From managing expenses to finding the right provider, getting mental health care can be challenging, no matter who you are. But for people with undocumented immigration status, the challenges are even greater.

“If you live in fear or you live in the shadows, you don’t really know how to get help,” said Rachel Rios, executive director of La Familia Counseling Center in Sacramento, California. The center provides counseling and support to low-income families in the Sacramento area, with a special focus on Latin American communities.

“If you don’t have access to a digital device, if you don’t know the language, you don’t really know that there might be help available to you,” Rios explained.

For this population, affordable mental health care is hard to find. While Medi-Cal, the government insurance for California, covers services for children regardless of immigration status, undocumented adults are not eligible. While some health clinics offer therapy to uninsured patients, the healthcare landscape can be difficult to navigate, particularly if English isn’t your first language.

Recently, LAFCC was approved for a grant allowing them to fund one-on-one counseling sessions for parents, in addition to children and family sessions. Because LAFCC is plugged into the community, they are well-positioned to connect people with mental health care who might otherwise go without. “We’re known within the community and we’re known within the school districts,” said Rios. 

Providers at LAFCC have found that, for many patients, being undocumented is a major stressor. “Parents have this incredible amount of fear around immigration status,” said Rios. “A lot of that is then manifested in their behavior.”

Rios described several scenarios in which one of two parents was deported, leaving the other caretaker and their children behind in the U.S. Understandably, the situation provokes major anxiety and depression. “We’ve had moms that just can’t get out of bed,” she said. In this situation, children often try to take care of themselves without the support of family or government services. “The kids didn’t want tell anyone because they’re afraid that Mom would get deported,” explained Rios.

In addition, many of these parents have endured trauma earlier in their lives, including during their migration to the United States. The counseling sessions have allowed some to talk about their experiences for the first time. “We can go deeper into…the abuses that the parents experienced but were never allowed to talk about because it wasn’t something that was even discussed.”

For many of these children, the family dynamic comes with its own challenges. There is “a lot of guilt from kids because they know how much their parents are sacrificing for them,” said Rios. Some feel pressured by expectations, leading to stress and anxiety. They want to “appreciate what their parents are sacrificing for and try to do something better for the family,” but experience “guilt when they can’t,” she explained.

Stigma is another concern for patients. “A lot of my work surrounds…normalizing what mental health is,” said LAFCC’s mental health coordinator Adriana Martinez, who does weekly check-ins to assess a family’s well-being and connect them with outside resources, including long-term counseling and legal help. “I call them wellness checks,” she says, explaining that the phrase “mental health” can cause hesitancy among patients.

While most referrals to LAFCC’s counseling program are made by schools or health care providers, more than half have come from parents themselves during the pandemic. These are called ‘self-referrals.’ “We thought that was success on all kinds of levels,” said Rios. “One, we’ve broken down this barrier about stigma, and two, parents [know] where to reach us.”

The success of these programs is largely due to providers’ own background and familiarity with their patients’ culture. Martinez, the mental health coordinator, moved from Oaxaca, Mexico when she was 7 years old. Her family is indigenous Mixtec. “My grandma still speaks Mixteco,” she said.

It’s for these same reasons LAFCC, which is primarily a children’s mental health provider, emphasizes family counseling. “In Latino culture, it’s really all about the family, and so you really can’t do one thing without the other,” explained Rios.

If parents need long-term counseling, LAFCC facilitates the connection with an outside provider. “By doing this warm handoff, what we’re also demonstrating to these other providers is that they need to have cultural competence.”

Rios recalled referring a non-English speaking patient to another counseling center. We “were like, ‘How are you going to translate? This person speaks predominantly Spanish,'” said Rios. The answer? The center used Google Translate for five months until finally hiring a bilingual therapist.

Direct Relief provided La Familia Counseling Center with a $50,000 grant to support their Covid-19 vaccination efforts. The organization, in partnership with the Sacramento Native Health Center, is hosting weekly vaccine clinics to protect medically underserved communities against Covid-19 and have worked with Sacramento County to translate Covid-19 vaccine information into Spanish.