Immigrant and Refugee Mental Health

Demographic Profile of The U.S. Immigrant and Refugee Population

Immigrants and Refugees in the United States make up a unique subset of the country’s population.  According to 2014 data, The U.S. immigrant population stood at more than 42.4 million, or 13.3 percent, of the total U.S. population of 318.9 million.  Of this population, immigrants in the United States and their U.S.-born children now number approximately 81 million people, or 26 percent of the overall U.S. population (Zong, & Batalova, 2016).  Out of this large number of immigrants to the United States, 48 percent of the foreign-born population in 2014 reported their race as white, 46 percent of immigrants reported having Hispanic or Latino origins, 26 percent as Asian, 9 percent as black, and 15 percent as some other race, and more than 2 percent reported having two or more races (Zong, & Batalova, 2016).  Furthermore, in 2014, 17.5 million children ages 18 and younger lived with at least one immigrant parent, which accounts for 25 percent of the 69.9 million children under age 18 in the United States  (Zong, & Batalova, 2016).  Thus, it is estimated that, by the year 2020, one in three children below the age of 18 will be the child of an immigrant (Working with Immigrant-Origin Clients, 2013). Thus, with the increases in immigrant and refugee populations to the U.S. over the years, the country continues to diversify.  A breakdown of the growth in immigrant populations within the U.S. is outlined in the table below.

Numerical Size and Share of the Foreign-Born Population in the United States, 1970-2014

chart-foreign-born-population.png

Source: Migration Policy Institute (MPI) tabulation of data from the U.S. Census Bureau's 2010 and 2014 American Community Surveys (ACS), and 1970-2000 decennial Census.

Factors fueling immigration for many include searching for work, reuniting with family members, and seeking humanitarian refuge.  More than 60 million people worldwide have been displaced from their homes fleeing war, violence, risk of persecution, and/or environmental disasters, coming to the U.S. as refugees. (Winerman, 2016; Working with Immigrant-Origin Clients, 2013).  The U.S. Immigration and Nationality Act defines a refugee as “a person who is outside his/her country of nationality or habitual residence; has a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group or political opinion; and is unable or unwilling to avail himself/herself of the protection of that country, or to return there, for fear of persecution.” (Working with Refugee Children and Families, 2009). 

In 2015, 69,933 individuals arrived in the United States as refugees, which is 20 percent higher than the 2012 total (Zong & Batalova, 2015).  Fifty-seven percent of these refugees in 2015 originated from Burma (also known as Myanmar), Iraq, and Somalia.  In addition to these top three countries, the Democratic Republic of Congo (DRC), Bhutan, Iran, Syria, Eritrea, Sudan, and Cuba make up the top ten countries of origin for refugee resettlement in 2015 (Zong & Batalova, 2015). The influx in refugees from various regions around the world that have entered the U.S. recently is demonstrated in the tables below. 

U.S. Refugee Arrivals by Region of Nationality, FY 2003-15

refugee-arrivals-by-nationality.png

Note: Data from the Department of State (DOS) Worldwide Refugee Admissions Processing System (WRAPS) on refugee arrivals differ slightly from the Department of Homeland Security’s Yearbook of Immigration Statistics due to a different data counting approach.

Source: MPI analysis of WRAPS data from the DOS Bureau of Population, Refugees, and Migration, available online.


Top Ten Origin Countries of Refugee Arrivals, FY 2013-15

refugees-top-ten-countries.png

Source: MPI analysis of WRAPS data.

More than 40 percent of these refugees are children, many of whom have experienced profound loss and survived devastating events that can impact their development and long-term functioning (Working with Refugee Children and Families, 2009).  For refugees of all ages, the journeys from one’s country of origin is often characterized by long periods of time lacking access to basic needs and are filled with instability and violence.  This is a large contributing factor to numerous mental health challenges that are experienced by immigrants and refugees.

Common Mental Health Challenges Experienced by Immigrants and Refugees

Refugees and immigrants to the U.S. experience unique stresses, prejudice, and poverty.  These individuals and families can be considered at-risk subpopulations for health, emotional, and behavioral problems, and, in the case of children, learning and academic difficulties as well (APA resolution on Immigrant Children, Youth, and Families, 2016). 

