But treatments are difficult to find as the state’s mental health system is overwhelmed by a post-pandemic surge in anxiety, depression and addiction. Recent immigrants also face severe language and cultural barriers. Healing from trauma means sharing intimate and often horrifying stories, ideally in the patient’s native language, but there aren’t enough bilingual therapists and counselors to meet demand. .
“For every 10 clients, there’s one of me,” said Stephanie Tavares, a therapist with Boston Healthcare for the Homeless. He speaks English and Spanish and treats many Spanish-speaking immigrants from Central America and the Caribbean.
Two years ago, Spanish-speaking customers typically waited a month to make an appointment with her, but now they wait four or five months, she said.
Mental health workers at Boston Medical Center’s Immigrant and Refugee Health Center are also nervous.
“Like every other place, we’re facing some pretty significant capacity challenges,” said Sarah Kimball, the center’s director. “It’s been a source of some heartache for our health care providers and staff.”
Georgia Thomas Diaz, director of respite behavioral health at Boston Healthcare for the Homeless Program, said these competency challenges also apply to immigrant children. They are just as likely as adults to be emotionally affected by traumatic situations in their home country or the grueling journey to the United States, but they may have more difficulty expressing their feelings. Once here, you may feel torn between two cultures in a different way than your parents experienced.
“It can cause identity confusion, stress to fit into society, and tension to maintain language and cultural traditions,” she says.
Children may need therapy from providers who understand their language and culture, have safe play areas, and help them meet and connect with peers from similar backgrounds.
Differences in the perception of mental illness in other countries can also create barriers to care. Mental illness can be considered taboo or explained in terms of physical or mental symptoms that may be overlooked by health care professionals. People with PTSD or depression may say they have nightmares, headaches, and body aches. This can lead to misdiagnosis, said health care providers who work with immigrants.
Thomas Diaz, who grew up in Haiti, said that in the Caribbean, mental illness often refers to people with symptoms that cause them to behave in extremely erratic ways. These are words that traumatized immigrants are afraid to apply to themselves.
“There’s a bias,” Thomas Diaz said. “You no longer belong to society.”
Because of the disconnect, it can take months to build trust with patients, Thomas Diaz said. One-on-one therapy is virtually non-existent in Haiti, and while educated immigrants may be well aware of the potential benefits of one-on-one therapy, many would never accept it, she said. said.
Thomas Diaz said group sessions are often better, giving people a chance to talk about their hurts with others who can relate. Mental health providers have explored other approaches, such as yoga and Reiki groups, which aim to heal by building community.
Healthcare workers at Boston Medical Center’s Immigrant and Refugee Health Center have expertise in treating the most complex cases among recent immigrants, but patients often do not visit them in person. Kimball, the health center director, said they first go to the emergency room or women’s health center.
BMC’s immigration center is offering more engaging wellness groups, more intensive therapy groups, and has started bringing in hospital chaplains to its clinics, she said.
“It’s our job to redirect the program so that it can actually meet the needs of people who may not be interested in one-on-one therapy,” Kimball said.
Some clients show noticeable improvement just by adding social interaction. Kimball has seen patients recover from more serious conditions such as depression and suicidal thoughts through medication and social interventions.
“My patients are very resilient people,” she says. “Humans have this resilient spirit, and I think it’s worth celebrating and naming.”
Tavares, a therapist with Boston Healthcare for the Homeless Program, agreed that mental health treatment can be very effective. Many of her clients feel deeply isolated and silent in a strange country.
“Just the pure space of saying, ‘This is my story,’ can have a huge impact on someone,” she says.
At a recent Women in Homeless Health Care event in Boston, Thomas Diaz brought up the topic of mental health to a group of 14 Haitian women packed into a classroom at the Albany Street Health Center.
She asked them in Haitian Creole, as if they felt weak or “couldn’t take it anymore.” The women nodded in recognition. One said she was still scared after Colombian police forced her into a cemetery where they searched her for cash and groped her. Another young woman and her stepmother can’t shake the memory of a dead body on a jungle trail in Panama.
“We feel very bad,” said a stepmother named Jacqueline. “We see a lot of bodies in the river. We see children. We see babies.”
Some were close to tears as they talked about life in the state’s shelters.
“We are not people in the shelter, we are not human beings,” Haitian immigrant Marie Roche sobbed during Thomas Diaz’s presentation at Boston Health Care for the Homeless.
Thomas Diaz knelt down and hugged the elderly woman.
“We’re seeing so many families without support,” she says.
Jason Laughlin can be reached at [email protected]. follow him @jasmLaughlin.
