Mental Health of Migrants in Mexico Takes Backseat to Getting to the US Despite Emerging Care

Los Invisibles: Nuances of Migration Along Mexico's Southern Border: Part 10 in a Series

CIUDAD IXTEPEC, MEXICO – Losing a soccer championship was the catalyst that pushed Danner López, 23, to leave his home country of Honduras for the U.S.

But the game was not the main reason López left. For years, he also had been having problems with the Mara Salvatrucha, the formidable gang also known as MS-13, which has a strong presence in Central America.

López joined the gang as a teenager but eventually disassociated himself from it because he no longer wanted to be a member, he says. When he did, other gang members threatened that he would pay for his desertion with a life. But it was not his life the gang members were after. Instead, they killed López’s wife five years ago, two months after she gave birth to their daughter.

López “fixed” the issue with the gang members two years ago, he says. He declined to give details about the arrangement, though he assures that he did not kill anyone. But his problems with the gang persisted, so he decided to flee.

López also left with hopes of finding a better job to support his 5-year-old daughter, whom he left in Honduras in the care of his sisters.

He sold his bicycle to earn money for his journey north. But thieves mugged him at the bus stop before he even left his country – forcing him to beg for money in the street to pay the fare – and again in Guatemala.

Thieves robbed him a third time in Mexico – this time at gunpoint – in Ciudad Ixtepec, a city in Oaxaca state. They took his cash and the cell phone he had managed to buy with money that his brothers, who live in Honduras and the U.S., had sent him.

López sought help at the nearby Hermanos en el Camino migrant shelter. He reported the crime,and the police found and apprehended his assailants. Now, López has to appear before a judge every two weeks as his case continues, so he still has not left the migrant shelter.

“If I had known that that was going to happen, I think that I would not have reported it,” he says. “I think in my mind: On one hand, it is good, but on the other, no, because it set me back. I think it is good because if some day I decide to send to bring my daughter, those crooks are not going to be on the road.”

López is a jovial man with a wide smile that stands out against his tanned, dark-skinned face. But his smile fades when he talks about the hardships he has lived through both in Honduras and as a migrant.

He does not like to talk to others about what has happened to him, he says.

“Telling this to people makes me feel bad, so it is better that I relax alone,” he says.

López does not even talk to his sisters about his problems, he says. When they talk on the telephone, he tells them that he is fine so that he does not disappoint them. He does not talk to his daughter because he feels that if he hears her voice, he will want to return to his country.

“I feel very unhappy for leaving my daughter abandoned because of problems,” he says.

Sometimes López cries to relieve himself, but he always does it alone, apart from other people, he says. When he wants to cry or needs to think, he takes a sleeping mat from the shelter’s male dormitory and lies down far from the others.

He sometimes stays up late, thinking of his problems or worrying that the other migrants at the shelter will steal his belongings.

“Here, a lot of problems happen to a person,” he says.

The violence and adversity that migrants face on their journey through Mexico can have psychological repercussions. Recognizing the importance of access to mental health care for these migrants, one organization has begun to offer psychological assistance. Still, many migrants treat their own mental health as a secondary concern, developing defense mechanisms so they can continue their journeys rather than pursuing professional care.

At least 88,500 migrants entered Mexico without authorization in 2012, according to data from Mexico’s National Institute of Migration. But the number is likely much higher, as the country’s federal migration authority bases its data only on the migrants it takes into custody.

Amnesty International has documented many cases of violence against migrants who travel through Mexico, including physical violence, mistreatment at the hands of authorities, arbitrary detention, extortion, assault, rape, murder, kidnapping and human trafficking.

Many studies have examined the mental health effects of migration among Mexican immigrants living in the U.S. But there is little evidence of studies that specifically evaluate the mental health of migrants who arrive in or travel through Mexico, even though the country is a destination and thoroughfare for migrants.

General studies about migrants, though, find that the violence and adversity that they face can have psychological repercussions. Traumatic events that occur before, while and after people migrate as well as poor living and working conditions can negatively affect their mental health, according to a 2007 study by researchers at the Universidad Autónoma Metropolitana in Mexico City.

At La 72 Hogar Refugio Para Personas Migrantes, another migrant shelter in southeastern Mexico, a 22-year-old Honduran woman opens up about these psychological effects.

The woman, who declined to publish her name for safety reasons, and her family fled Honduras after her husband’s cousin was killed, she says. After the crime, the family believed those responsible for the killing began to follow and to intimidate her husband and his brother. Fearing for their lives, the brothers decided to leave the country with their families.

The families have petitioned the Mexican government for refugee status. While awaiting a decision, they are staying at the shelter in Tenosique, a city in Tabasco state not far from the Mexican-Guatemalan border.

Two weeks have passed since they arrived at the shelter. This morning, the 22-year-old woman awoke sad but does not know why, she says as she cries on her bed in the women’s dormitory.

“Sometimes, I want to leave here,” she says. “Every day, I have been good, but I feel strange. I do not want to be here anymore because sometimes I remember … there [in Honduras], I had everything.”

Her 6-year-old daughter seems surprised to see her mother’s tears. She usually wears a smile in front of her two children but admits the journey has not been easy.

“The depressions get into a person when one leaves from there and [goes] to a strange place,” the mother says.

Migrants’ emotional states vary depending on the point of their journey, says Mariela Fuentes, a field psychologist for Médecins Sans Frontières, an international medical-humanitarian organization. Fuentes offers psychological consultations for migrants at the organization’s clinic in Ciudad Ixtepec.

