Mental health implications of undocumented immigrant status

The phrase undocumented immigrant, or its less charitable counterpart, illegal alien, tends to cause a stir in the media. The focus is on the paperwork, the lack of permission or legal status to be in the United States. However, for counselors to work effectively with this population, it is helpful to spend some time considering the second part of that phrase: immigrant.

For a person to decide to leave all that is known, familiar and comforting behind, he or she is likely in a state of considerable duress. Among the stressors that push immigrants to leave their homes are grinding poverty and starvation, threatened or actual violence, extortion from gangs, ethnic or religious discrimination and lack of hope that their situation will improve. Whether their journey involves hiding in a container in a cargo ship, clinging to the top of a moving train or walking through difficult terrain, it is not a decision to be taken lightly. Such a journey can last for months and be extremely perilous.

A person who decides to undertake such a journey as the “best available option” is already living in a state of physical, mental and emotional deprivation. We encourage counselors to consider the challenges posed by the pervasive stressors present in the person’s home country, the possible trauma encountered on the journey and the difficulty of living in the shadows in a new land where so much is strange and unfamiliar.

We have several goals with this article. We wish to clarify terminology and definitions to generate an accurate understanding of this population, describe some of the challenges facing families with undocumented members in the United States, outline some commonly occurring mental health issues among undocumented immigrants and provide counselors with some resources and ideas about how to respond to these clients. In addition to building individual capacity to respond among counselors, we hope to inspire advocates in our profession to consider systems-level responses or ways we can promote more equitable access to the support systems that undocumented immigrants often need. We are focusing on the undocumented portion of the immigrant population because of the severity of their needs and the relative scarcity of resources to meet those needs.

In terms of definitions, immigrants are people who leave their home country to live (temporarily or permanently) in a host country. They differ from refugees, which are defined as individuals fleeing persecution, war or natural disaster. The United Nations classifies refugees as a protected group, and if a host country offers these individuals asylum, it comes with automatic legal status. Immigrants can apply to receive temporary legal status based on a special function (such as a work visa or student visa), or they may become eligible for residency through a qualified family member who is a U.S. citizen. However, there are caps on each category (i.e., not every person who wishes to come to the U.S. to work or study may do so). Deferred Action for Childhood Arrivals (more commonly known as DACA) is a temporary permission to work that does not provide true legal standing in the U.S., and it can potentially be revoked by executive action.

It is important to have a trusted source for accurate information about immigration, especially when so much inaccurate information abounds in other public sources. In particular, counselors may wish to become familiar with eligibility for health and human services for undocumented immigrants. A helpful source for this information is the National Immigration Law Center website (nilc.org), which provides details about eligibility for health care services, education, workers’ rights, driver’s licenses, economic support programs and so on.

It also is important for counselors to be aware that differences exist between federal and state immigration policies and practices. Some states have created restrictive laws to govern activities such as enrolling an undocumented child in school, presenting for services in an emergency room and applying for a driver’s license. Thus, it is incumbent upon counselors to understand the climate and laws within their states and local communities. The current policy climate is changing rapidly, so staying up to date is essential.

Common challenges

Each immigrant family with at least one undocumented member is unique, but some typical challenges do exist. For adult immigrants who are undocumented, there are daily concerns about detection by the authorities, potential deportation and separation from other family members. Even an act as simple as driving to the grocery store can be perilous without a driver’s license, so undocumented immigrants may adopt the mantra “trust no one” and try to live in the shadows, undetected. The newest guidelines from the Department of Homeland Security (dhs.gov/executive-orders-protecting-homeland) include a broader definition of priorities for deportation. This change has generated enormous fear in the immigrant community.

Many undocumented immigrants must work jobs in which they are paid as part of the underground economy. Thus, they are not able to speak out against unsafe workplace conditions or unfair or discriminatory practices for fear of retribution. These jobs often pay poverty-level wages and involve hard manual labor. Some undocumented immigrants work more than one job to make ends meet.

Adults who are undocumented are also unlikely to have access to needed services such as health, legal, educational and other social support services, so they have unmet needs in terms of physical and mental health. In addition, it is common for these adults to have experienced some form of trauma — physical or sexual assault, robbery, threats, extortion, bearing witness to murder — during their journey to the U.S., so there is an accumulation of stressors that can become quite profound.

