Immigration enforcement impacts physical, mental health, study says

Immigration enforcement impacts physical, mental health, study says
(August/September 2009 Issue)

By Pamela Berard

A new study is investigating whether fear and anxiety stemming from increased immigrant enforcement efforts and other policies are keeping immigrants from seeking health care.

The Institute for Community Health, based at Cambridge Health Alliance, a Harvard-affiliated public healthcare system, was awarded a $50,000, one-year Harvard Catalyst Pilot Grant to study the "Impact of Immigration and Customs Enforcement Efforts on Immigration Health."

Karen Hacker, M.D., MPH, executive director of the Institute for Community Health, says her group was approached by a coalition from the city of Everett, Mass., which has seen an influx of immigrants from a number of countries.

"There's been an effort in Everett to really try to bring together their community," Hacker says.

"One of the things (community leaders and organizers) have begun to hear, particularly with recent ICE raids, is that there was a heightened level of anxiety," and that immigrants - both documented and undocumented - weren't keeping up with doctors appointments, prescriptions and other primary health or emergency room care, Hacker says.

"Clearly, if you identify somebody as different, both because they can't necessarily speak English that well and because of the way they look, there's a ripple effect there."

Hacker says recent state health care reforms and changes in insurance can be confusing for anyone to navigate.

"And for a lot of new immigrants, whether they are undocumented or documented, they don't know the level of detail that someone growing up in this country understands about how this country works," she says. "And (the information being presented to residents) isn't always necessarily clear."

Furthermore, undocumented immigrants are hearing word-of-mouth stories about people being deported and are experiencing anxiety that they may be targeted. Documented immigrants fear for family members or friends.

Cultural barriers also exist - for example, not all cultures understand the concept of preventative care and may think, "Why would you go to a doctor if you aren't sick?" Hacker says.

Her team is working with five organizations that represent immigrants as well as a number of community agencies in Everett. The study uses community-based participatory research methodologies and organizers conducted small focus groups with Everett immigrants in Spanish, Portuguese, Haitian Creole, Arabic and English. Hacker says her group is currently doing analyses on that information.

The study is also surveying health care providers and interviewing stakeholders; and later, will join focus group participants and stakeholders to discuss interventions to improve the situation.

Bob Marra, director of the Everett Community Health Improvement Partnership, which is assisting with the research effort, has worked with several immigration groups and heard first-hand stories about their concerns. He told of one 25-year-old woman from Brazil who is very fearful about being discovered by immigration authorities.

"She's very anxious and depressed," he says. Another woman is afraid to go outside, for fear of deportation, so she doesn't leave her home.

"These are the kinds of stories that have been relayed in the focus groups we've had," Marra says. "Every focus group we had had some story of stress."

"They are not seeking out (health) care for pretty much anything," Marra says, including mental health concerns. "And with mental health care, for many of them it's more difficult to access," noting the communication barriers and stigma attached to mental health issues. "(Stigma) is a problem for most Americans, never mind people from outside the country," Marra says.