This article is the third in a three-part series on the intersections of mental health and the refugee experience in the US.
As an individual belonging to an immigrant family, stigma surrounding the subject of mental health has acted as a considerable boundary, impeding many conversations over the years.
In my first article of this series, I took a deep dive into the fact that asylum-seekers and immigrants alike suffer a disproportionate risk when it comes to psychological distress, especially Post-Traumatic Stress Disorder. Many immigrant families face further trauma exposures once residing in the United States, where they may be subject to microaggressions, neighborhood disorder and violence, and other adverse circumstances that may exacerbate their condition.
In my second article, I examined some best practices for interacting with immigrants and advocating for their mental health, including trauma-informed care. Strong support systems are an integral part of decreasing the likelihood of developing a mental health issue. However, there is an element of stigma when it comes to discussing and diagnosing mental health issues in certain immigrant communities. For my last article of this series, I am probing this aspect of the immigrant experience and ask how we can encourage direct discourse surrounding the topic in such communities.
Stigma Within the Family
According to an article published by the National Center for Biotechnology Information, immigrants and refugees were less likely than individuals with citizenship to pursue or be referred to mental health services, even when experiencing proportionate levels of distress. In fact, even though rates of mental illness among Latinos and whites in the U.S. are roughly equivalent, individuals who were white are about 60 percent more likely to seek out mental health treatment services.
Krimayer cites structural and cultural barriers, such as a lack of mobility, a desire to deal with problems by oneself, a worry that their problems will not be comprehended by practitioners due to cultural differences or language barriers, and fear of stigmatization. Often, people within developing countries associate mental health services with custodial or hospital treatment of the most severely ill and psychotic patients. As a result, the stigmatization of mental health disorders is significant in these countries.
Moreover, particular cultural explanations of illness intensify this stigma, causing patients to be highly averse to attributing certain symptoms to a mental disorder. Eliza Martin and Hannah Todd cite some cultural traditions of privacy, a preference for non-Western treatment methods, a sense of pride in self-reliance, and skepticism with American health care as reasons that certain immigrants may be less likely to seek out care. According to a 2001 Surgeon General’s report, only about 20 percent of Latinos with a mental health disorder turn to a general health-care provider, while only 10 percent contact a mental-health specialist.
To add on, this article highlights that, “among women with depression, compared with U.S.-born white women, immigrant African women had over three times higher odds and immigrant Caribbean women had over six times higher odds of reporting stigma concerns.” For black women who are less likely to want care, this may stem from a lack of trust in the mental healthcare system to treat them equally or fairly. Amanda Machado writes about a certain level of trust that is missing when Latinos do decide to consult with healthcare providers in her article in The Atlantic, maintaining that there is a certain level of trust, or “confianza” as Machado puts it, with providers of Hispanic or Latino descent.
This stigma not only affects patients, but also their siblings and extended family members. Many families may decide against seeking help for their children as a consequence of stigma, and a child may be reluctant to reveal his or her struggles to parents. Additionally, children of immigrants may perceive their mental health needs as a problem that cannot or should not be validated, as they view their trauma to be trivial compared to what their parents had to experience. Often, first-generation children are experiencing a full-blown mental health crisis by the time they seek help, complicating their treatment.
Mental Health as a Norm
The failure to establish mental health well-being as a norm in many developing countries directly relates to the stigma that refugees hold with regards to mental health illnesses. In a study on mental health-related conceptualization, Shadi Sahami Martin found that participants viewed individuals who sought mental health treatment as “crazy,” assuming that they would only be offered treatment in the form of psychotropic medication. They believed that “Western medicine’s emphasis on targeting problems in the body only addresses part of the problem,” overlooking the spiritual aspects of their distress.
Diversity within the healthcare field is increasingly important, as cultural awareness must be present in order to effectively communicate with, diagnose, and treat immigrant families. Without an ethnically diverse or sensitive healthcare system, the reciprocal nature of the doctor-patient relationship may not be present. In order to explain the benefits and drawbacks of Western medicine, healthcare settings must not only take cultural competence into account, but also linguistic barriers that limit the ability to effectively communicate with patients.
Ways to Combat Stigma for Immigrant Communities
The National Alliance on Mental Illness identifies a few ways to target stigma in immigrant communities and normalize treatment. In order to productively fight the barrier of stigma in mental health treatment for immigrant families, we must provide culturally appropriate prevention opportunities, screening, and treatment through school-based programs. This is a way to make services more accessible to refugee children and youth. Moreover, the development of a community support system would allow for community leaders to serve as liaisons between the refugee population and mental health professionals.
Public-private partnerships at the national, state, and local levels could also push for the development of an environment that promotes mental health well-being for refugee children and youth. Lastly, emphasizing the role of education to providers and the overall community is important in order to promote which mental health services are available. Psychoeducation targeted toward destigmatizing mental health disorders is a powerful agent in combating stereotypes and barriers to seeking treatment.
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