Migration and Mental Health: a Discussion

Stability and safety are two goals that all human beings strive towards. As humans, we are constantly trying to make sense of the world and long for a sense of 'normalcy' in our day to day lives. Migrating out of what we call home into a new environment, with new people and surroundings disrupts these needs. People migrate for a variety of reasons. Some of them include, the search for a safer living environment, to escape conflict, or for a economic reasons. Regardless, leaving what is familiar puts us out of our comfort zone and can have various health impacts, especially in relation to our mental health.

At its core, human migration means the movement from one country or place to another (Blakemore 2019), which can include those seeking refuge. When moving from place to place, migrants face a risk of uncertainty and instability. On top of that, there can be a sense of a loss of community ties and belonging. All of these factors impact everyone differently, but can have detrimental health impacts on many. According to the World Health Organization (WHO), refugees, asylum seekers, and irregular migrants are at a higher risk for certain mental health disorders, including post-traumatic stress, depression, and psychosis. Compared to the rest of the population, refugees have three times higher rates of depression and anxiety (WHO 2017). Migration itself can already have stressful physical impacts on the body by enduring harsh travel conditions. Additionally, the lack of access to health promoting necessities can have lasting mental health impacts that are often looked over. On top of greater risk for mental disorders, migrants frequently also have a lack of access to health facilities in the countries they migrate to. Most countries have limitations of healthcare access for migrants, especially undocumented migrants. In the United States of America, undocumented people are not allowed to apply for Medicare or Medicaid for the most part. The only option for healthcare coverage in the USA as an undocumented person is to purchase unsubsidized insurance, which can be a large expense for an individual or family attempting to resettle in a new country (Uhler 2019).

In most European countries, access to healthcare is typically granted to asylum seekers and refugees, but undocumented migrants only have access to emergency healthcare services, which does not include mental healthcare (Winters et al. 2018). The only real exception being volunteer-based organizations that work to increase access to care for undocumented individuals. To make matters worse, applications for legal status can take months to process and approve, if approved at all. This means that even if migrants attempt to work with the system and jump through its hoops, as encouraged, many will not have access to healthcare services for months after their arrival, and that is if their application for legal status is accepted. As early treatment is essential to combating mental health issues, lack of access to treatment for months can be detrimental to a migrating person's mental health. A combination of higher risk for mental disorders and a lack of access to healthcare services puts migrants in a difficult position. Choosing to leave one's home and find a community elsewhere is already not an easy decision, and not having access to potentially lifesaving mental healthcare can severely limit one’s ability to cope with a life changing event. An example of the detrimental impacts on a migrating person's mental health are the United States of America's detention centers. The large majority of immigrants held in detention centers are not there because of a criminal offence, but are waiting for acceptance of legal status in the USA (Kassie 2019). The detention centers frequently provide inhumane conditions for immigrants, including children who are separated from their families. Unsurprisingly, those in the detention centers mostly do not receive access to any form of healthcare and enduring such unethical conditions only makes matters worse. The amount of emotional distress from being separated from one's family in a foreign country, living in a packed and volatile environment, and the treatment endured in these facilities could only bring about harm to one’s mental health, especially that of children.

In conclusion, migration, to most human beings, is a stressful event and when migrants are at higher risk for mental disorders, not having access to proper healthcare can have harmful long term implications for one's health as well as one's process of adapting to a new environment. Although the topic of migration and legal residence continues to be a controversial topic, policy makers and those implementing them need to be reminded of the fact that everyone deserves access to high quality health services; and no healthcare system can be universal without providing services to all inhabitants of a country. Mental health on its own is just recently being discussed more openly, and even more so related to a pressing topic, such as migration. Beyond physical health, mental health needs to be addressed when discussing overall health and wellbeing of migrants. Focusing on the mental health of migrants would work to greatly improve migration experiences and ease the stress of integrating into a new environment. At the core of what is ethically just, and beyond political differences, access to high quality healthcare should not be a matter of legal residence status, but of human rights.

Josie Allen Young Leaders for Health

References:

Blakemore, E., 2019. Human Migration Sparked by Wars, Disasters, and Now Climate. Migration facts and information. Available at: https://www.nationalgeographic.com/culture/topics/reference/migration/ [Accessed April 14, 2019].

Kassie, E., 2019. How the US Built the World's Largest Immigrant Detention System. The Guardian. Guardian News and Media, Available at: https://www.theguardian.com/us-news/2019/sep/24/detained-us-largest-immigrant-detention-trump [Accessed September 24, 2019].

World Health Organization, 2017. Migrant Populations, Including Children, at Higher Risk of Mental Health Disorders. Available at: http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/news/news/2017/04/migrant-populations,-including-children,-at-higher-risk-of-mental-health-disorders. [Accessed September 24, 2019]

Uhler, A., 2019. Here's How It Works If You're Undocumented and Need Health Care. Marketplace. Available at: https://www.marketplace.org/2019/07/09/heres-how-it-works-if-youre-undocumented-and-need-healthcare/ [Accessed July 19, 2019].

Winters, Ma., Rechel, B., De Jong, L., Pavlova, M., 2018. A Systematic Review on the Use of Healthcare Services by Undocumented Migrants in Europe.”BMC Health Services Research. BioMed Central. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774156/ [Accessed September 27, 2019].