Mental Health Of Migrants NPR's Lulu Garcia-Navarro speaks with Cristina Muñiz de la Peña, a psychotherapist who works with families from Central and South America affected by the Trump administration's immigration policies.

Mental Health Of Migrants

Mental Health Of Migrants

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NPR's Lulu Garcia-Navarro speaks with Cristina Muñiz de la Peña, a psychotherapist who works with families from Central and South America affected by the Trump administration's immigration policies.


A federal district judge in Los Angeles says the federal government must provide mental health services to families affected by the Trump administration's zero-tolerance immigration policy. Now, just to recap, that is the policy that allowed the U.S. to separate migrant families at the southern border as a sort of shock and awe deterrent.

Now, the judge's ruling this past week is being praised by people like Cristina Muniz de la Pena. She is the mental health director at a medical and legal services clinic based in New York that works with immigrants, and she joins us now to talk about what she's seeing.

Welcome to the program.

CRISTINA MUNIZ DE LA PENA: Thank you so much, Lulu.

GARCIA-NAVARRO: You've worked with some of the families impacted by this policy, and you've got lots of experience, I understand, working with unaccompanied minors from Central and South America. What kind of mental health problems have you seen in kids?

MUNIZ DE LA PENA: Well, we see very, very diverse problems because it varies depending on several factors - the age of the child, the duration of the separation, the level of contact they had during the separation and some other elements of what made the separation more or less cruel. So we see children of young ages exhibiting regressive behaviors a lot of times - so kids that had mastered language and they exhibit speech delays; kids that are bedwetting again.

And then older children exhibit depressive symptoms, helplessness and powerlessness from something that occurred to them that was out of their control. You also see hypervigilance, fear of going out, fear of the authorities, anxiety of being away from mom. And this anxiety can show up as merely - they express fear of being away from their mothers. But some other children or adolescents exhibit more behavioral problems - so more defiance or irritability. And when you dig down into those behavioral problems, you see that what is happening is they're struggling with constant distress because there's the constant fear of, what's going to happen if I'm not next to my parent?

GARCIA-NAVARRO: So, so many things, obviously - and what happens to the parents?

MUNIZ DE LA PENA: For the parents, you also observe different reactions. But something that we've observed is sort of an idea of, how can I prevent my child from being traumatized again? - because they still live day to day with the fear that another separation may occurred, that they may be deported or that they may just have a traumatic interaction with immigration authorities.

So we work with one mother who has identified in therapy her fear of connecting emotionally with her child because she's afraid that if they get separated again, the child will be traumatized more if the child is emotionally connected. So she can't express affection. She feels tense when the child is being affectionate with her just because she wants to protect her child.

And we're talking about the most basic foundation of attachment. So parents have trouble conveying the most basic elements of love. And that's very severe when you think of the psychological needs of a child.

GARCIA-NAVARRO: So this ruling - does it make you confident that people who have been traumatized will be getting help now?

MUNIZ DE LA PENA: Oh. Well, I am concerned about the ability of the system to be able to provide those services to the families. I definitely think they need and deserve those services. My concern is, one, that the system lacks professionals that speak the languages, that have the training and the experience in working with these kinds of issues. But me as a therapist - when I'm working with one of these families, a lot of the therapy and the interventions to help their mental health has to do with concrete issues of their daily life and not so much the emotional process and the trauma processing.

GARCIA-NAVARRO: So what does that look like when you try and intervene?

MUNIZ DE LA PENA: Well, there's a lot of limitations. One of the things that we constantly do in our program is coordination of services with social workers and case managers that work with us in the therapy process and make sure that whatever minimal services there are to cover those basic needs - that they connect with them.

GARCIA-NAVARRO: What do you think should happen now? I mean, the district judge has ruled. Obviously, there are people who need help. What can be done, in your view?

MUNIZ DE LA PENA: I think access to mental health services should be supported. And I am happy to hear this ruling. I think it should not be considered in isolation because processing trauma and emotional difficulties in therapy - it cannot be done if basic needs are not covered, or it can be detrimental to the family. The family needs stability. So I would say these families need and deserve support to cover the basic needs from the pyramid of the hierarchy that we all know - food, shelter, stability and then therapy.

GARCIA-NAVARRO: Cristina Muniz de la Pena is the mental health director of Terra Firma at the Montefiore Medical Center in New York. Thank you so much for speaking with us.

MUNIZ DE LA PENA: Thank you so much, Lulu.

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