Some of the mental-health related issues faced regularly by immigrants and refugees include:

  • Stress associated with the immigration and resettlement process
  • Acculturation to language, economics, health care, education, religion
  • Encounters with both individual and institutional bias, discrimination, and racism
  • Multiple traumatic experiences

Stresses involved in immigration and resettlement experiences can cause or exacerbate mental health difficulties, including anxiety, depression, posttraumatic stress disorder (PTSD), somatic complaints, sleep problems, behavioral problems in children, substance abuse, suicidal ideation, and severe mental illness (APA resolution on Immigrant Children, Youth, and Families, 2016; Working with Immigrant-Origin Clients, 2013; Working with Refugee Children and Families, 2009).  These difficult experiences paired with acculturation related issues can exacerbate mental health issues, causing them to become more acute and complex.

Acculturation related issues are often the root of what brings immigrant and refugee individuals and families to treatment.  Acculturation is a multidimensional process that may occur in stages and can be psychological and behavioral.  It refers to the process of adaptation, or lack thereof, which occurs when two cultures come into contact with one another.  This adaptation process is one of the central tasks for immigrants and refugees.  Immigrant and refugee families must learn to function in new cultures and make major adjustments.  Often this process comes with the added burden of finding adequate resources for basic needs.  Adjusting to a new society and managing challenging financial situations can be a particularly difficult experience for highly educated or former professionals from one country of origin who may face difficulties finding employment if their educational background or work experience is not recognized in by the U.S.  This can result in a loss of status, psychological stress, and economic hardship that adds to other relocation difficulties.  This difficulty with acculturation often exacerbates mental health issues as previously described. 

Important markers of acculturation include language(s) spoken, ethnic identity, and the degree to which individuals participate in cultural activities. According to the U.S. Department of Education (2010), 20% of children speak a second language at home.  Parents and children may acculturate at different rates, which is common among resettled refugee and immigrant families.  Children often adapt to new language and cultural norms more quickly than their parents, which can lead to intergenerational misunderstandings, tensions between old and new cultures, and challenges to identity development, family conflict and loss of communication, role reversal, and facing loneliness and isolation (Working with Refugee Children and Families, 2009; Working with Immigrant-Origin Clients, 2013).  Families working to cope with these stressors coupled with immigration trauma can lead to symptoms of depression, suicidal ideation, posttraumatic stress disorder (PTSD), and various other mental health concerns.  What is more, the language barrier impacts refugee and immigrant individuals and families’ abilities to receive proper health care.

In addition to acculturation-related difficulties and mental health challenges, traumatic experiences play a large role in immigrant and refugee overall well-being.  Traumatic experiences that can occur at various stages in the immigration and resettlement process place immigrants at risk for mental health problems. This can affect the ways in which these individuals and families adjust to their new cultural context. 

Trauma-based presenting problems include:

  • Migratory trauma, including pre-migration, migration, post-migration, and deportation
  • Interpersonal difficulties and violence
  • Depression, anxiety, PTSD
  • Compromised identification with country of origin, and adopted country
  • Feelings of persecution and distrust of authorities and institutions

Many immigrant and refugee individuals and families will have experienced and survived devastating and profoundly traumatic events.  Not only are they faced with pre- and post-immigration trauma, but the pairing of these adverse experiences with subsequent acculturation issues and other stressors makes for a uniquely complex trauma experience for many immigrants and refugees.  They are in great need of supportive services to promote health and wellbeing after resettlement in the United States, which can address a range of needs, including basic daily living, education, and physical and mental health.

Barriers to Mental Health Services for Immigrants and Refugees

Despite the great need for supportive mental health services, there are often numerous barriers to mental health services for immigrants and refugees.  Some of these barriers include:

  • Differences in symptom expression and attributions as well as conflicting views about the causes of, and ways of coping with, mental health problems
  • Stigma associated with mental health problems
  • Lack of access to appropriate and culturally sensitive mental health services in native languages
  • Lack of access to interpreters (language barriers impact abilities to receive proper health care)
  • Shortage of racial/ethnic minority mental health workers and/or persons trained to work with racial/ethnic minority persons and culturally diverse elders
  • Lack of knowledge of available and existing mental health services and resources (e.g. transportation, insurance, and child care) for accessing services
  • Lack of access to services and culturally competent service providers in rural areas
  • Challenged sense of safety and belonging, and difficulty trusting that systems of care will help them when they are facing mental health challenges
  • Fears related to unauthorized status or to frequent moves in search of work.

