Undocumented Refugees with Serious Mental Illnesses

Elena Cherepanov, Ph.D., LMHC, Certified Trauma Specialist

Cambridge College, Senior Instructor Elena.cherepanov@cambridgecollege.edu

I want to voice my concern about this group of people who fall through the cracks of legal, social and mental health systems. They drift through cities, not mixing up with the crowd, often ignored yet noticed. They can be found in homeless shelters, emergency rooms or on streets. They may look odd, act bizarre, or dress inappropriately for the weather. What's more? There is little way to know what they are up to- many of them don't speak English. When kindred spirits offer them help with housing, social programs, or temporary jobs, they shy away with the slightest mentioning of need to show ID or social security number. They don't exist from the legal, social and psychological points of view: they are in the country illegally; they are "not in the system" since they have neither income nor insurance of any kind; and they carry the stigma of being crazy. Those are the immigrants with serious mental illnesses but without legal immigration status. It has been shown that refugees and immigrants often struggle with mental health problems, steaming from culture shock, history of trauma and hardship, or being victims of violence. Their legal status, nevertheless, allows them to access the health care resources and social programs set up for them in order to prevent development of more severe mental health conditions, re-traumatization, domestic violence and suicides. The illegal immigrant, on the other hand, in many cases can rely only upon themselves, family and community support, and natural remedies in place of professional health care. It creates special challenges for those of them who suffer from serious and persistent mental illnesses such as severe PTSD, schizophrenia, bipolar disorders, or other psychotic disorders. In no way do I want to undermine the possible severity of adjustment disorder, anxiety, or psychosomatic problems. All of these conditions can be quite debilitating. The good news is that in many cases good community support, psychosocial programs, indigenous healing systems, use of the traditional coping skills, such as cultural rituals, as well as traditional values can bring some relief. For the persons with mental illnesses, on the contrary, its vital to have consistent access to the professional, clinical and psychosocial recourses, which includes access to medications. The traditional communities and families just dont have recourses to provide sufficient support to the mentally ill member. Who are they and how prevalent is the problem? Due to understandable reasons, it is difficult to gather any objective data. While estimated rates of depression and PTSD vary greatly depending on the political and socioeconomic context, the rates of schizophrenia, bipolar and other psychotic disorders remain similar: 0.5-2.0 % for each. The levels of

expected severe traumatization are much higher. According to Steven Camarota, the Director of Research at the Center of Immigration Studies, for the March 2005, there were around 10 million illegal aliens in the USA. (http://www.cis.org/articles/2005/back1405.html#author). The modest calculations show that there could be as much as one million undocumented refugees with serious mental illnesses in the USA. The real numbers well never know. They prefer to remain invisible. However, the problem seems significant enough to become a frequent focus of discussions where health professionals consistently share their frustration and helplessness in attempts to help undocumented immigrants with mental illnesses. They report disastrous lack of resources, support and referral systems. If the free care at the emergency rooms can be a solution for certain acute medical conditions, chronic mental illness requires systematic continuity. It is not unusual to take 4-6 weeks for some psychotropic medications just to reach therapeutic levels in blood. There are some organizations, such as Health Care for Homeless programs, which offer access to the psychiatric services and medications, regardless of the immigration status. But they are having a hard time keeping up with providing consistency, continuity and wrap-around services because of unstable and ever changing living arrangements of the homeless. To add to the picture, the refugees often come from the countries with poor health care; where they didnt have access to the doctors, nor have ever been diagnosed or treated. In most cultures mental illness is seen as a shame and stigma not only for the ill person, but for the whole family and even for the entire community. When I was working overseas in the refugee camps, on many occasions I witnessed that even there, where everybody was presumed equally powerless, persons with mental illnesses were ostracized, abused and taken of advantage there more than anybody else. I knew, for instance, one mentally ill person who agreed to exchange his seat on the bus (by giving his name to an other person) evacuating refugees from the camp to a western country for a can of soda. There may be a whole variety of reasons why persons with mental illnesses decide to come and stay in the US. Sometimes they flee their countries because of real or perceived fear. Some believe that they were persecuted. It could be true, but it also can be a delusion -sign of mental illness. One of our clients fled one of the secular Muslim countries out of fear of religious persecution because he believed he was Jesus Christ himself. The subjective value of these experiences does not necessarily coincide with geopolitical assessments of the situation. There is very thin line between imminent threat to life, and the perceived one. Occasionally their families send them, because in the US they treat schizophrenia. Sometimes they come on a visitor visa and overstay it. On other occasions, they come legally on a work visa, then, after the onset of illness, lose their job and, consequently, visa, and choose not to leave. Most often they arrive with their families. While other family members apply and successfully obtain asylum status, the mentally ill family member is incapable of following through with the immigration application process due to mental illness or cognitive limitations. Or the family members decide to exclude mentally ill members from the immigration process because of their unpredictable behavior or legal history that may jeopardize getting the legal status for the whole family.

Sometimes there are no reasons at all. A client once told me that he decided to come here because he heard a voice which told him that this is a right thing to do. I also heard about real miracles, when a person with mental illness passed through border patrol officers without showing any papers, and they, as if being hypnotized, just let him in. Desperate poverty, unhealthy life style, chronic mental illness with added depression, poor social support, being under-medicated all that correlates with the higher potential for drug and alcohol abuse, often for the purposes of self-medicating. If they get into trouble with the law, or arrested, they risk be detained and deported. I received many reports about mentally ill persons in prisons who await deportation. They broke the law, often while off their medications. They werent properly treated in prison and, in the case of deportation most probably wont be able to get treatment in the future as well. UN standards on disabilities identifies people with serious mental illnesses as special populations particularly vulnerable to discrimination. (International Norms And Standards Related To Disability updated by UN program on disabilities in 1995. Part 5). In the current geopolitical climate, they remain the group which falls through the cracks of most of the available systems. This disability is not as visible as other conditions; however it impacts all areas of their life.
There are public debates if the illegal aliens should be given the opportunity for amnesty or not. Those who have serious mental illness may not be able to exercise their choices. I strongly believe that undocumented immigrants must be screened for serious mental health problems while considering detentions, deportations or eligibility for the legal status based on humanitarian ground. They desperately need help, but dont really have the capacity to advocate for themselves, and the system works against them.

Sometimes I wonder what happens to them after they return to their countries. Ive never heard anything back. They just disappear without a trace