s the Trump administration worked to revise its immigration ban, the effects were already becoming apparent in the hospital where I work, where many immigrants seek care. During this time I was called to evaluate the mental health of a man who had tried to kill himself by cutting his wrists.
I talked with him, through an interpreter, after he came out of surgery to stitch up the wounds on his arms. The man told me that he had been depressed for nearly a year, but never sought treatment. Instead, like many people with mental distress, he turned to drugs for relief. But when his depression persisted, he felt he had no options and tried to end his life.
Now, sitting in a hospital bed — head slumped, arms bandaged — he told me soberly that he regretted his suicide attempt and needed help to relieve his depression and stop his drug use. I encouraged him by telling him depression and substance use are treatable. However, when I started describing treatment options, he simply shook his head in resignation.
He explained that, as an immigrant, he had avoided the health care system because he was afraid it would put him on the radar of immigration officers and increase his chance of being deported. He told me that he remained fearful and would not risk separation from his family or return to dangerous conditions from which they fled.
I did my best to reassure this patient that his health records were confidential, that he was being treated in a sanctuary city, and that his providers would not betray their oath to do him no harm. I spoke earnestly and emphasized his safety. Yet it quickly became clear that my words did little to diminish his fear. No amount of reassurance could offset the inflammatory rhetoric toward immigrants, news of hate crimes and immigration raids, and the looming executive order from our new president.
Restrictive immigration laws that discourage undocumented immigrants from accessing health care have broad implications for health in the US. As was the case with my patient, what starts a treatable illness may then develop into something life-threatening, such as a heart attack or a suicide attempt. On the personal level, this is inhumane. On the societal level, it leads to more expensive care. The cost of my patient’s emergency surgery was orders of magnitude greater than the cost of outpatient mental health care would have been.
The long-term health consequences of a harsh stance on immigration are perhaps most tragically illustrated by the effect on newborns and young children. Pregnant women who live with high chronic stress, such as the fear of mistreatment and deportation, or who don’t get proper prenatal care, often deliver babies with low birth weights and developmental delays.
Researchers saw the effects of deportation fears on pregnant women following a 2008 immigration raid in Postville, Iowa, that largely targeted Latino immigrants — at the time the largest US immigration raid. In the year after the raid, birth weights of babies born to Latinas decreased by 24 percent, while birth weights of babies born to non-Latinas remained unchanged. Lower birth weights were seen in babies born to Latina mothers who were immigrants and to those who were born into the US. This suggests that the stress and fear engendered by immigration crackdowns can be felt among entire racial and ethnic communities.
I have seen this fear up close when providing mental health care in an obstetrics clinic in a public hospital in California. Most of the women I treat are immigrants from Central America and Mexico. Many of them migrated to the US seeking refuge from political or interpersonal violence, often enduring further trauma en route. The effects of this trauma, predominantly depression and PTSD, is often what brings them to my clinic. Timely and attentive treatment can improve the women’s mental health as well as the long-term health of their babies.
After Trump was elected, I noticed many of these women were increasingly focused on the fear, stress, and uncertainty they were feeling due to the rhetoric about immigrants. Many didn’t necessarily talk about it — likely to avoid drawing attention to their immigration status — but instead began showing up less. Though my colleagues and I tried to reassure them, some simply did not feel safe returning for prenatal and mental health treatment. No woman should have to make a choice between health care for her and her baby and the perceived risk of deportation, with a return to often violent and traumatizing circumstances. With many women across the country faced with such a choice, the health of a generation of newborn Americans could be affected.
Immigration rhetoric and policy also affects health care providers and the many nonimmigrant patients they serve. Nationwide, there are thousands of providers who came from the six countries affected by the latest immigration ban. They are responsible for millions of patient visits each year, and many of them work in underserved areas, including many Rust Belt communities. Our biomedical research infrastructure, which drives advancements in medical treatment, also relies heavily on immigrants. In other words, our health as a nation is intimately tied to the fates of such immigrants.
I’m not writing to offer policy prescriptions, but rather to underscore the harm that the Trump administration’s rhetoric and policies are sowing among vulnerable populations and health care broadly. Stoking fear and driving immigrants out of care and out of critical positions in the health care industry is bad for the health of immigrants, communities, newborn Americans, and the nation as a whole. If we don’t change course soon, it will take a long time to heal.
Colin Buzza, MD, is a psychiatry resident at the University of California, San Francisco, an American Psychiatric Association Public Psychiatry Fellow, and a member of the national Committee of Interns and Residents.