Migration and Mental Health
Women’s History Month provides an opportunity to reflect on the long history of immigrant women in the United States. Women have made up a significant part of the immigrant population and currently comprise more than half of the total U.S. immigrant population. Throughout history, women have left their countries of origin fleeing poverty, conflict, persecution, and other conditions that affect their safety and livelihood. Surging tides of violence, including gender-based and gang violence, have also forced women to flee their homelands. Women migrate to pursue work, educational opportunities, and a better life for themselves and their families yet many face arduous and traumatic conditions on their journeys.
Women migrants are especially vulnerable to migration-related stressors and mental health distress often due to exposure to traumatic experiences before, during, and after migration. Prior to migration, exposure to extreme poverty and violence increases immigrants’ risk for depression. During migration, the risk of physical, psychological, and sexual violence, exploitation, human and drug trafficking, and inhumane detention conditions often contribute to post traumatic stress disorder (PTSD), depression, and anxiety. Once settled in this country, immigration policies, loss of social networks, discrimination, financial pressures, dangerous working conditions, and low socioeconomic status can further increase stress and unhealthy coping strategies.
Elizabeth, a pseudonym, is an immigrant from Ecuador who came to the United States in 2001 searching for a better life. Unfortunately, there was no American dream waiting for Elizabeth. The father of her four children had become her worst nightmare. He was emotionally, physically, and psychology abusive towards her. Due to fear of deportation and being separated from her children, Elizabeth hesitated going to the police and stayed with her husband. “I suffered everything a woman could possibly suffer,” she said to Al Día News. “I was afraid, alone and didn't even speak English.”
Elizabeth was finally able to escape and find resources for help when she moved to Philadelphia. As an undocumented single mother in a new city, Elizabeth had to support herself and her children. She sought support at the Sisters of Saint Joseph Welcome Center. The Center helped Elizabeth with her immigration and personal issues.
Migrant women like Elizabeth are among the most underserved people in the world. Policies and systems that recognize unequal power dynamics, fear of disclosure and deportation, barriers to judicial and immigrant support, and stigmatization are needed to support women who experience gender-based violence and abuse. The Violence Against Women’s Act, the U nonimmigrant status, and mental health counseling hold promising potential in providing justice for immigrant survivors.
Violence Against Women Act (VAWA)
The VAWA was passed by Congress in 1994. The VAWA created a special route to lawful immigration status for victims of domestic abuse. Victims of battery or extreme cruelty can self-petition if the acts were committed by spouses, parents, or children who are U.S. citizens or lawful permanent residents (LPR). Parents of U.S. citizens also can qualify for a VAWA self-petition. Most importantly, the VAWA self-petition allows victims of abuse “to get legal status without the participation or control of the abuser”. VAWA acknowledges the physical and psychological violence that U.S. citizens and LPRs commit against immigrants. It also emphasizes abuse in intimate partner settings and implicitly recognizes the potential imbalance of power in mixed-status interactions. VAWA’s immigration provisions have been incorporated into the Immigration and Nationality Act (INA), becoming permanent provisions that do not require congressional reauthorization – affirming the urgency of these cases. Along with victims of domestic abuse, victims of crime have also been provided a special route to lawful immigration status.
Congress created the U nonimmigrant status (U visa) in 2000 to help victims of crime. The U visa is meant for “victims of certain crimes who have suffered mental or physical abuse and are helpful to law enforcement or government officials in the investigation or prosecution of criminal activity”. The legislation aims to strengthen law enforcement agency’s ability to “investigate and prosecute cases of domestic violence, sexual assault, trafficking of noncitizens and other crimes” while also protecting victims of crime who help in the investigation or prosecution of criminal activity. Unlike the VAWA, U visas cases require law enforcement participation and the perpetrator’s immigration status is irrelevant.
Mental Health: More Than a Clinical Service
Undocumented individuals who are victims of domestic abuse or crime may seek services from mental health systems to deal with their trauma. Documentation of mental health services can be used to support a VAWA self-petition and U visa proceedings and initiate a path for lawful immigration status. For example, undocumented individuals who want to self-petition under the VAWA must prove that they were the victims of “battery or extreme cruelty.” During the self-petition process, individuals can receive the support of a domestic violence advocate or a mental health counselor who can write “corroborating statements”. Corroborating statements can describe the facts of the abuse and are especially helpful “when the abuse was not physical or there are no police reports, protection orders, or medical reports”.
U visa applicants also can send supporting evidence to prove their eligibility. If an individual is seeing a mental health therapist or counselor, a statement from that professional can be supporting evidence. The therapist can describe the facts of the crime to show “substantial harm” experienced by the applicant. Recounting instances of abuse can be retraumatizing for individuals thus, counselors can also explain details of the crime based on what the individual has disclosed.
Though mental health services can be critical in VAWA and U visa proceedings, migrants face several barriers to mental health care. Being unaware of publicly funded medical assistance, being hesitant to use public benefits in fear that disclosing personal information will increase their risk of deportation, limited access to translation services, transportation, employment and education all hinder immigrant women’s ability to understand and navigate the health system. Moreover, immigration status is a determinant of health care access. Due to exclusionary policies, immigrants have been systematically deterred from obtaining coverage and seeking necessary health services. While the Affordable Care Act (ACA) expanded health care coverage to lawfully permitted migrants and allowed them to purchase insurance through the Health Insurance Marketplace, undocumented immigrant adults and children were prohibited from purchasing health insurance and were left uninsured. Immigrants also work low paid jobs in industries that are less likely to offer employer-based health insurance and oftentimes cannot afford to pay for private health insurance. Additionally, the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) requires qualified immigrants to wait 5 years before being eligible to enroll in Medicaid and completely bars undocumented immigrants from Medicaid (PDF | 790 KB). These social and policy barriers can prevent immigrant women from seeking mental health care and must be addressed to increase mental health care accessibility among this population.
Mental health care can play critical roles in the lives of immigrant women who have experienced traumatic life events. The intersection of immigration and mental health shows that equity efforts are connected through policies that span public health and immigration sectors. Collaboration between mental health systems and immigration proceedings can create a transformative future that allows immigrant survivors to transcend victimhood and fear to find their own power, agency, and possibility.
Although SAMHSA does not have programs specifically addressing this population, many of their programs are inclusive of women’s behavioral health. The Residential Treatment for Pregnant and Postpartum Women grant program provides pregnant and postpartum women treatment for substance use disorders. The Early Childhood Mental Health Programs aims to reduce the impact of substance use and mental illness on our communities by funding programs that promote and support the health and wellness of young children and their families. These programs have a two-generational focus on children and caregivers of young children, which disproportionately involves women, though services are not offered exclusively to women/female caregivers. Lastly, SAMHSA’s findtreatment.gov website is a comprehensive resource for persons seeking treatment for mental and substance use disorders in the United States and its territories.
Please note that this blog is not referencing asylum seekers.