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Mental health professionals can help immigrant families threatened by separation
A paper published in Psychiatric Services offered recommendations to guide mental health professionals working with families who are or could be separated by changing immigration policies and enforcement in the United States.
Clinicians can help address mental health issues related to forced family separation by identifying the origins of distress, understanding family structures, developing communication practices, providing legal and economic resources, and preparing for decision-making.
“As mental health professionals, we are increasingly impacted by the changing immigrations policies and enforcement,” Brandon Kohrt, MD, PhD, Charles and Sonia Akman Professor in global psychiatry, associate professor of psychiatry and behavioral sciences, and director of the division of global mental health at George Washington University, told Healio Psychiatry.
“The changes in Temporary Protected Status, Deferred Enforcement for Departure and DACA are affecting more than a half-million families across the country,” he continued. “To make the situation worse, the vast majority of individuals are being sent to the most violent places in the world. Salvadorans and Hondurans, who make up two thirds of those losing Temporary Protected Status, are being sent to the countries with first and third highest murder rates globally. As mental health professionals, we have the skills, resources and duty to help these families.”
In their paper, the Kohrt and colleagues offered recommendations to help mental health care professionals address the psychological needs of families experiencing or at risk of forced separation. First, they recommend that clinicians understand which features of anticipated or current forced separation are most distressing to the family.
The overall emotional toll, loss of regular communication, isolation, economic hardship, loss of extended-family members who provide child care and the safety of family members being deported are all possibilities. However, instead of making assumptions about how forced separation affects a family, working with refugee families can help therapists identify and reinforce current and past healthy coping strategies.
“Clinicians need to create a comfortable environment for mixed-immigration status families to discuss what they are going through,” Kohrt said. “Recent studies have shown that families are reaching out less to professionals for help, so we need to give special attention to creating a safe space.”
Clinicians should also consider the effects on children of different age groups. For young children, attachment issues are most common, whereas school-aged children may experience conflicts in their loyalty toward the host society, which they may think is responsible for the separation, according to the authors.
Kohrt and colleagues also recommend clinicians understand the family structure and how separation or fear of separation affects family roles and duties. From the policy maker perspective, the relationships with grandparents, aunts, uncles, and even godparents are often overlooked. Mental health care professionals should look outside this nuclear model for effective care and should also identify traditions and rituals tied to cultural and family identities, such as finding ways to symbolically engage in milestones even if they cannot be there physically.
“We also need to familiarize ourselves with the organizations, advocacy groups, legal resources, and other supports available locally so that we can refer families,” Kohrt told Healio Psychiatry. “These connections are important because those organizations are also increasingly seeking our help for mental health services for their clients and staff.”
The authors also recommend that clinicians consider culturally congruent communication strategies for families undergoing forced separation to strengthen family interaction. Because severed communication is one of the greatest risks of immigration deportation, mental health professionals should identify barriers to communication including language issues (eg, access to English-based communication resources) and the terminology used to describe distress.
Because many families come to the U.S. to provide better opportunities for their children, deported adult members are faced a distressing choice: leave their children in the U.S. or bring them to a country where they could be at high risk for violent death. Clinicians can help families prepare for decisions regarding separation by addressing sources of distress, communication pathways and political, legal and health system resources.
“The only way to truly fix this situation, though, is to change policies and practices,” Kohrt said. “As clinicians, we need to educate lawmakers and the public about the long-term psychological damage of forced separation that not only affects immigrant families but also impacts us as communities and as a nation.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.