Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: October 2009

Immigrants’ Access to Mental Health

Lina C. Schlachter, MA


The United States has been called a melting pot  because of the high number of immigrants who enter this country looking for a better life.  In 2008, 3.7 million people were temporary residents characterized by a longer duration of stay (e.g. specialty workers, students, and nurses), 1.2 million people became legal permanent residents during the same year, and 69 thousand people were characterized as “expected” long-term residents (e.g. alien fiancés or spouses of U.S. citizens and children). In addition, in October 2008, the illegal immigrant population stood at 11.9 million. 

Even though many of these immigrants came to the US imagining that the neighbor’s grass is greener, the reality may be not consistent with their hopes, which may make living abroad an extremely challenging experience. The journey involves many new challenges, including learning a new language, becoming more independent, self-reliant and open to new customs.  Many of these changes do not come easily.  Immigrants face culture shocks, language barriers, and home sickness. Further, many immigrants may be exposed to other difficulties such as prejudice and discrimination. The process of acculturation must be solved as the new American struggles with which qualities from the old ways of life to keep and which qualities to take from American culture.  It is not simply a temporary adjustment but also, and mainly, about a new identity that is being formed. In the process, feelings of loneliness and isolation may be triggered.

Therefore, access to culturally and linguistically appropriate mental health services is very important for immigrants who are facing psychological and social difficulties in the US.   However, despite the critical need for mental health services, immigrants need to overcome significant obstacles to receiving quality mental health care.  Among these, we may list: (1) the limited access to health insurance (immigrant workers are less than half as likely to receive health insurance coverage through their employers), (2) the lack of understanding of their rights to mental health care, and (3) the lack of awareness of the options for affordable care such as sliding-scale fees (Gurvitch, 2009). Further, many immigrants are afraid of immigration consequences of using various services and benefits, as many of them believe that there is data sharing among health providers and immigration authorities.

In addition, finding culturally responsive services may be a challenge in itself. As Dr. Kleinman (2009) reminds us, the way we experience mental illness is profoundly influenced by our cultures. For instance, in many countries, people often experience depression in bodily terms (headache, trouble sleeping, stomachache, etc), and culture may have a role in how sadness is felt. To describe his or her depression, a Chinese person may use a term that is often translated as “congested.” A doctor who does not understand the Chinese culture will feel confused and may offer inappropriate treatment.

In Philadelphia, we have find centers and resources specifically concerned with delivering mental health care to immigrants. Community Behavioral Health (CBH), a non-profit corporation, is a behavioral health managed care organization that provides mental health and substance abuse treatment services to all Medicaid recipients in Philadelphia County.  CBH ensures access to services for immigrants whose first language is not English - including immigrants from Southeast Asia, Spanish-speaking countries, Russia, Eastern Europe and Africa. Further, the Association Puertorriquenos en Marcha (APM) and COMHAR offer mental health services for Spanish-speakers, and the Intercultural Family Services also have professionals with the ability to translate and interpret 22 languages and dialects. The Hall-Mercer Community Mental Health Center offers services for Asian patients. 


Resources

Asociacion Puertorriquenos en Marcha (APM): http://www.apmphila.org/

COMHAR : http://www.comhar.org/

Hall-Mercer Community Mental Health: http://www.med.upenn.edu/hallmercer/

Intercultural Family Services: http://www.ifsinc.org/Services/Intercultural-Behavioral%20Health-Center-West.aspx

Behavioral Health Services at Pennsylvania Hospital: http://www.med.upenn.edu/psychotherapy/index.html


References

DHS: Yearbook of Immigration Statistics. Retrieved October 5th, 2009, from http://www.dhs.gov/files/statistics/immigration.shtm

In Any Language: Mental Health Care for Immigrants. Retrieved October 5th, 2009, from http://www.lcmedia.com/mind380.htm.

Gurvitch, A. Immigrants’ Access to Mental Health Services in New York State: Barriers and Recommendations. Retrieved October 5th, 2009, from http://www.thenyic.org/templates/documentFinder.asp?did=331

Note:  The author, Lina Schlachter, MA is a clinical psychology intern in the Behavioral Health Service of Pennsylvania Hospital.  She is a native of Brazil and offers treatment services in English and Portuguese.