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IMMIGRATION AND BEHAVIORAL HEALTHCARE

July 1, 2006
by MICHAEL J. STOIL, PHD, WASHINGTON EDITOR
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Immigrants shouldn't count on Uncle Sam to help them with behavioral health problems

In the debates over legal and illegal immigration, good intentions sometimes confuse the issues.

Roughly a year ago, as a suburban county struggled with the impact of tens of thousands of young immigrants arriving in the area, a “town meeting” was held to discuss burgeoning activity by MS-13, a violent gang with nationwide chapters. A participant suggested that the county's proposed school-based antigang programs might be ineffective because gang membership seemed to consist primarily of young Latino men who were not in school. The local official who organized the meeting snapped in reply, “We shouldn't blame this problem on one ethnic group.” The exchange effectively ended further discussion of tailoring the county's antigang activities to the culture of the gang's recruits.

The well-intentioned county official probably was trying to prevent the discussion from unleashing prejudice against people of Mexican- or Latin-American origin. The problem with her comment, though, was that the speaker's observation was not about ethnicity. Historically, most waves of immigration to America have been accompanied by a related increase in gang activity. Irish-Americans fueled the ranks of New York's notorious “Dead Rabbits” in the 1840s while sons of post-Civil War Jewish immigrants formed the Purple Gang of Detroit and Manhattan's Eastman Gang.

Community psychologists and sociologists now recognize that family conflicts and feelings of alienation encourage gang membership, especially among immigrant children. Research sponsored by the federal Office of Juvenile Justice and Delinquency Prevention on gang involvement among Vietnamese-American youth found that “Contrary to popular belief… Vietnamese youth who reject their Asian identity and find it difficult to adopt an American identity are not more likely than other Vietnamese youth to become involved with gangs.” In other words, the most important source of gang involvement is the stress of the immigrant experience rather than cultural factors.

Recent changes in immigration to the United States may increase behavioral health issues among immigrant children. Specifically, emigration from Latin America is no longer dominated by the traditional pattern in which young men arrive first and, if married, later send for other family members. Writing in the American Journal of Orthopsychiatry, Victoria B. Mitrani, PhD, and colleagues at the University of Miami's Center for Family Studies report:

As opportunities for documented and undocumented employment for women have increased, larger numbers of women have initiated their family's “step-wise” migration to the United States…. A substantial number of women are immigrating alone, leaving children behind in their country of origin, and reuniting with them years later.

According to Mitrani and colleagues, clinical practice with Hispanic youth and families at risk for behavioral health problems has found that:

[A] history of mother-child separations plays a decisive role in weakening the bond between mothers and children, and disrupts key parenting practices…. In addition, during the separation from their mother, children often develop a strong attachment bond to their surrogate caregivers and experience a second separation on reunification with mother: the first from their mother and the second from their surrogate mother.

Juvenile problems are only one of the consequences related to the behavioral and emotional health issues of immigration. In 2004, an extensive review of the literature for the National Academy of Sciences reported that, “Some studies indicate that the risk for more severe depressive symptoms… increases as ethnic immigrants become more acculturated.” Study authors Hector Myers and Wei-Chin Hwang suggested that “when immigrants come to the United States, the increased stress and burden of adapting to a new place increases risk for becoming depressed….” They also note that many immigrants risk the loss of factors that protect against mental illness, such as large family and friend networks. These conditions appear to increase with age if immigrants continue to experience social alienation and isolation, contributing to an unusually high suicide rate among elders from some immigrant ethnic groups.

Immigrants also can import disabling stresses from their home countries. Many recent arrivals in the United States are escaping from wars, famine, ethnic and religious violence, and outright genocide. Researchers are discovering that stress from such experiences can continue to influence symptom severity decades after resettlement far away from the source of the trauma. More than a half-century after World War II, for example, the elderly survivors of concentration camps appear to exhibit an attempted suicide rate three times higher than similar elderly immigrants.

In one sense, the behavioral health community in the United States is better prepared than ever to meet the mental health challenges presented by the current wave of immigration. The experience of addressing the mental health needs of refugees from communist regimes in Cuba and Southeast Asia during the 1960s, 1970s, and 1980s has left a legacy of knowledge about how to provide help to immigrant populations. Solid, evidence-based research has led to a collection of best practices, ranging from Jose Szapocznik's innovations in structural family therapy to assessment tools developed by the Minneapolis-based Center for Victims of Torture. Federal agencies and courts largely have driven the push for cultural competency in mental health and addiction treatment services, ensuring that hospitals don't repeat the infamous mistake of assuming that an elderly psychiatric patient speaking Ukrainian was uttering meaningless babble.

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