August 8, 2025 • 41 mins
In this episode of the Psychiatric News Special Report podcast, Dr. Adrian Preda is joined by Dr. Lisa Fortuna, chair of the APA Council on Children, Adolescents and Families, to explore the profound mental health impact of U.S. immigration policy on children and families. Drawing from the August 2025 Special Report, they discuss how policy-driven fear, trauma, and instability affect not only undocumented immigrants, but also U.S.-born children in mixed-status households. Dr. Fortuna underscores the urgent need for psychiatry to move beyond the clinic, recognize immigration enforcement as a public health issue, and provide trauma-informed, culturally grounded care. The conversation highlights structural trauma, intergenerational stress, and the importance of community-based mental health responses.
You can read the Special Report here: https://psychiatryonline.org/doi/10.1176/appi.pn.2025.08.8.19
PsychNews Special Report is a production of Psychiatric News, a media platform dedicated to serving as the primary and most trusted source of information for APA members, other psychiatrists and physicians, health professionals, and the public about developments in the field of psychiatry and mental health that impact clinical care and professional practice. Learn more at psychiatryonline.org/journal/pn.
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Episode Transcript
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(00:12):
Welcome to the Psychiatric News Special Report podcast, a monthly podcast produced byPsychiatric News for the APA's Medical Minds channel.
I'm your host, Dr.
Adrian Preda, Editor-in-Chief of Psychiatric News and Professor of Clinical Psychiatry andHuman Behavior at UC Irvine School of Medicine.
Today, our goal is to unpack a really profoundly important topic and unfortunately onethat's often overlooked.
(00:38):
We are talking about the very real human impact of
contemporary current US immigration policies and enforcement, specifically on immigrantchildren and their families.
This isn't just abstract legal policy.
It's about the deep consequences that policy has on mental health and well-being.
Today's discussion is based on the Psychiatric News August 2025 Special Report.
(01:03):
To discuss this report, my guest today is Dr.
Lisa Fortuna, a professor of psychiatry and neuroscience and chair of psychiatry at UCRiverside, and also the chair of the APA Council on Children, Adolescents and Families,
and also the report lead author.
To start with, Lisa, I got to say, I'm really impressed with how you pull together in yourreport such a rich mix of clinical insights, broader epidemiological data, and most
(01:31):
importantly, community-based research.
to shed light on what's a very complex dynamic between policy and mental health.
I'm going to start by telling you that after reading the report actually last night, Iread it a couple of times preparing for today's podcast.
What impressed me the most is that you're making a very, uh very important argument thatconsidering what's happening, essentially psychiatry, couldn't, shouldn't stay on the
(01:59):
sidelines.
take what's happening in the policy and in-fortunteria and argue pretty forcefully thatthis moment demands a fundamental rethinking on how we understand and how we treat both
structural and intergenerational trauma.
So let's start there.
Yeah, I'm, you know, I thought it was really important in writing this paper that we thinkabout how policy can have a direct impact on the well-being and mental health of
(02:29):
communities.
So I would say that that's the overarching message that I really framed this around.
And in this case, we're talking about immigration policy.
And it, my focus was really to take it from not
thinking just politically, right?
Because that's not really the point of the article, but policy, right?
(02:53):
And policies have especially profound impact in my belief on children and adolescents.
Children and adolescents and their families, of course.
But children are amongst the most vulnerable populations that we have globally.
They don't have a lot of rights as we would hope that they would.
(03:16):
including in the United States.
And when there are policies that directly impact their safety, their rights to be able tohave their family and to feel safe in schools and in their family, we have to think about
sort of those root causes of distress and how they can impact generations of children.
(03:36):
Yeah, it's really important to understand that these policies are not just about bordercontrol and paperwork, right?
They could in fact become immediate mental health threats.
And in your report, you highlight how the current policies have become a major source ofchronic fear, instability, and frankly, trauma for millions.
Yes, m and that's an important word that you're stating in saying trauma, right?
(04:03):
Or, you know, trauma, uh very extreme and toxic distress and stress.
you know, the authors and myself, one of the things that we wanted to point out is howdoes this really manifest?
And there's a few ways that that can really happen and is happening currently.
(04:25):
We can look at this
understanding of raids and immigration policy, right?
And this, the messaging that people will be removed.
But, you for children and families, it really is a message of being separated,potentially, and not having access to work and safe spaces at school and healthcare.
(04:48):
You know, what we're seeing, even as we speak, is that, families are living in extremefear.
even families that may have been working on their immigration process, but fearful to beable to even move forward with that because they believe that they might be separated from
their families or separated from everything that they know.
(05:12):
And that becomes a very distressing thing.
And we know that for children and adolescents, feeling that your support systems, yourfamily, your caregiver, your school setting is in threat.
and not safe creates a very significant stressor for at least a production of anxiety,depression.
(05:34):
And we have even seen in our clinical settings, even suicidality in both parents andchildren due to the distress of that fear and threat of separation and loss.
And when you witness those things within your community actually happening, you know, wehave seen
in research that it can have a very direct and negative impact on everyone in thatcommunity.
(06:00):
And so we can talk a little bit more about that, but there's even research on how it canimpact citizen individuals that are from that community very negatively, including
anxiety, stress, and even low birth weight babies um increasing among pregnant women thatare from that community.
because of the level of distress and physiological stress, right, of being able to seethese things.
(06:26):
Yes.
So we are talking about really specific things here, like the expansion of enforcementmechanisms, including worksite rates, people being held in detention for longer periods of
time, and also an erosion of protections in places that used to be considered safe, likeschool health clinics.
Right.
Yes.
And you're making this point, which I think is really important, that all this is not justlimited to immigrant children themselves, but it also affects millions of U.S.
(06:55):
born children.
kids living in what's called mixed status households.
Yes, yes, most definitely.
You know, these a lot of there are a lot of instances, right, millions of children who areborn here in the United States and have mixed status families may have a, you know, status
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parents, you know, one that has US citizenship and one that does not and has some otherstatus in terms of immigration.
And what we have found in the empirical research is that even
citizen children, and especially citizen children who may have one parent or a very closerelative who is at risk of immigration issues like deportation, have increased rates of
(07:43):
anxiety and depression.
oh You know, one of my colleagues, Louis Zayas, has a book and also some articles thatreally did research, research the impact on citizen children of these issues.
and found elevated risks of depression, anxiety, even PTSD, and school difficulty.
(08:05):
And this was an issue for younger children, but even also adolescents.
the other part that I think it's important to consider is that in some of these situationsand probably in the majority of cases, some of the stress starts before the families even
arrive to the United States.
In the US, for instance, parents often migrate ahead of their children, perhaps to findwork and establish themselves, which then in turn leads to prolonged separations.
(08:32):
How does that affect and affect us into the increased risk?
Yes, yes.
I mean, that is definitely an issue that comes up a lot in terms of that there aresometimes uh sequential separations, right?
Where exactly what you're saying, that family members, parents, for example, mother orfather, may come earlier into the United States to be able to work and to set a pathway to
(08:59):
be able to bring their family, hopefully, right?
