Mental health services for immigrants and refugees in Philly must be reworked

If the past several months of discussion and action around supporting immigrants and refugees in Philly has shown us anything, it’s that the city wants to help in as many ways as possible.

Whether that’s by providing collective legal counsel or helping newly arrived immigrant professionals transition to familiar careers, socially minded groups and individuals are certainly doing their part to help these populations.

Yet it can’t be understated that many immigrants and refugees, especially those who are forced to leave their war-torn homes or have even experienced domestic abuse and human trafficking, are dealing with immense emotional and mental distress. Even with the resources that are slowly being made more available, the transitional issues that come with trying to adjust to life in a new country — financial and employment difficulties, hardships with the school system, access to healthcare — are a whole other beast for these groups.

Fortunately, nonprofits and organizations in Philly are starting to address this need for immigrant- and refugee-centered mental health services. Council for Relationships (CFR), a nonprofit that focuses on family-focused therapy for their clients as well as post-graduate therapy training for master’s students, recently started working with the Nationalities Service Center (NSC) to provide pro-bono services via interns and students for its clients, all of whom are refugees and immigrants.

The partnership started to take shape last year after the election and the following immigration ban.

Emma Steiner, associate director of clinical and business operation and staff therapist at CFR, said the discussion for a partnership with NSC, which is the first one for CFR that’s geared toward this population, started sometime last summer but really started to take shape after the election and the following immigration ban.

Steiner added that their family-focused approach to therapy is especially needed for immigrants and refugees, since many have been separated from their families.

NSC itself has taken a more proactive approach in providing mental health services for immigrants and refugees, having started its official health and wellness program just two years ago after discovering the need to “integrate, standardize and expand our network in that area,” according to Gretchen Shanfeld, the director of the health and wellness department.

Shanfeld said NSC and other immigrant- and refugee-facing orgs are in dire need of healthcare providers who can serve uninsured individuals, like the majority of immigrants and refugees who come to America.

But as Steiner and Shanfeld have learned, just having trained therapists and counselors on hand doesn’t make for a fully comprehensive solution — language barriers and cultural differences have complicated the process. Bilingual therapists who can communicate one-on-one with clients are still not as readily available and with NSC serving over 5,000 people from more than 10 countries every year, Shanfeld said the “tell-me-how-you-feel” approach doesn’t work for everyone.

Instead, religious observance, social support and exercise are some of the most recommended alternatives among the people she’s talked with.

“We really try to operate at the standpoint of cultural humility [which] really talks about letting the client guide the process and be the expert for you as you help navigate things,” she said.

(Photo by Clever Girl Photography)

There is at least one organization in Philly that has had the mindset from its beginning in building up a capacity of bilingual therapists and counselors who specifically want to work with immigrant and refugee communities: La Puerta Abierta (LPA), or “the open door.”

Cathi Tillman, founder and director of LPA, has an expansive history behind the root system of the small nonprofit which spans back 22 years in South America. That’s where she was involved with a group “trying to change the way mental health services were being provided to underserved communities around the region.”

It was eight years ago when she decided to bring this mindset to Philly and now, LPA has a main office based at the Norris Square Neighborhood Project in North Philly where an average of five graduate interns every year are working in social and family therapy, as well as all being bilingual in serving mainly the Spanish-speaking population.

"We need to really shift from this idea that we are the experts that are fixing the problems in other people’s lives."

In addition to serving language and cultural needs though, Tillman said LPA is part of a “shift in paradigms” within the mental health field that is looking at more “holistic” approaches to healing, whether it’s through art, music, youth programming, storytelling, et cetera.

“From the beginning, our philosophy has been that we need to really shift from this idea that we are the experts that are fixing the problems in other people’s lives,” Tillman said. “We really believe in the need for community-building and relationship-building.”

If anything, she said there definitely needs to be more conversations around why more traditional forms of mental therapy may end up being more damaging to immigrants and refugees who have been born and raised in a “transnational context.”

The hope is that these conversations happen sooner rather than later — even though it’s a much smaller organization, La Puerta Abierta gets five to eight referrals a week from the court system, public health clinics, schools and hospitals. Sometimes there are five in one day.

“It’s complicated, it’s messy, it’s vast but we’re here to do that work,” Tillman said.