1. MENTAL HEALTH CARE FOR
UNDOCUMENTED IMMIGRANTS:
A GROWING CONCERN
*Note: The power of language. The term “undocumented” will be used in place of “illegal” to describe the
immigrant population. Take action and “Drop the I-word” by visiting http://colorlines.com/droptheiword/take-
action/charlotte-observer-action.html

2. Issue & Current Status
 Disproportion between mental  Agencies use sliding scales to
health needs and the number determine rates based on
of mental health services income level
available for undocumented  Services include crisis
immigrants intervention, family and
 Underutilization of services individual counseling, child
 Undocumented immigrants guidance, and group therapy
living in New York State may  The Affordable Care Act will
obtain services through the not provide coverage for
Department of Health and undocumented immigrants
Mental Hygiene (DHMH) and  Addendum prevents
public hospitals undocumented immigrants
 Undocumented immigrants are from for their own health care
not eligible for regular through private exchanges
Medicaid, but can obtain
emergency Medicaid if they
meet income requirements

3. Unmet Needs: Prevalence of Mental Illness
among Undocumented Immigrants
15% of the U.S. Population are undocumented immigrants.
Numbers may be higher due to trauma caused by migration,
exploitation in the labor force, and loss of social supports.

4. Causes
 Undocumented immigrants are not valued members of society
 Limited information is available about the needs of
undocumented immigrants as they are not accounted for in
census surveys
 Cultural stigmas of mental illness and mental health
treatment
 Lack of culturally competent providers including translators
and general knowledge of immigrant experience
 Long waiting lists due to insufficient number of providers
to appropriate serve undocumented immigrants
 The constant fear of being detained, imprisoned, or deported
by authorities discourages undocumented immigrants from
seeking services
 Lack of knowledge of available mental health services
 Work-related migration

5. Macro Effects
 Emigration struggles exacerbated
 Loss of extended family support
 Loss of familiar values and language
 Psychological distress
 New economic challenges
 Potential exposure to trauma
 Excessive use of emergency services due to a
lack of preventative services
 Drives health care costs up
 Misdiagnosis of presenting problem
 Increased domestic violence and child abuse

6. Macro Effects Continued
 People with SPMI are a severely under-
served sub-population
 High cost of medication
 Inability to obtain Rx
 Cyclical generational effects on children
due to parent’s untreated mental illness
 High rates of substance abuse and suicidal
ideation among undocumented youth
 Increased burn out rate for social workers

7. Micro Effects
 Yanelli Hernandez-Serrano, 22-year-
old who was deported in January 2012
after two suicide attempts while in a
detention center
 Joaquin Luna, 18-year-old suffered
from depression and anxiety took his
own life in November 2011

8. History
 Devolution and Immigration and Nationality Act
 Harsher anti-immigrant legislation in the wake of 9/11.
 i.e. Arizona’s SB1070
 Welfare Reform of 1996
 Public Charge Policy
 NY Immigration Coalition advocates for medical health
service, but not mental health services
 Emergency Medical Treatment and Active Labor Act of 1986
 Immigrant Confidentiality Protection
 Executive Order 41 prohibits most NYC workers from
asking anyone about their immigration status

9. Political Context
Opposition Support
 In terms of current  In terms of current
political parties, political parties,
Republicans have Democrats have been
opposed immigration more likely to be in favor
reforms at state, federal, of immigration reform at
and local levels state, federal, and local
 Those in favor of the levels
Border Protection Anti-  Those in favor of the
Terrorism Illegal Comprehensive
Immigration Control Act Immigration Reform Act
of 2005 of 2006, which did not
 Those in favor of the pass
Arizona SB1070 Act of
2009 and the Alabama
*In general, better provision of mental health services is not a
political priority

10. Conflicting Viewpoints
Opponents of Undocumented Immigrant Rights Might
Argue…
 Undocumented immigrants cost taxpayers more money at
federal, state and local levels
 Undocumented immigrants contribute low-level tax
payments because they have lower skills and earn lower
wages
 They have a high rate of consumption of governmental
services
 They increase cost of expenditures for education, criminal
justice, and emergency medical care
 17% of U.S. prisoners are undocumented immigrants
 They are more likely than taxpayers to use social services
 New immigrants are unwilling to assimilate to the U.S.
*It’s incredibly difficult to retrieve hard data on undocumented
immigrants because they are unaccounted for in several systems

11. Conflicting Viewpoints
Supporters of Undocumented Immigrant Rights Might Argue…
 Undocumented immigrants contribute to the U.S. economy through
investment and consumption of goods and services
 This contribution is cited at $800 billion per year in consumption of goods
and services and production for employers
 Undocumented immigrants compose 5% of the labor force
 They contribute $ 7 billion per year to Social Security, and $1.5 billion per year
to Medicare
 They contribute, but are not eligible to collect anything from Social Security or
Medicare programs
 ¾ of undocumented immigrants pay income taxes using taxpayer IDs or false
Social Security numbers
 Undocumented immigrants earn 20% less than documented residents or
citizens that are foreign-born (pro-con.org)
 Many undocumented immigrants take jobs that other Americans would not
take, such as migrant farmworkers, domestic work, or hospitality jobs in
restaurants
 (include a gallup poll)

12. Proposed Solution: Policy
Using California’s Model (MHSA)
 In 2004, California passed a measure called the Mental
Health Services Act (MHSA)
 MHSA’s goals were to provide increased funding and
expansion of mental health services by raising income
taxes by 1% for people earning over 1 million dollars each
year
 MHSA’s definition of expansion included extending
coverage to specific populations who need it and are not
covered by federal programs
 Establish a Mental Heath Services Oversight and
Accountability Commission (MHSOAC) to ensure efficient
implementation of proposed policy

13. Proposed Solution: Policy
New York’s Proposed MHSA (Joaquin’s Law)
 The proposed policy in New York would be similar to MHSA,
except that expanded coverage would also apply to
undocumented immigrants and would be funded through the
same mechanism by raising income taxes in New York by 1%
for people making over a million dollars per year
 The policy would include a requirement that when the state
asks for additional federal funding for the Disproportional
Share Hospital (DSH) program, they (anonymously) count
undocumented immigrants already receiving services through
mental health providers, which would increase funding from
the federal government to reimburse those providers (DSH
site)
 Similar to MHSA in California, the policy would emphasize the
importance of cultural and linguistic competence and
designate funding for better translation services and better

14. Agenda
Concrete Goals Broader Goals
 Passing the NYS version of the  In order to be successful, we
MHSA through the state must reframe why
legislature undocumented immigrants
 Designing a toolkit for deserve access to mental
community mental health health services
service providers to conduct  We must reframe the
better outreach and provide discussion to include how
education around mental undocumented immigrants
health, reducing stigma contribute to our overall
 Conducting targeted outreach prosperity by participating in
to communities with a high our workforce
density of undocumented  Raising awareness about the
immigrants and telling them prevalence of mental health
why the policy is important issues in order to reduce
 Supporting citizens who care stigma
about this issue to register to
vote, sign petitions, and
contact their state
representatives

15. Strategy & Tactics
Targeting Key Decision Partnering Organizations
Makers  Supporters of the NYS Dream
 NYS Assembly: Members of the Act
Mental Health and Health
Committees and the Puerto Rican/  New York Immigration
Hispanic Task Force
Coalition (NYIC)
 NYS Senate: Members of the Mental  Pew Hispanic Center
Health and Developmental
Disabilities, Social Services, and  New York State Immigrant
Health Committees and the Puerto Action Fund
Rican/Latino Caucus
 NYS Senators: Bill Perkins, Gustavo
 National Latino Evangelical
Rivera, Liz Krueger, Toby Ann Coalition
Stavisky, Shirley Huntley, Thomas
Duane, Tony Avella, Daniel
 National Immigrant Youth
Squadron and Adriano Espaillat Alliance (NIYA)
 NYS Assembly Members: Guillermo  Undocumented Students
Linares, Rory Lancman, Joseph Action and Resource Network
Lentol, Jack McEneny, Carl Heastie,
Sam Hoyt, Alec Brook-Krasny, Brian
Kavanagh, Matthew Titone, Michael
DanDekker, Grace Meng, Francisco
Moya and Sam Roberts,

16. Strategy & Tactics
Actions
 Attending Lobby Day in Albany with citizen supporters
 Circulating petitions to constituents and delivering them to their legislators
 Hosting phone banking events to call constituents and talk to them about these
issues
 Hold voter registration drives
 Targeting constituents who’s representatives at the state level are against the
proposed policy
 Educate undocumented immigrants about their rights when accessing services
 Name the legislation after a person who could’ve been helped by it’s passage, (in
this case, Joaquin Luna)
 Engage media organizations to write about Joaquin Luna’s case, in order to publicize
the legislation’s importance


