Humanitarian Protection is a Mental Health Issue
by Pablo Baeza Breinbauer (he/they/el/elle)
Associate Psychotherapist
Axis Mundi Center for Mental Health
Former Social Services Program Manager at Oasis Legal Services
As my clinical supervisor, Ruben Garibaldo, always says, “An asylum grant is a mental health intervention.” Indeed, my last three years as Oasis Legal Services’ Social Services Program Manager have shown me how truly powerful humanitarian protection and immigration relief for the many brilliant, thoughtful, and endlessly resourceful clients I have worked with can be.
In my career as a social worker, and especially during my time at Oasis, I have dedicated myself to working with clients who have had no choice but to leave their countries of origin in search of a stabler, more peaceful life in the United States. Some of these clients are escaping civil war or dictatorship. For those who come to Oasis, they are fleeing governments, police, and military forces who do not believe lesbian, gay, bisexual, transgender, intersex and queer people—especially when they are ethnic minorities—have the right to legal protection from violence or discrimination (or to be anywhere, except for dead or in jail).
As such, the behavioral and psychological impacts of suffering violence, neglect, and persecution often last years or even decades after their flight from their countries of origin. For the LGBTQ+ clients that Oasis specializes in working with, past trauma is compounded by an experience of profound social isolation – few, if any, friends or relatives from their countries of origin will accept them for who they are, much less help them with housing or material resources. Fear that they will continue to be discriminated towards and targeted in the United States takes over, especially given the highly public backlash happening towards immigrants and LGBTQ+ people right now, and deep ambivalence about connecting with other immigrants from their countries of origin and those who speak their language hinders connection, for fear of being rejected.
As a trained mental health professional and advocate for immigrants, I have often heard some variation of “people don’t need therapy, what they really need is money.” I wholeheartedly agree with the reality that the systems available in this country to poor and working-class communities, especially immigrants, are tragically insufficient relative to the wealth present in the U.S. and the long-held rhetorical notion that the United States is and was “built by immigrants.” Yet, I firmly believe the reality is that trauma and material lack often mutually reinforce each other, and that supporting immigrants, asylum seekers and refugees will take both real compassion and a commitment to reforming systems to make them truly accessible and empowering.
As a social worker, I have seen the intersections of post-traumatic fear and anxiety, and difficulty getting by, firsthand. I have worked with many clients who were never taught how to read because they were discriminated against for being transfeminine. I have worked with many clients who repeatedly ask, “will I get deported if I try to go to the doctor?” and who are afraid they will not be able to gain legal status if they access a food bank. I have worked with many clients for whom the source of deep social anxiety has been the experience of having been detained without trial or accused of crimes just for being “gay in public.”
Part of my role is to answer these questions honestly, both assuaging and validating clients’ fears in a society that is both often dismissive at best of LGBTQ people and immigrants but also offers them chances at economic opportunity and social belonging that many countries still systematically deny them. While I’ve seen a lot of hardship in my time at Oasis and think we can and should do a lot better as a society, I have also seen how the trusting consistency of a case manager or therapist has led clients to consider, and even pursue, futures they once held as unimaginable. I’ve worked with clients who, in middle age, have gained work authorization, obtained asylum, and have ventured to date in the gay community for the first time in their lives, or decided to pursue gender-affirming medical transition. I’ve worked with clients whose work authorization has allowed them to recognize how “not feeling assertive enough” was a condition of having to live undocumented, or with temporary statuses that could end at any moment, and who have then become advocates in their communities. I’ve worked with clients who, upon learning about California’s commitment to broadly accessible medical care, have obtained consistent HIV care, even in rural farmworker communities, for the first time in their lives.
So many of the people I have worked with bring so many dreams aborted due to persecution – of being musicians who revive the old musical traditions of their countries, of being architects, lawyers, performers. So many people have, in their struggle to survive in this country, brought with them their family recipes going back five generations that they want to introduce to this country, or brought with them a desire to start businesses, or to create more equity for LGBTQ+ immigrant communities in fields as varied as cosmetology and truck driving. I have also worked with clients who, after receiving work authorization, tell me they want to work in schools, in hospitals, with young people – so that this next generation grows up being affirmed and accepted, no matter who they love or how they express themselves.
Though this country has been and often still is a cruel place, I do believe it has the power to support LGBTQ+ immigrants and refugees, and I have witnessed firsthand, in our whole team’s work with our clients, how compassion and advocacy can help clients internalize a sense of empowerment and dignity that can make a way for them to contribute to the diversity of ideas and experiences that I believe make this country great. After all, while I did not come to the United States due to forced migration, I only became a United States citizen in late 2013. During my naturalization interview in Baltimore, the officer who interviewed me asked me what I hoped to do with my citizenship. “I want to help lift other people wanting to make a home in this country up,” I said. She smiled; her own parents had been immigrants. Complicated as these systems are, I think there’s so much we can still do within them to change lives – not just materially, but psychologically, for each and every person who deserves dignity and respect.
Published February 13, 2024