Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Ethiopian taxicab drivers: forming an occupational niche in the US Capital

ABSTRACT

This paper analyzes the relative roles of cultural and structural factors in the emergence and solidification of taxi driving as an ethnic occupational niche among Ethiopian immigrants in the Washington DC metropolitan area within the wider context of globalization and immigrant integration. An ethnic occupational niche is the concentration and specialization of members of an ethnic group in a particular occupational activity. Using data from the US Census Bureau and in-depth interviews with 25 (male) Ethiopian cab drivers and three Ethiopian cab company owners, it examines the factors that affected the entrance of first-generation Ethiopian immigrants in this occupation since the 1980s. This research demonstrates that mixed embeddedness or the interplay of structural factors such as blocked mobility as well as cultural factors such as the strong social networks that exist among Ethiopian immigrants were important in the induction of new immigrants into taxicab driving. The demographic composition of the Washington metropolitan area and policies of the DC Taxicab Commission that allow for fairly easy entry of new drivers in the taxicab business also facilitated the emergence of this occupational niche.     

Mexican Immigrants

Abstract

Social Work's history is embedded in this profession's service and commitment to immigrant populations. This new century presents itself with a new mixture of immigrants who come to United States (U.S.) shores seeking a better life. The challenge to social workers is to be well-versed in social policy, human behavior, and practice realms related to serving these immigrants. Schools of social work must insure that curriculum reflects the needs and situations of this new mix of immigrants. One of the largest groups in this mix are those immigrants from Mexico. Of particular concern is the adaptation of Mexican and other Latino immigrants who come to this country without documentation. Social workers have an ethical responsibility to serve these clients in a culturally competent and informed manner. They must keep updated on immigration policy and entitlement or eligibility issues that mitigate these immigrants' ability to survive.     

Surviving Chernobyl in America

Abstract

This paper fills an informational gap for multidisciplinary providers of services to the former Soviet Union (FSU) immigrants in the United States, highlighting the long-term medical and mental health consequences of this group's pre-migration exposure to the 1986 Chernobyl nuclear disaster. The international literature is selectively presented together with recent findings of Chernobyl mental health sequelae in a cohort residing in the United States. Guidelines for service providers, as well as Russian language health service resources in US cities populated by significant FSU communities, are also furnished.     

Solving the security–democracy dilemma: the US foreign policy in Tunisia post-9/11

Abstract

Scholarly consensus postulates a sharp contrast exists between liberal values and realist interests in US foreign policy in the Middle East and North Africa (MENA) region, which finds its expression in the ‘security–democracy’ dilemma.? This means the US rhetorical determination to abide by the values of a ‘liberal’ foreign policy is neutralised by the ‘realist’ priority of maintaining US strategic interests, which requires support for friendly authoritarian rulers. Scholarship tends to apply this reasoning indistinctly to the entire region, providing an encompassing framework of analysis for understanding US foreign policy, which is valid across time and space. This study challenges this theoretical assumption and argues that while the US might indeed have a comprehensive regional approach in the MENA, the resulting foreign policy follows country-based trajectories that respond to national specificities and the perceived implications for US strategic interests. Exploring US foreign policy in the MENA after 9/11, the article demonstrates that while the US emphasis on liberalism crumbled when faced with security issues, the US liberal approach to Tunisia unfolded more consistently. Although the US continued formal cooperation with Ben Ali’s regime, it empowered at the same time a coalition of democratic opponents, solving the security–democracy dilemma and positively influencing the Tunisian democratisation.     

Foreign Aid and Illegal Immigration

Abstract

Gaytán-Fregoso and Lahiri (2000) claim that foreign aid may increase the level of illegal immigration. This comment reconsiders their perverse findings under endogenous as well as exogenous income repatriation. Furthermore, modifying Gaytán-Fregoso and Lahiri's model, in which aid is allotted in a lump-sum fashion, it is suggested that the actual amount of foreign aid should depend on the source country's performance, i.e., on the number of illegal immigrants, since such a policy will further reduce the number of illegal immigrants.     

Impact of the 1996 Welfare Reform and Illegal Immigration Reform and Immigrant Responsibility Acts on Caribbean Immigrants

SUMMARY

This paper examines the impact of the 1996 Welfare Reform and Illegal Immigration and Immigrant Responsibility Acts on Caribbean immigrants in the United States. Drawing from the conceptual framework posited by Dye's (1984) Elite Preference Modelof policy analysis, the author argues that the three laws have created enormous economic and psychological difficulties among families in the United States. Developing countries in the Caribbean region have been severely impacted by the law since they have had to accommodate returning citizens when they are deported under provisions of immigration policies. The question for consideration by this paper is how may the legal and human rights of deportees be balanced against the rights of the U.S. government to secure its borders and ensure the security of its citizens? The paper also addresses issues of immigration, and international relations particularly the north-south dialogue between powerful developed countries such as the United States and small developing states of the Caribbean.     