And then sometimes,
the children will come later and there is this prolonged separation sometimes for manyyears, maybe sometimes with other, know, having had stayed with uh other relatives like
grandparents.
And then sometimes there's separations from those caregivers, right?
Once they come to the United States, like a grandparent left behind, for example.
(09:23):
And then the reunification can sometimes be very challenging.
And so that's another area where separation can be very difficult.
I think what is happening here is that those children, as well as children who are bornhere, right, and been born here with their parents here, are all facing different degrees
(09:44):
and readjustments around this risk of maybe yet another separation, but now a traumaticseparation.
That's one of the things that I wanna sort of highlight too.
Even though it can be very difficult to have a parent move out of your country to set uh apathway forward for you in the United States, there's something particularly difficult
(10:13):
about what I state is a traumatic separation, right?
Where you are in a family with your parents and there is this risk that they will suddenly
and traumatically be taken from and maybe taken somewhere that you do not know.
And there's a little bit of a increased intensity about that traumatic experience.
(10:41):
It's really hard to kind of conceptualize this level of stress that is sort of setting upa slippery slope, which then further increases the risk for anxiety, depression, also
PTSD.
And I would imagine, and I think that's an important factor that we also discuss in yourarticle, the stress is compounded by the effect of the stress on also the parents' mental
(11:07):
health themselves.
Yes, absolutely.
You know, we know that children and I would say even adolescents, we don't always thinkabout adolescents in this way.
When they see that their parents, their caregiver, they're the person that they're lookingto keep them in a good place, in a safe space, that very important and primary
(11:29):
relationship.
When they see that the parents are stressed and reacting to that stress, it really is amessage that, you know, things are really going
to a very dangerous place and an unsafe place and my core support system is beingdismantled, right?
And so that it's really the way it reacts, the reaction is psychologically for childrenand adolescents.
(11:56):
And that translates into a real physiological stress, right?
You're on the, know, my gosh, I have to be on fight, flight, I have to be vigilant.
You know, the
main core of the person that keeps me safe and that I care about is at threat here.
And, you know, and that's why I, we also bring up in the article that it's that primaryspace of caregiving that is at risk, which is very stressful.
(12:26):
um And then for some, you know, most children and adolescents, then in that school space,the school community is another place of safety.
And when there's messaging that that might not be safe, um that's very, very challenging.
um So it is compounded.
It is compounded.
And that stress within the family um also becomes a significant salient place of stress.
(12:50):
Yes, and you cite actually talking about adolescence, a US national study where kids aged11 to 16, if they had a family member detained or deported, they had a significantly
elevated uh risk for suicidality, acting out behaviors, and even alcohol use.
(13:10):
And for the younger kids, the abrupt loss of a caregiver led to things like sleepproblems, appetite changes.
difficulty regulating emotions and even developmentary regression like losing skills.
Yes, yes.
And as you are, you you're talking about those symptoms or outcomes of those separations,we can, if we step back, we could see that that really sounds like a post-traumatic stress
(13:39):
disorder, right?
Or a constellation of symptoms that we might fall in that because it is traumatic, right?
And it is a reaction that comes from a very traumatic event.
And, you know, because we see those in post-traumatic stress.
And whether we feel that the youth meets full criteria for PTSD or not, those areconstellation of symptoms that we think that happen in those circumstances, right, that
(14:03):
are traumatic or disastrous or very difficult and stressful situations.
uh And that's what we do see with these kinds of events.
And thinking about trauma, I think it's important to emphasize that possible separationisn't just a sad event.
It's recognized clinically as an adverse childhood experience.
(14:24):
Absolutely.
It's one of the most adverse childhood experiences uh that we can think of as loss of aparent.
I we may also think about that as death of a parent, right?
But loss of a parent where you are unsure of what will happen next or they're uh beingreunified, will you be reunified or not?
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Where will I go?
I mean, there's circumstances where children may not
have other people to care for them and they worry about, know, am I going to be in fostercare?
Am I going to be like, what's going to happen to me?
um Adolescents or older adolescents who feel like, am I going to be the caretaker of myyounger children?
(15:10):
It is really a dismantling of your life, right?
All of your support systems, your uh attachment, right?
Because we're also talking about a disruption of attachments, especially for youngerchildren.
And all these we know can be
very traumatic and adverse childhood events and can also really lead to psychological anddevelopmental consequences as you mentioned.
(15:33):
It's actually regression and development in part also because we're creating a stressor inthat primary attachment relationship.
and then it's not just the actual separation, it?
It's the threat of it too.
Yeah, that was a very important thing that we wanted to bring in this article.
(15:55):
I think most people would say, if you see a parent separated from you in such a manner asa raid or something like that, that that would be potentially traumatic for a child or
would likely be traumatic for a child.
But what we have found, uh I think clinically, absolutely, and definitely in theliterature, is the threat, the risk that this may happen to me because I have a parent
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caregiver who's vulnerable to this happening and where our family is vulnerable to thiscan in itself be a very significant stressor.
And we have seen that, you know, where, you again, in studies of even citizen children inmixed families, that just having the threat or risk of that happening to your family
(16:40):
increases and elevates all of these symptoms and disorders that we're talking about.
Right.
the anxiety is the fear of unknown.
And this is probably the epitome uh of the fact that nothing could be known in terms ofwhat's going to happen the next day or even in the next moment.
And to make things maybe even more complicated, the whole landscape of US immigrationpolicy seems to be constantly shifting, often unpredictably, which must amplify these
(17:10):
challenges.
Absolutely.
is, you know, one of the things that we have found in both these situations and disastersituations, it's the uncertainty, the threat, the risk of harm to yourself and to your
family.
And I would say in these circumstances, threats and risks that seem very real.
(17:35):
Right.
And I think that that's a really important component that we have to highlight here.
It's not
especially in the current environment, it's not just the imaginations of a child, right,that I might be separated, that we might think in a separation anxiety, right, where, you
know, I'm worried that something might happen.
There are a lot of things in the environment and fast changing, as you were describing,that make that threat very real and very concrete and very present.
(18:03):
And that's one of the things that we wanted to talk about here, because that's wherepolicy is making one of
a child's fears a very real impossible reality.
And it seems like that's something that it's unfortunately contributing to this because weare looking at the context of expanding legal ambiguity.
(18:25):
ah It's not very clear who are the targets.
It could be a new citizen, lawful permanent residence, people on non-immigrant visas,undocumented individuals.
So there is this lack of clarity ah with uh almost like situations where it's not clear ifthe application is consistent.
there is not that much transparency, which then turn intensifies the fear and uncertaintyuh within the immigrant communities.
(18:54):
Yeah, absolutely.
You know, and I think that that's, you know, that's also leading to the degree of anxietyand fear in the adults, right?
A lot of adults in the immigrant community with various immigration statuses, right, havea lot of concern and fear right now of whether protections or uh sort of ways of
(19:18):
addressing their immigration status are no longer present.