Resilience and Strength of Immigrants and Refugees

Despite extreme adversity, great risk for mental health challenges, and barriers to support faced by refugees and immigrants, these individuals and families demonstrate extraordinary resilience and strength.  “Within the framework of war and trauma, resilience is defined as personality traits that help protect against the psychological disorders resulting from exposure to terrifying incidents, such as mass violence or deportation under life-threatening circumstances; it encompasses bouncing back and positive adaptation in the face of safety-challenging experiences” (Arnetz et al.,, 2013).  Many immigrants and refugees display remarkable resilience, survival strategies, coping mechanisms, and abilities to adapt within what are often entirely new and unfamiliar environments.

Arnetz et al., (2013) indicated in their research that refugees are at a substantially increased risk for pre-migration exposure to violence rendering them more vulnerable to war and trauma related mental health disorders, including severe psychological distress, posttraumatic stress disorder (PTSD) and other acute symptoms.  Additionally, refugees, as compared to immigrants from a similar culture, reported more psychological distress and PTSD symptoms. Regardless of migrant status, however, pre-migration exposure to violence is a significant predictor of both psychological distress and PTSD symptoms. The resilience demonstrated by these individuals- both refugees and immigrants- was a significant protective factor against of psychological distress.

Despite facing many risks such as poverty, discrimination, taxing occupations, fewer years of schooling, and social isolation, immigrants who have recently arrived to the U.S. appear to do better than expected (as compared to those who remain in the country of origin and second-generation immigrants) on a wide range of psychological and behavioral outcomes.  Additionally, research has shown that immigrants today are highly motivated to learn English and do so more quickly than did previous generations.  Furthermore, immigrant and refugee children seem to behaviorally adapt to the U.S. culture quickly.  (Working with Immigrant-Origin Clients, 2013)  Optimism, greater family cohesion, and availability of community supports all contribute to the strength and resilience demonstrated by immigrant and refugee populations.

Resource Organizations » Immigrant/Refugee Mental Health

In Massachusetts

Boston Center for Refugee Health and Human Rights

617-414-4794

We are situated within Boston Medical Center and we embrace its’ mission to provide exceptional care without exception.  We also honor the importance of community as a vehicle of healing and recovery.

Utilizing an innovative, holistic approach we work with survivors of torture and refugee communities from around the world to provide vital care for a healthy body, mind, and soul.

Our Mission is to provide holistic health care coordinated with social services and legal aid for asylum seekers, refugees, survivors of torture, and their families.

 

We also train professionals to serve this population, conduct research to understand and implement best-practices, and promote health and human rights, locally and globally, to improve the quality of life for survivors of torture and their communities.

Boston Language Institute

617-262-3500

Email: info@bostonlanguage.com

More than 55,000 students and professionals have studied English as a Second Language and over 140 foreign languages at the Boston Language Institute. Drawing on the Institute's TEFL Certificate Program, we employ the most modern methods in the field of language acquisition. Through the Communicative Method, which views each aspect of language learning -- grammar, conversation, reading and writing -- as a necessary support for the others, students learn new vocabulary and grammar while enhancing their English communication skills in a discussion-based and interactive class. Class themes focus on high-interest topics that present language in context and stimulate conversation. Translation and interpretation services are also available.

Catholic Charities, Community Interpreter Services

(617) 268-9670

Email: info@ccab.org

Community interpreter services (CIS) program recruits and trains interpreters to help bridge gaps in communication for limited English-proficient clients. We dispatch interpreters to state agencies, hospitals, schools, and businesses and provide document translation. The CIS network includes more than 100 trained, professional interpreters who, collectively, are fluent in over 70 languages.

Center for Multicultural Training in Psychology

617-414-4646

Email: info@cmmh-cmtp.org

This organization is an APA-accredited pre-doctoral internship training program and a post-doctoral fellowship program for psychology interns and fellows. The program's primary mission has always been and remains focused on training ethnic minority and other cross-cultural oriented psychologists to work with inner-city, low income and racially/ethnically diverse populations.

Haitian American Public Health Initiative

617-298-8076

HAPHI was founded in 1989 by a group of Haitian-American health care professionals to address pressing public health issues confronting Boston's Haitian community. It is a non-profit agency dedicated to providing members of the Haitian-American community in Metro Boston with culturally and linguistically accessible information and services to improve their health and wellbeing.

