Mental health access disparities among New York City’s immigrant population

Isobel van Hagen
Aug 31, 2018 · 4 min read

There are glaring healthcare access disparities faced by New York City’s immigrant population — 35% of the 1.4-million noncitizen city residents are uninsured, and 64% of the nearly 541,000 undocumented immigrants are uninsured. Max Hadler, Senior Manager of Health Policy at New York Immigration Coalition, notes that without a comprehensive insurance plan in New York, there are a very limited number of places you can go to receive quality care. This is particularly true, he said, for mental health care services.

A report by the American Psychological Association for the Presidential Task Force on Immigration in 2013 says that “the stress involved in the immigration process can cause or exacerbate mental health challenges including anxiety, depression, posttraumatic stress disorder (PTSD), substance abuse, suicidal ideation, and severe mental illness”. There a sort of self-fulfilling, cyclical prophecy in the overlap of immigration and mental healthcare– that the people in society who seemingly could benefit from this sort of healthcare the most, are the people for whom it is most difficult to receive. Immigrant life in America — whether undocumented or not -may be psychologically and emotionally jarring, and there are many significant barriers to the remedy.

There are significant policy-based barriers to access, like a lack of understanding in health care information. When young adult immigrants in NYC were asked what benefits they could access from DACA (before its potential elimination), 85 percent knew they could get a social security card, but only half knew they might qualify for health care. There is also a limited access to insurance (about one third of the Latino population is uninsured).

Even if an undocumented, uninsured person is aware of their rights regarding healthcare, a report by the Hastings Center and the New York Immigration Coalition said that “behavioral health services…are especially difficult for the undocumented uninsured population to obtain, due to long wait times for appointments with qualified providers in primary care settings, licensure restrictions on potentially qualified providers, and uneven geographic distribution of qualified providers who have the linguistic skills and cultural knowledge needed to serve the City’s diverse undocumented community”.

The question of “access” in the case of mental healthcare is not only related to question of information and insurance, but also social stigmas ad gendered issues. “You’re swimming uphill against all this baggage”, when trying to serve mental healthcare to the undocumented immigrant population of New York, said Trish Marsik, the Chief Operating Officer for Services for the Underserved.

The Latino community is particularly unlikely to seek mental healthcare; A 2001 Surgeon General’s report found that only 20% of Latinos with symptoms of a psychological disorder talk to a doctor about their concerns. Only 10% contact a mental health specialist. Amy Richards, Health Coordinator at Make the Road, said, “I think that there’s definitely stigma [in the Latin community], we try to say ‘how are you doing’? Rather than, ‘how’s your mental health’?” She referred to the term “loco” — many Latinos do not seek treatment for fear of being labeled this way. Veronica Morgenstern, Adult Non-residential Counselor at Sanctuary for Families, corroborates this claim; “it’s a cultural thing for Latinos — the idea that therapy is just for people who are ‘loco’ — like a schizophrenic person — that’s who goes to therapy…clients don’t realize a lot of times that anyone in the entire world may be experiencing what they’re experiencing”.

Hadler said that while it is true there are social and cultural stigmas preventing immigrants in New York from seeking mental healthcare, “that pales in comparison to the lack of structure in place. Many people are willing to seek it out — it’s not like there’s an abundance of culturally and linguistically competent places that people just aren’t using”.

A study conducted in 2014 evaluating the New York State Hospital Language Assistance Law passed in 2006 found that most hospitals don’t employ full or part-time medical interpreters, and of those who did, all of them could only translate in Spanish. Morgenstern said that, “a lot of times in my first session with people, I hear ‘I’ve been trying to go to counseling but I’ve not been able to find anyone who speaks Spanish’, so there’s a language barrier for a lot of people. Maybe there’ll be [a counselor] who says they speak Spanish, but it’s only at a high school level, or something”.

The current political atmosphere and changes in policy has added to this ‘uphill battle’: “There’s always been a problem specifically with access to mental health, particularly to undocumented immigrants, but it has gotten substantially worse since November 8th. There’s not a lot of hard evidence, but anecdotally and qualitatively…it’s particularly acute right now because of the problem with DACA recipients” said Hadler.

Morgenstern explained, “Across the board, the day after the election none of my clients would come to the office because they wouldn’t leave their homes…and now, people can’t get away from [worrying about ICE], which makes it even harder to do my job because there is the initial chronic mental healthcare to worry about, as well as the broader, political climate”.