Youth living in a family with at least one undocumented member experience some of the same stressors — concerns about deportation of a family member, poverty, lack of services, etc. But some of their concerns are different. In most cases, these youth will have access to basic K-12 education, so they often acculturate to U.S. language and culture norms more quickly than do their parents. This can be difficult in the early phases of adjustment, but it does bring some benefit in terms of language proficiency, educational opportunity and socialization.

However, when their friends start moving through rites of passage such as getting a driver’s license, landing a first job or applying to college, youth who are undocumented or who have an undocumented parent have a strikingly divergent experience. Some are already aware of their legal status, but other youth first learn about their lack of documentation when they ask their parents to assist with these normative tasks. At this point, some youth become disillusioned and depressed, believing that all of their dreams and aspirations are now beyond their reach. Without a socially sanctioned way to participate in society, these youth may become involved in maladaptive coping strategies (e.g., gang involvement, substance abuse). Other undocumented youth become more determined and start fighting to achieve their goals, even if they have to create new systems outside of the defined legal structures.

In both cases, it is unlikely that their parents will be able to provide much assistance, so undocumented youth will almost always need advocates or champions from outside of their group to assist them. It is risky to identify oneself as undocumented in today’s hostile political climate, so finding an advocate is not a straightforward process. Adults who are familiar with the signs and signals that a youth (or a youth’s family member) may be undocumented — for example, not driving, not applying to college even with a good academic record, having many absences from school that are not typical — may find ways to reach out and indirectly inquire about the youth’s circumstances or offer resources. Counselors might wish to review websites such as the Department of Education’s Resource Guide: Supporting Undocumented Youth (www2.ed.gov/about/overview/focus/supporting-undocumented-youth.pdf) and the UCLA clearinghouse of resources on undocumented youth (smhp.psych.ucla.edu/qf/undoc.html).

Using ecological systems theory 

It is important that counselors understand the singular environmental factors and societal barriers that have the potential to affect the development and mental health of undocumented youth and families. This understanding can prepare counselors to apply more effective strategies when working with undocumented clients or families.

Urie Bronfenbrenner’s ecological systems theory may be a particularly helpful tool for counselors in this regard. Bronfenbrenner’s theory describes human development in terms of interactions between individuals’ personal characteristics and their environmental systems. The five environmental systems are the microsystem, mesosystem, exosystem, macrosystem and chronosystem.

The microsystem is the most immediate environment in which an individual interacts. For children, microsystems commonly consist of a small group of people, such as parents, siblings, schoolteachers, friends and classmates. The mesosystem is the interaction between microsystems, such as the communications between parents and teachers.

The exosystem is outside of one’s direct interaction but still has the potential to impact one’s mental health and development because it directly influences members of one’s microsystem. This might include a parent’s relationship with his or her boss or co-workers, or a teacher’s relationship with his or her principal. A common example of the influence of the exosystem on someone is that of a parent who feels unappreciated and disrespected at work and then displaces that anger and frustration onto his or her children.

The macrosystem is the largest ecological system. It includes cultural values and beliefs, and political and economic systems. The chronosystem, which includes constancy and change, reflects the influence of time on one’s development.

Undocumented immigrant status can influence all aspects of a person’s ecological system. In the microsystem, immigration may affect the relationships among and between family members. The combination of fewer community and financial resources plus the need to stay obscure or in the shadows may reduce the number of microsystems that undocumented youth and families have. For example, documented youth may engage in more extracurricular activities than do undocumented youth. This expands the microsystems of documented youth to include additional people, such as teammates, music teachers and coaches.

Immigration, and particularly undocumented immigration, may also change traditionally microsystemic relationships into exosystemic relationships. For example, it is common for undocumented families to immigrate to the United States in waves, with a parent initially leaving children with extended family members. This can lead to parents becoming part of their children’s exosystem for a period of time. Later, when children are able to immigrate to the United States to reunite with their parents, the relationship rapidly shifts back to one that is microsystemic. These sudden shifts in interactions can require an adjustment period and strain the relationships between undocumented youth and their parents. Changes in microsystems can also occur as the result of other factors such as deportation.

Undocumented immigration may also influence the mesosystem, or interactions between microsystems, particularly in reference to the quality and frequency of such interactions. One example is the relationship between a child’s schoolteacher and parents. Language differences between parents and teachers can affect the strength of this relationship, which can in turn reduce the ability of undocumented parents to be fully involved in their child’s school. This can prove particularly challenging when difficult and complicated situations such as discrimination or bullying occur.