17. Evaluation Plan
If it passes… Further action if it doesn’t
 Anonymously track how pass…
many undocumented  Monitoring votes in the NYS
immigrants access service Senate and NYS Assembly in
each year and see if that order to more effectively
number increases due to our target outreach to additional
educational efforts legislators and their
 Survey families to see if they constituents in “swing”
are aware of mental health districts
services and if they find  Continue to expand outreach
expanded access useful efforts through social media
 Use MHSOAC data to track and by engaging more/
decreased rates of: different advocacy groups for
 Homelessness their assistance
 School suspension
 Incarceration/Arrests
 Hospitalization

18. Cost
 Cost per Medicaid  How much money would
enrollee in 2009 in NYS we make by taking 1%
is $8,960 more for income taxes
 Estimated number of  The current tax rate for
undocumented people who make over
immigrants $1 million a year is
 Divide it so that we’re 8.82%, which would be
only taking 20% of that raised to 9.82%
total number of
undocumented
immigrants; those who
will use mental health
services
 This will equal the
amount of cost for

19. References
Boozang, P., Dutton, M., Lan, A., & Bachrach, D. (2010). Implementing federal health care reform: A roadmap for New York State. Retrieved
from: http://www.healthcarereform.ny.gov/research_and_resources/docs/roadmap_for_nys.pdf
Bryan, K. (2008, Apr 23). Immigrant mental health services and the church. [Video file]. Retrieved from: http://www.youtube.com/watch?
v=U3ZL0HVUuuU
Jones, S. (2012). Working with Immigrant Clients: Perils and Possibilities for Social Workers. Families in Society, 93(1), 47-53.
Henry J. Kaiser Family Foundation. (2011). State Medicaid fact sheets. Retrieved from http://www.statehealthfacts.org/mfs.jsp?rgn=34&rgn=1
Tax Foundation. (2012). State individual income tax rates. Retrieved from http://www.taxfoundation.org/files/
state_individualincome_rates-2000-2012-20120216.pdf
Novoa, M. (2011). Beyond Politics: How undocumented youth can find emotional support. Retrieved from: http://colorlines.com/archives/
2011/12/joaquin_luna_and_suicide_prevention.html
Saavedra, M. (2012 Jan 31). Activist race to stop deportation of a suicidal youth. Retrieved from: http://undocuhealth.org/press-release-
undocuhealth-org/
Varsanyi, M. Lewis, P., Provine, D.M., & Decker, S. (2012).
New York Immigration Coalition. (2006). The immigrant and refugee guide to affordable health care in New York State. Retrieved from:
http://72.34.53.249/~thenyic/sites/default/files/ImmigrantHealthGuide_FINAL040907.pdf
Pumariega, A.J. & Rothe, E. (2010). Leaving no children or families outside: The challenges of immigration. American Journal of
Orthopsychiatry, 80(4), 505-515.

20. References Continued
20
U.S. Department of Human Health and Services. (2012). Disproportionate share hospital. Retrieved
from http://www.hhs.gov/recovery/cms/dsh.html
California Dept. of Mental Health. (2011). Mental Health Services Act. Retrieved from http://
www.dmh.ca.gov/Prop_63/mhsa/
California Dept. of Mental Health. (2005 Feb 16). Vision statement and guiding principles for DMH
implementation of the mental health services act. Retrieved from
http://www.dmh.ca.gov/Prop_63/mhsa/docs/Vision_and_Guiding_Principles_2-16-05.pdf
California Dept. of Mental Health. (2004). Mental health services act. Retrieved from http://
www.dmh.ca.gov/Prop_63/mhsa/docs/MHSAafterAB100.pdf
New York City Health and Hospitals Corporation. (2012). Immigrant Confidentiality Campaign Public
Service Announcement. Retrieved from
http://www.nyc.gov/html/hhc/downloads/pdf/immigrant-psa.pdf
NAMI California. (2010). Prop. 63 Fast facts for prevention and early intervention. Retrieved from
http://www.namicalifornia.org/webbdata/MHSA-DTD-0000-00/mhsaoac%20fast%20facts%202010/
fastfacts_merged_eng.pdf
Bajaj, R. (2011). Public hearing testimony. Retrieved from
http://www.omh.ny.gov/omhweb/Statewideplan/2006/testimony/507/nyc/bajaj.html