Photo: A photograph of the women’s group is displayed at Jesuit Refugee Services in Tapachula, Mexico
The migrant crisis is evident everywhere in this city of 350,000 near Mexico’s southern border.
Migrants queue up at dawn to apply for immigration documents. Sidewalks overflow with migrants peddling fried rice and flat bill hats. A park, once a popular tourist attraction, is a makeshift campground. The sounds of Spanish, Hatiatian Creole and other languages rise above the teeming streets.
But one facet of the crisis simmers, invisible and largely ignored: The devastated mental health of migrants passing through Mexico on their way to the U.S.
For most migrants in Mexico, trauma is inescapable. It’s in the gang violence, domestic abuse and lack of basic necessities that prompt them to leave home, and it’s on the journey through Panama’s Darién Gap – a perilous route where rape, assault and death are common. And trauma waits for them in Mexico, where any hope of respite vanishes as they spend months sleeping in the streets, struggling to find work or sewing their mouths shut to protest the torpid immigration system.
Experts say it’s even in the migration and asylum process, which requires migrants to recount over and over again the violence they’ve endured.
The migration system “seeks to destroy the souls and minds of the people,” said Yamel Athie, a Tapachula psychologist and migrants’ rights activist.
The Mexican government does little to prioritize mental health for its own people, let alone people from other countries. Mexico trails its peers in both mental health spending and number of mental health professionals, making services hard to access all around.
And even where services are available, providers face numerous obstacles. Many migrants avoid seeking help because of the stigma attached to mental health issues, or because they come from cultures where trauma is so commonplace it goes unrecognized. Some don’t see the point in starting therapy or medication in a place they view as temporary. Others are simply too busy trying to survive.
Nongovernmental organizations are working tirelessly to fill the gap in need, creating innovative, culturally-competent services to meet migrants where they are.
Still, providers and experts agree that the problem eclipses all existing resources. As the migration crisis in Tapachula continues to worsen, they said, so, too, will migrants’ mental health.
“This is not just a crisis,” said Nadia Santillanes, a social anthropologist at University of California, San Diego’s Center for Global Mental Health. “This is going to be permanent.”
Cycle of trauma
After walking for eight days, her feet blistered and cracked, SYH finally arrived in Tapachula from El Salvador.
The mother of three, who asked to be referred to by her initials to protect her identity, was anguished over leaving her home and family behind. But she felt she had no choice: After she and her partner refused to continue paying extortion money to a local gang, the gang kidnapped her and attacked her with an aluminum bat, she said. Fearing for her life, she fled.
Within her first few days in Tapachula, a sympathetic stranger helped connect SYH with Hospitalidad y Solidaridad, a shelter for refugees and asylum seekers. There, she was given a medical examination and two sessions with a psychologist. Just being able to vent about what she’d been through, she said, was cathartic.
“That helped me a lot, to get it off my chest,” she said.
SYH’s circumstances are common. The majority of migrants passing through Tapachula are from El Salvador, Honduras, Venezuela, Cuba, Chile and Haiti, where poverty, government corruption and gang violence are everyday occurrences.
In many migrants’ cultures, violence and trauma are so common they are normalized, experts said. And around the world, mental health treatment often still is thought of as only for people with serious mental illness, such as schizophrenia or severe bipolar disorder, and require institutionalization. More common symptoms, like depression and anxiety, are overlooked.
Pair those factors with most migrants’ realities as they struggle in Mexico to find work, shelter and feed their families, and it’s not surprising that relatively few seek mental health support.
“They are busy with other things. They are concerned with other things,” said Dr. Ietza Bojorquez, a researcher in the Department of Population Studies at El Colegio de la Frontera Norte in Tijuana, Mexico. “They are not going to seek a psychologist because they are blue.”
This history of untreated trauma, combined with the dangers migrants face on their journeys, the hardships they endure once in Mexico and the sense of loss they feel from leaving their homes, snowball into what some experts call “migratory grief.”
“They’re making the decision to move away from their countries. They’re experiencing mental health issues before even starting the process of migration,” said César Infante, a researcher at Mexico’s National Institute of Public Health.
Many migrants expect their situations to improve once they arrive in Mexico, he said, only to be immersed yet again in violence, deprivation and scarcity of food, water and shelter.
“So at the end, people end in crisis, no?”
The sluggish migration process, which often keeps migrants trapped in Tapachula for months, can cause these crises to spiral. Multiple migrants have died by suicide in Tapachula in recent years, according to local news media reports.
The problem is widespread: According to data and testimony recorded by the global NGO Doctors Without Borders, of the thousands of migrants in Mexico it interviewed during mental health consultations in 2018 and 2019, the majority appeared to have anxiety, depression and PTSD. More than half said they had been exposed to violence on their migration route. Of the women surveyed, a third said they had suicidal thoughts.
And that was before the pandemic. In March 2020, U.S. President Donald Trump implemented Title 42, a controversial public health order that drastically restricted migration from Mexico and Canada in an attempt to stop the spread of COVID-19. This left many migrants stuck in limbo, unable to move forward in the U.S. asylum process. (The Biden administration has attempted to end Title 42 but has been blocked in federal court.)
In the pandemic’s early days, Bojorquez said, some migrant shelters implemented lockdowns that prevented people from coming and going freely, which made many feel even more trapped.
“The feeling of autonomy is very important for mental health,” she said. “That was lost during that time.”
Even the migration system itself is traumatic, doctors and aid workers said, as people must recount what they’ve been through in great detail at multiple steps in the process.