Harvard Program in Refugee Trauma

617-876-7879

Email: rmollica@partners.org

The Harvard Program in Refugee Trauma (HPRT), originally founded at the Harvard School of Public Health, is a multi-disciplinary program that has been pioneering the health and mental health care of traumatized refugees and civilians in areas of conflict/post-conflict and natural disasters for over two decades. Its clinical program serves as a global model that has been replicated worldwide. HPRT designed and implemented the first curriculum for the mental health training of primary care practitioners in settings of human conflict, post-conflict, and natural disasters. Its training activities have been successfully conducted in Bosnia-Herzegovina, Cambodia, Croatia, Japan, and the United States. HPRT’s landmark scientific studies have demonstrated the medical and mental health impact of mass violence as well as the cultural effectiveness of its clinical treatment and training programs. Working closely with Ministries of Health throughout the world, HPRT has developed community-based mental health services primarily in existing local primary health care systems. It has also successfully established linkages to major foreign university settings. HPRT’s bicultural partnerships with international collaborators have resulted in culturally effective and sustainable programs that rely primarily on local human resources and indigenous healing systems. In order to achieve its mission, memorandums of agreements have been signed between HPRT and universities in Bosnia-Herzegovina, Italy, Japan, and Thailand. As a university-wide program, HPRT has access to the full resources and talents of Harvard University, including the Medical School (HMS), the School of Public Health, the School of Education, and the Massachusetts General Hospital (MGH). HPRT is currently administered by MGH, one of America’s oldest and most prestigious hospitals, which is a major teaching hospital of HMS.

International Institute of Boston

617-695-9990

Email: info@iine.us

The International Institute of Boston provides newcomers with direct and practical assistance in the form of English & literacy courses, Refugee Resettlement services, Citizenship Education, Economic Development, Employment Training & Placement, Legal Aid and Social Services.

Islamic Society of Boston Cultural Center

617-858-6114 (M-F 10am-6pm)

Email: office@masboston.org

The Islamic Society of Boston Cultural Center (ISBCC) is operated by the Muslim American Society of Boston, and provides a range of services. This includes housing a mosque, a school, as well as being available to both the Muslim and non-Muslim members of the community to provide education and outreach about the Muslim faith. The ISBCC also provides social services such as assistance in getting health insurance, finding health care providers and finding mental health supports in addition to consulting with the Imam.

Massachusetts Immigrant and Refugee Advocacy Coalition

617-350-5480

The Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA) is the largest organization in New England promoting the rights and integration of immigrants and refugees. We serve the Commonwealth's one million foreign-born residents with policy analysis and advocacy, institutional organizing, training and leadership development, strategic communications, citizenship assistance, and AmeriCorps initiatives that provide capacity-building for community-based organizations. The Coalition involves an active membership of over 130 organizations, including community-based groups, social service organizations, ethnic associations, schools, refugee resettlement agencies, health centers, hospitals, religious institutions, unions and law firms, as well as thousands of individual members, contributors, and allies.

New Bostonians

617-635-2980

Email: immigrantadvancement@boston.gov

The purpose of the Office of New Bostonians is to strengthen the ability of immigrants and the diverse cultural and linguistic communities of which they are a part to fully participate in the economic, civic, social and cultural life of the City of Boston. Our goal is to make sure immigrants have the same access to services that all residents enjoy. 

Refugee and Immigrant Assistance Center (RIAC)

617-238-2430

Email: riac@riacboston.org

RIAC provides cultural and linguistically appropriate services to refugees, asylees and immigrants in the greater Boston Area such as interpretation services, domestic violence prevention, resettlement and placement programs and citizenship programs.

Refugee and Immigrant Support Services

617-661-1010

The counseling staff and volunteers at CLSACC come together to help people who may have lived through painful experiences in their home country or may be having difficulty adjusting to the United States. We provide specialized services for survivors of torture, victims of crime, and individuals affected by war and other types of human rights violations.

Refugee Health Technical Assistance Center

Email: refugeehealthta@jsi.com

The Refugee Health Technical Assistance Center (RHTAC) recognizes that refugees have unique health needs. We are dedicated to improving the well-being of refugees by providing tools, resources, and support for health and mental health providers in order to better meet the needs of refugees in resettlement

Saheli

866-472-4354

Email: info@saheliboston.org

Saheli, Friendship for South Asian Women is a group dedicated to helping South Asian women in Boston and surrounding areas. Saheli provides friendship, support, guidance and resources in the areas of career and economic empowerment, physical and mental health, legal and immigration issues, support for families, and social and cultural volunteer opportunities.

