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Mental Health Support for Immigrants Is Critical Now, Says Professor

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Few issues burn hotter on the worldwide stage today than immigration. In May, President Donald Trump instituted a zero-tolerance policy for anyone arriving at the southern border, and today, many immigrant children who were taken from their parents there have yet to be reunited with them.

Looking beyond the headlines, Gregory Acevedo, Ph.D., an associate professor at Fordhamā€™s Graduate School of Social Service, says there is real human misery associated with immigration that we have a moral responsibility to address.

Listen here:

And in an extra track, AcevedoĀ talks about the mental health needs of Puerto Ricans affected by Hurricane Maria who are expected to move to areas such as Florida and New York City this year.

Full transcript below:

Gregory Acevedo: U.S. social policy history’s really continuing history of reform and reaction. It really is this kind of like few steps forward, a few steps backwards. Maybe in the long rhythm of time, you’re moving forward. We have these regressive periods where we really do turn the clock back, unfortunately return to some past ways of thinking and doing. They’re never fully gone. There’s always some tinge of nativism that’s out there.

Patrick Verel: Few issues burn hotter on the worldwide stage today than immigration. In May, President Trump instituted a zero tolerance policy for anyone arriving at the southern border. Today, many immigrant children, who were taken from their parents there, have yet to be reunited. It’s rattling Europe as well. Italians recently elected a coalition government formed by two antiestablishment parties who share a common dislike of immigrants.

But beyond the headlines, Gregory Acevedo, an associate professor at Fordham’s Graduate School of Social Service says there is real human misery that we have a moral responsibility to address. I’m Patrick Verel and this is Fordham News.

What is the Immigrant Behavioral Health Roundtable project, and why is it so important these days?

Gregory Acevedo: The project’s being organized by the New York Immigration Coalition. They invited me because of the work that I’ve done in terms of immigrant and refugees and their mental health and social service needs. They’ve become concerned that with the Trump administration’s current policies that it’s having a negative impact on the behavioral and mental health of immigrant communities in New York City and elsewhere, of course. It involves people from government, healthcare providers, researchers, advocacy, and community based organizations, and the actual community members themselves.

The goal really is to develop long term policy recommendations for how to increase access to behavioral health for immigrants. In response to the current crisis, but also with the long term view that after this crisis is gone, trying to improve really behavorial healthcare access for immigrants period. It’s important because behavioral health is such a critical component of wellbeing for any person, non-immigrant or migrant alike. For example, behavorial health affects our physical health, our relationships, our job performance.

Migration inherently involves stress. Even a legal migrant coming with all their papers, well-resourced, there’s going to be some degree of stress. For any migrant, the context of the reception that they receive is a powerful determinant of how they’re able to cope with that stress. I think unwelcoming contexts heighten the risk of behavorial health problems occurring. We’re certainly in current context that’s pretty unwelcoming.

Patrick Verel: A key aspect of the debate happening in the country is the distinction between immigrants who come here legally and those who come here illegally. From a mental health perspective, do you see any distinction between these two?

Gregory Acevedo: Yes, insofar as illegality involves a higher level of, let’s say, risk and uncertainty. The fact that it heightens anxiety and insecurity. The fact that kind of living on the run, as it were, involves additional stressors than those that are already part of the stress involved in migration. I think there’s definitely a difference between an illegal journey and a legal journey.

I think it, for a healthcare provider or a mental healthcare provider, the issue is to be attuned to the fact that illegality brings with it, if you will, a certain level of being guarded. Clients or patients might not be as forthcoming or open about their experience, about their feelings, about their wants, their needs. I think that kind of guarded response is rational, but it may appear to somebody who isn’t taking that into account as something that’s, in the old parlance I guess, a resistance. I think you have to understand it from the point of view of someone who has an illegal status and the way that it changes their behavior really.

Patrick Verel: When it comes to your ethical responsibility to offer care, I would imagine that there is no distinction though.

Gregory Acevedo: Oh, of course, yeah. I think clearly morally I don’t find a distinction. It’s a technical issue, first of all legally. It’s an issue that’s important in terms of understanding, as I said earlier, people’s behavior. But I’m very clear about my … you’re here to serve everyone, right? So it’s the idea that you don’t make those distinctions. Clearly, from a human rights framework, which I think is very important, those aren’t distinctions that have any validity when it comes to receiving treatment.

Patrick Verel: Anti-immigrant sentiment is not a new phenomenon in this country, of course. Are there any lessons from the past that you incorporate into your work?

Gregory Acevedo: I teach courses on advocacy and policy practice. I use the example actually of the Immigration and Nationality Act of 1965 because it really offers a great lesson on time, if you will. That act actually undid the racialized national origins quota system that we had in place since the early 1900’s in U.S. immigration policy. It took decades of political effort and social cultural change to really undo a deeply entrenched nativism that informed that national origins quota system that we had.