And there's a lot of uncertainty of what might happen to them.
And that's creating part of the extreme stress or in fears, especially in adults who areseeing that and understanding that, or in some process, right, of asylum or other
immigration status, feeling like that is extremely at threat.
(19:41):
And even with adults, working with adults, immigrant populations, when you haveuncertainty about your pathway to some kind of safe status,
or being able to stay here in this country, asylum seekers who have experiencedsignificant uh issues in their countries of origin, violence included, there is an extreme
(20:03):
increase in anxiety, depression, and PTSD in those adults.
And when they have children, that is definitely transmitted, right?
Children and adolescents see their parents stressed and worried, and they understand thethreats.
And that creates those tensions that we were talking about earlier within families.
So this ervasive fear is directly linked to increased symptoms of PTSD and also internalexperiences such as anxiety and depression.
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when it comes to children, you're also making the point that there are behavioral changes.
Yeah, yes, absolutely.
You know, because, again, if we take this from attachment, relational anxiety, you know,all the ways that we might think about how children manifest psychological distress and
(20:52):
symptoms, you know, that's one of the things that we see in young people is that there arealso developmental behavioral consequences.
Right.
I started this, you know,
discussion a little bit talking about the fact that children and adolescents areparticularly vulnerable populations, right?
(21:15):
They don't have all of the opportunities to make the decisions that adults may have andthey're reliant, right, on adults and systems to keep them healthy and to keep them safe.
And when some of those things seem at threat, or all of those things seem at threat,
a lot of that distress for children may be where they feel like they don't have agency,right?
(21:40):
And they're feeling that sort of psychological anxiety and sadness.
It can result in acting out and behavioral issues, right?
You know, not listening, being hyperactive, not being able to focus in school, not wantingto go to school, becoming aggressive, because it's one of the ways that we know that
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children may...
they manifest that both because they don't have a lot of agency to do a lot of otherthings.
And also because that's the way that they may not understand exactly how to express thingsum at a more sort of mature level.
And that's why we often see that behavioral issues are really around this dysregulation,right?
What we call, you're just feeling really dysregulated and out of sorts and not having anagency to do it any other way and feeling so distressed.
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Then I have these behavioral problems.
And so we have to look at those behavioral problems as not just sort of wanting to do thewrong thing, right?
But that it's really a manifestation of feeling really distressed and not right.
And then we can see kids avoiding school, dropping their grades, becoming sociallyisolated.
And really with all this missing out on chances for developmental support or mental healthhelp that they might really need.
(22:54):
Exactly and that's something else that we wanted to mention in the article.
It's a disruption of you know really those opportunities right.
It's not only sort of a direct distress and trauma which is enough of a problem but it isabsolutely what you're saying a disruption of opportunity for other healthy experiences
(23:18):
and growth and in some cases even education.
Considering this context, aren't these understandable responses?
Yes, you know, and you know, if we if we think about our humanity, right, when we havethis immediate threat to the things that are most important and close to us to react with
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uh retreat, or agitation, or absolutely sadness and these psychological, you know,distressing symptoms.
That's that's what happens to us, right?
When when when things that are so
who are well-being are a threat.
So it's very human and it's very developmentally appropriate and it's what we wouldexpect.
(24:06):
To bring this all into really sharp focus, you are presenting a case study.
It's a mixed case study, but I think it's very informative.
It makes a comparing case for how this very complex dynamics play out.
Let's talk about Anna.
She's 17.
She's a US-born high school student living in a mixed status household.
(24:33):
and her parents are undocumented immigrants and she comes for her appointment in theclinic.
What's happening with Anna?
Yeah, yeah.
So Anna, you know, is experiencing a lot of the things that we talked about, you know, andas a sort of a composite vignette of things that we are seeing, you know, clinically,
(24:54):
where adolescents are, are very aware of what is occurring in their community and in theirfamily, all these things that we've been talking about, so the risk and the threat, right
of deportation, seeing the degree of stress in her
parents and be very aware that that only escalates her understanding of the threat becauseher parents are also very distressed and reacting to that distress.
(25:23):
And in the vignette, Anna starts doing some things that are really around expression ofher distress, like some self harm, some cutting, which is another thing that we might see
because she's trying to hold it together.
And she's trying to get to school and not maybe always succeeding in that.
(25:45):
But she's trying to hold it together, which is one of the things that we see withespecially adolescents where they also don't want to escalate their parents' distress by
disclosing their own distress, which is another element of this, right?
Where everyone tries to keep it from one another and there's not an opportunity to reallyfear of talking about it.
(26:08):
Right.
Which is one of the reasons that clinically we're, we're having families talk about it,right.
And plan and see how they could help one another and understanding and that parents can besupportive even within their own distress.
The other things that is in the Anna story is that disruption or disconnection fromothers.
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Because one of the things that we find is that not only do family members have difficultysometimes talking about this because it's
such a horrible story, right, to talk about together.
They start moving away from other resources because of fear, right, of going out, but alsonot wanting to sort of disclose what's going on.
(26:51):
It's sort of a secret.
And in the vignette, we talk a little bit about the importance of reconnecting Anna tocommunity, right, to community organizations, to supportive things and institutions that
can support her family as well as a unit.
to sort of address all these compounded effects that are on families and how it mightimpact on an adolescent.
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And the other part that I thought was really important in Ana's history is that she shareda really powerful piece of her family history.
Her grandmother had fled political violence during El Salvador Civil War, ah which traumaremained largely unspoken in the family, but it shaped her mother's upbringing in the
(27:37):
environment.
So there is a very important intergenerational
is there as well, which tends to be common in this population.
Absolutely.
I'm glad you're bringing that up because there is this, you know, we mentioned in thearticle in a few different ways, this idea of intergenerational, right?
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And it's not just absolutely just what's happening now, but what has happened historicallyin the family where there have been circumstances of political violence, separation, and
we had talked about before, even loss and death.
right of individual family members through through through political violence and otherviolence in their countries of origin.
(28:22):
And so there is this living history of uh fear of loss and death.
And again, going back to real threats that have historically happened, and that arepotentially happening again, through circumstances and in uh do policy and politics.
So and again, it speaks to this idea of
(28:44):
what's often unspoken, but living within families, their anxieties, their fears aboutthese things, the trauma that they hold in their history and in their minds and even in
their bodies in terms of increased stress hormones and everything else that are activatedin situations, right?
And so, that relates to how the parents are reacting to these things and their ownre-triggering of trauma and how that is transmitted in the...
(29:13):
the family unit in terms of distress and stress and how do we manage this?
How do we talk about this?
How do we find support for this?
And I think that's, those are really critical pieces of Anna's story.
So, know, yes, I found Anna's story emblematic of a broader pattern of structural harm.
(29:35):
Her mental health isn't just shaped by what happened to her individually, but bygenerations of history, current policies, and then these fundamental social conditions of
whether she feels like she belonged or she was excluded.
Absolutely.
