Barriers to Help-Seeking Among Immigrants and Refugees

Originally published in NASW-NJ FOCUS, January 2022

By Elma Kaiser, Ph.D. MSW & Zakia Clay, DSW, LCSW, CPRP

The steady influx of immigrants and refugees seeking opportunities and a better life in the United States has garnered much attention in political and social arenas. Sadly, less consideration is given to the stories and experiences of those who leave their native country. Some immigrants come to the U.S. by choice, while some flee their countries due to fear and violence. Some come here legally with approved and established privileges, while others do not. All these circumstances influence their acceptance and rights in the host country. However, irrespective of their path to the U.S., many immigrants and refugees encounter discrimination while trying to settle and build a new life.

The period before and during migration can be traumatic for many immigrants and refugees. They may experience physical and sexual violence, have life-threatening encounters, or be threatened with persecution. 1 The deplorable and inhumane conditions at Immigration Customs Enforcement detention centers have been well documented and underscore the trauma that can ensue for some following arrival. In recent years, there has also been an uptick in xenophobia and disparaging political rhetoric that contributes to stress and anxiety among immigrant communities. During resettlement, language barriers, family separation, and changing expectations around gender roles can all become salient determinants of physical and mental health outcomes. 2

Many immigrants and refugees hold on to their culture, religion, and traditions as they provide a sense of identity and security. Yet, continuing to embrace native beliefs and practices can contribute to prejudice, stereotypes, and discrimination. The juxtaposition of these factors can lead to insecurity among immigrants and refugees alike. It is important to understand that these individuals face multiple jeopardies during their process of relocating from their current familiar environment into a new one. In response to these external factors, many immigrants and refugees begin to disassociate themselves from their own culture and identity in hopes of acceptance in their new environment. During the process of dissociation, individuals can be left confused, desolate, and alienated from both their previous and current communities. These physical and psychological changes can contribute to a complex level of anxiety, depression, and other mental health issues among many immigrants and refugees.

Immigrants and refugees face various obstacles that prevent them from receiving adequate health care including cultural, social, and structural barriers. The migration process can be a risk factor in developing mental health issues causing significant trauma affecting both immigrants and refugees. The combination of various migration stressors and culture can create a different level of mental and physical health issues making it challenging for individuals to assimilate. Some migration stressors impacting immigrants and refugees include language barriers, lack of employment, social isolation, industrialization, legal status, family conflict, role changes, discrimination, racism, and xenophobia. 3 When immigrants and refugees are impacted by these stressors, they develop both mental and physical complications. Additionally, these stressors can hinder engagement in health care services.

As mentioned, many immigrants and refugees hold on to their strong cultural beliefs. They believe in their own traditional treatment and may refuse to comply with mainstream health services, not only because of cultural influences, but also due to lack of trust in the system. 4 Furthermore, there are many cultures where mental health is unexplored, creating an environment where mental health concerns are not addressed despite continued growth in these problems. Mental health issues are also highly stigmatized in some cultures making it difficult for individuals to feel comfortable reaching out for the help they need. 5

Immigrants and refugees with lower education levels, lesser knowledge of health care systems, and language barriers face even more challenges in receiving services. This can cause a significant hindrance when clients seek health services, especially when many of them may not have access to or knowledge of technology. 6 There are immigrants and refugees moving from lowtech environments with limited or no access to electricity, to high-tech, busy urban environments. Many immigrants and refugees live in areas that are medically underserved in the U.S. Lack of transportation, lack of health insurance, long wait times, lack of physicians, etc. are also major factors in many of these communities. Research shows they are victims of institutional discrimination. 7 They are also unable to get services due to lack of financial resources. 8

In social work, we pledge to engage in culturally competent practice, yet this may not be enough to meet the needs of immigrants and refugees in our communities. It can be easy to be complacent and trust that simply satisfying our profession’s continuing education requirements for cultural competency will suffice in preparing us to work with immigrants and refugees. However, it is important we listen to the narratives and stories of these individuals. Taking additional time to provide a space for immigrants and refugees to share the nuances of their lived experiences and how they are adjusting to a new country is warranted. It is important to understand the various layers of adjustment they have had to face. From the migration process to assimilation and acculturation and experiences with discrimination, they find themselves in battle with their new environment; they are exposed to these stressors over a long period of time. This places a toll on their overall physical and mental health, in ways they have not encountered before. It is very important for practitioners to understand the complexity behind these issues.

Social workers must be aware of these challenges and be sensitive towards the needs of those who face these issues to work effectively with immigrant and refugee populations. Well-prepared, culturally competent, and sensitive clinicians who can attune themselves to the culture, traditions, and lived experiences of immigrants and refugees— from experiences in their home country to their migration journey, to their experiences upon arrival in the U.S.—can help ease the client into the therapeutic process and provide a healing environment that feels both safe and affirming.

About the Authors:

Dr. Elma Kiser is an Assistant Professor at Fairleigh Dickinson University’s Master of Social Work Program. Her research interests include international social work, diversity, violence against street children, gender-based violence, displaced populations, underprivileged children, mental health of minority women and adolescents, and macro-level social work.

Dr. Zakia Clay is an Assistant Professor and the Director of Field Education for Fairleigh Dickinson University’s Master of Social Work Program. She is also a licensed clinical social worker who practices in New Jersey.

References

Sangalang, C. C., Becerra, D., Mitchell, F. M., Lechuga-Peña, S.,Lopez, K., & Kim, I. (2019). Trauma, post-migration stress, and mentalhealth: a comparative analysis of refugees and immigrants in the UnitedStates. Journal of immigrant and minority health, 21(5), 909-919.

Williams, D. R. (2018). Stress and the Mental Health of Populationsof Color: Advancing Our Understanding of Race-related Stressors.Journal of Health & Social Behavior, 59(4), 466–485. https://doi-org.libaccess.fdu.edu/10.1177/0022146518814251

Potocky, M & Naseh, Mitra (2019). Best practices for social work withrefugees and immigrants (2nd ed.). Columbia University Press, NY.

Pavlish, C. L., Noor, S., & Brandt, J. (2010). Somali immigrant womenand the American health care system: Discordant beliefs, divergentexpectations, and silent worries. Social Science & Medicine, 71(2), 353–361. https://doi-org.libaccess.fdu.edu/10.1016/j.socscimed.2010.04.010

Disney, L., Mowbray, O., & Evans, D. (2021). Telemental HealthUse and Refugee Mental Health Providers Following COVID-19Pandemic. Clinical Social Work Journal, 1–8. https://doi-org.libaccess.fdu.edu/10.1007/s10615-021-00808-w