Rollback of Policies Protecting Critical...
On January 20, the U.S. Department of Homeland Security (DHS) issued a directive rescinding “sensitive” zone policies, which have long...
READ FULL STORYBy: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert
with USCRI’s Refugee Health Services in Arlington, VA
The flood of announcements by the new Administration, including the indefinite suspension of the US Refugee Admissions Program (USRAP; read USCRI’s statement on this Executive Order), the resumption of Migrant Protection Protocols (MPP) or commonly known as the “Remain in Mexico” policy (read USCRI’s statement on this Executive Order), and the termination of the humanitarian parole program for Cuban, Haitian, Nicaraguan, and Venezuelan nationals (read USCRI’s statement on humanitarian parole termination), as well as the possibility of ending other parole programs, have far-reaching implications for millions of refugees, asylum-seekers, immigrants, and their families.
There is growing evidence that hostile post-migration environments and restrictive and punitive immigration policies are associated with devastating physical and mental health outcomes among refugees, asylum-seekers, and immigrants. Moreover, restrictive immigration policies also have widespread consequences for all U.S. citizens, especially those from racial/ethnic or religious minority populations, as well as U.S. citizens with family members without legal residency. Since immigration policies are a major global determinant of physical and mental health and given that mental disorders are among the leading causes of diminished human productivity and contribute as much to lifetime disability as cardiovascular and respiratory diseases, a call for action is desperately needed (Martinez et al., 2015). Resettlement agencies, community-based organizations, and healthcare providers play a crucial role in advocating for, mitigating the negative effects of restrictive immigration policies, and supporting and promoting the mental health and well-being of refugees and immigrants.
Impact of Restrictive Immigration Policies on Mental Health
An undocumented immigrant is a foreign-born person who enters the U.S. without legal status because of entering the country without inspection, remaining longer than their visa permits, or violating the terms of their admission. Federal, state, and local laws and policies directly and indirectly impact the physical and mental health of undocumented immigrants. These laws and policies can limit access to education, health insurance, food assistance, employment, preventive healthcare, and public health services. Laws and policies aimed at increasing police and immigration surveillance and enforcement result in decreased mobility for undocumented immigrants, disruptions in employment opportunities and social support relationships, and limited access to public services, as well as chronic fear, anxiety, and stress surrounding deportation, detention, and family separation (Ornelas et al., 2020). These laws and policies affecting undocumented immigrants can also result in U.S.-born children living without a parent, increased poverty, lower educational attainment for children, and distrust of authority (Ornelas et al., 2020). Research indicates that restrictive and punitive immigration policies are directly associated with adverse mental health outcomes among undocumented immigrants, including increased rates of depression, anxiety, posttraumatic stress disorder (PTSD), and substance use (Hacker et al., 2015; Martinez et al., 2015; Ornelas et al., 2020).
Detention, a common component of restrictive and punitive immigration policies, has consistently been recognized across the research literature as having detrimental effects on mental health, even in countries where detention standards are regarded as relatively benign (von Werthern et al., 2018). Research has demonstrated that adults, adolescents, and children experience high levels of mental health problems, including anxiety, depression, PTSD, poor quality of life, self-harm, and suicidal ideation while in detention, as well as after being released (Filges et al., 2024; von Werthern et al., 2018). As a post-migration trauma that involves the loss of liberty and agency and the threat of forced return to the country of origin, detention, for many immigrants with a history of major pre-migration trauma, is reminiscent of situations in their country of origin where they were persecuted, deprived of their liberty and human rights, and exposed to social isolation and abuse (von Werthern et al., 2018). The Physicians for Human Rights and Bellevue/NYU Program for Survivors of Torture (2003) research study found that among detained asylum seekers, 86%, 77%, and 50% experienced significant symptoms of depression, anxiety, and PTSD, respectively.
Many migrants live in a state of limbo or protracted uncertainty because of the impermanence of their immigration status and the threat of deportation, (Côté-Olijnyk et al., 2024). The research literature highlights the relationship between this state of limbo and poor mental health among vulnerable migrants, and several studies show the association between insecure migration status and mental illness (as cited in Côté-Olijnyk et al., 2024). A recent meta-analysis found that among asylum-seekers and undocumented migrants in situations of indefinite waiting for asylum, over one third experienced PTSD, over a third experienced an anxiety disorder, and about half of them experienced depression (Côté-Olijnyk et al., 2024). Furthermore, the meta-analysis (Côté-Olijnyk et al., 2024) also found that the main stressors for asylum-seekers and undocumented migrants were the threat of deportation, uncertainty about the future, exclusion from society, and experiences of stigma. Even two years after being released from immigration detention on temporary visas, research has shown increases in ongoing resettlement difficulties, social isolation, and difficulties with acculturation among refugees, demonstrating the long-term psychosocial implications of restrictive immigration policies (Steel et al., 2011). Increased deportation rates and the fear of deportation are also associated with reductions in enrollment in healthcare and social welfare programs, increased poor general health, poor cardiovascular health, food insecurity, delays in receiving prenatal care, increases in low birthweight babies, reduced K-12 school completion, increased childhood poverty, and worse mental health outcomes (as cited in Perreira & Pedroza, 2019). The overwhelming fear of being exposed to more trauma, and even death, if returned to one’s country of origin not only contributes to poorer mental health outcomes, but also compromises the ability of individuals to overcome practical, daily challenges associated with migration and resettlement (Nickerson et al., 2011).