And it's the reason that, you know, the recommendation, I think that's implicit with uhAnna's story is having an opportunity to talk about those things and supporting the entire
(30:08):
family and that idea of reconnection, right?
Where in my community, where in my circumstances do I have a community of adults?
culturally appropriate understanding that can help us, right?
Because that idea of isolation is one thing that has to be addressed.
(30:32):
And the other thing that has to be addressed is that there can be a lot of internalizationby children and adolescents that there's wrong, inherently wrong about them and how
they're reacting and how they're responding.
And one of the things that we have to do is transmit or transform that narrative.
into you're not the problem, it's the situation, right?
(30:53):
That's the problem.
And then we have to address that together, we have to support you through this problem,right?
As well as take care of your emotional distress, but we need to sort of make clear thatthe narrative is about what's happening, right?
And we have to address those things with you.
So it's almost like we're looking at not only complex but sort of a layered set of nottrauma but traumas.
(31:17):
I think maybe that's a better way to understand it.
And then in your article, you argued that this set of traumas directly affect the brainand the body.
Absolutely.
We know that very distressful situations and perhaps in stages of development, childrenand adolescents, that you're talking about increased stress hormones, elevated stress
(31:47):
hormones uh more chronically, impacting brain structures that we associate with PTSD,post-traumatic stress.
amygdala, hippocampus, we know that those areas are negatively affected by elevatedstress, acute and or chronic.
(32:09):
uh And that those areas also have an impact on development, right?
And learning, as well as, you know, sort of associating with other parts of the brain thathave to do with learning.
And so when those things are elevated, it's very difficult.
It can have a significant impact on
the ability to learn, right?
(32:29):
At least in that moment.
And that's why we see in the literature that that's one of the things that might be anoutcome of post-traumatic stress or these very distressful situations where there are
difficulties in school and in learning and a sense of uh well-being and identityformation, right?
Because there is this ongoing risk and threat.
(32:50):
So it's very, it's very significant.
And it's why we really wanted to talk about it.
uh in this article looking at it from a child and adolescent perspective because it is avery clear policy and structural stressor that can have impact on children and adolescents
development for some time.
(33:11):
And it's something that we can address structurally.
Yes.
And with that, it's important to acknowledge that standard treatments like maybe SSRImedications or trauma-focused therapy could help.
But it's really important to consider the broader context and uh medications orpsychotherapy really are not enough on their own in this situation.
(33:36):
Yes, I mean, you I would say you have to if you you diagnose a child with PTSD because ofthese circumstances and again, it could be because of cumulative things like we've been
talking about, you know, past other traumas and threats and then now this and they do havePTSD and they meet criteria, treat the PTSD and we have good evidence based treatments for
(34:00):
treating PTSD, but not not stopping there.
because these are situations where we have to think about the context, as we've beentalking about, like what's happening to the family?
Has someone been separated?
Is there a potentially risk of the child not having a place to stay or be with, or they'regonna be displaced from their family home and to be with someone else because of what's
(34:22):
happening?
Are they having problems with being connected to their school?
Are they becoming isolated?
we have to think about those situational, circumstantial, environmental factors that aregonna perpetuate the distress that they have.
And so that's why we have to a little, let's take a step beyond the clinical uh setting,our office, and thinking about these other environmental issues that we might have to
(34:51):
address.
And we don't have to address them alone.
And I would say it's very unlikely we can address them alone, which is why we really
we try to tell clinicians that one of the important things to do is to build relationshipswith organizations and community-based organizations, for example, or churches and other
things that might be areas and places of support, or working with families to identifythese other places of support.
(35:19):
Because what's happening is not only internal, it's not just internal, it's environmental,right?
It's social.
And we have to think about what are the things that we can bring to support children inthose other realms, school, family, community, church, those places that can hold them and
help them through this.
and I think that's such an important point that when it comes to treatment is not justabout individual patients, but it's important to engage families and systems to make the
(35:49):
point that the relational care is key.
And also you discuss the importance of narrative and culturally grounded therapies thathelp restore meaning and connection.
Absolutely, because you want to speak the cultural and literal language of the experienceof what communities.
(36:13):
so we know, especially in situations of extreme distress, we go to those core things aboutwho we are.
And we know under distress, it's very difficult to talk about things in your firstlanguage.
We sort of go to our
primary language of uh expression of what we're feeling, very difficult to do throughinterpreter services alone, even though that is very helpful.
(36:39):
There's nothing else.
And to understand the cultural context of everyone's experience, right?
This is not only impacting Latino communities, it's many other communities that areimpacted, for example, and we have to understand all of the things that we're talking
about.
What is the cultural context of how these things are spoken?
What are the historical situations of
(36:59):
communities and how can these things be best expressed that are very difficult to expressat all and therefore have to be at least expressed in one's primary dominant language.
so much in here.
How about the workforce development and policy advocacy?
Yeah, we need more of that.
I know a lot of places are, you know, trying to increase our workforce of mental healthproviders.
(37:27):
Absolutely, we need that.
We do not have enough bilingual, bicultural across different communities.
Again, not just speaking about Spanish.
Available for a lot of communities to be able to do this.
There is a big movement in some states to also have
paraprofessionals, workforce development, like promotoras, community health workers thatare trained in understanding mental health and can be the front line in terms of
(37:54):
engagement.
And also working with other organizations like community based organizations, we mentionedchurches, to be able to have outreach, right around these mental health issues, engaging
people in reaching out for support, addressing issues of stigma, uh
trying to address this issue of silence and isolation.
(38:16):
And so we need workforce at all the different levels from psychiatrists topsychotherapists, psychologists, social workers, and also these community health workers
in the community helping.
And there are initiatives around the country.
I think we need more because we definitely need that diverse workforce.
And we need to keep naming immigration enforcement as a mental health issue, which meansdocumenting it, researching it, publishing on it.
(38:45):
Psychiatry must bear witness and not from the sidelines.
I think that's a very important point that your report is making.
Yes, yes, we have to definitely look at this as a determinant of mental health incommunities, immigrant and citizen.
It is a very negative and powerful traumatic force right now for a lot of communities.
(39:09):
And we have to name it, right?
We have to go upstream, as we say, right?
It was determinants of the health and the public health of our communities.
Absolutely.
Lisa, as we close, what's one key message you'd like to leave with our listeners?
I would like to leave our listeners, especially our psychiatrists and mental healthprofessionals know that your work is uh exquisitely needed right now.
(39:36):
We have to be able to open our minds in understanding how the things that uh we think maynot be in our realm as healthcare providers, as mental health providers, and just in
policy are absolutely in our realm.
And we're called to action right now to speak when we know that
things in our country are negatively impacting our patients and our communities that weare called to serve.
(40:02):
We have to move outside of this, clinical realm, because actually this is in our clinicalrealm, right?
It is a direct determinant of the well-being, especially when we serve children andadolescents and families.
Lisa, thank you so much for this urgent and illuminating conversation.
Your work powerfully reminds us that mental health care must be both clinically preciseand socially aware.
(40:26):
Yes.