Second Generation Connections and Resources

508-875-8101 (Lillian Fox)

Email: LFox2GCR@aol.com

Second Generation Connections and Resources provides a setting for discussion and learning, as well as a location to seek helpful resources. Second Generation Connections and Resources provides an ongoing supportive/educational discussion group for children of Holocaust survivors. Discussion group topics include: sharing, learning and understanding about your family's or relative's experiences, understanding the impact of family experiences on yourself, your personal experiences and your life, learning from historical perspectives, informing and teaching the next generation, dealing with any concerns or needs you may have, and seeking helpful resources and information.

Outside Massachusetts

Organizations with hotlines

Survivors of Torture International

1-888-724-7240, 619-278-2400 (Office)
Email: survivors@notorture.org

This organization works with the San Diego Access and Crisis Line at 1-888-724-7240. It is confidential and free of charge, the line is immediately answered 7 days a week, 24 hours a day and can assist in 150 languages within seconds. The goal of this organization is to:

  • Facilitate the healing of torture survivors and their families;
  • Educate professionals and the public about torture and its consequences;
  • Advocate for the abolition of torture.

Organizations without hotlines

America's Literacy Directory

Email: ald@lincs.ed.gov

A free website that enables immigrants to find local citizenship, civics, and/or English as a Second Language (ESL) classes (searchable by zip code) in communities nationwide.

Center for Victims of Torture

1-877-265-8775

Email: CVT@CVT.org

The Center for Victims of Torture works toward a future in which torture ceases to exist and its victims have hope for a new life. We are an international nonprofit dedicated to healing survivors of torture and violent conflict. We provide direct care for those who have been tortured, train partners around the world who can prevent and treat torture, and advocate for human rights and an end to torture.

Cultural Orientation Resource (COR) Center

The Cultural Orientation Resource (COR) Center focuses on a critical element of refugee resettlement and integration, providing technical assistance regarding the orientation refugee groups receive about their new lives in the United States, either before their departure for the U.S. or after their arrival. The organization offers online materials to help refugess adjust to their new life in the United States. These resources are available in multiple languages. 

HealTourture.org

This organizations offers a wide array of resources to survivors of torture throughout the Unities States. This includes immigrants and refugees. Resources are available for providers on related topics as well. 

International Society for the Prevention of Child Abuse and Neglect

(720)449-6010

The International Society for the Prevention of Child Abuse and Neglect is a multidisciplinary international organization that brings together a worldwide cross-section of committed professionals to work toward the prevention and treatment of child abuse, neglect and exploitation globally. ISPCAN's mission is to prevent cruelty to children in every nation, in every form: physical abuse, sexual abuse, neglect, street children, child fatalities, child prostitution, children of war, emotional abuse and child labor. ISPCAN is committed to increasing public awareness of all forms of violence against children, developing activities to prevent such violence, and promoting the rights of children in all regions of the world.

National Center for Refugee Employment and Self-Sufficiency

410-230-6717

Email: information@higheradvantage.org

Working in partnership with service providers and employers nationwide, we are committed to helping refugees achieve economic self-sufficiency. Higher offers an array of free on-line training modules that will help prepare new Americans who are seeking work or looking to advance in their careers.  Training topics cover how to find and keep a job, how to prepare for a job interview, and what to expect in the U.S. workplace. 

National Partnership for Community Training

727-479-1800

Email: partnership@gcjfcs.org

The National Partnership for Community Training (NPCT) is a technical assistance program funded by the Office of Refugee Resettlement that supports refugee providers throughout the United States. Our provider objective is to build capacity in refugee mental health for providers to effectively screen, refer, assist, and service refugees' mental health issues and to continue growing formal and nontraditional mental health service provision. By leveraging the internal expertise of our Refugee Youth Program and the Florida Center for Survivors of Toture within Gulf Coast Jewish Family and Community Services, to promote best and promising practices in service provision, NCPT provides TA opportunities focused on national and regional issues.

U.S. Citizenship and Immigration Services

1-800-375-5283

TDD for the Deaf/Hard of Hearing: TTY / ASCII: 800-877-8339, Voice: 866-377-8642

Video Relay Service (VRS): 877-709-5798

The U.S. Citizenship and Immigration Services website has location and filing information for immigration benefits, including political asylum. Free immigration forms may be downloadable or filed from this site. Case status information for cases pending with USCIS may be obtained.