Working with Caribbean Immigrants After the World Trade Center Tragedy

SUMMARY

Caribbean immigrants were among those transfixed by the destruction and human suffering caused by the World Trade Center tragedy. An emergent cliché is that life will never be the same after September 11th. This study explores the issues that impact the health and well-being of English-speaking Caribbean immigrants and challenges social workers to reassess their intervention with immigrant populations in the Post 9/11 era.     

Airlines and Empires: Great Britain and the “Scramble for Africa,” 1919–1939

This study examines the dynamics of female African immigration and settlement in the United States and discusses the research and policy implications for these processes. It highlights a significant surge in female immigration from African compared to non-African countries in recent years. This surge is driven by female immigration from Africa's most populous countries, from countries affected by civil conflicts, and from English-speaking countries in the region. African women are also more likely to arrive as unmarried singles than other female immigrants. In addition, they have the highest prevalence of bachelor's, master's, and doctorate degrees among women in the US. African females are also about twice more likely to be enrolled in US educational institutions compared to other women. Those in the labor force are more likely to work as nursing professionals than in technical occupational groups such as engineering and computing. The study concludes by discussing the research and policy implications of these findings for countries in the developing world.     

A Framework for Visualizing the Process of Immigrant Absorption

ABSTRACT

This paper presents a schematic framework to assist in the visualization of the goals and processes involved in the absorption of immigrants. It is intended to help those engaged in working with immigrants to individualize persons and groups of immigrants in terms of various attitudes, values and behaviors, and to determine the goals, models and time-frames suitable for strengthening, and/or supporting and/or changing these aspects. The inter-relationship among some of the aspects is examined, and the paper includes examples of absorption, melting-pot and cultural-pluralism in various countries.     

Immigration to Ghana

Abstract

The globalization of international labor migration is manifest in all countries now engaging in migration systems that are growing in size and complexity and producing an increasing diversity of flows. Furthermore, many of the processes that create and drive these systems operate on a worldwide basis, the consequence of economic globalization, capital mobility and widespread realization by governments that human resources can be traded for profit like any other resource.

This paper looks at Ghana's immigration policy in the light of its economic situation. It characterizes Ghana's immigration policy as geared towards using immigration to attract critical foreign investment, transfer of technology and human resource capital/skills for socio-economic development. Running concurrently is the policy to prevent illegal immigration, transnational crime, economic exploitation, social corruption and human trafficking.

The paper concludes that when the economic situation of Ghana was buoyant in the 1960s it attracted many immigrants especially from neighboring West African countries, however when the country's economy saw a down turn, immigrants were used as a convenient scapegoat and many were expelled. The irony though is that while the current poor economic situation of Ghana has made Ghanaians to immigrate to other countries, the political stability of the country does attract other West Africans and non-Africans and it is affording the country the opportunity to streamline its immigration and citizenship laws.     

America's immigration "problem."

Immigration has traditionally aroused strong passions in the US. Though Americans profess pride in their history as a nation of immigrants, each new wave of immigrants is met with strenuous opposition. Sassen points out that this opposition underestimates the US's capacity to absorb more people and fails to appreciate the political and economic forces that give rise to immigration. The outcry over rising illegal immigration culminated in the 1986 Immigration Reform and Control Act. So far, the law's effectiveness has been limited. 1.8 million immigrants applied to regularize their status. However, there is growing evidence that the employer sanctions program is resulting in discrimination against minority workers who are US citizens, and in various abuses against undocumented workers. Meanwhile, illegal immigration continues to rise. The 1986 law, like earlier laws, is based o a faulty understanding of immigration causes. The US played a crucial role in the 1960s and 1970s in developing today's global economic system. This system contributed to the creation of pools of potential immigrants and to the formation of links between the industrialized and developing countries. In sum, foreign investment and promotion of export-oriented growth i the US in developing countries has served to increase immigration to the US. A workable US immigration policy would be based o the recognition that the US bears a certain amount of responsibility for international labor migrations. The precise features of a fair immigration policy will have to be elaborated. However, it is clear that US immigration policy will continue to be counterproductive as long as it places the responsibility for the formation of international migrations exclusively upon the migrants themselves.     

