For immigrants, status and stigma affect mental health, few resources exist

By Stephanie Manriquez (SJNN Fellow Cycle 2) and translated by Monica Reynoso. Also published in The Gate Newspaper and Contratiempo. 

It’s been almost 40 years since he first set foot on American soil. A young man who was only able to finish the first grade, he also had the task of supporting his family as the oldest child.

Between going back and forth from Recoveco, Sinaloa, Mexico to Chicago, he met his wife, a domestic worker who had the opportunity to attend high school thanks to the people she worked with. In search of a better future, the newlyweds decided to settle on this side of the border. After the first few years their oldest son was born, and later, their daughter, Manuela Perez.

At first glance, it could be a model family. But their emotional well-being was precarious. An alcoholic and violent father, a mother with high blood pressure and psychotic episodes, a brother who suffered a brain injury that left him emotionally disabled, and Manuela, who was diagnosed at age 13 with manic depression or bipolar disorder, after her first suicide attempt.

With a lack of education about mental health, her parents refused to accept her diagnosis.

Perez, now 31 years old, recalled that her parents’ response was, “These people [the doctors] are just making it up, they’re so dramatic.”

Her family’s lack of understanding of mental illness led her to silently cope with her illness and those traumas from her childhood.

She dealt with a hostile home environment due to her father’s alcoholism, and the clash between American culture from school and a culture at home based on very conventional traditions from rural Mexico.

“I grew up with a foot here and the other one over there, I never found myself,” Perez said. “I grew up confused; my parents didn’t understand me, not my teachers, my friends. Neither from here nor there.”

Immigrant families often come to the U.S. in search of socioeconomic and educational improvement for their children.  Unfortunately, cultural and legal issues may delay their progress such as traumatic experiences in crossing the border, lack of status, and transitioning to life in America.  This can then overwhelm emotional stability. Yet, many immigrants disregard their own mental wellness; especially if they come from communal cultures, where is is not accepted or expected to focus on themselves as a single individual. Instead, the vital focus is the family as a whole.

The family is a link to the new environment, an immigrant clings to their family in order to ease their transition. It’s a solid yet vulnerable base, posing a series of unsolved dilemmas.

The emotional health of many members of Latino families depends upon the immigration status of each member.  Even if some family members are documented, they face stress related to the status of undocumented relatives.

The accumulation of stress due to isolation, family responsibilities, and financial obligations can prevent immigrant parents from playing an active part in their community. Immigrant children, meanwhile, often assume adult roles to support their parents while also  facing language and cultural clashes at home and in school.

These situations all have mental health impacts, including increased rates of depression and anxiety — as well making it challenging to cope with any other personal health and wellness issues.

Breaking Stigmas

Chicago’s Little Village is a neighborhood where you find one of the highest concentrations of Mexicans and Mexican-Americans in the Midwest. It’s an immigrant, working-class community where it’s important to understand family structure, the pace of cultural change and the idea that people’s actions are based on past experiences in their countries of origin.

“Communication within my family is complicated, each member suffers from his or her own mental disorder without admitting it, except for me,” said Perez, who grew up between Little Village and the nearby neighborhood of Pilsen.

For Perez, the journey to self-acceptance has been long: two suicide attempts, taking refuge in alcohol and illegal drugs, relapses on six different occasions to psychiatric treatment and medications…all in an effort just to get control of those overflowing emotions.

Those emotional tides, Perez said, would bring her from a false happiness where she wanted “to eat the whole world in one bite”…to “wanting to never wake up again.”

While Perez struggled with mental health issues, her brother’s situation was even more serious.

“For a long time, I insisted on the severity of my brother’s condition, but my family refused to accept it out of ignorance and stigmas” from their cultural background, Perez said.

Ultimately, she took action on the matter and secured a court order giving her the power to temporarily institutionalize her brother for treatment. After a while, her parents noticed a decrease in her brother’s erratic and negligent behavior.

Mirna Ballestas is a clinical psychologist and director of the Under the Rainbow program at Mount Sinai Hospital’s Department of Psychiatry. She’s also a member of Roots to Wellness—a coalition of different mental health advocates and service providers in Little Village.

