The Migration of Mental Health
I am all alone
Stumbling in the dark for a hand
I hold onto a life of in-betweenness
Where I am the bridge between me and what once was a fantasy
All of the pain and sorrow, I guess, is my destiny
Every day I sit in emptiness, but that is the only way to forget
That I am trapped between the snow
In a house that will never be a home
- Written by the Authors
Despite being unexplored within academic discourse, migration may be a causal contributor to worsened mental health status due to the detrimental impacts migration processes can have on migrants’ health. The migratory process is highly complex, interrelated, and incites differing experiences, which may result in a significant toll being taken on individuals, their families and more broadly, their communities. Underlying motivations to migrate differ from person to person, but oftentimes, migration is driven by the possible attainment of improved quality of life, namely in the form of increased employment opportunities or avoidance of persecution. Support systems and social networks serve as migrants’ coping mechanisms when interacting with pervasive stressors that the migration process induces. However, resources are not always readily accessible for migrants, and many may even avoid these resources due to underlying social and cultural stigma that surrounds mental health. Mental health is commonly conceptualized as an individual issue or choice rather than a macro-level societal responsibility. Given this, the multifaceted impacts of mental health are habitually minimized, particularly in the analysis of migratory patterns and trends. The question then becomes, how significant is individual and social responsibility in regard to the burden mental health imposes within migration?
Original illustration by Cassandra Seal
Mental Health and Migration: An Overview
Migration is a heterogeneous process by which all migrants must face various mental and physical burdens either when migrating within a country from rural to urban areas, internationally, or escaping the dangers of civil unrest [1]. As such, the connection between mental health and migration is not explicit and warrants a richer, more holistic approach in order to delineate how these two concepts intersect to impact a migrant’s well-being, health, and success in adaptability to new environments [2; 3]. External and macro-structural factors should be considered as these contribute to the alteration of one’s environment, regardless of whether the initial intention of migration was to seek a better life or not. Prominent factors within countries of origin include war, environmental risk factors, lack of employment opportunities, discriminatory laws, and denominated push factors, for instance, civil unrest [3].
In addition to external circumstances where uncertainty is prevalent, migrants are forced to face the social burden of integration, overcome language barriers, face limited employment and legal aid opportunities, and secure a home in a new environment [4]. Moreover, it is essential to highlight the importance of age and the immense impact it has on the obstacles that various migrant groups face. For instance, the hurdles one faces when migrating as a 60-year-old vastly differ from the challenges a teenager typically encounters [2]. As such, the prominent challenges faced by older migrants may include acquiring legal status, whereas younger migrants cite loneliness, neglect, and lack of social connections as being the most significant challenge during the adaptation process to a new school system [5]. Regardless of age, migrants face alienation and discrimination, which is further exacerbated by mental health’s intangible effects, forcing migrants to face such struggles silently while the world around them moves forward [3].
Availability, Accessibility, and Mental Health Resources
Limited availability and accessibility to mental health services in tandem with the detrimental ramifications that flow from such scarcity result in a stark reality for migrants [2]. Such ramifications are amplified through a migrant’s legal status given that informal migrants and refugee seekers often avoid accessing official government networks and institutions in an attempt to circumvent legal retaliation [6]. Through this, it is elucidated that stigma and fear markedly increase without an opportunity to address them. According to Straßmayr et al. (2012), mental health services for migrants are often forward-looking and geared towards resolving a specific crisis. Hence, forward-looking services are implemented more often compared to those operating retrospectively in an effort to prevent the effects of mental health, leaving struggling migrants on their own [7].
Misconceptions Surrounding Mental Health and Migration
When examining migratory processes and its ramifications, there are various identifiable misconceptions. Mental health is often framed as an independent problem rather than a societal one, which not only dehumanizes migrants but relegates them to feelings of loneliness and helplessness [8;1]. This can be extremely challenging to navigate as destination countries are seldom welcoming and resourceful, especially given the accompanying culture shock. Culture shock refers to the process where an individual experiences a sense of loss or deprivation, confusion in role expectations and self-identity, and feelings of helplessness [1]. Thus, depicting mental health as an individual burden is highly stigmatizing and minimizes the ways for migrants to speak up and receive the proper treatment and care. One prominent reason this may occur is due to the connotations surrounding the word ‘migrant,’ which falsely implies that migration is a choice [8]. Typically, migration is thought to improve access to opportunities and result in an overall better quality of life. Hence, mental health faced by migrants is diminished due to this narrative, ultimately creating barriers in receiving care [9]. Forced migration increases the incidences of worsened health outcomes both physically and mentally. Communicable diseases and post-traumatic stress disorder (PTSD) are the most frequently reported health outcomes amongst migrants which often result in irreversible damage but are downplayed by healthcare systems they migrate into [10]. Therefore, migration intricately labels mental health as an individual burden rather than a societal one, where the resources should be available and accessible for all.
