How is the city handling the mental health of newly arrived migrants?

The mental health of asylum-seekers coming to New York City has taken a back seat to providing the more immediate needs of food, shelter and clothing. However, as service providers see more patients, the need for mental health services continues to escalate.

“Mental health needs to be at the center of this crisis, as much as physical health and public health,” said Dr. Theodore Long, senior vice president of ambulatory care and population health for NYC Health + Hospitals.

“That stress and that level of both trauma that people experienced in the country that they’re coming from and on the journey here put them at very high risk for having mental health needs that we want to address again very quickly after arriving in our city.”

Asylum-seekers who cross the border into Texas and take a bus to New York City may arrive with stark mental health needs. A bill proposed by New York City Council Members Lynn Schulman, Shahana Hanif and Jennifer Gutiérrez would require mental health coordinators at each of the city’s 218 migrant shelters. However, the bill has yet to pass. In the meantime, multiple city agencies, including the Department of Health and Mental Hygiene, the Department of Education and the Department of Youth and Community Development are working with nonprofit organizations to deliver mental health services to migrants.

To address the ongoing influx of migrants coming to New York City, the Adams administration created a plan explaining ways in which the city will respond to new arrivals. In the plan, asylum-seekers at navigation and relief centers are enrolled in health insurance and given health care appointments through a referral process.

Migrant families who come into the city are directed to New York City’s 11 emergency relief centers.

The arrival center at the Roosevelt Hotel is run by NYC Health + Hospitals and has been open since May 2023. It has become the one-stop shop for medical care for asylum-seekers. The arrival center conducts health care screenings for diseases, such as tuberculosis, COVID-19, measles and chickenpox, and provides case management services and referrals for legal services. This has become an essential first step for asylum-seekers coming into New York City.

When it comes to mental health, migrants ages 12 and above are screened for depression through the patient health questionnaire. If someone screens positive and then scores a certain level on an additional test, they are immediately connected to a social worker who will assess any immediate mental health needs and create a plan of care. All those seeking mental health assistance are referred to a mental health clinic in the NYC Health + Hospitals system. Some sites include Roberto Clemente Center, which has an influx of bilingual staff available, and the Bellevue Program for Survivors of Torture, which offers rehabilitative services. Community health workers follow up with asylum-seekers in the event they miss an appointment. In some cases, migrants come to New York without a cell phone and are hard to contact. Organizations such as Catholic Charities of New York provide such resources for free.

Since opening, the Clemente Center has conducted mental health screenings for over 150,000 migrants. Other relief centers across the city offer the same screening services and continue to provide referrals throughout the NYC Health + Hospitals system for adults.

What about youth?

When it comes to migrant youth going to school and attending after-school programs, the Department of Education and the Department of Youth and Community Development do not track immigration status or country of origin, so migrant youth who need mental health services are not uniquely accounted for or treated any differently than the general youth population. The Department of Education has school-based mental health clinics in over 340 schools and supplemental health support services in 590 schools.

A young person who is in need of services would have to tell that to a guidance counselor or social worker at their school, who is the first point of contact, or be identified by school staff and be deemed “at-risk.” Depending on the severity of the case, they would then refer them to the mental health clinic in their school or a community partner the school works with, which is typically a nonprofit that runs a local mental health clinic. However, with such demand for mental health services, some clinics have waitlists of up to six weeks. Additionally, mental health clinics have a shortage of psychiatric nurses, who mainly are the ones prescribing medication.

One nonprofit that provides mental health services is The New York Foundling, which serves 22 schools and has four foster care clinics and a community clinic in Harlem.

“The (mental health) symptoms tend to be kind of stronger (in migrant children),” said Kristy-Lee Jean-Pierre, senior vice president, mental health services at The New York Foundling. “They last for a lot longer. The length of stay tends to be longer for migrant children than we’re finding for other groups of children. And I think it’s a function of all of the different stressors that are impacting the family. That just makes it a little bit harder to find that space of safety.”

Young people are given mental health services based on insurance. If they have no insurance, they are given services for free. Each school-based clinic is required to have at least one mental health counselor on-site.

When a youth comes for mental health services, sometimes the need for other services is identified, which can sometimes postpone the mental health services. For example, if housing is an issue, the child and their family are provided referrals to organizations to help with housing. But in the case of a crisis, school officials would call mental health workers and crisis intervention teams.

Challenges such as distance or language barriers tend to arise as well. For youth who live too far from a mental health clinic, telehealth is also an option. The city hopes to expand telehealth services for youth through a $9 million initiative.

Another challenge nonprofits see is the stigma related to mental health and not wanting to report abuse or harm due to the fear of being taken from their families, which oftentimes, are the only people they have in this country. Organizations, such as The New York Foundling, are providing education to students and their families about addressing their mental health and developing good habits to cope.

While the city is partnering with mental health clinics to address the more short-term needs of students, they are unable to provide long-term counseling services. Young people who need more long-term services are put through a referral process to see a therapist on a consistent basis.