Ballestas explains that within the Latino population, the terms “mental illness” and even “mental health” are hard to digest. They are very ambiguous concepts that can be associated with insanity.

“There is a lot of pain and trauma in the community” of Little Village, Ballesta said. “Many families— first generation—through their past and their country of origin are used to thinking that the family dysfunction, domestic violence, alcoholism and aggression at home is not going to change. A complacent mindset about abuse is created.”

While some immigrant families have left behind their support systems, others are dysfunctional families in transition. They may have left members in their home country, or they’re waiting to be reunited.

These drastic transitions and significant losses coupled with the stress of the immigration process can mean higher levels of emotional disorders such as post-traumatic stress disorder (PTSD) and depression. According to a report published by the Roots to Wellness Alliance in November 2014, 21 percent of the adult population in Little Village suffers from some type of mental illness. Of those, 35 percent are related to some type of depressive state, while 19 percent are divided among post-traumatic stress disorders, generalized anxiety and panic disorders.

The same report determined an estimated 10,500 individuals in the community suffer from some kind of mental illness and that only 3,100 people seek or receive some type of service.

Support services are often only accessed when a third party intervenes.

They could be general practitioners, social workers, teachers, counselors or someone close to the person. Ballestas mentions that, “word of mouth information is a great support for the families. Although informal, it is the most convenient, reliable and receptive form; for instance mothers talking to other mothers about resources received.”

Gradually, people in Little Village are not only getting educated on the importance of mental health, but also about the emotional wellness of an individual and the effects on those around them: family, friends, community. This education is due to an increase in awareness and resources being offered by agencies, organizations and health services. All are involved in receptive fields and safety zones, providing a voice and community strength in schools, churches, centers or health fairs.

“The mental health issue is starting to become relevant in this community,” said Ballestas. “Families have started receiving the information. They’ve been able to create a different family dynamic with a powerful healing effect to which they now cling.”

Family separation, living in fear

Even as immigrant families become more aware of mental health issues and resources, immigration status presents a problem. Many families are separated and living in fear, according to Angelica Velazquillo. She’s a doctoral student at the University of Chicago and is currently investigating the intersection between health programs and the immigrant community. Velazquillo said that factors causing emotional instability include “not being able to return to your country to visit your ailing mother or father or even worse, already deceased (parent.) Or not knowing if you or your loved one will come home from work or school due to a deportation process.”

Uncertainty about the future and immigration status of oneself or loved ones wreaks havoc on emotional wellness. It could be that at least one member of the family doesn’t have his or her documents — the father, the mother or perhaps both. A family might have only one head of household who happens to be undocumented. Or the older children may be undocumented while the younger children have legal status, born as a U.S. citizen or receiving status through the Deferred Action for Childhood Arrivals (DACA) program.

Even though young adults protected under DACA have temporary permission to stay in the United States, their mental health is still impacted by immigration status issues. They continue to talk about the fear and concern felt by their family members who are still without documents.

“You can’t disconnect an individual like that from his family, friends and from the community still lacking [status] and in fear,” said Velazquillo, who was eligible for DACA.

“My immigration status has marked me, it’s part of my identity. [My] DACA was granted, and I am grateful for the opportunities it has brought me. But the situation of other members of my family hasn’t changed.”

Velazquillo said her brother, who is ineligible for DACA, was processed in the immigration system, criminalized and treated inhumanely, just like other members of her family were.

“It was hard growing up in the conditions I did, believing in the American Dream and that once my documents were assigned everything would work out,” Velazquillo said. “But it wasn’t like that. Thinking about my brother and the proceedings my family went through while his case was solved, emotionally [drains] me.”

Roots to Wellness

How accessible are mental health services for immigrants? How viable are the services in Spanish? How is medical coverage adjusted for families with different immigration statuses among members? Are there any options for immigrants who don’t have health insurance?

There is clearly limited availability of mental health services for immigrants. And many don’t know how or where to search for and get informed about services and programs that are available. There is a great lack of bilingual and bicultural mental health experts who understand immigrants’ experiences, and finding such a professional near one’s location can be difficult.

