The Importance of Mental Health Advocacy for the Central Valley Undocumented Community
By Aurora De Luna and Yesenia Solis
In the United States, access to health care is considered a privilege. For undocumented people, it is a luxury that they cannot afford. Not only do undocumented people live with the fear of deportation, but they also face the challenges of navigating the complicated healthcare system. Many undocumented folks are unable to access medical insurance because of their lack of social security numbers. They face transportation and language barriers that prevent them from accessing the scarce resources that are available to them. Many undocumented folks also fear using services because they think it could jeopardize their stay in the US because of the recent public charge rule¹. All of these barriers hurt their access to health care, including mental health resources. We must advocate for undocumented folks as they are one of the most vulnerable communities in the US.
The Barriers To Accessing Mental Health Services
The presence of 12 million undocumented people in the US has created tensions and moral responsibility among policy representatives, who have failed to provide any successful relief for this population. Due to current policies, about 45% of undocumented people in the country are uninsured. Although California allowed undocumented adults under the age of 26 to apply to Medi-Cal, this continues to exclude a large amount of the population from healthcare. For example, undocumented immigrants account for two fifths (41%) of the remaining uninsured in California and at least a third of the uninsured population in Arizona, Florida, North Carolina, and Texas. Undocumented folks are not eligible for Medicare, Medicaid, or CHIP (Children’s Health Insurance Program). Even DACA (Deferred Action for Childhood Arrivals²) recipients are not eligible to apply for these resources. To be able to receive access to Medicare, Medicaid or CHIP you have to receive or be eligible to receive retirement benefits from Social Security or the Railroad Retirement Board. Additionally, you or your spouse has to have Medicare-covered government employment, which excludes all undocumented immigrants who lack a social security number. As a result, these agencies contribute to the disparity of health support among undocumented residents in the United States.
The historical exclusion of undocumented people from healthcare services is only exacerbated when it comes to mental health resources. The Central Valley houses an estimated 900,000 immigrants in several counties such as Fresno, Kern, Merced, San Joaquin, Tulare, Stanislaus, Madera, Butte, Colusa and Kings counties. As of 2013, an estimate of 238,500 undocumented folks were residing in these counties. The lack of mental health resources is evident by the data presented by the Berkeley Interdisciplinary Migration Initiative (BIMI). The data tracks resources in three counties (Stanislaus, Merced, Kern) in the Central Valley. In these counties, only nine clinics offer behavioral health support. It can be argued that mental health support does exist, but the limited resources available creates another barrier for undocumented people. This area is the seventh-largest agricultural producer, where approximately 250,000 people live in rural and poor areas.
These impoverished living conditions make undocumented residents the most vulnerable population since they are three times more likely to be hospitalized for mental health complications in comparison to non-poor residents.
One Young Immigrant’s Story
Yesenia’s experiences are very similar to most Central Valley residents, where navigating the healthcare system in search of mental health support is an extremely daunting task. Yesenia is 21-year-old undocumented student who resides in the Central Valley. For a long period of time, she felt that something was wrong with her but she was never able to pinpoint the problem. Yesenia went to several doctors for physical exams but was never diagnosed with any physical disorder. Depression, anxiety, and self-sabotage are not symptoms of a healthy teenager. They are symptoms of trauma. Such symptoms are prevalent in low-income and undocumented people. After experiencing an anxiety attack, her mom sought support for her. With the support of her mother, she was able to see a general practitioner, the only physician available in her rural town. As a general practitioner, the most the doctor could do was refer her to a psychiatrist in a town 45 minutes away. Even after receiving this support, she had a hard time. The therapist was available only once a week. Yesenia’s story is not much different from other undocumented people residing in the Central Valley.