Social Justice Advocacy by and for Tibetan Immigrants

Abstract

Advocacy for immigrants empowers them to fight for social justice. For Tibetan immigrants this struggle for justice inside their home country has been part of their U.S. immigration experience. They have also been part of New York City immigrant coalitions that are advocating for basic services lost during the 1996 Welfare Reform. The need for more equable access to education is also addressed. Finally, the harshness of expedited removal of asylum seekers needs to be supplanted by procedures that safeguard human rights.     

Regularization of Irregular Migrants and Social Policies: Comparative Perspectives

Abstract

This paper examines the social policy implications of the regularization of irregular immigrants. As an act of legal integration regularization arguably is about irregular migrants’ inclusion into mainstream social and legal structures and, as a corollary, has important implications for migrants’ access to social rights. Based on a recent comparative study of regularizations and their impact in seven EU Member-States, the study finds that access to social rights associated with regularizations indeed are reported as the most important impacts of regularization by regularized migrants themselves, next to access to work and related welfare entitlements.     

China’s road from socialism to global capitalism

Abstract

China’s engagement with global capitalism is driven by the emergence of a statist and private transnational capitalist class. Nevertheless, aspects of China’s foreign policy from the Maoist period still echo today. Consequently, elements of third world solidarity and opposition to Western domination continue to exist as China’s past is redefined to further its transnational strategies in Latin America and the US. The main Chinese investments in South America have been in energy and infrastructure among the left lead countries of the Pink Tide. In the US, Chinese capital has grown despite heated political rhetoric. This paper will examine how economic ties in South and North America reflect past and present conditions, and if China has initiated a non-Western globalisation.     

Can alternative service delivery save cities after the Great Recession? Barriers to privatisation and cooperation

ABSTRACT

Cities continue to face fiscal challenges after the Great Recession and alternative service delivery is being emphasised as a solution. How promising is alternative service delivery as a solution and what are its barriers? Regression analyses using 2012 survey data of US local governments show that local governments manage procedural barriers, but structural barriers of economy and demography hinder privatisation and cooperation. Places with a housing bust (measured as decline in home values) can use privatisation, but not places with more or increased poverty. Cooperation is more promising for places with increased poverty, but lack of a willing partner hinders this spatially constrained tool. Neither cooperation nor privatisation is promising for places with low home values. State governments must level the playing field for localities with weak economies if market approaches to service delivery are the main tools for local governments to survive fiscal stress.     

Worlds in collision,worlds in collusion: The uneasy relationship between the counterterrorism policy community and the academic community∗

Abstract

This paper explores the tension and barriers to cooperation between the government and academic communities in policy‐relevant areas. In the field of political terrorism, the time urgency of dealing with violence or the threat of violence characterizes the government professional's approach, while the academic views terrorism with a long‐range perspective. Other differences in missions, role requirements, and attitudes within the two communities contribute to the gap between them. Exchanges of personnel, ongoing programs for the exchange of information, and increasing the number of academic advisors with security clearances are among the recommendations for narrowing the gap.     

Mental Health Intervention with Hispanic Immigrants

Abstract

The underutilization of mental health services by Hispanic immigrants has been well documented in the literature. Hispanic immigrants encounter numerous obstacles which prevent them from successfully navigating through the mental health system. This reality is further compounded by the fact that research appears to suggest an increased rate of mental health disorders among Hispanics. This article underscores the importance of understanding the influence of a Hispanic client's worldview, language, and religion on the provision of mental health services. A case vignette is presented as a means of illustrating key conceptual points. Practice principles or conclusions drawn from this article should be used as a general guide by mental health practitioners.     

Chapter 2. Mental Health in the Hispanic Immigrant Community

Abstract

This chapter addresses the mental health status of Hispanics in the United States. The prevalence and incidence of mental health disorders among different Hispanic ethnic subgroups is examined. Patterns of mental health services utilization and barriers to mental health care are also reviewed. Research specific to best mental health practices with Hispanics is stressed.     

Agricultural Production and the Nutritional Status of Family Members in Tanzania

Abstract

The paper studies the effect of crop output value and livestock ownership on the nutrition of children, adolescents and adults in agricultural households. Using anthropometric data to measure nutritional status, this paper finds that both crop values and large livestock ownership have positive and significant effects on the nutrition of children under age 10. The effects persist after controlling for household socioeconomic status. Higher crop values and ownership of livestock are linked to better long-term indicators of nutrition (height-for-age) among the youngest children and better short-term indicators (BMI-for-age and weight-for-age) among older children. The effects also vary between boys and girls.