Immigrant mental health, resettlement and migration, and its potential ties to third culture

Migrants, refugees and asylum seekers are in significant need of mental health support due to the high prevalence of adversity and trauma within their lives. Adverse lived experiences, such as violence, persecution, detention, torture, losing family members and loved ones, etc., can result in greater traumatic stress, depression, anxiety, prolonged grief and adjustment issues, physical health problems, impaired social functioning, and an overall lower quality of life (Bojic, Njoku & Priebe, 2015; Steel et al., 2009). The prevalence of mental health conditions, especially posttraumatic stress disorder (PTSD) and major depression, is notably high among refugees who have experienced extreme trauma before, during, and after forced migration (Kessler et.al., 2017). Such problems are known to present challenges for the entire family system: parenting problems, impaired marital and family relations, family conflict, and increased risk of poor mental health, development, and functioning in children and young adults (Hoffman et al., 2020; Beardslee et al., 2003; Ellis et al., 2010; Kalipeni & Oppong, 1998).   

Mental health of immigrants is also exacerbated by post-migration and resettlement stressors, such as finding employment, attaining permanent legal status, and navigating American systems. This is compounded by barriers such as English-Language Proficiency, security of basic needs such as food and shelter, and a lack of social support, in addition to racism and xenophobia (Bennouna et al., 2024). 

In response, mental health care for refugees and immigrants should be structured with a multi-layered approach, holistically addressing their needs through the integration of prevention, treatment, and stability strategies (Shaw et. al., 2021; Bunn et al., 2023).  

As an immigrant, I have experienced many of these challenges, which have led me to pursue a career in the field of immigrant mental health. Waiting on a pathway to citizenship led me to question if I belonged in the U.S. and my educational and career aspirations. This past summer, as my graduate cohort was preparing to depart for internships around the globe, I was once again faced with barriers associated with my immigration status. Having to grapple with a different internship experience from my peers, I was left wondering how I could make the most of my own summer and career path. My internship with the Trauma and Disaster Recovery Clinic (TDRC) helped provide meaning.   

Affiliated with the International Disaster Psychology: Trauma and Global Mental Health Program at the University of Denver, TDRC aims to promote the wellbeing of immigrants, refugees, asylees, and asylum seekers in Colorado. Over my summer there, I worked as a student clinician providing direct psychotherapeutic care to torture survivors. In this program, immigrants who have experienced torture and other human rights abuses are provided trauma-informed and culturally responsive care, utilizing professional interpretation services or by matching clients to clinicians who speak their primary language. In my role, I provided care focused on re-establishing safety and stability for clients grounded in their cultural backgrounds, beliefs, and values. Evidence-based trauma-informed approaches to address ongoing adversity and trauma were integrated into sessions on rebuilding trust, building on strengths and resilience, social connections, self-efficacy, dignity and empowerment.    

The experience of delivering holistic care to immigrants had a profound impact on me, personally and professionally. I recognized the story I was telling myself, through the lens of my immigrant identity: that I was inherently disadvantaged. De-constructing this stereotype meant intentionally shifting my perspective so that I could move out of this stuck belief and feeling. Despite being unable to travel this summer, I had a profound opportunity to give back to my community, strengthen my clinical skills, and find greater value in my own immigration status.     

Integrating my own experiences with the immigrant stories I heard over the summer, I was struck by the perpetual limbo associated with immigration. This was especially apparent for immigrants who do not yet have a pathway to permanent residency or citizenship. Constant shifts in status and a lack of consistency in the immigration system can lead to a deep sense of insecurity about one’s home and identity and complicate healing from losses and traumas. This uncertainty can impact mental health, especially for those who are survivors of torture. Crucial to the development of each human is their sense of identity and the specific geographical locations where one grows up (Miller, Wiggins, & Feather, 2020; Utržan & Northwood, 2017). People often ask where one is from; this question becomes increasingly difficult to answer when one is from a country that is inextricably linked to an immigration status. To find one’s identity in the mix of wanting to be a citizen in the U.S., while continuing to honor ethnic and cultural heritage, is a constant challenge.   

The ability to express my own passions through this internship, with the support for funding from the Center for Immigration Policy and Research (CIPR), opened my eyes not only to the unique needs of this community, but the silver linings in my own immigration status. Helping other immigrants find acceptance for their own immigration status while living in limbo motivates me to advocate for this community’s mental-health needs. Services like the ones offered at the TDRC are crucial to supporting the mental health and dignity of immigrants, refugees, asylees, and asylum seekers in the U.S. Given the chaotic nature of the immigration system, it is important for our systems of care to acknowledge the need for translation services and investment in clinicians who speak other languages.   

During my internship, I discovered Third Culture kids/adults (TCK/A) theory and research. “Third culture kids” are shaped by the intersecting dynamics of three cultures including: the parents’ original country [passport country/home culture], typically where their children are born; the family’s country of residence and employment [host culture]; and the community of individuals who share the same experience of growing up internationally [third culture].  Essentially, third culture is the experience of living between cultures. In learning about this model, I became curious about its applications for young immigrants struggling to make sense of their identity after arriving in the U.S. It may help shift the concept of acculturation into the U.S. from a fixed model to a fluid one, encompassing the experiences of immigrants and helping them find solace in their own life journey. I wonder if there is potential for finding security in the third culture model because it provides flexibility and adaptability to the process of acculturation to the U.S.   

There is something to be said about the threads between immigrants and TCK’s: These are humans trying to figure out their place in the world. This resonated with my own lived experiences and observations during my internship with the TDRC. I wonder: Could further exploration of these two contexts can create a pathway for a bigger global community to be built and connected? Living as an immigrant is an experience of learning how to cope and thrive while constantly shifting between safety and uncertainty. Seeing a third space of understanding who I am between those two contexts helped me feel more secure about myself. If this can happen to me, what can it do for others?