Recently, I learned that one of my clients committed suicide. The client was a young man who filed his asylum case in 2015. He had been waiting for an interview ever since. I did not know this client very well. He started his case with a "helper" who did a poor job of helping. Later, he hired me, but since the case was stuck in backlog limbo, there was not much for me to do. Because I am busy, I have little time to check in with clients waiting in the backlog, and so I had not heard from this person for some time.

I mention all this because, the fact is, I do not know whether the long delay in his asylum case or the underlying issues that caused him to leave his country were contributing factors in his death. Very possibly, there were other issues as well. That said, I can't imagine that the delay and uncertainty, and the other issues related to his asylum case, improved my client's mental health.

Indeed, the data available about asylum seekers and refugees supports a conclusion that such people have a higher prevalence of mental health difficulties than the general population. For example, one recent meta-analysis (a study of many different studies) found "lifetime prevalence in the general population is 3.9% for PTSD [post traumatic stress disorder] and 12% for any depressive disorder compared to... 31% for PTSD and 31.5% for depression" among asylum seekers and refugees. Whether this correlates with higher suicide rates is not entirely clear, as we have limited data on that point. But the evidence that is available suggests that suicide rates among refugees is higher than the general population--and in some cases, significantly higher.

Of course, this makes intuitive sense. People who have been forced to leave their country, their family, and all that is familiar, and who have arrived in a new place that is often not very welcoming, are facing many stress factors. Our asylum system, with its interminable delays and uncertainty, clearly adds to that stress. I have heard this many times from my clients, and I have had many clients treated for mental health difficulties, including suicide attempts.

All this raises some practical questions for those stuck in asylum limbo: What can be done to empower yourself in a situation that seems beyond your control? Where can you find support? What do you do if you are having thoughts about harming yourself?

I am no expert, but it seems to me that one psychological issue for my clients is their lack of control over the situation. They have to wait and wait, with their lives seemingly on hold. To the extent possible, I think it is important to live your life: Go to work or school, buy a house, start a relationship. This is easy advice to give, but much harder to implement. Even so, for those who can find meaning and purpose, and who can build a future--even amidst uncertainty--it will likely be easier to heal and to endure the long wait. Also, asylum seekers are not entirely powerless. They can try to expedite a case at the Asylum Office or in Immigration Court. Asylum seekers can also take action to improve the asylum system, by lobbying Congress, for example. I plan to write more about that in a future post.

Also, support is available for asylum seekers. This includes mental health assistance, support groups consisting of asylum seekers helping each other, and organizations that can assist with many aspects of resettlement in the United States. To find these groups is not always easy, but a good starting point is this state-by-state guide to immigration non-profits. Find a non-profit near you, call them, and tell them what you need. They may be able to direct you in the right direction. If they can't, there are plenty of other non-profits to try. In addition, religious communities are often an excellent places to find support and friendship. Many larger churches and mosques have committees devoted to assisting refugees (my synagogue does), and people at these institutions are usually eager to help.

Finally, what to do if you are thinking about suicide or self harm? Or if you fear that someone you know is considering suicide? Help is available in these situations. The National Suicide Prevention Lifeline (NSPL) "is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week." This help is available in many languages (through a telephone interpreter) at 800-273-8255. The NSPL makes several important points about preventing suicide--
  • Suicide is not inevitable for anyone. By starting the conversation, providing support, and directing help to those who need it, we can prevent suicides and save lives.
  • Evidence shows that providing support services, talking about suicide, reducing access to means of self-harm, and following up with loved ones are just some of the actions we can all take to help others.
  • By offering immediate counseling to everyone that may need it, NSPL's local crisis centers provide invaluable support at critical times and connect individuals to local services.

The NSPL also provides a list of risk factors and warning signs to keep in mind.

Asylum seekers and refugees have often undergone past trauma. Combine that with the challenge and loneliness of moving to a new place and starting a new life, and the uncertainty of the asylum process itself, and you have a perfect recipe for mental health difficulties. We can mitigate these hardships and help prevent any more asylum-seeker suicides by staying connected and being aware of the warning signs, and by reaching out when we see others in need of help.

Originally posted on the Asylumist: