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Building a mental health support system for immigrants and their families

Flickr user masha_k_sh

This past summer thousands of women and young people flooded over the border -- seeking to escape terrible violence in South and Central America. Many who came brought little with them, but they carry emotional baggage. And that’s where mental health counselors step in -- to help the recently arrived deal with the trauma they’ve faced, and even to help convince American courts to let them stay. But there are a lot of barriers to good mental health care for immigrants.

Dr. Barbara Waterman is a clinical psychologist who works with immigrants in Oakland. She’s showing me the sand trays she uses for sand play therapy. She uses other unconventional tools too -- the drawers and shelves of her living room, which doubles as her office, are filled with figurines and toys.

With these toys children create a scene that Waterman can then analyze for psychological meaning. She says that sand-play therapy is like “a person creating a waking dream.”


“It’s very much like a manifestation of unconscious matters,” she says.      


But these children and the families she sees are not living in a dream. They are in very real danger of having their families split apart. Waterman works with families where a U.S. Citizen is at risk of having a non-U.S. Citizen spouse or parent deported. Let’s say a woman has a non-U.S. Citizen husband who is going through deportation proceedings -- Waterman interviews the woman and her family to evaluate the psychological trauma that would be caused by the deportation of the woman’s spouse. Then, Waterman testifies in court. An undocumented person can stay in the U.S. If they prove it will cause significant hardship to them and their family.


“My first case ever was a woman who had serious cancer," Waterman says.


At the same time, her husband was up for deportation.


“And so in addition to having me evaluate the family for the mental health aspect, she was also submitting papers from her oncologist to show that it would be a tremendous hardship if her spouse couldn’t stay here.”

The courts allowed him to stay. Still, it can be difficult to watch families struggle through deportation proceedings. Especially since it can often take months for a case to be resolved. But there are happy endings -- like in an asylum case she remembers vividly.


“This woman had just suffered so much in Guatemala, because of the Guatemalan Civil War, because of family sexual abuse, because of family domestic violence ... and she was granted asylum. She just wept in relief that she could feel safe again and stay in this country.”

Those lovely moments -- of connecting with a client, of providing comfort and relief -- are few and far between. The fact is, many immigrants and refugees arrive carrying deep trauma.

“They were born in refugee camps or were expelled from their communities, their homelands,” Lauren Markham says. She’s the community school manager at Oakland International High School, where all the students are immigrants and English language learners.

“They were stalked by gangs, they were raped, they were persecuted because of their religion or their ethnicity. They were forced out of their countries,” Markham says.

The school provides counseling so students can talk about the trauma they have been through, but counseling can be scary and new. Many of these students aren’t just dealing with the traumas that brought them here -- they are also going through deportation proceedings or watching family members go through deportation proceedings.

“So the idea of going to court is really scary. And then, of course, there's the idea of being deported if they are genuinely fleeing danger, which the vast majority of our students who are unaccompanied minors are they are really feeling legitimate danger. The idea that you will go to court, have this super scary experience in court, and high stakes that you could be deported back to this danger. It’s pretty horrifying and terrifying,” she says.

Imagine being a teenager in a strange land. And on top of that, you have to deal with the stress that you might be sent back to your homeland - a place where you experienced so much trauma. It would definitely be difficult to pay attention in history class. Beyond the stress of deportation, Markham says, is the stress of getting counseling. It can even be a challenge to find a counselor you can understand.


“There are just not enough bilingual counselors, so there are not enough counselors who speak enough languages.”

The students of OIHS speak more than 32 different languages -- everything from Spanish to Arabic. Markham says that leaves a lot of students with literally no one to talk to. Psychologists can use nonverbal cues, but without cultural, and actual literacy, it’s almost impossible to treat someone you can’t understand.

“I think that we really need to encourage linguistically and culturally diverse people to go into the field of counseling. Because if you don’t have counseling in someone’s language, how are they going to get counseling?”


And it’s not just language differences -- many of Markham’s students come from places that don’t look kindly on counseling.


“In a lot of cultures where our students are coming from the idea of mental health is really stigmatized. It’s like, 'mental health equals crazy person. Counseling equals you are crazy and you need a doctor for your brain.'”

Markham and the other staff at OIHS have worked hard to change that perception. Out of 400 students, about 80 have accepted counseling. And the more people that go to counseling -- the more it becomes normal for others.

“So, when they are like, ‘Oh it’s not just me the crazy kid, it’s like all of these students here,’ I think that helps,” Markham explains.

Culture can cause some immigrants to feel shame about seeking out counseling. It can also shape how someone views the world and the best way to heal. Some were not raised to think that talking about the past solves problems. Despite the challenges of providing mental health care to immigrant populations both Markham and Waterman say it’s worth it.

Back at her office, clinical psychologist Barbara Waterman says her work isn’t just about helping people, it’s also about learning from her clients.


“In this work I get to see all the diversity and all the richness of different cultures, but I also get to see how we are all essentially just human beings, and if people could see what I see, I think they would be more likely to try to make a bridge across cultures, between differences, rather than have conflicts about it.”

Every person has unique experiences but we are all capable of helping each other heal. By being sensitive to the languages and cultures of clients, mental health providers can be a support system for immigrants in a very scary time of their lives. These providers realize that, sometimes, the best way to begin healing is to have someone who is just willing to listen.

This piece is part of a series of stories, "Waking up to the American Dream," created by student journalists at Mills College in Oakland.