The indirect aspect of the exosystem may be particularly pronounced with undocumented youth and families. Parents who are trying to make ends meet but who are not legally allowed to work in the United States may work long hours at very low-paying jobs and experience exploitation, prejudice and discrimination. Parents who experience financial stress and fear of potential deportation may inadvertently displace their preoccupations onto their children in the form of irritation and frustration. This can negatively impact the mental health and development of these youth.

The macrosystem also may have a profound effect on mental health and development. In particular, marginalized groups such as undocumented youth and families are particularly vulnerable to economic and political trends. This is certainly true in reference to the legislation and execution of laws associated with undocumented immigration. As previously mentioned, undocumented youth who learn of their undocumented status and the barriers associated with that status in terms of securing education, employment, a driver’s license and so on may be particularly susceptible to feelings of despair, hopelessness, helplessness, anxiety and fear.

Unique factors associated with the chronosystem also may be in play with individuals and families who are undocumented. In particular, the possibility of change, such as deportation, may constantly be on the minds of undocumented youth or members of their microsystems. Changes (or a lack thereof) in immigration policies and laws may also affect the mental health of undocumented individuals. For example, in 2010, Dreamers anxiously awaited the prospect of gaining citizenship through federal legislation (known as the Dream Act). However, this legislation was met with barriers and did not pass Congress. This was a huge blow to many who were leaning on this legislation for the prospect of stability, opportunities for education and careers, and other privileges of full citizenship.

More recently, political rhetoric and actions associated with securing the U.S. border and enforcing immigration laws more strictly have created a great deal of uncertainty and fear in undocumented immigrant communities.

Strategies for working with undocumented clients 

Counselors can do a number of things to help undocumented individuals and their families. With respect to the microsystem, counselors can provide a space for undocumented youth and families to vent their frustrations, fears, mistrust and sadness associated with their experiences of discrimination, exploitation and barriers. Helping parents to express their frustrations may reduce the chances of them displacing anger and frustration onto other members of the family unit. Counselors can also help parents problem-solve and cope with challenging aspects of their lives, such as dealing with disrespectful co-workers or prejudicial bosses. In addition, counselors can help parents prepare for worst-case scenarios, such as steps they could take in the event that one or both parents were detained or deported.

Concerning the mesosystem, counselors can help youth and families develop their relationships with other microsystems, such as teachers and other school personnel. In particular, it is important for counselors to help undocumented youth and parents brainstorm ways to respond to school personnel about school issues such as academic struggles, behavioral challenges, discrimination and bullying. With clients’ permission, counselors working with undocumented youth and families may also consider taking on an advocacy role with school systems, particularly when discrimination and unresolved bullying are occurring.

With respect to the macrosystem, counselors may consider advocating for changes in the law regarding illegal immigration. This may include advocating for pathways to citizenship, better access to community resources and so on. It also may take the form of advocating against movements or legislation that would be harmful to undocumented youth and their families.

Counselors can also help youth and families draw upon and cultivate resilience. This may take the form of helping clients to remember the struggles and obstacles they have already been through and rediscover the strengths they possess that have helped them navigate these trials.

Case study

The following is a brief case study of a counseling experience that one of the article authors had with an undocumented family. Specific names and circumstances have been changed to protect the family’s identity. Many of the details of this case are common experiences that undocumented families face.

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Marcus, an undocumented immigrant who is 14 and speaks Spanish, was referred to you by the school social worker. Marcus attends the first session with his 45-year-old mother, Elizabeth, who also speaks Spanish and is undocumented. Elizabeth shares with you that she immigrated alone to the United States 10 years ago. Because of financial difficulties, she had to leave Marcus with her parents in her country of origin. A few months before this first session, Marcus was able to join his mother in the U.S. Elizabeth shares that Marcus refuses to call her “mom” and acts very standoffish toward her.

Marcus shares that he doesn’t know why he had to come to the United States. He says that he was happy in his country of origin and misses his friends, grandparents and cousins. He also says that he doesn’t like school, that English is difficult for him to learn and that students at the school pick on him. He says he can understand the names the other kids call him and the mean things they say. He doesn’t have enough command of English to fight back with his words, however, so he uses his fists. Marcus has used his fists to fend off verbal attacks a number of times and, on each occasion, he has been suspended from school.