In cities like Chicago, where there is a larger concentration of Latino immigrants, there is a greater sense of awareness among service providers and more organizations that offer support in a familiar culture and language.

Roots to Wellness LogoIn Little Village, the coalition of organizations called Roots to Wellness promotes and advocates for mental health care, increasing awareness on the issue as well as addressing stigmas and other barriers that prevent people from seeking and accepting help.

Roots to Wellness and other programs help Latino families in Little Village who often have an internal mix of different immigration statuses and individuals with or without health insurance. The programs are adjusted to the individuals depending on the severity of their mental disorder, with formal and informal options offered in hospitals, clinics and community centers, as well as prevention strategies and mental health education.

For instance, Mount Sinai Hospital is located right near the Little Village and Pilsen neighborhoods. The bilingual programs and services at Mount Sinai are specifically designed to satisfy the cultural needs of Latino families regardless of their immigration status.

Mount Sinai’s Under the Rainbow program provides assistance in Spanish and English to children and youth between three and 18 years of age, with a wide range of mental health services such as individual, group and family therapy, as well as psychiatric services. It provides a diagnosis based on basic behaviors or emotional programs that could be caused by depression, adaptation or anxiety disorders, posttraumatic stress disorders and psychosis. Since all children in Illinois are guaranteed health coverage regardless of immigration status, Under the Rainbow programs are accessible to all immigrant children.

And parents of children in the Under the Rainbow program are also offered mental health care, regardless of their immigration status or health insurance situation.

Through a program known as Abriendo Puertas (Opening Doors), professionals work with whole immigrant families. Opening Doors promotes family values and advises how to educate children facing their new environment and cultural changes.

Another member of the Roots to Wellness coalition is St. Anthony’s Hospital. Its mental health services are free, in Spanish and geared toward low-income adults without any medical coverage. St. Anthony’s offers counseling services for depression, anxiety, anger management and treatment for traumatic situations, that unfortunately, people have often learned to handle on its own. The hospital’s reputation is very well-established thanks to word-of-mouth among patients, many who found treatment there for the first time.

Moving Forward

Even with these resources, there are still many challenges to be faced by immigrants and their families in accessing mental health care. In order to foster a healthy emotional well-being, we must improve as individuals, and eradicate the stigmas and barriers that we set ourselves as individuals and as a society. We must be committed to grow as a healthy community. And for that, an education and a thirst to keep ourselves informed are necessary. We must set aside the ignorance and the shame, we must seek and demand resources that benefit us while also keeping open a dialogue.

Manuela Perez is an example of how this can be done.

Art by Manuela Perez depicting mental health and recovery
Art by Manuela Perez depicting mental health and recovery

After spending years as a community artist and art events organizer in Pilsen and Little Village in Chicago, Perez currently resides in Wisconsin where she works as a nursing assistant and lives with her partner and son who is almost two years old.

She’s aware of the cycles and factors that lead to her mood swings, and has learned to cope with her illness.

“It’s a matter of being honest with yourself and of daily and constant communication,” she said. “Educating yourself is to be able to make peace with your past, and accepting yourself. Having attempted to take my own life is a fact that I now consider alarming. I’ve learned to identify those waves, those trigger factors and I’m capable of self-analyzing me. Stay calm, think, step back, stabilize myself and move on.”

Meanwhile many young adults including Velazquillo have faced their emotions and improved their own mental health by continuing activism. They narrate their experiences and problems in different open and closed public spaces and online sites.

They share their stories using the motto “Undocuhealth, Undocumented, Unapologetic and Unafraid.”

For these young people, making their voices heard is the beginning of healing. These empowered and assertive youth are forging their own way toward their mental well-being.

Velazquillo feels optimistic about the future of mental health in immigrant Latino communities.

“We are fighting from every different front,” she said. “We’ll have general practitioners, social workers, doctors, school counselors, anyone within the healthcare field, or like myself, pursuing a masters in social service administration. On the other hand, there are the leaders who fight for health services and new health reforms.”

“Our professionals will have our cultural background and experience” as more young immigrants enter the workforce, she added. “It gives me a lot of hope.”