Although some of the government employees who conduct immigration interviews now receive sensitivity training, retraumatization is still “inherent” in the asylum process, said Blaine Bookey, the legal director for the Center for Gender and Refugee Studies at the University of California, Hastings College. The legal requirements for establishing eligibility and credibility require applicants to provide a granular level of detail, she said.
“To some extent, even utilizing the best practices, it just is a traumatizing process,” Bookey said, adding that she believes every client she’s ever had has needed mental health support.
At Hospitalidad y Solidaridad in Tapachula, as SYH prepares to apply for asylum, shelter staff have warned her how emotionally demanding the process can be. She’ll likely have to tell her story many times over, they told her. Still, she’s determined to move forward.
“What happened to me, I will never forget,” she said. “But I have to be strong and get on.”
Mental health isn’t a priority for Mexican government
Mexico’s refugee agency, the Comisión Mexicana de Ayuda a Refugiados, known by its Spanish acronym COMAR, recognizes the dire need for more mental health services for migrants, said Alma Cruz, who heads COMAR’s Tapachula office.
But her agency receives no money from the federal government to address it.
“We have zero pesos” for mental health services, she said. “It’s a big, very big problem.”
In Mexico, it’s not only migrants’ mental health that goes overlooked. Doctors, researchers and NGO workers agreed that the country barely addresses the mental health needs of its own citizens: In 2017, only 2% of Mexico’s overall health budget – just more than $1 per person – was allocated to mental health. In a 2011 report, the World Health Organization described Mexico’s mental health workforce as “insufficient” and “poorly distributed.” And for people in Tapachula, the nearest psychiatric hospital is in Tuxtla, five hours away by car.
“I think mental health is an abandoned issue in Mexico,” Infante said. “Not only for migrants but for everybody.”
In 2019, a group of experts began working with the Mexican Secretaría de Salud’s mental health council to draft a plan to address migrants’ mental health. But the COVID-19 pandemic and staff turnover at the ministry interrupted the effort, said Bojorquez, who was part of the group. There has been no follow-up since.
Cruz, the COMAR worker in Tapachula, said federal agencies recently sent migrants to Tuxtla for psychiatric care in a few severe cases. But for the majority of migrants, their mental health goes unattended.
Darwin Chevez, 30, left home in Nicaragua because of the tumultuous political situation and failing economy. But living in Tapachula was even worse, he said in March. He and his girlfriend spent their nights on a piece of cardboard under a tree in the park, trying to sleep while constantly worrying about being robbed, kidnapped or deported.
At one point, he became depressed when he thought about returning home and realized he couldn’t. He had only 200 pesos left, the equivalent of $10.
Mental health services would have been helpful, Chevez said, but he didn’t hear of any.
“For all the immigrants who arrive in Mexico, it’s hard because they don’t receive any medical care from any institution,” said Chevez, who has since left Tapachula and arrived in California.
Part 4: NGOs and migrant advocates are stepping in
Where government response lags, migrant shelters and NGOs long have acted as a safety net. Now, many in Tapachula are adding mental health to their already long list of services.
Fray Matías Human Rights Center, a local nonprofit, has teams of social workers, lawyers and psychologists that work to comprehensively meet each migrant’s needs. At the international organization Jesuit Refugee Services, psychologists run support groups for migrant men, women and adolescents. And at Global Response Management, an international medical NGO, intake workers screen patients and refer them to appropriate mental health services.
Above all, organizations on the ground have adopted a “psychosocial” approach that addresses migrants’ mental health in a culturally competent way, such as through group activities centered on family, community and self-expression.
“How they speak about mental health is revolutionary,” said Santillanes of UC, San Diego, who has studied mental health protocols in shelters in Mexico.
When Mirta arrived in Tapachula three years ago, she had just escaped domestic violence, had left her three children behind in Guatemala and was sleeping in the street, her mental health in ruins.
She soon joined a support group at Jesuit Refugee Services, where twice a week she bonded over food, conversation and such activities as painting and jewelry making with other women who had survived similar experiences.
She could breathe again, said Mirta, whose last name is being withheld for her protection.
“I’m always, always going to be grateful for this service,” she said. “Why? Because it’s changed my life.”
Although such services are essential, they are scarce. Marilú Cárcamo Menéndez, the psychologist who runs the women’s group at Jesuit Refugee Services, said the group has helped about 100 women since its inception in 2019 but hasn’t been able to accommodate everyone who wants to be involved.
For the migrants who can access mental health services, caring for them isn’t always easy, doctors and health care workers said.
Dr. Jorge Eduardo Montesinos Balboa, one of only a handful of psychiatrists in Tapachula, said giving medications can be particularly challenging. For example, antidepressants are supposed to be managed over the course of a year – but with patients who are migrating, there’s often little or no opportunity for follow-up.
“One just barely begins to offer medicine and you put them on a plan for a year, but who knows if they will be able to do that? Who knows what is going to happen?” he said.
It can also be hard on the health care workers themselves who, by working closely with migrants, are susceptible to vicarious trauma.
Laura Benitez, a project manager at Global Response Management, often spends her days taking migrants to the hospital and connecting them with other services. Listening to their stories weighs heavily on her, she said. She recently restarted therapy as a way to protect her well-being.
“I think a lot of people in activist or humanitarian groups, they are so busy helping people, they don’t put their mental health as a priority,” she said.
Despite the challenges in providing care, medical and NGO workers agreed that more resources need to be put toward making sure migrants’ comprehensive needs are met. On top of general mental health services, specialized services are also lacking, Benitez said, such as grief counseling and services for people with intellectual disabilities.
But shelters and NGOs are already stretching their resources thin. In the end, they often are the only line of defense for migrants’ mental health.
“In general, without NGOs here, people would be suffering way more,” Benitez said. “Because government doesn’t do enough.”