Some days, the stress of figuring out what she needs to do for her immigration case, where to enroll her 11-year-old son in school and how she’ll put food on the table overwhelms Guadalupe, a 26-year-old single mom from El Salvador, to the point that she can’t think clearly.
So at her cousin’s house in Houston she would practice deep breathing, a technique a psychologist taught her while she was living at the Matamoros, Mexico, tent camp from January 2020 until March of this year.
The past words of encouragement from her therapist fill her mind: ” ¡Ánimos!” she would say, continuing in Spanish by saying, “You are a fighter and you can get through any situation.”
Guadalupe, who did not want her full name to be used for fear of reprisal if she does not win her asylum case and is sent back to El Salvador, is one of more than 70,000 asylum seekers who were stuck in Mexico under the Remain in Mexico program, also known as the Migrant Protection Protocols, which were launched by the Donald Trump administration in January 2019 and forced asylum seekers to wait in Mexico while their cases were pending in the U.S. immigration system.
In February, the Department of Homeland Security announced it would begin processing asylum seekers and allowing them to enter the United States while their cases were pending, fulfilling a campaign promise by President Joe Biden to end the Trump-era program. In March, Guadalupe and her son entered the U.S. to live with family in Houston.
On Tuesday, Reuters reported that the U.S. had formally ended the Trump-era policy. Still, Guadalupe continues to report feeling anxious on a daily basis both because of the violence she experienced by kidnappers in 2019 and the new challenges that migrants face in a new country. But, thanks to the mental health care she received at the border, she is better prepared to handle the hardships and frustrations that come her way.
Immigration advocates lauded the decision to end the Remain in Mexico program as a positive first step toward a more humane asylum policy at the border. Yet others who were enrolled in the program are still stuck in Mexico, extending their uncertainty and anxiety. Health care workers, psychologists and immigrant advocates warn that the mental health toll of the previous policy can lead to long-term consequences even after migrants have entered the U.S.
“What worries me the most is their emotional state,” says Mileydis Tamayo Salgado, a Cuban nurse who worked at the Matamoros tent camp with the nongovernmental organization Global Response Management. “There are some people who put on a strong front, who try to think positive, but there are others who feel like they can’t go on anymore.”
The High Risks of Developing Mental Health Issues
Asylum seekers and refugees are among the most vulnerable to mental health issues. They have often witnessed and fled extreme violence only to end up living in a place just as unsafe. Inequality, exposure to violence, and an unstable living situation are all risk factors that increase the chances of developing depression, anxiety or other common mental health issues, according to the World Health Organization.
More than 20% of people living through conflict experience these symptoms. The United Nations High Commissioner for Refugees (UNHCR) estimates that figure is two to three times more than the general population.
If untreated, mental health issues in migrant and refugee populations, including post-traumatic stress disorder, can lead to chronic health problems even after resettling in a new country, according to Edgar Jones, professor in the history of medicine and psychiatry at King’s College London. “If trauma is not addressed in a reasonable amount of time, people begin to suppress the traumatic memories in order to be able to cope on a daily basis,” he says. “This takes a lot of energy, so the trauma tends to reemerge in physical form as headaches, bodily pains, poor sleep, irritability, difficulty concentrating.”
Patients can begin to show signs of improvement between six to 16 weeks after beginning mental health treatment, although each patient is different, Jones says. These improvements can have an enormous impact on their lives, increasing their confidence, sense of self-worth and ability to get a well-paying job, which in turn helps them create a more stable environment for their families.
Guadalupe thought she was leaving her stress and suffering behind when she fled El Salvador in August 2019 when the gang that controlled her neighborhood tried to recruit her son. But her troubles did not end once she reached the border a few weeks later. The Remain in Mexico policy prevented her from entering the U.S. while she pleaded her asylum case. The Department of Homeland Security said the program would ” restore a safe and orderly immigration process.”
But journalists and human rights groups quickly began documenting reports of extreme violence against migrants in the program, including at least 1,500 rapes, kidnappings, extortions and other violent assaults. On the way to her court appointment in September 2019, Guadalupe and her son were kidnapped by armed men who demanded thousands of dollars in ransom for her release. She doesn’t know why, but they let her and her son go. Still, they threatened to kill them if they ever saw them again.
After the kidnapping, Guadalupe says she rarely had energy for daily activities and “didn’t feel like doing anything” — clear signs that the trauma she experienced was harming her mental health.
A Mental Health Crisis for Refugees
A report from Human Rights Watch, Stanford University’s Human Rights in Trauma Mental Health Program and Willamette University’s Child and Family Advocacy Clinic found that the Remain in Mexico policy subjected … “children and adults to serious, ongoing harm” and that “violence and hardships in Mexico take a toll on mental well-being.”
About 60% of migrants and asylum seekers at the U.S.-Mexico border show signs of anxiety, according to Nora Valdivia, the mental health supervisor for Doctors Without Borders (MSF) in Mexico, which provides health services to migrants in Mexican border cities. Depression and post-traumatic stress are also common, although the organization does not have exact numbers on the prevalence of these mental health conditions, according to Valdivia. Refugee populations worldwide reported a high incidence of mental health issues during the pandemic, according to a WHO survey of 30,000 refugees, in which the majority of participants reported feeling stressed, irritated and hopeless.