To our listeners, thank you for joining us for this episode of the Psychiatric NewsSpecial Report podcast.
For more in-depth coverage of this topic, we encourage you to read the full article uh inthe August 225 issue of Psychiatric News or online at psychnews.org.
We've posted a link to the article in the episode description.
(40:48):
If you enjoyed this episode, please take a moment to subscribe, rate, and review thepodcast.
It helps others discover these important conversations.
Until then, stay informed, stay compassionate, and take care.
This is Dr.
Adrian Preda signing off.
you
Welcome to the Psychiatric News Special Report podcast, a monthly podcast produced byPsychiatric News for the APA's Medical Minds channel.
I'm your host, Dr.
Adrian Preda, Editor-in-Chief of Psychiatric News and Professor of Clinical Psychiatry andHuman Behavior at UC Irvine School of Medicine.
Today, our goal is to unpack a really profoundly important topic and unfortunately onethat's often overlooked.
(00:38):
We are talking about the very real human impact of
contemporary current US immigration policies and enforcement, specifically on immigrantchildren and their families.
This isn't just abstract legal policy.
It's about the deep consequences that policy has on mental health and well-being.
Today's discussion is based on the Psychiatric News August 2025 Special Report.
(01:03):
To discuss this report, my guest today is Dr.
Lisa Fortuna, a professor of psychiatry and neuroscience and chair of psychiatry at UCRiverside, and also the chair of the APA Council on Children, Adolescents and Families,
and also the report lead author.
To start with, Lisa, I got to say, I'm really impressed with how you pull together in yourreport such a rich mix of clinical insights, broader epidemiological data, and most
(01:31):
importantly, community-based research.
to shed light on what's a very complex dynamic between policy and mental health.
I'm going to start by telling you that after reading the report actually last night, Iread it a couple of times preparing for today's podcast.
What impressed me the most is that you're making a very, uh very important argument thatconsidering what's happening, essentially psychiatry, couldn't, shouldn't stay on the
(01:59):
sidelines.
take what's happening in the policy and in-fortunteria and argue pretty forcefully thatthis moment demands a fundamental rethinking on how we understand and how we treat both
structural and intergenerational trauma.
So let's start there.
Yeah, I'm, you know, I thought it was really important in writing this paper that we thinkabout how policy can have a direct impact on the well-being and mental health of
(02:29):
communities.
So I would say that that's the overarching message that I really framed this around.
And in this case, we're talking about immigration policy.
And it, my focus was really to take it from not
thinking just politically, right?
Because that's not really the point of the article, but policy, right?
(02:53):
And policies have especially profound impact in my belief on children and adolescents.
Children and adolescents and their families, of course.
But children are amongst the most vulnerable populations that we have globally.
They don't have a lot of rights as we would hope that they would.
(03:16):
including in the United States.
And when there are policies that directly impact their safety, their rights to be able tohave their family and to feel safe in schools and in their family, we have to think about
sort of those root causes of distress and how they can impact generations of children.
(03:36):
Yeah, it's really important to understand that these policies are not just about bordercontrol and paperwork, right?
They could in fact become immediate mental health threats.
And in your report, you highlight how the current policies have become a major source ofchronic fear, instability, and frankly, trauma for millions.
Yes, m and that's an important word that you're stating in saying trauma, right?
(04:03):
Or, you know, trauma, uh very extreme and toxic distress and stress.
you know, the authors and myself, one of the things that we wanted to point out is howdoes this really manifest?
And there's a few ways that that can really happen and is happening currently.
(04:25):
We can look at this
understanding of raids and immigration policy, right?
And this, the messaging that people will be removed.
But, you for children and families, it really is a message of being separated,potentially, and not having access to work and safe spaces at school and healthcare.
(04:48):
You know, what we're seeing, even as we speak, is that, families are living in extremefear.
even families that may have been working on their immigration process, but fearful to beable to even move forward with that because they believe that they might be separated from
their families or separated from everything that they know.
(05:12):
And that becomes a very distressing thing.
And we know that for children and adolescents, feeling that your support systems, yourfamily, your caregiver, your school setting is in threat.
and not safe creates a very significant stressor for at least a production of anxiety,depression.
(05:34):
And we have even seen in our clinical settings, even suicidality in both parents andchildren due to the distress of that fear and threat of separation and loss.
And when you witness those things within your community actually happening, you know, wehave seen
in research that it can have a very direct and negative impact on everyone in thatcommunity.
(06:00):
And so we can talk a little bit more about that, but there's even research on how it canimpact citizen individuals that are from that community very negatively, including
anxiety, stress, and even low birth weight babies um increasing among pregnant women thatare from that community.
because of the level of distress and physiological stress, right, of being able to seethese things.
(06:26):
Yes.
So we are talking about really specific things here, like the expansion of enforcementmechanisms, including worksite rates, people being held in detention for longer periods of
time, and also an erosion of protections in places that used to be considered safe, likeschool health clinics.
Right.
Yes.
And you're making this point, which I think is really important, that all this is not justlimited to immigrant children themselves, but it also affects millions of U.S.
(06:55):
born children.
kids living in what's called mixed status households.
Yes, yes, most definitely.
You know, these a lot of there are a lot of instances, right, millions of children who areborn here in the United States and have mixed status families may have a, you know, status
(07:16):
parents, you know, one that has US citizenship and one that does not and has some otherstatus in terms of immigration.
And what we have found in the empirical research is that even
citizen children, and especially citizen children who may have one parent or a very closerelative who is at risk of immigration issues like deportation, have increased rates of
(07:43):
anxiety and depression.
oh You know, one of my colleagues, Louis Zayas, has a book and also some articles thatreally did research, research the impact on citizen children of these issues.
and found elevated risks of depression, anxiety, even PTSD, and school difficulty.
(08:05):
And this was an issue for younger children, but even also adolescents.
the other part that I think it's important to consider is that in some of these situationsand probably in the majority of cases, some of the stress starts before the families even
arrive to the United States.
In the US, for instance, parents often migrate ahead of their children, perhaps to findwork and establish themselves, which then in turn leads to prolonged separations.
(08:32):
How does that affect and affect us into the increased risk?
Yes, yes.
I mean, that is definitely an issue that comes up a lot in terms of that there aresometimes uh sequential separations, right?
Where exactly what you're saying, that family members, parents, for example, mother orfather, may come earlier into the United States to be able to work and to set a pathway to
(08:59):
be able to bring their family, hopefully, right?
And then sometimes,
the children will come later and there is this prolonged separation sometimes for manyyears, maybe sometimes with other, know, having had stayed with uh other relatives like
grandparents.
And then sometimes there's separations from those caregivers, right?
Once they come to the United States, like a grandparent left behind, for example.
(09:23):
And then the reunification can sometimes be very challenging.
And so that's another area where separation can be very difficult.
I think what is happening here is that those children, as well as children who are bornhere, right, and been born here with their parents here, are all facing different degrees
(09:44):
and readjustments around this risk of maybe yet another separation, but now a traumaticseparation.
