Mental Health Care for Immigrants: The Importance of Cultural Competency

By Bridget Hogue and Kassy Rush

There are approximately 44.8 million immigrants living in the United States. U.S. immigrants have grown significantly from just 5.4% of the population in 1960 to 13.7% of the population today (Budiman et al, 2021). Data shows that 25% of U.S. immigrants originate from Mexico, and another 25% originate from other Latin American countries. In other words, Latinx individuals make up half of the U.S. immigrant population (Budiman et al, 2021). As the Latinx immigrant population continues to grow, it becomes more important to consider how immigration can affect one’s mental health and well-being. Many individuals immigrate from countries in which mental health education is either lacking or non-existent. When discussions of mental health rarely take place, it becomes more difficult to access or seek out resources in a new country such as the U.S. (Ponte, 2019). The National Alliance on Mental Illness (NAMI) finds that 17% of Hispanic/Latino adults are affected by mental illness each year (NAMI, 2021). Factors such as identity formation, trauma, migration, and a lack of culturally competent care can further complicate the mental health of immigrants and necessitate discussion on this issue.

For the past several years, rhetoric and policies have circulated throughout U.S. politics on who should be allowed to enter the country. The 2016 presidential election exacerbated harmful threats toward immigrants crossing the U.S.-Mexico border, with repeated encouragements to “Build the Wall.” This language swiftly transitioned into executive orders in 2017 to halt entry into the U.S. for several immigrant groups across the globe (American Psychiatric Association, 2021). The struggle to enter the United States is only one aspect of a trauma that many immigrants face. The American Psychiatric Association (APA) outlines several aspects of the migration process that can induce a traumatic experience, particularly for undocumented immigrants. Prior to migration, immigrants are commonly facing financial stressors, the need to escape violence, social or political oppression, or the threat of disasters. During the migration process, immigrants may witness or experience violence, abandonment, separation, environmental hazards, or death. In the aftermath of the migration process, several new factors may contribute to poor mental health for the individual. Immigrants must adjust to a new environment, avoid exploitation, grapple with limited resources, and some live with the fear of deportation (American Psychiatric Association, 2021).

The different stages of the migration process portray immigrants’ risk and likelihood to experience a traumatic event. Family separation is a specific traumatic experience that effects vast numbers of Latinx individuals who immigrate to the United States. In many cases, immigrants are fleeing a disastrous or dire situation back home and are then confronted with the fear of losing their family. In an article for TIME, author Jasmine Aguilera (2020) tells the story of Mari, an asylum seeker from Guatemala, who was unaware she had reached the U.S.-Mexico border upon being arrested. Her son Jesus was taken and sent to a shelter, and agents told Mari they were unaware as to when they would be reunited. Mari was fleeing Guatemala to escape her abusive husband (Aguilera, 2020). Their story is one of more than 5,500 children separated from parents at the border due to the 2018 “Zero Tolerance” policy employed by then-Attorney General Jeff Sessions. Mari and Jesus have since been reunited but continue to experience trauma from their separation (Aguilera, 2020). Furthermore, there are still over a thousand children who have not been reunited with their families since separation at the border (Alfonsi, 2021).

What are the implications for an individual’s mental health in the aftermath of this experience? In response to the border crisis, a court order was enacted in November 2019 for the U.S. government to cover the cost of mental health care for any families who experienced separation at the U.S.-Mexico border. While the order was set to expire by June 2021, over 230 families have requested the service (Aguilera, 2020). The U.S. government placed the responsibility of providing mental health services with the Seneca Family of Agencies, a nonprofit organization in California. With such a task, these mental health professionals faced three major challenges: locating potential clients, building trust, and creating a network of culturally competent mental health professionals (Aguilera, 2020). Their program, Todo Por Mi Familia, has connected with 1,300 families and has gathered over 540 professionals to help provide services (Seneca Family of Agencies, n.d.).

Regardless of the number of professionals an agency may have, the application of cultural competency to the mental health care provided is crucial. In the mental health field, cultural competency involves a clinician’s awareness of their own cultural values and biases, awareness of the client’s worldview, and the ability to implement culturally appropriate intervention strategies (Sue, 2019, pg. 71). The Latinx community represents an extremely diverse group of individuals, so no assumptions should be made with a one-size-fits-all approach. However, since the majority of mental health clinicians in the U.S. are white or European American, many therapeutic interventions stem from Westernized culture and values. A lack of cultural sensitivity can create a significant barrier for a Latinx individual seeking mental health treatment. Further, anti-immigrant stigma and mental health stigma can cause the Latinx population to feel excluded from the mental health care system and their communities at large (Mlodgenski, 2020). Stigma can perpetuate the misconception that those seeking treatment will appear “weak,” and can devalue the individual’s personal experience. Additionally, the lack of Spanish-speaking clinicians within the profession poses a barrier to accessible mental health resources.

Latinx immigrants in the Pittsburgh community may face a unique array of challenges as well. Despite the growing Latinx population across the U.S., the 2020 Census found that Latinx individuals comprise only 3.2% of Pittsburgh’s population, or 28,000 people in all of Allegheny County (U.S. Census Bureau, 2019). Nevertheless, mental health resources do exist for the Latinx community in Pittsburgh. An individual should seek mental health care if they experience interpersonal conflict, substance abuse, sexual abuse, domestic violence, depression, or anxiety. (Casa San Jose, 2021). These are a just few examples of potential indicators for mental health issues.

Salud Para Niños, Casa San Jose, and UpStreet are three organizations which seek to provide culturally competent care for Pittsburgh’s Latinx population. Salud Para Niños at Children’s Hospital of Pittsburgh, nestled between Lawrenceville and Bloomfield, provides bilingual health services to promote empowerment for children and families. Their services include behavioral health as well as social workers who can provide screenings and referrals for mental health care. Casa San Jose is located in the South Hills of Pittsburgh near Beechview—a growing Latinx community—and provides a number of services for immigrants and refugees to thrive in Pittsburgh (Casa San Jose, 2021). Health insurance is not needed to access their mental health care. Services offered in Spanish include individual or group counseling, support groups for victims of domestic violence and sexual abuse, and referrals to psychiatrists, psychologists, counselors, and social workers when needed. For those who prefer a virtual option, UpStreet is an organization based in Pittsburgh which provides therapy sessions with translators for teens and young adults. Sessions can be extended to accommodate the needs of the individual, and fees are arranged on a case-by-case basis. The organization is determined to provide mental health care to individuals without cost barriers (UpStreet Pittsburgh, 2021).

The growing population of Latinx immigrants in the U.S. face a myriad of stressors and mental health challenges. Many have experienced trauma, hardship, and discrimination. The need for culturally competent practitioners should be stressed in all clinical and academic settings in an effort to provide the best services possible. The Latinx community may grapple with social isolation and stigmatization in Pittsburgh as well as across the U.S., but the city has resources available for mental and behavioral health treatment with consideration given to stigma, cultural identity, and financial barriers. Our communities and clinicians must be open and receptive to the unique needs of Latinx immigrants to create a more inclusive and culturally sensitive environment.


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