Most of the Central Valley residents’ lives depend on agricultural work, making up 48% of the field workers in California. Their occupation creates an obstacle to accessing health services because often they are unable to commute to the clinics. These health clinics are generally located in larger cities, far away from rural areas where most undocumented people reside. San Joaquin Valley is home to an estimate of 18,000 young undocumented folks and 50,000 undocumented parents with US citizen children. Many parents, and some teens, work in the fields. To obtain services they have to drive far for mental health clinics, something their job does not allow. Field workers do not have the ability to drive 66 miles or more to a different town when they need to be at work all day. This made it difficult for Yesenia as she was a minor and needed her mom to take her to her intake appointments.
Even if people manage to make it to the clinics far away, when they arrive or attempt to schedule an appointment, they may face a language barrier. In a study conducted by Kathryn L. Braun, it was demonstrated that immigrants of Asian and Central American origin who are not proficient in English have the lowest health literacy. Health literacy is the level at which an individual is able to understand, obtain, and process basic health information. Because of their lack of language skills, it is more difficult for immigrants to understand how the healthcare system works. Limited English proficiency hinders their ability to access information, making the process of navigating the healthcare system very difficult.
We Need Change!
Undocumented workers in the United States have been historically affected by harmful legislation such as the current public charge rule. The lack of healthcare is one of these challenges. Immigrants risk their lives for better opportunities. They should not be deprived of health care access. To better support these communities we should consider how we think about mental health. We need more access to this information and may need to implement new labor laws, and educational policies. Still, one of the main problems is the lack of therapists in rural areas and a lack of interpreters. It’s essential to have multilingual workshops, websites, therapists. Due to the diversity of the Central Valley, it’s essential that we think of the accessibility of mental health support. Working with policymakers and health clinics is fundamental for the well being and future of the undocumented community.
¹ On Nov. 2, 2020, the U.S. District Court for the Northern District of Illinois vacated the Inadmissibility on Public Charge Grounds final rule (84 Fed. Reg. 41,292 (Aug. 14, 2019), as amended by Inadmissibility on Public Charge Grounds; Correction, 84 Fed. Reg. 52,357 (Oct. 2, 2019)) (Public Charge Final Rule) nationwide. That decision was stayed by the U.S. Court of Appeals for the Seventh Circuit. On March 9, 2021, the Seventh Circuit lifted its stay, and the U.S. District Court for the Northern District of Illinois’ order vacating the Public Charge Final Rule went into effect.
² Deferred Action for Childhood Arrivals (DACA) provides administrative relief from deportation. The purpose of DACA is to protect eligible immigrant youth who came to the United States when they were children from deportation.
About the Authors
Yesenia Solis (she/her) is a Legal Studies major at the University of California, Berkeley. She is part of the Undocumented Research Program (URP), a collaborative program between UC-Berkeley’s Institute for Research on Labor and Employment (IRLE) and the Berkeley Interdisciplinary Migration Initiative (BIMI).
Aurora De Luna (she/her) is a Data Science major at the University of California, Berkeley. She identifies as a first-generation, low-income queer Latina from Jalisco, Mexico. Some of the communities that Aurora is part of on-campus are the Undocumented Students Program, Disabled Students Program, Berkeley Hope Scholars, and Data Scholars. She is also part of the Undocumented Research Program (URP), a collaborative program between UC-Berkeley’s Institute for Research on Labor and Employment (IRLE) and the Berkeley Interdisciplinary Migration Initiative (BIMI). Aurora hopes to become a software engineer one day and transform her technical skills into a social good career.
About BIMI — Subscribe to our Newsletter!
The Berkeley Interdisciplinary Migration Initiative (BIMI) is a partnership of migration experts at UC Berkeley who investigate the social, political, legal and economic dynamics of migration globally as well as locally. We strive to advance thoughtful and substantive conversations on migration that leverage the university’s cutting-edge scholarship and its public mission to educate current and future generations. We embrace new data-gathering technologies as well as embedded, on-the-ground fieldwork, drawing from the interdisciplinary expertise of faculty, students and the communities with which we engage. Bringing together research, training and public engagement, BIMI aspires to inform, educate and transform knowledge to improve the well-being of immigrants and the communities they live in.