Understanding and Managing Your Risk for Mental Health Issues
It is often said that the wounds and afflictions that we cannot see are sometimes the most difficult to heal. While there has been a notable effort to increase awareness and educate the public about mental health disorders and the benefits of treatment, there continues to be a stigma around mental health issues that leave many afraid to seek answers or treatment. As a result, many people wind up struggling to heal themselves in private. Much of this stigma comes from lack of understanding of what specific disorders, such as depression and anxiety, actually are. Some people have been misinformed about mental health issues and view their suffering as a personal failure, or assign a moral value to their condition, thinking such things as “I am a bad mother because I am not happy around my children” or “I am not a good provider because my anxiety affects my ability to work.” The reality is that 1 in 5 Americans suffer from a mental health disorder and 1 in 25 live with serious mental health disorders. And while these statistics from the National Institute of Mental Health may help illustrate the high number of people living with a mental health diagnosis, they do not begin to address the far greater number of people that go undiagnosed or are experiencing temporary but significant symptoms across a variety of mental health disorders.
In the mental health field, it is widely known that the more risk factors a person experiences in their lives, the far greater the odds are that a person will experience a mental health issue. While genetic factors can make some people more susceptible, studies demonstrate that people are more likely to experience mental health disorders if they have experienced risks such as growing up in poverty, instability in the home, having parents with addiction issues, or being the victim of abuse or crime. There are many types of factors that can lead to conditions such as anxiety or depression, and what may be considered a risk for one person may have little or no effect on another person. What is important to recognize is that there is not one group or type of person that is immune from mental health issues and the factors that contribute to these disorders are rarely things that people choose to experience.
In examining how risk factors can lead to conditions such as anxiety or depression, it is crucial to consider populations that, by their definition, are living with increased experiences of adversity and instability. In the last several years, there has been a growing amount of research on individuals and families that are living in a stressful state of suspense and fear as they attempt to either navigate or avoid the U.S. government’s immigration system. In the general population, we see an increase in anxiety and depression when people experience helplessness, a lack of control of their circumstances, less access to resources, a lack of stability, or live a life with little predictability. Individuals and families of individuals who are not documented experience all of these and many other types of adversity.
Threat or fear of deportation is one of the most stressful factors for families and “produces marginalization by promoting a constant state of hypervigilance and fear in everyday life” (De Genova 2002). Families also must struggle and adapt to living in a situation where they have less access to supportive and financial resources, and have reason to lack trust in many institutions. The result is that many families earn less money, have less employment opportunities, live in less safe environments, feel unable to ask for help from authorities, and have less freedom to simply travel, out of fear of contact with authorities. Living with these limitations creates a climate of fear and anxiety. Parents often report that their stress is exacerbated by worry for their children and guilt related to feeling unable to give their children the life they want for them. This stressful situation often leads to anxiety being passed down to the children of non-citizens.
With recent changes in immigration laws and an increase in reports in the news about greater restrictions being placed on our immigrant population, there has been a documented increase in stress and anxiety within immigrant families. Fear related to changes in the laws and news reports have led to an increase in family discussions about how to handle potential deportations, an increase in actively avoiding authorities in public and an increase in immigrant families fearing for their children (Roche, 2018). This heightened awareness and fear has been correlated with an increase in mental health symptoms. One recent study shows a 300% increase in psychological distress for parents that have experienced any negative effects, police contact, or harassment due to their status (Roche, 2018).
Not every population experiences mental illness in the same way. Differences in culture, language, family structure, and even biology can inform how a person is affected by anxiety or depression and how successfully they may be treated. In cultures where men are seen as providers, some may experience greater distress if they are not able to earn enough to support their family or be close to their family. Many immigrant women see their role as a mother to be the most important and show increased anxiety when they must work to provide for their family or are living under risk of being separated. In Latino populations, we see an increase in “somatization” or physical symptoms of mental health issues (Alarcon, 2014). This could mean that a depressed person fails to address their suffering because it is dismissed as headaches, body aches, or muscle tension rather than being aware of the underlying emotional issues. Biological differences, such as how a body processes pharmaceuticals, can affect how effective treatment with medication may be. In the Latino population, a difference in metabolism can even determine the effectiveness of some antidepressants (Alcaron, 2014).