Contrastingly, governments and their actors believe that migrants’ mental health is not overlooked and adequately addressed. For instance, ReNu Counselling and Psychotherapy in Ontario provides psychotherapy services and counselling performed by trained professionals to migrants and refugees [11]. These services can be covered by insurance or other government programs such as the Interim Federal Health Program (IFHP) [11]. The only caveat here is that migrants and refugees need to be eligible to receive these services, however, what happens when eligibility requirements are too stringent? Many migrants are turned away from such essential services for not meeting specific criteria. Even in cases where migrants are eligible for government-subsidized programs, they often feel discouraged from participating as submitting formal applications can induce stress given the lengthy nature of being granted access to government programs [3]. Given this, it is necessary to ask migrants for their first-hand anecdotal experience with mental health resources and accessibility to gain a more holistic picture of the migratory process. One of the crucial questions asked was, when you migrated, did you know of any mental health resources that were available to you? And if so, were they made easily accessible? If not, what deterred you from accessing them? Lauren Niakmen, an individual who migrated from Egypt to Canada in the 1960s, stated how the migration process was greatly dehumanizing and felt that she and her family were treated as a number and accepted only based on their perceived value and contribution to Canadian society. Lauren stated that she was unable to access mental health resources, referring to the stigma correlated with receiving help and the lengthy process she had to go through to access help as the most noteworthy barriers. She expressed the exorbitant levels of stress and anxiety she underwent and how she no longer wanted to go through such a time-consuming process that demanded the procurement of multiple legal documents. This is the unfortunate reality of the migration process, as it leaves many individuals more stressed than supported. Though services may be available, it is not always accessible to all migrants suffering from mental health issues.
Detention Centres, Migration, and its Effects
Many migrants entering countries may potentially face detainment in what is described as prison-like detention centres, ultimately causing greater stress. Human rights violations, inadequate living conditions, and lack of medical attention are just some of the inequalities migrants have experienced in detention centres [12]. There is a significant focus on ethical and policy controversies regarding the nature of these detention centres; therefore, the mental health of migrants detained is often overlooked [12; 13]. The U.S Immigration and Customs Enforcement (ICE) is a regulatory body that consistently fails to uphold proper infrastructure and operation, fractures families, violates fundamental human rights and provides subpar living conditions [14]. Many individuals who have encountered detention centres face immense psychological distress, namely, poor mental health and, in extreme cases, suicidal behaviour due to the structural violence that is embedded within the immigration processes [14]. Cases of self-harm and suicide are not uncommon in these facilities as qualitative research regarding the death reports of ICE demonstrate the inadequate prevention and supervision policies that go unregulated in many detention centres, calling for greater evaluation of the organizational structure of these facilities [15; 14]. Empirical evidence such as the 2010 Leitner Center Report concerning depressive disorders among refugee populations elucidates that 62% of Cambodian refugees experienced PTSD, 51% of which experienced the comorbidity of major depression [15]. This demonstrates that mental health issues related to detention centres are attributed to overall organizational oversight and poor infrastructure of immigration processes. Moreover, when observing data on detention centres in conjunction with mental health, there is a significant association between the length of time spent in detention and the severity of mental distress [12]. This suggests that the infrastructural processes responsible for the system within detention centres may indeed affect the well-being of detainees [12]. This lack of oversight in detention facilities can be attributed to many centres being understaffed and inadequately resourced, impeding the well-being of those detained in these centres [14]. Oftentimes, mental health resources are perceived as optional medical care rather than essential, despite the increasing rates of PTSD, anxiety and depressive mental disorders experienced within the walls of detention facilities [15]. This alerts us to the importance of implementing new policy interventions that widen access to mental health services while increasing greater advocacy towards the mental health of migrants.
Barriers to Accessing Mental Health Resources
Accessing mental health services as a migrant can be extremely difficult as many attitudinal and structural barriers exist, resulting in many individuals not seeking treatment. More specifically, financial costs and the initiation and continuation of treatment can be examined more in-depth to describe the barriers of accessing mental health services. There is a lot of research being done on mental health srvices surrounding attitudinal factors such as the perceived need for treatment and correspondingly, the initiation and continuation of treatment [16]. In addition, data regarding low perceived need was present in 44.8% of respondents with a mental health disorder who did not seek treatment [17]. When analyzing attitudinal barriers, research suggests that 97.4% of respondents found these barriers were more prominent when initiating access to mental health services compared to structural barriers, which accounted for 22.2% of respondents [17].