Historically, more immediate humanitarian concerns such as food and shelter have taken precedence over mental health care for migrant and refugee populations. “Before the pandemic, refugee mental health was a severely overlooked and under-prioritized issue. Now it is a full-blown crisis,” UNHCR psychiatrist Peter Ventevogel said in an interview published by the U.N. refugee agency.
MSF and other health organizations in Matamoros recognized the importance of mental health care for migrants even before the pandemic. “The body can get sick from so many emotions that aren’t expressed and dealt with,” Valdivia says. “They (asylum seekers) need to be heard, and feel validated and supported, and that’s where our team of psychologists come in.”
As Guadalupe’s case shows, treating mental health can have an impact that extends beyond the time that migrants spend in refugee camps.
In Matamoros, as Guadalupe struggled with a loss of appetite and difficulty carrying out her daily tasks, she learned of mental health care services that were available to asylum seekers like her through MSF. Guadalupe soon began one-on-one counseling sessions with a therapist trained to address the issues of asylum seekers.
In addition to counseling, MSF also provides group therapy (following social distancing guidelines) to hundreds of asylum seekers. MSF staff have carried out more than 3,100 mental health sessions in Matamoros and nearby border city Reynosa from January to August 2020, according to the latest statistics shared by the organization.
Helping migrants with their mental health presents its own challenges, since many migrants are resistant, in part because of a deeply ingrained societal stigma and general distrust, according to MSF’s Valdivia.
To overcome the challenge of mental health stigma, MSF workers carry out daily talks in the camp related to mental health. They point out potential signs of depression, anxiety or post-traumatic stress: headaches, trouble sleeping or a loss of appetite.
These talks and their consistency have allowed MSF to build trust with migrants and correct common misconceptions they may hold regarding mental health care as a service for “crazy people,” according to Valdivia.
Once they trust the psychologists, asylum seekers like Guadalupe open up to the process. “There were so many things that we lived through, and there was always someone there to say, ‘You can’t get discouraged. You have to keep going,’ and to make you feel like there are reasons to carry on,” Guadalupe says.
On top of breathing exercises, the MSF psychologist often encouraged Guadalupe to find joy in the little things in life, like singing and dancing, and to express her emotions instead of holding them in. “I always remember what she would say to me,” Guadalupe says. “There are days when you have your ups and downs and when you don’t know what to do, but there is always a way out.”
Global Response Management (GRM), which also works in Matamoros, has also provided mental health services to migrants there. They hired many doctors and nurses who are asylum seekers themselves and can better relate to patients.
Mileydis Tamayo Salgado is a 50-year-old nurse with GRM who fled Cuba last year. She has since been able to enter the U.S., but while working in the camp, she also dealt personally with the psychological impact of spending more than a year stranded in Matamoros. “As a migrant I identify with the situation of everyone in the camp because it’s truly painful what we are going through,” she said in September while still in Mexico. “I try to talk with them and give them a positive outlook.”
Another member of the camp, a mother who agreed to be identified as Lorena to protect her identity since she fears for her life in her native Mexico, says she often takes off running down the Rio Grande when she feels overwhelmed by the weight of her husband’s murder in Guerrero, a state on the country’s Pacific coast, and her yearlong wait for the chance to seek asylum.
Before she met the doctors in the camp, she wouldn’t have thought twice about how she was feeling, let alone try to go to therapy. Now, she realizes the importance of taking care of her mental health, both for herself and her family.
Her 11-year-old son Jose, whose name has also been changed for his safety, has also been struggling with nightmares and depressive moods. “If I don’t receive treatment, how is my son going to move forward?” she asks.
Many parents at the camp say their children have frequent nightmares, wet the bed and exhibit rebellious behavior, all signs of increased anxiety and fear, according to a January 2021 Human Rights Watch report.
Children like Jose show the symptoms of trauma in different ways, so MSF tailors its mental health treatment through interactive games and activities since children can struggle to express their emotions through words, explains Valdivia.
Although MSF does not have data on the outcomes of its mental health programs at the U.S.-Mexico border, past research has shown play therapy to be effective in helping refugee children deal with their mental health challenges. A 2020 study on a “theraplay” program for refugee children in Turkey showed that it improved their mental health, particularly related to post-traumatic stress. A 2018 study of North Korean refugee girls in South Korea showed play therapy led to ” reduced symptoms of anxiety and depression.”
Anecdotally, MSF reports that its mental health programs strengthen the ” desire to continue living and fighting” for women such as Guadalupe. Similar mental health programs for refugees in Iraq and San Diego that focus on understanding their specific challenges of refugees have also reported positive results.
Valdivia knows the patients at the camp won’t be there forever. The goal, she says, is to “reduce symptoms and teach them to handle situations that come up.”
After staying with her cousin in Houston for a few weeks, Guadalupe decided to move to Los Angeles, where an uncle and more family friends live. All the preparations — calling a lawyer about her immigration case, figuring out if flying is possible with her current immigration status, then actually booking the flight — was enough to make her heart race.
But she remembers what her psychologist told her: “Inhale, exhale.”
Photojournalist Lexie Harrison-Cripps contributed reporting.
This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, http://solutionsjournalism.org.
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Migrants Learn to Confront Lingering Mental Health Issues That Come With Uncertainty originally appeared on usnews.com