Immigrants’ Access to Mental Health Services in New York State: Barriers and Recommendations
| Contact Adam Gurvitch: agurvitch@thenyic.org.
OVERVIEW Research shows that stress and other predictors of mental health and substance abuse problems are consistently high within the immigrant population. Immigrants and refugees are frequently the survivors of trauma in their home countries, and experience high levels of economic and social marginalization intensified by communication barriers once in America. The lack of availability of adequate mental health services in languages other than English, coupled with under-utilization of available services by immigrants in general resulting from fears, costs, and stigma, point to an area of fundamental need in New York COMMUNICATION BARRIERS In general, the mental health service delivery system that has been created in the U.S. has not adapted to the needs of immigrants. The enormous shortage of trained bilingual counselors, therapists, and social workers make it impossible for many limited-English-proficient New Yorkers to obtain referrals and timely, appropriate mental health services. This situation has been made worse by the almost complete absence of trained medical and mental health interpreters in New York’s clinics and hospitals. While mental health services are unfamiliar or culturally suspect to many newcomers, the fact remains that immigrants who seek care or are referred for such services typically face waits of weeks and months to be seen by a provider who can speak their language. It is clear that the proportion of mental health professionals who render services in a language other than English falls far short of current needs, and will constitute a critical service gap for many years to come. IMMIGRANT CONCERNS More than two of three uninsured adults in New York are immigrants. While immigrants are as likely to be employed as native-born New Yorkers, immigrant workers are less than half as likely to receive health insurance coverage through their employers. Immigrants are also faced with a set of distinct concerns that severely limit their access to needed care - few immigrants understand their rights to mental health care, including counseling and treatment services, many are low-income and lack insurance, and most are unaware of the options for affordable care such as sliding-scale fees. Significantly, many immigrants - legal and undocumented alike - are afraid of perceived immigration consequences of using various services and benefits. The immigration status of parents constitutes a well-documented barrier to care for children, even when these children are themselves U.S. citizens. Many immigrants avoid enrolling in public programs or accessing the health care safety net due to a belief that doing so will interfere with their ability to sponsor and re-unite with close family members such as spouses, children, and parents who live abroad. Immigrant households are also increasingly concerned about the possibility of data sharing among health providers, public programs, and immigration authorities, which adds to the chilling-effect of policies directed specifically at immigrants such as public charge, sponsor liability, and restrictions on eligibility. DEMOGRAPHIC CHARACTERISTICS According to Year 2000 Census, immigrants comprise 36 percent of New York City’s population, and immigrants and their children account for almost two-thirds of the City’s population, and just over one-third of New York State’s. Forty-seven percent of New York City households speak a language other than English at home, and more than one-quarter of the City’s residents are limited-English-proficient, meaning that they would not be able to undergo a psychiatric evaluation, crisis intervention, or counseling using English. Among New York City’s 3 million immigrant residents, roughly 500,000 are undocumented immigrants who are categorically barred from public insurance in Medicaid and Family Health Plus. RECOMMENDATIONS The following policy recommendations are aimed at improving access to mental health services for immigrant New Yorkers; the recommendations focus on how to increase access to qualified bilingual providers, and address the problems of millions of uninsured community members:
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