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In this case example, Marcus’ microsystem changed suddenly. He was uprooted from the only life he had known, where he had friends and close connections to extended family. Using Bronfenbrenner’s model as a reference, we see that Marcus was separated from his ecological system — a system in which he knew the explicit and implicit cultural beliefs, values and rules and interacted with people who looked like him and shared his language. His microsystem changed from that of friends, grandparents, uncles, aunts and cousins to that of his mother and a schoolteacher.

Furthermore, Marcus’ mother, who for many years had been part of his exosystem — someone who influenced his life indirectly but didn’t interact with him outside of an occasional phone call and letter — became his primary microsystem. Elizabeth, who missed her son dearly and felt guilty for not being there to raise him, wanted desperately to pick up where they had left off before she immigrated to the United States. Marcus was not able to reciprocate her feelings, which hurt Elizabeth deeply.

Although Elizabeth had lived in the United States for a decade, she had interacted primarily with other Spanish speakers and largely remained in the shadows to avoid detection. Therefore, she struggled to communicate with school personnel at Marcus’ school and did not know how to help her son deal with the bullying that he experienced.

The counselor should take into account a number of factors when conceptualizing and treating this family. Systemically, it is important to recognize the changes (chronosystem) that have occurred in the lives of both Elizabeth and Marcus and how they are adjusting to those changes. The counselor might help Elizabeth recognize the adjustments that Marcus is experiencing and assist her in developing realistic expectations regarding their relationship. It also would be beneficial to further assess her relationship and interactions with Marcus’ school (mesosystem) and co-construct strategies to help her figure out what is going on in school and how to advocate for her son. The counselor also might consider ways that he or she can advocate appropriately on behalf of the family.

The counselor also might assess Marcus’ exosystem by understanding the stressors that Elizabeth faces in her daily life. These include working multiple jobs, experiencing pressure from family members in her country of origin to help out financially and dealing with ongoing fears of deportation. If Elizabeth is facing a great deal of stress and anxiety, the counselor could take care to validate Elizabeth’s emotions and provide her with stress-reduction tools.

The counselor can work with Marcus to develop healthy strategies for dealing with the verbal abuse he reports experiencing at school. The counselor also might work to broaden Marcus’ microsystem by looking into community programs in which Marcus might be interested, including sports programs, after-school programs or a mentorship program.

Conclusion and resources

Seemingly insurmountable barriers exist for undocumented children and families, but counselors can take a number of steps to facilitate the mental health of these clients. It can be particularly helpful to conceptualize undocumented families’ circumstances from a systemic perspective, such as Bronfenbrenner’s ecological systems theory. It also is helpful to validate clients’ experiences while drawing upon their resources, including the resilience and skills they have used to overcome past trials and struggles.

Finally, it is important for counselors to be aware of the resources that exist to help undocumented families. The following resources will get you started.

• The American Psychological Association’s guide to working with immigrant-origin clients: apa.org/topics/immigration/immigration-report-professionals.pdf
• Immigrant Legal Resource Center:
  ilrc.org/for-immigrants-para-inmigrantes/know-your-rights
• The College Board guidance on advising undocumented students: professionals.collegeboard.com/guidance/financial-aid/undocumented-students
• Kaiser Family Foundation information on access to health care: kaiserfamilyfoundation.files.wordpress.com/2013/02/8420.pdf

In addition, we recommend the following books for those who wish to deepen their personal understanding of the narratives of undocumented immigrants:

• Enrique’s Journey: The Story of a Boy’s Dangerous Odyssey to Reunite With His Mother by Sonia Nazario
• Underground America: Narratives of Undocumented Lives compiled and edited by Peter Orner

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Laura M. Gonzalez is an associate professor in the School of Education at the University of North Carolina at Greensboro, having received a Ph.D. in counselor education from North Carolina State University and an M.Ed. in college counseling from the University of Delaware. In addition, she has conducted research and outreach to the Latino immigrant community with the goal of enhancing educational access. Contact her at lmgonza2@uncg.edu.

Nathaniel N. Ivers is an assistant professor in the Department of Counseling at Wake Forest University. He received his master’s in counseling from Wake Forest University and a Ph.D. in counseling and counselor education from the University of North Carolina at Greensboro. He has published research and conceptual papers related to Latino immigrants and has provided counseling to the Spanish-speaking immigrant population in North Carolina. Contact him at iversnn@wfu.edu.

Letters to the editor: ct@counseling.org

 

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Editor’s note: After this article ran in Counseling Today, one of the co-authors, Nathaniel N. Ivers, was interviewed by Newsweek on this topic. See the article here.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.