigrants, whose fear, anxiety, or depression can be a very appropriate response to the threats to their lives and livelihoods, says Laura Minero, PhD, a recent doctoral graduate and DACA recipient, whose clinical work and research focuses on examining how policies impact undocumented populations. Psychologists should also think of ways to bring their expertise in mental health to bear in policy recommendations for immigrant communities, she says. “As psychologists, it is our responsibility to act as advocates and take a stand for these issues,” she says. 

Garcini and her colleagues are now launching a longitudinal survey to identify the mental health and wellness needs of the DACA community, not only in the wake of the Supreme Court decision but also in response to the COVID-19 pandemic and the protests against police brutality throughout the United States. Many DACA recipients are under extreme pressure as the only members of their families with the ability to work legally, especially as the economic impacts of the pandemic hit immigrant communities hard. 

“These kids have been adults since they were kids, since they arrived here,” Garcini says.

The political attacks on DACA recipients and the undocumented immigrant community are unlikely to let up. There are questions about when and how new applications to the DACA program can begin. Meanwhile, President Trump has struck an adversarial tone in response to the ruling, tweeting on June 19 that the administration would be submitting “enhanced papers” in a second attempt to shut down DACA. Legal experts told reporters that a second attempt to end DACA by the president was unlikely to bear fruit, given the looming 2020 election. But DACA recipients and their supporters are aware that getting a permanent and more inclusive solution to the problems of the immigration system will require congressional action. To support advocacy efforts, Cadenas is leading a group of nine APA divisions and NLPA in connecting with local immigrant rights organizations in each region of the U.S. The goal is to develop a set of recommendations for psychologists and activists to collaborate on advocacy that is sensitive to local contexts.

“We are seeing how vulnerable DACA is and that we need something better,” Ramirez says. “But today we celebrate. We celebrate the fact that we fought and that we won.”