That's one of the things that I wanna sort of highlight too.
Even though it can be very difficult to have a parent move out of your country to set uh apathway forward for you in the United States, there's something particularly difficult
(10:13):
about what I state is a traumatic separation, right?
Where you are in a family with your parents and there is this risk that they will suddenly
and traumatically be taken from and maybe taken somewhere that you do not know.
And there's a little bit of a increased intensity about that traumatic experience.
(10:41):
It's really hard to kind of conceptualize this level of stress that is sort of setting upa slippery slope, which then further increases the risk for anxiety, depression, also
PTSD.
And I would imagine, and I think that's an important factor that we also discuss in yourarticle, the stress is compounded by the effect of the stress on also the parents' mental
(11:07):
health themselves.
Yes, absolutely.
You know, we know that children and I would say even adolescents, we don't always thinkabout adolescents in this way.
When they see that their parents, their caregiver, they're the person that they're lookingto keep them in a good place, in a safe space, that very important and primary
(11:29):
relationship.
When they see that the parents are stressed and reacting to that stress, it really is amessage that, you know, things are really going
to a very dangerous place and an unsafe place and my core support system is beingdismantled, right?
And so that it's really the way it reacts, the reaction is psychologically for childrenand adolescents.
(11:56):
And that translates into a real physiological stress, right?
You're on the, know, my gosh, I have to be on fight, flight, I have to be vigilant.
You know, the
main core of the person that keeps me safe and that I care about is at threat here.
And, you know, and that's why I, we also bring up in the article that it's that primaryspace of caregiving that is at risk, which is very stressful.
(12:26):
um And then for some, you know, most children and adolescents, then in that school space,the school community is another place of safety.
And when there's messaging that that might not be safe, um that's very, very challenging.
um So it is compounded.
It is compounded.
And that stress within the family um also becomes a significant salient place of stress.
(12:50):
Yes, and you cite actually talking about adolescence, a US national study where kids aged11 to 16, if they had a family member detained or deported, they had a significantly
elevated uh risk for suicidality, acting out behaviors, and even alcohol use.
(13:10):
And for the younger kids, the abrupt loss of a caregiver led to things like sleepproblems, appetite changes.
difficulty regulating emotions and even developmentary regression like losing skills.
Yes, yes.
And as you are, you you're talking about those symptoms or outcomes of those separations,we can, if we step back, we could see that that really sounds like a post-traumatic stress
(13:39):
disorder, right?
Or a constellation of symptoms that we might fall in that because it is traumatic, right?
And it is a reaction that comes from a very traumatic event.
And, you know, because we see those in post-traumatic stress.
And whether we feel that the youth meets full criteria for PTSD or not, those areconstellation of symptoms that we think that happen in those circumstances, right, that
(14:03):
are traumatic or disastrous or very difficult and stressful situations.
uh And that's what we do see with these kinds of events.
And thinking about trauma, I think it's important to emphasize that possible separationisn't just a sad event.
It's recognized clinically as an adverse childhood experience.
(14:24):
Absolutely.
It's one of the most adverse childhood experiences uh that we can think of as loss of aparent.
I we may also think about that as death of a parent, right?
But loss of a parent where you are unsure of what will happen next or they're uh beingreunified, will you be reunified or not?
(14:49):
Where will I go?
I mean, there's circumstances where children may not
have other people to care for them and they worry about, know, am I going to be in fostercare?
Am I going to be like, what's going to happen to me?
um Adolescents or older adolescents who feel like, am I going to be the caretaker of myyounger children?
(15:10):
It is really a dismantling of your life, right?
All of your support systems, your uh attachment, right?
Because we're also talking about a disruption of attachments, especially for youngerchildren.
And all these we know can be
very traumatic and adverse childhood events and can also really lead to psychological anddevelopmental consequences as you mentioned.
(15:33):
It's actually regression and development in part also because we're creating a stressor inthat primary attachment relationship.
and then it's not just the actual separation, it?
It's the threat of it too.
Yeah, that was a very important thing that we wanted to bring in this article.
(15:55):
I think most people would say, if you see a parent separated from you in such a manner asa raid or something like that, that that would be potentially traumatic for a child or
would likely be traumatic for a child.
But what we have found, uh I think clinically, absolutely, and definitely in theliterature, is the threat, the risk that this may happen to me because I have a parent
(16:20):
caregiver who's vulnerable to this happening and where our family is vulnerable to thiscan in itself be a very significant stressor.
And we have seen that, you know, where, you again, in studies of even citizen children inmixed families, that just having the threat or risk of that happening to your family
(16:40):
increases and elevates all of these symptoms and disorders that we're talking about.
Right.
the anxiety is the fear of unknown.
And this is probably the epitome uh of the fact that nothing could be known in terms ofwhat's going to happen the next day or even in the next moment.
And to make things maybe even more complicated, the whole landscape of US immigrationpolicy seems to be constantly shifting, often unpredictably, which must amplify these
(17:10):
challenges.
Absolutely.
is, you know, one of the things that we have found in both these situations and disastersituations, it's the uncertainty, the threat, the risk of harm to yourself and to your
family.
And I would say in these circumstances, threats and risks that seem very real.
(17:35):
Right.
And I think that that's a really important component that we have to highlight here.
It's not
especially in the current environment, it's not just the imaginations of a child, right,that I might be separated, that we might think in a separation anxiety, right, where, you
know, I'm worried that something might happen.
There are a lot of things in the environment and fast changing, as you were describing,that make that threat very real and very concrete and very present.
(18:03):
And that's one of the things that we wanted to talk about here, because that's wherepolicy is making one of
a child's fears a very real impossible reality.
And it seems like that's something that it's unfortunately contributing to this because weare looking at the context of expanding legal ambiguity.
(18:25):
ah It's not very clear who are the targets.
It could be a new citizen, lawful permanent residence, people on non-immigrant visas,undocumented individuals.
So there is this lack of clarity ah with uh almost like situations where it's not clear ifthe application is consistent.
there is not that much transparency, which then turn intensifies the fear and uncertaintyuh within the immigrant communities.
(18:54):
Yeah, absolutely.
You know, and I think that that's, you know, that's also leading to the degree of anxietyand fear in the adults, right?
A lot of adults in the immigrant community with various immigration statuses, right, havea lot of concern and fear right now of whether protections or uh sort of ways of
(19:18):
addressing their immigration status are no longer present.
And there's a lot of uncertainty of what might happen to them.
And that's creating part of the extreme stress or in fears, especially in adults who areseeing that and understanding that, or in some process, right, of asylum or other
immigration status, feeling like that is extremely at threat.
(19:41):
And even with adults, working with adults, immigrant populations, when you haveuncertainty about your pathway to some kind of safe status,
or being able to stay here in this country, asylum seekers who have experiencedsignificant uh issues in their countries of origin, violence included, there is an extreme
(20:03):
increase in anxiety, depression, and PTSD in those adults.
And when they have children, that is definitely transmitted, right?
