Pathways to Health
By International Community Health Services

Increased fear of discrimination and harsh immigration policies are causing mental anguish for people in Seattle’s minority, immigrant, and refugee communities. The unease is so prevalent it’s keeping them from seeing a doctor or therapist, and creating paralysis when the community could most use the support of counseling and other health-related services.

“Patient anxieties have increased along with certain executive actions and the loud national debate on health care,” said Randon Aea, behavioral health manager at International Community Health Services (ICHS).

ICHS providers are seeing distress that interferes with patients’ daily lives and decisions, including an increase in complaints of sleeplessness, paranoia of being followed, difficulty concentrating, and hypervigilance.

“Patients have increased anxiety about their health care benefits being cut and their immigration status questioned, said Jeshmin Bhaju, ICHS psychologist. “Some feel an urgency to apply for U.S. citizenship, while others are not sure about making travel plans to visit other countries because they fear not being allowed back into the United States.”

“I have patients in the process of seeking political asylum. They are worried they will be deported. Some have already experienced trauma in the process of leaving their home country to come to the United States,” said Joe Gobunquin, behavioral health specialist at ICHS. “They may already have post-traumatic stress disorder.”

Lusa Hung, ICHS psychologist, says the impact extends beyond fears of deportation to include those already on the path to citizenship.

“I have seen an increase in anxiety in my patients who hold green cards. More people are asking for waivers for the English and civics testing requirements for naturalization due to mental impairment,” said Hung. “Patients are also hesitant to continue behavioral health services because they don’t know if their insurance will cover it in the future. Rather than risk a personal expense, they are foregoing care.”

Fear is hitting people of all ages and all backgrounds and can include entire families. For example, Gobunquin has young patients being bullied because they “look ethnic.”

“They complain of being teased and that other kids don’t want to play with them,” he said. “Family stress includes situations where one partner preys on or abuses the other with threats of ‘I will report you if you don’t do as I say.’ I’ve seen this kind of pressure lead to suicidal thoughts.”

“Several patients are concerned about racial and ethnic discrimination,” said Terra Rea, ICHS psychologist. “Specifically, I have Latino patients concerned about deportation, and Muslim patients concerned about Islamophobia. These macro concerns tend to exacerbate mental health issues.”

But perhaps more alarming than what Aea and his colleagues are seeing is what they know they aren’t.

Biases about mental health, other barriers add to silence

Compounding their fear and vulnerability is the long reach it already takes for minorities, immigrants, and refugees to connect with mental health services. Newcomers in a strange land, marginalized from the mainstream—transportation, child care, cost, insurance, and time off already offer a challenge.

Some find other reasons to stay away.

“People with mental illness are taught to feel shame, to believe they have a character or moral deficiency. This perception is especially true among many ethnic communities,” said Aea. “Most people don’t want to deal with why they experience certain feelings, they just want them to go away. Those seeking treatment are the brave ones.”

Sometimes, help literally gets lost in translation. Medical professionals like those at ICHS, who are trained to be culturally sensitive, as well as fluent in other languages, help bridge gaps.

“Communication is influenced by the translator’s cultural filter and biases, as well as their interpretation ability,” said Aea. “We tend to generalize people of different cultures based on our past interactions. People may misread cues.”

Healing starts with community, compassion, and kindness

“Whatever the source of anxiety, we can make a difference in how we respond,” said Aea.

Health care centers—falling under a category with hospitals, schools, places of worship, protests, funerals, and weddings—are considered “sensitive locations” by Immigrations and Customs Enforcement (ICE). This designation generally bars agents from searching, interviewing or arresting potential undocumented immigrants.

In addition to preparing staff in how to respond in the unlikely event of an ICE inquiry, ICHS takes precautions with patient information to ensure privacy and does not require patients disclose the details of their immigration status.

“We assure patients,” said Aea. “We don’t need to know if you are documented. The fear of being ‘caught’ or ‘discovered’ should never keep you from seeking any kind of health care. If you have been feeling anxious or sad, there are welcoming people at clinics near you that would be happy to dig deeper into these feelings, and in doing so help alleviate them.”

“I try to normalize the situation,” said Gobunquin. “I provide information and education. I reassure my patients that they can give us a call with any question and any doubt. We will look for resources to help them.”

Neighbors, family, and friends—all members of the community—need to acknowledge negative feelings and bring them into the light, said Aea. He offered a reminder that it is important that people seek treatment, just like they would with any other illness.

“Mental illness should be seen on par with any other medical diagnosis. Like diabetes or heart disease or any other condition, it needs to be addressed with medication, support and behavior change,” he said. “Minorities, immigrants, and refugees feeling fear and stress need to come see us, especially now.”

July is Minority Mental Health Month, which focuses on the challenges of mental health conditions and how they are increased by less access to care, cultural stigma and lower quality care in many minority communities. More information can be found at

About ICHS

Founded in 1973, ICHS is a non-profit community health center offering affordable primary medical and dental care, acupuncture, laboratory, pharmacy, behavioral health WIC, and health education services. ICHS’ four full-service medical and dental clinics—located in Seattle’s International District and Holly Park neighborhoods; and in the cities of Bellevue and Shoreline—serve nearly 29,000 patients each year. As the only community health center in Washington primarily serving Asians and Pacific Islanders, ICHS provides care in over 50 languages and dialects annually. ICHS is committed to improving the health of medically underserved communities by providing affordable and in-language health care. For more information, please visit

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ICHS’ welcoming statement reminds patients of its commitment to health care for all; welcoming all people, regardless of immigration status and regardless of ability to pay.
Image by ICHS

What it means to be welcome

As a Federally Qualified Health Center, International Community Health Services’ (ICHS) doors have always been open to any and everyone. Recently the community health center has taken extra steps to make sure patients feel welcome—including staff training and a welcome statement posted in all clinics that make it clear patient dignity, privacy and security are a priority.

“ICHS is providing staff training to offer consistent and considered responses to patient concerns about issues such as disclosure of personal information and immigration status. We also make sure our staff is aware of resources such as free legal support, that can be passed along to ease some of the challenges facing our community members,” said Michael McKee, director of health services and community partnerships at ICHS.

Patients and visitors to ICHS’ International District, Bellevue, Holly Park, and Shoreline clinics will soon be greeted with multilingual posters offering reminders of ICHS’ commitment to health care for all, regardless of ability to pay.

“We’ve created a message that reminds patients how much we value them—how much we truly value everyone,” said McKee. “We will be launching this as a welcoming statement to further help put people at ease.”

“Our clinic works alongside patients to support them in achieving their health goals. An important aspect of this partnership is that patients feel comfortable and relaxed about going to see their healthcare team,” said Teresa Lee, ICHS.

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