Immigration enforcement that leads to deportation and detention can also lead to the involuntary separation of parents and children. Research evidence, as well as anecdotal evidence, has consistently demonstrated that policies that separate families have dire psychological effects on both adults and children (Edyburn & Meeks, 2021; Miller et al., 2018; Ornelas et al., 2020). In one study, family separation was found to be a major source of distress for refugees, and significantly contributed to their symptoms of depression, anxiety, and PTSD and poorer psychological quality of life (Miller et al., 2018). A study that compared children in the U.S. who had been separated from their parents with those who migrated with their parents found that separated children were three times more likely to experience serious emotional or behavioral problems, such as attachment issues, anxiety, depression, loss of appetite, sleep disturbances, withdrawal, peer problems, and aggressive behaviors, with some of these difficulties continuing even after reunification two years later (Edyburn & Meeks, 2021; Lu et al., 2020; Miller et al., 2018; Ornelas et al., 2020).
It is imperative that research inform policy, and the research evidence is clear: Restrictive and punitive immigration policies that restrict or strip already vulnerable immigrants’ rights to protection, asylum, and dignity adversely impact their physical and mental health and potentially expose them to greater harm. By ensuring the health, protection, and human rights of the most vulnerable populations on the planet, we continue to uphold the fundamental Constitutional protections of due process and equal protection, regardless of immigration status. Providing access to asylum and protecting the safety and rights of immigrants and refugees fleeing humanitarian disasters and persecution is not only a moral imperative, but a legal one.
If you or someone you know is thinking about suicide or would like emotional support, call or text 988, the Suicide and Crisis Lifeline that is available 24/7. If you or someone you know is having a life-threatening emergency, please call 911 or go to your nearest hospital emergency room.
For resources or information about USCRI’s Refugee Health Services program for refugees, please visit: https://refugees.org/behavioral-health-support-program/ . If you are an immigrant or refugee experiencing sadness, anger, anxiety, fear, difficulties sleeping or functioning, or any other form of distress, call USCRI’s Wellness Helpline at 800-615-6514 for counseling and support.
References
Côté-Olijnyk, M., Perry, J. C., Paré, M-E., & Kronick, R. (2024). The mental health of migrants living in limbo: a mixed-methods systemic review with meta-analysis. Psychiatry Research, 337, 115931. https://doi.org/10.1016/j.psychres.2024.115931
Edyburn, K. L. & Meek, S. (2021). Seeking safety and humanity in the harshest immigration climate in a generation: a review of the literature on the effects of separation and detention on migrant and asylum-seeking children and families in the United States during the Trump Administration. Social Policy Report, 34(1), 1-46. https://doi.org/10.1002/sop2.12
Filges, T., Bengtsen, E., Montgomery, E., & Kildemoes, M. W. (2024). The impact of detention on the health of asylum seekers: An updated systematic review: A systematic review. Campbell Systematic Reviews, 20(3), e1420. https://doi.org/10.1002/cl2.1420
Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A., Pinto, R., Rhodes, S. D., Moya, E., & Chavez-Baray, S. (2015). Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. Journal of Immigrant and Minority Health, 17(3), 947–970. https://doi.org/10.1007/s10903-013-9968-4
Miller, A., Hess, J. M., Bybee, D., & Goodkind, J. R. (2018). Understanding the mental health consequences of family separation for refugees: Implications for policy and practice. The American Journal of Orthopsychiatry, 88(1), 26–37. https://doi.org/10.1037/ort0000272
Nickerson, A., Steel, Z., Bryant, R., Brooks, R., & Silove, D. (2011). Change in visa status amongst Mandaean refugees: Relationship to psychological symptoms and living difficulties. Psychiatry Research, 187(1-2), 267-274. https://doi.org/10.1016/j.psychres.2010.12.015
Ornelas, I. J., Yamanis, T. J., & Ruiz, R. A. (2020). The health of undocumented Latinx immigrants: What we know and future directions. Annual Review of Public Health, 41, 289–308. https://doi.org/10.1146/annurev-publhealth-040119-094211
Perreira, K. M., & Pedroza, J. M. (2019). Policies of exclusion: Implications for the health of immigrants and their children. Annual Review of Public Health, 40, 147–166. https://doi.org/10.1146/annurev-publhealth-040218-044115
Physicians for Human Rights and Bellevue/NYU Program for Survivors of Torture. (2003). From persecution to prison: the health consequences of detention for asylum seekers. Retrieved from https://phr.org/wp-content/uploads/2003/06/persecution-to-prison-US-2003.pdf
Steel, Z., Momartin, S., Silove, D., Coello, M., Aroche, J., & Tay, K. W. (2011). Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine, 72(7), 1149-1256. https://doi.org/10.1016/j.socscimed.2011.02.007
von Werthern, M., Robjant, K., Chui, Z., Schon, R., Ottisova, L., Mason, C., & Katona, C. (2018). The impact of immigration detention on mental health: a systematic review. BMC Psychiatry, 18(1), 382. https://doi.org/10.1186/s12888-018-1945-y
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