Throughout the year that I have spent as a Social Work Intern at HIRCP, one of the most pressing issues I have come to recognize is the prominence of mental health challenges in the immigrant community that arise from encounters of discrimination, xenophobia, obstacles to language access, and policies of exclusion.
As mental health conditions are on the rise worldwide, it is important to recognize the unique challenges immigrants in the U.S. experience that impact mental health. Many immigrants applying for humanitarian relief have experienced trauma, which can lead to mental health challenges such as anxiety, depression, and post-traumatic stress disorder. For children, traumatic experiences can create challenges to learning and behavior, and mental health stressors are not confined to experiences in countries of origin. Upon arriving in the U.S, many clients we assist face ongoing race-based discrimination in their communities or workplaces. For those who attempted to apply for asylum at our borders, policies like the Migrant Protection Protocols, immigrant detention, and forced family separation, can cause people to feel isolated and ashamed. Reestablishing some stability and a sense of trust takes time, and the emotional aftermath of those experiences may require them to seek professional support.
Immigrants face multiple barriers to accessing mental health services. For undocumented and documented immigrants, health insurance is not always accessible or affordable and each state has its own eligibility requirements. Even for those residing in Massachusetts, where undocumented immigrants are eligible to apply for MassHealth, the system can be difficult to navigate. Organizations like Health Care for All help decrease barriers to becoming insured and have multilingual staff available for free assistance, yet even with insurance, there are challenges to accessing care. Many behavioral health clinics are linked to larger hospital systems, which require patients to establish care with a primary care physician before connecting to mental health care.
In Massachusetts, Health Safety Net can assist undocumented immigrants that may not qualify for MassHealth, yet it obligates them to receive care at certain hospitals or clinics. Health Safety Net members also cannot access private practice therapists. This system of exclusion limits patients’ choice of providers and thereby increases wait times. For example, one client I was assisting was told that they would need to wait two months to see a primary care doctor, and then be placed on a behavioral health wait list that could be upwards of four months long. The social work team was able to step in and is working to find a therapist that accepts this client’s insurance.
One project I worked on during my time at HIRCP was to find mental health care options for clients who were uninsured, under-insured, or who cannot wait six months to be seen through their primary care’s behavioral health unit. These alternatives heavily rely on student interns, who might see clients for lower rates as part of their training, or group practices that offer occasional sliding scale rates. Compounding the challenge of securing one of these limited spots for therapy is the short supply of clinicians who can offer clients services in their native language. Whereas certain clinics are obligated to provide language access, it is not a universal requirement. Recent data shows that nearly 25% of people living in Massachusetts speak a language other than English at home.
Here at HIRCP, we are taking action to support our clients’ mental health and advocating for access to mental health care. HIRCP has had a social worker and social work interns on the team for the last nine years to provide various services to clients depending on their needs. The social work team supports clients in a case management capacity and assists with health insurance enrollments, emergency housing, food access, and education access, all of which can be complex systems to navigate. We provide short-term emotional support to our clients who are on waitlists at mental health clinics or are going through a difficult situation. We also provide support for clients throughout their meetings with HIRCP attorneys, as preparing legal cases often brings up past trauma and the uncertainty and long wait times involved with immigration cases can be difficult. As our clients aim to be active participants and contributors to their surrounding community, our team strives to decrease the burden of accessing quality and timely care by advocating for clients’ basic rights and accompanying them to receive that care.
The need for increased mental health care access for immigrants is evident. Connecting to a qualified, affordable clinician can be instrumental in reducing mental health symptoms and increasing quality of life.
This post was written by former HIRCP social work intern Hannah Oettgen.