Elaine P. Congress, DSW, LCSW is Professor and Associate Dean at Fordham University Graduate School of Social Service in New York City. She will be discussing her new book, Social Work with Immigrants and Refugees, Second Edition: Legal Issues, Clinical Skills, and Advocacy, at the Academy at an Author’s Night on April 7, 2016.
Q: Social isolation among older immigrants causes stress, mental and possible physical health concerns. How can better support networks be created for this population?
A: Older immigrants, because they’re not still in school or working, are less likely to learn another language. Many also fear traveling independently. But there are senior centers where people can be with people from similar cultural backgrounds and they try to have staff who speak the clients’ languages. It’s also important to have community agencies and visible storefronts for people to come to and find out what they’re eligible for. For a lot of older immigrants the personal contact is very important.
Q: How can providers address immigrants’ fears of deportation and the medical bills that often dissuade them from accessing care?
A: Most health providers are seen to be an extension of the government, like we’re going to report them to homeland security—there’s a lot of anxiety about that. So I think in the beginning, it’s really important to assuage their anxieties and stress that it’s confidential. Don’t ask their immigration status.
Q: What can be done to increase awareness about the importance and availability of preventive care within immigrant communities?
A: Many people come from countries where there’s no emphasis on prevention and you don’t go to a doctor until you’re very sick. For example, a woman went to the emergency room with her two-year-old son who had a very high fever and was asked about her child’s immunization record. She said he was never sick before so she never took him for immunizations. It shows a cultural difference—it didn’t occur to her. So you have to have information where people can see it, such as bodegas, the beauty parlor. You have to have literature in languages they speak. You need health facilities in communities like storefronts and have someone who can help them access care, and possibly volunteers who may provide free services.
There are some state programs like Childcare Plus where children of undocumented people can get care. Many immigrants and refugees will bring their kids to Head Start for preschool services. Maybe that’s a place to reach mothers in terms of preventive health care.
Q: What can be done to increase awareness about mental health issues and help remove the stigma in immigrant communities around accessing mental health care?
A: I worked in a mental health clinic for many years before I went into Academia. People are embarrassed that you have a “loco” (crazy person) in the family so people hide or negate it, but also people come from rural countries and rural settings without mental health services, so education is very important. Research also suggests that one-stop clinics can help. If it’s a community center, for example, that has both physical and mental health services, there’s less of a stigma.
Q: What are some of the unique health and mental health challenges facing refugees that differ from those of immigrants?
A: In terms of mental health issues, many refugees have experienced terrible traumas; some have had seen their family members killed and themselves narrowly escaped death. There’s also a lot of sadness about not being able to go home again. Refugees can get "green cards" and work toward becoming citizens, but if you’re really troubled by PTSD, it’s hard. The U.S. refugee resettlement program only provides assistance for three months, which is certainly not sufficient time to them adjust to a new country. I think there should be much more of a focus on working with refugees and developing appropriate services.
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