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.     

Chapter 3. Mental Health Care of Hispanic Immigrant Children

Abstract

This chapter addresses the mental health care of Hispanic immigrant children within a school-based context. The school system is presented as a natural support agent that is psychologically, culturally and geographically accessible for the delivery of culturally competent mental health services. The development of a multifaceted New York City public school-based program created, by the first author of this chapter, in response to the psychosocial needs of Hispanic immigrant children is discussed as a viable approach that may be used in the provision of ethnic-sensitive mental health care.     

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.     

Resilience in the Face of Adversity: African Immigrants' Mental Health Needs and the American Transition

The aims of this qualitative study were to explore key sources of emotional distress and coping strategies among West African immigrants. Thirty-eight adult West African immigrants participated in six semistructured, open-ended focus group sessions. Focus group data were analyzed using a grounded theory approach. While participants reported high levels of psychological distress associated with racial/cultural discrimination, intimate partner violence, parenting, extended-family demands, and problematic immigration status, they demonstrated resilience and the ability to identify a range of coping strategies that draw on their cultural heritage. Only two of the participants reported having used psychological services; both outcomes were negative. The findings of this study are considered in terms of their clinical implications.     

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.     

2008年以来民进党修补与美国互信关系的效果及前景分析

2008年民进党下台以来,持续透过访美、恢复驻美代表处、在两岸政策和对美政策上积极迎合美国等做法,修补与美国的互信关系,为其重返执政创造条件。民进党对美示好的做好虽得到美方善意回应,但因民进党拒绝放弃“台独”立场,无法提出令美放心的两岸政策新主张,因此双方互信提升程度有限,美始终对民进党重新执政充满疑虑。因受美国对台战略考虑、民进党两岸政策转型的复杂性等因素制约,未来双方关系的发展前景充满变数。     

The changing nature of the transatlantic link: U.S. approaches and implications for Central and Eastern Europe

This article examines the changing security, economic and diplomatic components of the transatlantic link, with a particular focus on Washington's approach and implications for Central and Eastern Europe. The United States continues to play an essential role as security underwriter in the region, but the military dimension of the transatlantic relationship is transforming and will result in greater burdens on Europeans. Economic links between the U.S. and Central Europe are developing more strongly than generally understood, and the Transatlantic Trade and Investment Partnership is likely to drive both political and economic ties. Unconventional gas developments are enhancing U.S. engagement in European energy markets. Finally, the U.S. remains keen to engage its European partners on a broad agenda of global and regional issues and retains its own interests in working particularly with Central and Eastern European countries to lend stability to ‘wider Europe’.     

The Changing U.S. Immigration Policy on the Nexus of Security and Economy: Extending Visa-Waiver Program and Advocacy-Coalition Framework

By examining the Advocacy Coalition Framework (ACF) in the case of the U.S. Visa Waiver Program (VWP), this article suggests that a dynamic foreign policy change on immigration issues is a function of trade-off between economy and security. In other words, when policy makers ensure that economic gains can offset security loss and vice versa, policy change in immigration issues is rapidly made. Two polarizing advocacy coalitions, security-concerned and economy-concerned, exist within the policy subsystem on the VWP and each coalition has different belief systems, policy actors and stakeholders.     

Networked Co-Production of 311 Services: Investigating the Use of Twitter in Five U.S. Cities

Prior studies highlighted the importance of adopting new technologies to co-produce 311 services, yet they failed to provide empirical evidence of the implementation. Taking Twitter as an example, the present study aims to fill the gap by examining the characteristics of actors in five 311 Twitter networks and the relationship between government 311 Twitter accounts and followers. The results demonstrate multiple-group engagement yet low level of connections within a network, with varying response rates of Twitter requests among all five networks. The overall limited Twitter use in 311 systems calls for shared best practices and efficient account promotion efforts.     

Fund Accounting from the Italian Early Tradition to the U.S. GAAP for Governments

Surprising correspondences emerge from the parallel investigation of fund accounting practices in Italian entities until the late nineteenth century and in the contemporary U.S. public sector. The analysis attempts to interpret similarities and differences in light of dissimilar environmental features, and wonders if the Italian tradition could have some explanatory capability on the U.S. present standards. The “fund” concept and its use are strictly similar; they are founded on information needs for governance and internal control. Contemporary requirements for democracy and transparency, and opportunities coming from modern ICT tools bring U.S. organizations to be accountable to the citizenry.     

Measuring Municipal Fiscal Condition: The Application of U.S.-Based Measures to the Context of Thailand

This research attempts to apply U.S.-based measures in order to examine municipal fiscal conditions in Thailand. Fourteen municipal governments located in the central and eastern regions of the country are explored, utilizing data from FY 2001 to 2006. The findings show that the selected measures of revenue-raising capacity and expenditure provide a sensible picture of Thai municipal fiscal conditions when compared to U.S. cities during past decades. Large, highly populous central cities as well as semi-rural, residential areas are fiscally weak. By contrast, suburban and industry-based cities are fiscally healthy. This study provides a foundation for the design of intergovernmental transfer systems that takes into account the local fiscal conditions and helps to extend the external validity of existing analytical tools.