When I teach a course content on policy and advocacy work, I always emphasize the long view and the importance of the long view. There’s a sentiment that was expressed centuries ago by Rabbi Tarfon, I now share with my students, “It’s not your responsibility to finish the work of perfecting the world, but you are not free to desist from it either.”

The idea is that you’re probably not going to see that change that you’re looking for immediately, maybe even in your lifetime, but that shouldn’t lead to cynicism, pessimism or walking away from the work. You have to stay in that work for the long term.

Patrick Verel: The thing that keeps coming up is this notion of the fear of the other. It’s something that is, like I said, it’s not new. We experienced before. It seemed like we sort of got a little over it. Now we’re right back where we started it seems like. Any idea why?

Gregory Acevedo: One of my favorite scholars in this area, when he writes about actually the history of the war on poverty. There’s this big debate, the war on poverty was a success, was it a failure, et cetera. I think he reframes it in an important way where he says, “History, U.S. social policy history is really a continuing history of reform and reaction.” It really is this like a few steps forward, a few steps backwards and maybe in the long rhythm of time, you’re moving forward. But we truly, we have these regressive periods where we really do turn the clock back and, unfortunately, return to some past ways of thinking and doing. They’re never fully gone. There’s always some tinge of nativism that’s out there.

Then global events and other events and national kinds of currents change and it sparks up and it’s back again. You can say this about almost any major policy issue in U.S. History. There’s a quote I use a lot in class. I think it was Karl Deutsch from the Harvard School, Kennedy School of Government. He talked about how U.S. social welfare policy history follows the random walk of a drunkard. They think they’re moving forward, but they’re stumbling from side to side. Sometimes they’re even moving backwards. They might fall on their face. They have to get back up again. It is, it’s one of those times when I think we’re taking a great step backwards unfortunately.

Patrick Verel: When you talk about the work that you’re doing, how much of that is discussed, this notion that, “Okay, we take two steps forward on this issue, but sometimes we take one step back”?

Gregory Acevedo: I mean, I think it’s almost natural that that topic comes up. It’s based really on a generational point of view. If you’ve been around a while, you’ve seen these things before. Many of my students are younger. They weren’t even born during the Reagan years. Yet, I see many parallels between the Trump administration and the Reagan administration. I think that is just naturally in the minds of many folks who do this kind of work. It’s that idea that we’re still working on Dr. King’s Dream. You really have to be vigilant. This work has to be ongoing ’cause it’s so easy to slip back and go back to an earlier period.

Extra Track

Patrick Verel: It’s been estimated that between 114,000 and 213,000 Puerto Ricans will move to the U.S. mainland over the next 12 months as a result of the devastation of Hurricane Maria. I would imagine many of them will move here to New York City. What should those in social services working with that population be paying close attention to?

Gregory Acevedo:Ā I think some of the central issues are trauma, which, thankfully, these days in terms of providing particularly mental health services, has become an important aspect of how we think about how we do our work. These days, many things go under the moniker of trauma informed or practice, for example. This idea of trauma, I think social workers and mental health practitioners, many of them will have that already in their toolkit and to recognize that there is layers of trauma involved here. There is the trauma of the actual hurricane and the devastation and dislocation of that. There is the trauma of the reaction of the United States and the lack of provisioning and care and the kind of like dealing with the crisis once the hurricane happened. Then there’s the trauma involved of being uprooted, having to move perhaps when you didn’t want to, relocating to a place that you hadn’t even planned for. There’s a big thing in the literature on migration that the longer you have to plan and the better the plan and preparation you have to migrate, the more it lowers the stressor involved in migration.

Being unprepared, being dislodged, having to do it without doing it voluntarily but involuntarily, I think the level of trauma is really high for a lot of Puerto Ricans. Then there’s the continuing kind of traumatic experience of almost being shunned and ignored by your own country, which I think is shameful. I think that that’s very real to many Puerto Ricans and yet for many Americans who are not Puerto Ricans, I don’t think it’s something they fully fathom or understand.

And there’s the concrete services that are needed. Places to stay that are long-term, not just sheltered. If people want to relocate and stay for a long time, what are they doing to need? Connecting up with schools, with other services that are needed.

I really do think it’s being attuned to the fact that there’s going to be this need for these concrete services and there’s going to be this need for the mental health and behavioral aspects that are involved. I think that’s what mental health practitioners probably need to be most attuned with when it comes to working with Puerto Ricans who’ve been basically dislodged by the hurricane. It’s kind of like an exile of sorts where you’re not quite sure when you can go back, right? And so, when will Puerto Rico be up and running again? I mean, it is for some folks, right? It’s like anywhere else where if you’re probably in San Juan and some of the more urbanized areas, things are probably better off than if you’re elsewhere. Of course, those who have already had more resources and privileged are probably doing better than those who don’t. I think that’s another thing that we need to account for. There’s a certain type of Puerto Rican migrant that’s going to come to the United States, and its a lot more about issue of resourcing than anything else.

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