How a mental health evaluation can change the course of an immigrant’s life

Immigrants know that one document can change the course of their lives.

The right visa or passport means new opportunities and, in some cases, the difference between safety and danger.

For some people in immigration proceedings, the assessment or psychosocial assessment is that essential document. In many cases, it can help to verify someone’s story in the absence of physical evidence, and show immigration officials why someone needs a new home, whether it’s an undocumented Honduran asylum seeker or a torture victim fleeing the Philippines.

“Sometimes it’s easy to see the damage,” says Henry Huang, direct attorney with the Northwest Immigrant Rights Project, a nonprofit that serves immigrants in the area. You can get a medical evaluation for visible scars or signs of trauma. But there are many cases where the trauma is not visible.”

The Mental Health Project is an initiative in the Seattle Times that focuses on covering mental health and behavioral issues. It is funded by the Ballmer Group, a national organization focused on the economic mobility of children and families. The Seattle Times retains editorial control over the work produced by this team.

The assessment is conducted by a licensed mental health professional, usually during a 2- to 4-hour interview to create a 12- to 15-page report – essentially a snapshot of someone’s mental health.

When used in immigration procedures, they can greatly improve the chances of approval, which means that immigrants and their families will remain in the United States but there is more demand than supply when it comes to trained counselors who can conduct assessments. The reports can be expensive for people trying to build a new life with scarce resources.

Understanding the past

Psychological assessments are vital in cases where there is not necessarily evidence of their harm – there is no police report of assault or a paper trail of their persecution. They help immigration judges understand why a person is reluctant to respond to questions about their trauma or why that trauma, in turn, means that they may not be able to remember specific details.

This report could also improve their chances of life in the United States—a 2008 study from Immigrant and Minority Health, one of the most cited, found that asylum cases evaluated were 89% successful. In contrast, the national average without one was 37.5%.

In deportation proceedings when someone is about to be deported, family members of US citizens are also assessed by a therapist. This way the judge can understand how children and spouses will be affected emotionally and in some cases, financially, by the loss of a loved one.

Perhaps one of the most powerful side effects of the assessment is that immigrants can safely tell their story and begin their path to recovery.

Cecilia Racine, a clinical social worker based in Washington, DC, says:

Racine has done more than 500 reviews, often sharing new terms with clients to understand their experiences. Symptoms such as insomnia, social withdrawal, and flashbacks often coincide with depression, anxiety, and other mental health disorders. For a customer who panics when he hears a loud noise, he sure knows there’s a reason: he’s experiencing the effects of shock.

Costs create an obstacles

However, reviews are not cheap. It can cost from $500 on the low end to over $2000 for more complex cases. For an immigrant who is already paying an immigration attorney’s fees or struggling to make ends meet, that’s a lot.

This is where the Evaluation Network comes in. It’s a unique partnership that began in 2012 between Harborview Medical Center and the Northwest Immigrants and Refugees Rights Project in the Northwest, which work together to connect immigrants in Puget Sound with volunteers who provide free assessments.

Alison Taylor, clinical director of Refugees Northwest, estimates that the network has helped about 700 people. Many of the immigrants she works with are from Latin America, but she sees people from all over the world. And she expects soon to connect people from Afghanistan to local counseling services as well.

However, the need is always greater than they can deliver, and Taylor’s volunteer-based network of 120 mental health professionals has waned during the COVID-19 pandemic. She said the number of volunteers actively performing assessments has fallen by about 30%. While some providers usually give six ratings Free, last year they reduced it to two; Other therapists have even paused their practice, overwhelmed by the number of clients seeking services

“I think we all found it more difficult to work on really deep and dark matter during this time,” Taylor said. “This is really hard. …People who volunteer justifiably take care of themselves and do fewer assessments.”

Huang said he has had to reach out to volunteer providers in other states because the waiting list for some of his clients has become too long, and now it takes months before a therapist can schedule an evaluation.

“life itself”

Customers are also having a hard time adjusting to the changes brought about by the pandemic. While telehealth in some cases makes it easier so that people don’t have to travel or discover childcare, Zoom is not nearly as conducive to building a relationship of trust between clients and therapists, especially when painful and intimate facts are shared.

“We have to intentionally get a lot of details from someone we just met that day probably,” Taylor said. It makes the first confrontation difficult. But so far, it has been working.

Some networks such as the Mount Sinai Human Rights Program have even experimented with telephone assessments and have found some success in remote networks. Now a therapist in Colorado can talk to an immigrant in New York, bridging the gaps when local resources are scarce.

However, the process of sharing the trauma is never easy.

“I didn’t want to remember, I didn’t want to talk about it,” Maria Candelaria said in Spanish, reflecting on her experience prior to her psychiatric evaluation years ago. Originally from Mexico and now living in the Seattle area, she is in the process of obtaining a U visa – a visa intended for victims of certain crimes – and has asked the Seattle Times not to use her full name because her immigration case is still pending.

When asked by local police about her assault, Maria Candelaria struggled to respond, but sharing that information with law enforcement is a necessary part of the process. Without it, you will not be eligible for the visa. With the help of a counselor she found herself able to share more details.

“I liked the way the questions were asked, to the point where I was unpacking and narrating what had happened to me, and what was stressing me out,” she said.

This change motivated her to help others and eventually she changed jobs, from nail technician to community health worker. Now, she works on a number of fronts, including helping people with immigration mental health assessments, and educational workshops for Latino families to speak and reflect on their mental health through a program called Nuevos Caminos or New Pathways.

The goal is to help parents and young people share their experiences and enhance their resilience. She says last year and change have been difficult. People lost their families, struggled with paying bills, and experienced stress and exhaustion in general. And she’s calling this fall, as families enter a second pandemic winter, mental health should be prioritized.

“Mental health is life itself,” said Maria Candelaria. “Without it, there is nothing else.”

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