Additionally, economic principles should be examined to analyze the affordability and accessibility of resources in public health care systems regarding mental health services. For instance, barriers such as language and cultural differences across migration and its processes are prominent. Communication between medical professionals and patients becomes an essential factor in articulating health care needs [18]. When communication between patient and physician is unclear or not translated effectively, diagnosis and courses of treatment become increasingly difficult, and in certain cases, detrimental. Such differences across language and comprehension levels may affect migrants and their attitude towards seeking medical care [18]. The continuity of treatment also heavily relies on attitudinal perception of treatment effectiveness. For instance, in a study conducted by Mojtabai et al. (2010), 39.3% of respondents reported perceived ineffectiveness of mental health treatment as the reason for discontinuing their treatment. This demonstrates that while structural barriers are indeed considerable factors in pursuing treatment and mental health services, the low perceived need for treatment and attitudinal barriers are just as much, if not more, important in analyzing the diverse barriers to healthcare. Structural barriers, such as the cost of mental health treatments and services, may also be factors preventing individuals from seeking help [19]. For instance, adverse health outcomes are more evident in low-income populations where research suggests that, in the United States, those of lower socio-economic status face more significant financial barriers to accessing mental health services compared to those in Canada [19]. Nevertheless, both attitudinal and structural barriers should be used in conjunction to analyze access to mental health services.
Recommendation to Overcoming Barriers
Comprehension of the aforementioned barriers is crucial in moving towards equitable mental health care and treatment for migrants. Language barriers are one of the most common barriers faced by migrants when accessing mental health care due to the lack of communication or inaccurate translation of integral aspects of one’s health. Language barriers serve as a deterrent to seeking adequate care contributing to the added “fear of not understanding or being understood” [20, p. 209]. Despite few service providers offering language translations, they are grossly overworked and understaffed, rendering this service unproductive and ineffective [3]. To resolve this issue, greater funding must be explicitly allocated to medical language translators, as having medical needs interpreted correctly is crucial. Ultimately, creating a universal healthcare translation system in Canada with the proper funding is a step in the right direction in addressing the inequitable barriers migrants face in receiving care.
Migration is an intricate process through which migrants disproportionately face physical and mental stressors that adversely affect their health. The limited focus on mental health and curative medicine drive migrants to face mental health illnesses independently without being able to access comprehensive services that actively address the burden of migration. Additionally, the notion that mental health is an individual burden rather than a collective one heightens the stigma that exists within migrant populations, further exacerbating their efforts in attaining help. Similarly, legal and physical barriers such as detention centres pose an immense threat to one's physical and mental health. These centres are often overcrowded, have poor infrastructure, and subject migrants to dehumanizing treatment, including physical violence, ultimately contributing to the deterioration of their mental health.
Although countries with high immigration rates argue that mental health services are widely available, they are not holistic nor fully accessible as the challenges that flow from language and legal barriers are neglected. Such mental health services are solely oriented towards attending to emergencies and crises, such as suicide prevention hotlines which are equipped to address individual suicide concerns, rather than implementing interventions that prevent them. While studies have expanded the rhetoric surrounding stress factors and the existing stigma migrants face when dealing with mental health issues, there is an imminent need to address the barriers that deter migrants from accessing mental health services. Thus, we have a collective responsibility to raise our voices and demand our governments and world leaders for a more comprehensive approach in aiding migrants and eradicating the stigma around mental health.
Daniella Ekmekjian (she/her) is a recent graduate from University of Toronto where she double majored in Health Studies and Criminology with a minor in Women and Gender Studies. She is now completing her Master’s in Criminology at the University of Cambridge. Her research interests lie in state violence and how it is justified by governmental bodies.
Valentina (she/her) I'm a fourth-year undergraduate student majoring in Health Studies with a double minor in Political Sciences and Latin American Studies from the University of Toronto. My research interests include Health Policy in Latin America and Women's Health, specifically policy research and advocacy for sexual and reproductive rights.
Virginia Ma is a fourth-year Arts & Science undergraduate student at the University of Toronto, specializing in a double major of Health Studies and IRHR (Industrial Relations and Human Resources).
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