Children and adolescents see their parents stressed and worried, and they understand thethreats.
And that creates those tensions that we were talking about earlier within families.
So this ervasive fear is directly linked to increased symptoms of PTSD and also internalexperiences such as anxiety and depression.
(20:30):
when it comes to children, you're also making the point that there are behavioral changes.
Yeah, yes, absolutely.
You know, because, again, if we take this from attachment, relational anxiety, you know,all the ways that we might think about how children manifest psychological distress and
(20:52):
symptoms, you know, that's one of the things that we see in young people is that there arealso developmental behavioral consequences.
Right.
I started this, you know,
discussion a little bit talking about the fact that children and adolescents areparticularly vulnerable populations, right?
(21:15):
They don't have all of the opportunities to make the decisions that adults may have andthey're reliant, right, on adults and systems to keep them healthy and to keep them safe.
And when some of those things seem at threat, or all of those things seem at threat,
a lot of that distress for children may be where they feel like they don't have agency,right?
(21:40):
And they're feeling that sort of psychological anxiety and sadness.
It can result in acting out and behavioral issues, right?
You know, not listening, being hyperactive, not being able to focus in school, not wantingto go to school, becoming aggressive, because it's one of the ways that we know that
(22:00):
children may...
they manifest that both because they don't have a lot of agency to do a lot of otherthings.
And also because that's the way that they may not understand exactly how to express thingsum at a more sort of mature level.
And that's why we often see that behavioral issues are really around this dysregulation,right?
What we call, you're just feeling really dysregulated and out of sorts and not having anagency to do it any other way and feeling so distressed.
(22:27):
Then I have these behavioral problems.
And so we have to look at those behavioral problems as not just sort of wanting to do thewrong thing, right?
But that it's really a manifestation of feeling really distressed and not right.
And then we can see kids avoiding school, dropping their grades, becoming sociallyisolated.
And really with all this missing out on chances for developmental support or mental healthhelp that they might really need.
(22:54):
Exactly and that's something else that we wanted to mention in the article.
It's a disruption of you know really those opportunities right.
It's not only sort of a direct distress and trauma which is enough of a problem but it isabsolutely what you're saying a disruption of opportunity for other healthy experiences
(23:18):
and growth and in some cases even education.
Considering this context, aren't these understandable responses?
Yes, you know, and you know, if we if we think about our humanity, right, when we havethis immediate threat to the things that are most important and close to us to react with
(23:42):
uh retreat, or agitation, or absolutely sadness and these psychological, you know,distressing symptoms.
That's that's what happens to us, right?
When when when things that are so
who are well-being are a threat.
So it's very human and it's very developmentally appropriate and it's what we wouldexpect.
(24:06):
To bring this all into really sharp focus, you are presenting a case study.
It's a mixed case study, but I think it's very informative.
It makes a comparing case for how this very complex dynamics play out.
Let's talk about Anna.
She's 17.
She's a US-born high school student living in a mixed status household.
(24:33):
and her parents are undocumented immigrants and she comes for her appointment in theclinic.
What's happening with Anna?
Yeah, yeah.
So Anna, you know, is experiencing a lot of the things that we talked about, you know, andas a sort of a composite vignette of things that we are seeing, you know, clinically,
(24:54):
where adolescents are, are very aware of what is occurring in their community and in theirfamily, all these things that we've been talking about, so the risk and the threat, right
of deportation, seeing the degree of stress in her
parents and be very aware that that only escalates her understanding of the threat becauseher parents are also very distressed and reacting to that distress.
(25:23):
And in the vignette, Anna starts doing some things that are really around expression ofher distress, like some self harm, some cutting, which is another thing that we might see
because she's trying to hold it together.
And she's trying to get to school and not maybe always succeeding in that.
(25:45):
But she's trying to hold it together, which is one of the things that we see withespecially adolescents where they also don't want to escalate their parents' distress by
disclosing their own distress, which is another element of this, right?
Where everyone tries to keep it from one another and there's not an opportunity to reallyfear of talking about it.
(26:08):
Right.
Which is one of the reasons that clinically we're, we're having families talk about it,right.
And plan and see how they could help one another and understanding and that parents can besupportive even within their own distress.
The other things that is in the Anna story is that disruption or disconnection fromothers.
(26:31):
Because one of the things that we find is that not only do family members have difficultysometimes talking about this because it's
such a horrible story, right, to talk about together.
They start moving away from other resources because of fear, right, of going out, but alsonot wanting to sort of disclose what's going on.
(26:51):
It's sort of a secret.
And in the vignette, we talk a little bit about the importance of reconnecting Anna tocommunity, right, to community organizations, to supportive things and institutions that
can support her family as well as a unit.
to sort of address all these compounded effects that are on families and how it mightimpact on an adolescent.
(27:13):
And the other part that I thought was really important in Ana's history is that she shareda really powerful piece of her family history.
Her grandmother had fled political violence during El Salvador Civil War, ah which traumaremained largely unspoken in the family, but it shaped her mother's upbringing in the
(27:37):
environment.
So there is a very important intergenerational
is there as well, which tends to be common in this population.
Absolutely.
I'm glad you're bringing that up because there is this, you know, we mentioned in thearticle in a few different ways, this idea of intergenerational, right?
(27:59):
And it's not just absolutely just what's happening now, but what has happened historicallyin the family where there have been circumstances of political violence, separation, and
we had talked about before, even loss and death.
right of individual family members through through through political violence and otherviolence in their countries of origin.
(28:22):
And so there is this living history of uh fear of loss and death.
And again, going back to real threats that have historically happened, and that arepotentially happening again, through circumstances and in uh do policy and politics.
So and again, it speaks to this idea of
(28:44):
what's often unspoken, but living within families, their anxieties, their fears aboutthese things, the trauma that they hold in their history and in their minds and even in
their bodies in terms of increased stress hormones and everything else that are activatedin situations, right?
And so, that relates to how the parents are reacting to these things and their ownre-triggering of trauma and how that is transmitted in the...
(29:13):
the family unit in terms of distress and stress and how do we manage this?
How do we talk about this?
How do we find support for this?
And I think that's, those are really critical pieces of Anna's story.
So, know, yes, I found Anna's story emblematic of a broader pattern of structural harm.
(29:35):
Her mental health isn't just shaped by what happened to her individually, but bygenerations of history, current policies, and then these fundamental social conditions of
whether she feels like she belonged or she was excluded.
Absolutely.
And it's the reason that, you know, the recommendation, I think that's implicit with uhAnna's story is having an opportunity to talk about those things and supporting the entire
(30:08):
family and that idea of reconnection, right?
Where in my community, where in my circumstances do I have a community of adults?
culturally appropriate understanding that can help us, right?
Because that idea of isolation is one thing that has to be addressed.
(30:32):
And the other thing that has to be addressed is that there can be a lot of internalizationby children and adolescents that there's wrong, inherently wrong about them and how
they're reacting and how they're responding.
And one of the things that we have to do is transmit or transform that narrative.
into you're not the problem, it's the situation, right?