In many cultures, there are taboos or different ways of explaining mental health issues that may prevent people from seeking help. Many cultures have traditions of healing that involve spiritual or community healers. The Hmong tradition has used shamans for healing, and many Latino cultures have forms of “curanderos” that use folk remedies to heal illnesses. Many families that find spirituality to be a sustaining force in their lives may feel more comfortable in turning to a spiritual leader for guidance in personal matters. This can delay or prevent some people from seeking treatment in a clinical setting. In some cultures, symptoms of depression and anxiety are understood as a result of having sinned or not being faithful enough. Viewing depression or anxiety as a result of spiritual failure may create shame and increase the stigma of having a mental health issue.
Although there is an increased risk for potential mental health problems in non-citizen populations, this does not mean that everyone living with the stress of uncertain citizenship status or the fears that come with being undocumented will have significant issues with their mental health. Many mental health disorders are preventable and all of them are treatable. People tend to feel better when they are in control and educated about their problems. The following list includes a number of recommendations for people living with uncertain immigration status or who have family members that are in the process of working towards lawful status or citizenship.
1. Educate yourself about mental health issues and what the symptoms look like. There are many excellent organizations out there that can provide materials to help you identify and seek solutions to issues such as depression, anxiety, and substance abuse. Consider looking at the resources on the webpage for the National Association for Mental Illness (nami.org) or the Substance Abuse and Mental Health Services Administration (samhsa.org).
2. Find a doctor you can trust. Mental health treatment is often identified by primary care physicians. Be open with your doctor and don’t be afraid to share personal information or discuss minor symptoms. Doctors cannot help you unless they know how you are really feeling.
3. Take care of the basics. It is hard to manage stress and anxiety if you don’t feel good. Many parents are struggling to balance all of their responsibilities and become burned out. Find time to get enough sleep, eat healthy meals, drink water and take your medications.
4. If you are able to, get moving. Exercise is a great way to help manage and reduce stress. The health benefits of exercise may also help reduce complications that can make anxiety and depression worse.
5. If you are working with an immigration lawyer, let them know how you are being affected by your journey through the immigration process. While they cannot give you direct advice on managing your mental health issues, they may be able to direct you to a counselor or clinic that may help you.
6. Educate yourself about the immigration process and your rights. Many people suffer increased anxiety because they carry fear or perceive threats that may not be realistic. Learning what you do and don’t need to worry about can be helpful, and knowing your rights can help you feel more in control. There are some very helpful community organizations focusing on the rights of immigrants that would be happy to help you learn more.
7. Allow yourself time to focus on the future and imagine positive outcomes. When you are going through the immigration process, it is easy to spend a lot of time focusing on the “What Ifs.” Spending a large amount of time imagining bad things that could happen doesn’t leave a lot of time to focus on what it will be like if everything works out. Visualize the day you no longer have to worry about things like an appeal being denied or someone asking for your driver’s license. None of us can predict what will happen, so why not allow some time to imagine a better life in the future? Doing this makes our dreams feel a little more possible.
8. If you ever have thoughts about hurting yourself or someone else and you feel you cannot control them, or have thoughts of wanting to die that you think you may act on, seek help immediately. Know and keep on hand the phone numbers you can call if you are in crisis.
In Milwaukee County there is a 24-hour, confidential crisis line you can call for support and assessment. This number is 414-257-7222. The number for children is 414-257-7261. If you are in Waukesha County you can call 262-548-7666 during the day, and after hours you can call Waukesha County hotline at 262-547-3388 and ask to speak with a mental health crisis worker.
Alarcon, R., Oquendo, M., Wainberg, M. (2014) Depression in a Latino man in New York. American Journal of Psychiatry, 171, 506-508
De Genova, N.P. (2002) Migrant “illegality” and deport ability in everyday life. Annual Review of Anthropology, 31, 419-447
Roche, K., Vaquera, E., White, R., Rivera, M. (2018) Impacts of immigration actions and news and the psychological distress of U.S. Latino parents raising adolescents. Journal of Adolescent Health, 62, 525-531
Ryan Larkey is a licensed psychotherapist and substance abuse counselor that has worked with families and individuals experiencing immigration-related issues. He has worked in both Milwaukee and Racine Counties providing individual, couples, and family therapy. He is committed to supporting and advocating for immigrants and undocumented workers in the area and has personally benefitted from the services of Soberalski Immigration Law in his spouse’s recent application for a green card. Ryan is available to talk to you about your mental health concerns and provide therapy services. Please contact him directly at firstname.lastname@example.org or call him at (414) 839-1821.