Migration and mental health: the risk of exclusion

Andrés Fontalba

The human being has managed to colonize all habitable regions of our planet thanks to migrations. Due to cultural, economic, political or geographic movements, the population has moved en masse from prehistory to the present day, these movements being in some cases spontaneous and others forced. It is, therefore, a process of mobility intimately linked to us as a species.

At present, there is a general perception of migration as a recent phenomenon, when the data indicate otherwise. Although international migratory flows have increased considerably in absolute terms (from a cumulative total of 75 million in the year 1960 to 214 million in 2010) according to United Nations estimates, their percentage over the total world population is practically unchanged (2.5% in 1960, 2.9% in 1990 and 3.1% in 2010).

If we compare the current moment with the migration of the late nineteenth century, we notice that the current flows are, in fact, quite limited (3.1% compared to 8.5% of the world population that was reached before the First World War, and even more so if we take into account the improvements and the considerable lower cost transport systems that we enjoy nowadays.

Among the causes that increase migration are the economic disparity, looking for the benefits that can be associated when going from a poor to a rich country, although the benefits for the host country must also be considered, as demonstrated by the United States’ economy in terms of productivity and economic growth related, among other factors, to immigration.

A widely discussed phenomenon is the impact of migration on mental health. Epidemiological studies have established a general pattern of lower risk of mental health disorders among first generation immigrants (born abroad) in the United States, although recent studies emphasize that this pattern is modified by factors such as ethnicity, national origin, gender and socioeconomic status. Factors of the immigrant's environment, such as family and neighbourhood, social position, experiences of support or social exclusion, one's own competence and linguistic abilities as an adaptation strategy, exposure to discrimination and stress further influence the relationship between immigration and mental health.

The main protective factor against the onset of mental illnesses would be resilience, understood as the ability of a person to overcome traumatic circumstances and, in turn, the way in which social relations develops in the new environment and how the social support network works. On the other hand, a serious risk factor to which immigrants can submit is inequality, which increases the appearance and severity of mental disorders. In countries with serious social inequalities, the prevalence of mental illnesses is increased. In the same way, inequality and the degree of it proportionally determine an increased risk of suffering mental disorders. These differences generate poverty and inequity and subject the person to serious stress, which precipitates the appearance of risk behaviours for their health, both physical and mental, with a loss of life expectancy of more than 20 years. Other factors would be having lower income, debt, violence, stressful life events, housing problems, poverty in terms of fuel and unemployment. Suicide is associated with mental illnesses, physical illnesses, alcohol and drug use, certain personality traits, experiences of abuse, unemployment, social and occupational class, poverty and stressful life events, all of these factors having an important social component closely related with exclusion. Inequity can also be a barrier when it comes to accessing treatment, so by offering interventions in mental health there is a risk that they are highly demanded by those who least need them and not by those who really need this support.

In migratory phenomena, exclusion and rejection positions are based on stereotypes and prejudices, defined as beliefs or organized ideas associated with different social groups and the emotions they arouse. These prejudices can lead us to take certain decisions without verifying their veracity, from frustration and this being the basis of discrimination that goes against human dignity. On the other hand, integration favours cohesion and the absence of conflicts, as well as prevention and recovery in mental disorders. The prevention of child maltreatment and the promotion of healthy attachment from childhood have shown efficacy when it comes to preventing mental disorders, especially in the early stages of life.

If we prevent exclusion, we reduce the inequality and if we tackle the inequality, we reduce mental disorders.