(30:53):
That's the problem.
And then we have to address that together, we have to support you through this problem,right?
As well as take care of your emotional distress, but we need to sort of make clear thatthe narrative is about what's happening, right?
And we have to address those things with you.
So it's almost like we're looking at not only complex but sort of a layered set of nottrauma but traumas.
(31:17):
I think maybe that's a better way to understand it.
And then in your article, you argued that this set of traumas directly affect the brainand the body.
Absolutely.
We know that very distressful situations and perhaps in stages of development, childrenand adolescents, that you're talking about increased stress hormones, elevated stress
(31:47):
hormones uh more chronically, impacting brain structures that we associate with PTSD,post-traumatic stress.
amygdala, hippocampus, we know that those areas are negatively affected by elevatedstress, acute and or chronic.
(32:09):
uh And that those areas also have an impact on development, right?
And learning, as well as, you know, sort of associating with other parts of the brain thathave to do with learning.
And so when those things are elevated, it's very difficult.
It can have a significant impact on
the ability to learn, right?
(32:29):
At least in that moment.
And that's why we see in the literature that that's one of the things that might be anoutcome of post-traumatic stress or these very distressful situations where there are
difficulties in school and in learning and a sense of uh well-being and identityformation, right?
Because there is this ongoing risk and threat.
(32:50):
So it's very, it's very significant.
And it's why we really wanted to talk about it.
uh in this article looking at it from a child and adolescent perspective because it is avery clear policy and structural stressor that can have impact on children and adolescents
development for some time.
(33:11):
And it's something that we can address structurally.
Yes.
And with that, it's important to acknowledge that standard treatments like maybe SSRImedications or trauma-focused therapy could help.
But it's really important to consider the broader context and uh medications orpsychotherapy really are not enough on their own in this situation.
(33:36):
Yes, I mean, you I would say you have to if you you diagnose a child with PTSD because ofthese circumstances and again, it could be because of cumulative things like we've been
talking about, you know, past other traumas and threats and then now this and they do havePTSD and they meet criteria, treat the PTSD and we have good evidence based treatments for
(34:00):
treating PTSD, but not not stopping there.
because these are situations where we have to think about the context, as we've beentalking about, like what's happening to the family?
Has someone been separated?
Is there a potentially risk of the child not having a place to stay or be with, or they'regonna be displaced from their family home and to be with someone else because of what's
(34:22):
happening?
Are they having problems with being connected to their school?
Are they becoming isolated?
we have to think about those situational, circumstantial, environmental factors that aregonna perpetuate the distress that they have.
And so that's why we have to a little, let's take a step beyond the clinical uh setting,our office, and thinking about these other environmental issues that we might have to
(34:51):
address.
And we don't have to address them alone.
And I would say it's very unlikely we can address them alone, which is why we really
we try to tell clinicians that one of the important things to do is to build relationshipswith organizations and community-based organizations, for example, or churches and other
things that might be areas and places of support, or working with families to identifythese other places of support.
(35:19):
Because what's happening is not only internal, it's not just internal, it's environmental,right?
It's social.
And we have to think about what are the things that we can bring to support children inthose other realms, school, family, community, church, those places that can hold them and
help them through this.
and I think that's such an important point that when it comes to treatment is not justabout individual patients, but it's important to engage families and systems to make the
(35:49):
point that the relational care is key.
And also you discuss the importance of narrative and culturally grounded therapies thathelp restore meaning and connection.
Absolutely, because you want to speak the cultural and literal language of the experienceof what communities.
(36:13):
so we know, especially in situations of extreme distress, we go to those core things aboutwho we are.
And we know under distress, it's very difficult to talk about things in your firstlanguage.
We sort of go to our
primary language of uh expression of what we're feeling, very difficult to do throughinterpreter services alone, even though that is very helpful.
(36:39):
There's nothing else.
And to understand the cultural context of everyone's experience, right?
This is not only impacting Latino communities, it's many other communities that areimpacted, for example, and we have to understand all of the things that we're talking
about.
What is the cultural context of how these things are spoken?
What are the historical situations of
(36:59):
communities and how can these things be best expressed that are very difficult to expressat all and therefore have to be at least expressed in one's primary dominant language.
so much in here.
How about the workforce development and policy advocacy?
Yeah, we need more of that.
I know a lot of places are, you know, trying to increase our workforce of mental healthproviders.
(37:27):
Absolutely, we need that.
We do not have enough bilingual, bicultural across different communities.
Again, not just speaking about Spanish.
Available for a lot of communities to be able to do this.
There is a big movement in some states to also have
paraprofessionals, workforce development, like promotoras, community health workers thatare trained in understanding mental health and can be the front line in terms of
(37:54):
engagement.
And also working with other organizations like community based organizations, we mentionedchurches, to be able to have outreach, right around these mental health issues, engaging
people in reaching out for support, addressing issues of stigma, uh
trying to address this issue of silence and isolation.
(38:16):
And so we need workforce at all the different levels from psychiatrists topsychotherapists, psychologists, social workers, and also these community health workers
in the community helping.
And there are initiatives around the country.
I think we need more because we definitely need that diverse workforce.
And we need to keep naming immigration enforcement as a mental health issue, which meansdocumenting it, researching it, publishing on it.
(38:45):
Psychiatry must bear witness and not from the sidelines.
I think that's a very important point that your report is making.
Yes, yes, we have to definitely look at this as a determinant of mental health incommunities, immigrant and citizen.
It is a very negative and powerful traumatic force right now for a lot of communities.
(39:09):
And we have to name it, right?
We have to go upstream, as we say, right?
It was determinants of the health and the public health of our communities.
Absolutely.
Lisa, as we close, what's one key message you'd like to leave with our listeners?
I would like to leave our listeners, especially our psychiatrists and mental healthprofessionals know that your work is uh exquisitely needed right now.
(39:36):
We have to be able to open our minds in understanding how the things that uh we think maynot be in our realm as healthcare providers, as mental health providers, and just in
policy are absolutely in our realm.
And we're called to action right now to speak when we know that
things in our country are negatively impacting our patients and our communities that weare called to serve.
(40:02):
We have to move outside of this, clinical realm, because actually this is in our clinicalrealm, right?
It is a direct determinant of the well-being, especially when we serve children andadolescents and families.
Lisa, thank you so much for this urgent and illuminating conversation.
Your work powerfully reminds us that mental health care must be both clinically preciseand socially aware.
(40:26):
Yes.
To our listeners, thank you for joining us for this episode of the Psychiatric NewsSpecial Report podcast.
For more in-depth coverage of this topic, we encourage you to read the full article uh inthe August 225 issue of Psychiatric News or online at psychnews.org.
We've posted a link to the article in the episode description.
(40:48):
If you enjoyed this episode, please take a moment to subscribe, rate, and review thepodcast.
It helps others discover these important conversations.
Until then, stay informed, stay compassionate, and take care.
This is Dr.
Adrian Preda signing off.
you
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