Beyond access: Psychosocial barriers to undocumented students’ use of mental health services

Abstract

Rationale: Little is known about how undocumented immigrants navigate healthcare utilization issues apart from access. Objective: We examine a unique population of undocumented immigrants who have access to healthcare -college students at the University of California -to identify how immigration status hinders mental health service utilization in the absence of barriers related to eligibility and insurance coverage. Method: We conducted semistructured interviews between March and July 2017 with 30 undocumented students at a University of California campus. Results: We argue that undocumented immigration status informs mental health-related illness cognitions to negatively affect students' ability to assess their own mental health and need for services. Students expressed low perceived need because they normalized mental strain as a natural product of their unstable immigration status. Many viewed treatment as futile because it could not address underlying immigration-related issues. They also anticipated stigmas associated with mental illness as well as their own undocumented status. Conclusion: Solutions to address utilization disparities must go beyond eliminating formal barriers to health access and address such psychosocial barriers, as well as the larger political and social context that produces them.

Undocumented migrants in the Netherlands: adverse life events, living conditions and mental health

“…Several other studies have emphasized the vulnerability of UMs and refugees to physical and sexual assault. (5,27,36) Counterintuitively and contrasting with the subjective experience of UMs themselves as found in other studies,(7,8) we found no significant correlation between poor living conditions and mental health. This may be related to the relatively small sample size in our study.…”

“…(34) On the other hand, the stigma associated with psychological difficulties might have led to an underestimation of the prevalence of mental health problems in our study due to underreporting. (7,8,16,35)…”

“…(2) UMs consider mental health problems as a direct result of their poor living conditions and illegal status. (7,8) Dutch health care professionals confirm that stress, traumas, sleeping problems and gloominess are more common than in the general population. (3,9) There is ample evidence on the prevalence of potentially traumatic experiences in refugees.…”

“…(7,9) In addition, UMs often consider mental health care unlikely to be beneficial in their situation and therefore see it as a last resort, after seeking support from friends or in religion. (7,8)…”

“Waking Up Every Day With the Worry”: A Mixed-Methods Study of Anxiety in Undocumented Latinx College Students

“…This macrosytemic context has shaped societal attitudes toward immigrants, resources, and the opportunity structure for students (14) and has implications for a host of outcomes including educational trajectories and psychological wellbeing (23). While recognizing the extraordinary resilience of undocumented youth, the stressors they are facing at this macrosystemic level place them at heightened psychological risk (12,14,23,24).…”