undocumented refugees with serious mental illness

7/29/2019 Undocumented Refugees with Serious Mental Illness

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Undocumented Refugees with SeriousMental Illnesses

Elena Cherepanov, Ph.D., LMHC, Certified Trauma Specialist

Cambridge College, Senior Instructor

[email protected]

I want to voice my concern about this group of people who fall through the cracks of legal, social and mental health systems.

They drift through cities, not mixing up with the crowd, often ignored yet noticed. They canbe found in homeless shelters, emergency rooms or on streets. They may look odd, actbizarre, or dress inappropriately for the weather. What's more? There is little way to know what they are up to- many of them don't speak English. When kindred spirits offer themhelp with housing, social programs, or temporary jobs, they shy away with the slightestmentioning of need to show ID or social security number.

They don't exist from the legal, social and psychological points of view: they are in thecountry illegally; they are "not in the system" since they have neither income nor insuranceof any kind; and they carry the stigma of “being crazy”.

Those are the immigrants with serious mental illnesses but without legal immigration status.It has been shown that refugees and immigrants often struggle with mental health problems,steaming from culture shock, history of trauma and hardship, or being victims of violence. Their legal status, nevertheless, allows them to access the health care resources and socialprograms set up for them in order to prevent development of more severe mental healthconditions, re-traumatization, domestic violence and suicides. The illegal immigrant, on theother hand, in many cases can rely only upon themselves, family and community support,and natural remedies in place of professional health care.

It creates special challenges for those of them who suffer from serious and persistent mentalillnesses such as severe PTSD, schizophrenia, bipolar disorders, or other psychotic disorders.In no way do I want to undermine the possible severity of adjustment disorder, anxiety, orpsychosomatic problems. All of these conditions can be quite debilitating. The good news isthat in many cases good community support, psychosocial programs, indigenous healing systems, use of the traditional coping skills, such as cultural rituals, as well as traditional values can bring some relief.

For the persons with mental illnesses, on the contrary, it’s vital to have consistent access to

the professional, clinical and psychosocial recourses, which includes access to medications. The traditional communities and families just don’t have recoursesto provide sufficient support to the mentally ill member.

Who are they and how prevalent is the problem? Due to understandable reasons, it isdifficult to gather any objective data. While estimated rates of depression and PTSD vary greatly depending on the political and socioeconomic context, the rates of schizophrenia,bipolar and other psychotic disorders remain similar: 0.5-2.0 % for each. The levels of



expected severe traumatization are much higher.

According to Steven Camarota, the Director of Research at the Center of ImmigrationStudies, for the March 2005, there were around 10 million illegal aliens in the USA.

( http://www.cis.org/articles/2005/back1405.html#author ).

The modest calculations show that there could be as much as one million undocumentedrefugees with serious mental illnesses in the USA. The real numbers we’ll never know. They prefer to remain invisible. However, the problem seems significant enough to become afrequent focus of discussions where health professionals consistently share their frustrationand helplessness in attempts to help undocumented immigrants with mental illnesses. They report disastrous lack of resources, support and referral systems. If the free care at theemergency rooms can be a solution for certain acute medical conditions, chronic mentalillness requires systematic continuity. It is not unusual to take 4-6 weeks for somepsychotropic medications just to reach therapeutic levels in blood. There are someorganizations, such as Health Care for Homeless programs, which offer access to the

psychiatric services and medications, regardless of the immigration status. But they arehaving a hard time keeping up with providing consistency, continuity and wrap-aroundservices because of unstable and ever changing living arrangements of the homeless.

To add to the picture, the refugees often come from the countries with poor health care; where they didn’t have access to the doctors, nor have ever been diagnosed or treated. Inmost cultures mental illness is seen as a shame and stigma not only for the ill person, but forthe whole family and even for the entire community. When I was working overseas in therefugee camps, on many occasions I witnessed that even there, where everybody waspresumed equally powerless, persons with mental illnesses were ostracized, abused and takenof advantage there more than anybody else. I knew, for instance, one mentally ill person who agreed to exchange his seat on the bus (by giving his name to an other person)evacuating refugees from the camp to a western country for a can of soda.

There may be a whole variety of reasons why persons with mental illnesses decide to comeand stay in the US. Sometimes they flee their countries because of real or perceived fear.Some believe that they were persecuted. It could be true, but it also can be a delusion -signof mental illness. One of our clients fled one of the secular Muslim countries out of fear of religious persecution because he believed he was Jesus Christ himself. The subjective valueof these experiences does not necessarily coincide with geopolitical assessments of thesituation. There is very thin line between imminent threat to life, and the perceived one.

Occasionally their families send them, because in the US they “treat schizophrenia”.Sometimes they come on a visitor visa and overstay it. On other occasions, they come legally on a work visa, then, after the onset of illness, lose their job and, consequently, visa, andchoose not to leave. Most often they arrive with their families. While other family membersapply and successfully obtain asylum status, the mentally ill family member is incapable of following through with the immigration application process due to mental illness orcognitive limitations. Or the family members decide to exclude mentally ill members fromthe immigration process because of their unpredictable behavior or legal history that may jeopardize getting the legal status for the whole family.



Sometimes there are no reasons at all. A client once told me that he decided to come herebecause he heard a voice which told him that this is a right thing to do. I also heard aboutreal miracles, when a person with mental illness passed through border patrol officers without showing any papers, and they, as if being hypnotized, just let him in.

Desperate poverty, unhealthy life style, chronic mental illness with added depression, poor

social support, being under-medicated –all that correlates with the higher potential for drug and alcohol abuse, often for the purposes of self-medicating. If they get into trouble with thelaw, or arrested, they risk be detained and deported. I received many reports about mentally ill persons in prisons who await deportation. They broke the law, often while off theirmedications. They weren’t properly treated in prison and, in the case of deportation mostprobably won’t be able to get treatment in the future as well.

UN standards on disabilities identifies people with serious mental illnesses as specialpopulations particularly vulnerable to discrimination. (International Norms And StandardsRelated To Disability updated by UN program on disabilities in 1995. Part 5). In the currentgeopolitical climate, they remain the group which falls through the cracks of most of the

available systems. This disability is not as visible as other conditions; however it impacts allareas of their life.

There are public debates if the illegal aliens should be given the opportunity for amnesty or not. Those who have serious mental illness may not be able to exercise their choices. I strongly believethat undocumented immigrants must be screened for serious mental health problems whileconsidering detentions, deportations or eligibility for the legal status based on humanitarian ground. They desperately need help, but don’t really have the capacity to advocate for themselves, and thesystem works against them.

Sometimes I wonder what happens to them after they return to their countries. I’ve neverheard anything back. They just disappear without a trace…

undocumented refugees with serious mental illness

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