Depression is common among the migrants the organization has attended to in Ciudad Ixtepec, Fuentes says. Ciudad Ixtepec is about 450 kilometers (280 miles) from the Guatemala border. By the time migrants get there, they are beginning to miss their families and to feel far from home.

“We talk about how they are since they left their country,” she says. “We know that they come missing their family, which can be linked with depression, with low self-esteem, with feeling sad and with despair.”

Farther south, in Chiapas state, the organization noted more fear and worry among migrants who visited its former clinic in the municipality of Arriaga, Fuentes says. This is because it is the first place where migrants climb onto the cargo trains that they clandestinely ride atop to travel north.

“There is a difference with those who arrived at Arriaga,” Fuentes says from her post in Ciudad Ixtepec. “The majority of the symptoms were anguish, anxiety. And here, there is depression. We believe that, in Arriaga, for the fact of seeing the train and those situations that they start to talk about – of the train, of the accidents, the acts of violence – we believe that that is why they present more symptoms of anxiety.”

Any person who lives through a traumatic situation can emerge with problems in their personality and conduct, says Ana Elizabeth Vázquez, a psychologist who works with migrant women who are victims of sexual abuse. She works for a women’s support program run by Mexico’s Ministry of Social Development.

For victims of sexual abuse, such as the female migrants Vázquez works with, post-traumatic stress can cause nightmares, insomnia, agitation, and the fear of going out in the street or seeing men, she says. Some victims can get to the point of a psychological break.

Because of the psychological burden many migrants carry, it is important that they have access to mental health care, medical experts say.

Any person who has suffered violence should seek psychological attention, Vázquez says. Even if a migrant does not have time for extended treatment, she recommends a crisis intervention and a brief period of psychotherapy.

“Violence leaves consequences … so I believe that, yes, emotional assistance is something very important,” she says.

In 2012, Médecins Sans Frontières launched a holistic health care program for Central American migrants at three clinics in Mexico, says Mado Conte, coordinator of the organization’s program in Ciudad Ixtepec. It offers medical and psychological consultations at clinics along the route that many migrants who enter Mexico illegally follow.

Because migrants are in transit, Fuentes says that she and her colleagues offer a “one-shot” treatment in which they focus on the principal problem that the migrant manifests. The psychologists know it may be their only chance to meet with the migrant, so they offer advice specific to this issue.

In May 2013, the organization closed its clinic in Arriaga, Conte says. The decision came after the International Committee of the Red Cross opened a mobile clinic there, so Médecins Sans Frontières considered it unnecessary to duplicate efforts. The clinic offers general health care, but its approach does not include psychological care.

There is also not psychological care available at other stoppings points along the journey. The 22-year-old Honduran woman, for example, does not have access to mental health care in Tenosique.

Médecins Sans Frontières is exploring the possibility of opening more clinics on the migratory route that begins in Tenosique as well as in northern Mexico, Conte says.

Mexico’s Constitution recognizes the rights of victims of crimes, including migrants who have entered the country illegally, to receive urgent psychological care when needed. But beyond victims of crimes, the government’s mental health care programs for migrants focus on serving Mexican citizens who have returned from the U.S.

Still, even when psychological care is available, many migrants treat their mental health as only a secondary concern, health experts say.

Various obstacles stand in the way of providing mental health services to migrants, Fuentes says. Principal among them is the low level of importance that migrants themselves give to mental health.

“For them, mental health is something secondary,” she says. “The objective that they have is to reach the United States. And it does not matter how they go, it does not matter if they arrive more or less well, but they have to arrive.”

Time is therefore also a deterrent, as migrants in transit are often not willing to postpone their journeys in order to undergo psychological treatment, Fuentes says. For many migrants, train schedules dictate how long they will stay in a community. They often do not know how long they will be able to stay, so scheduling appointments can be difficult.

Even migrants who have been victims of crime prefer to continue their journeys instead of interrupting them in order to seek psychological attention, Vázquez says. This is because they feel more pressure to arrive in the U.S., to find jobs, and to send money to their families than to take care of their mental health.

An additional limiting factor is that many migrants believe that psychological care is for “crazy people,” Fuentes says.

In the face of the difficulties and dangers of the journey, migrants instead create their own defense mechanisms in order to survive, Fuentes says. These include not sharing one’s problems with others. Migrants are hesitant to talk to psychologists, though those who seek care tend to be more open.

“They know that it is not good to talk about their emotions or their feelings with anyone else,” she says, “because they can utilize it as a weapon, because they make fun of them, because they remember their family. … They are protecting themselves from other people, from what they may feel.”

López knows that Médecins Sans Frontières offers psychological consultations to migrants in Ciudad Ixtepec. But he declines to seek professional care because he prefers not to tell his problems to others.

Another defense strategy that migrants use is mentally preparing themselves for everything that may happen during their journey, Fuentes says.

Luis Flores, head of the suboffice of the International Organization for Migration in Tapachula, a city in Chiapas, has worked with mental health issues among migrants who are victims of crime. Migrants’ own resilience can make it difficult for them to recognize when they have been victims of crimes, he says. It may also lead them to reject psychological care without considering whether they need it.  

“When you talk with the women who were raped, you see them with the drama, with the resentment, with the rage because of everything that happened to them,” he says. “But, at the end, they say, ‘Well, I already knew that this could happen.’”

With various reasons keeping migrants from seeking care, the Médecins Sans Frontières clinic in Ciudad Ixtepec sees only a tiny fraction of the tens of thousands of migrants who enter Mexico each year, Fuentes says. The organization gave a total of 270 psychological consultations at the clinic there in 2012 and 200 between January and July 2013.

“The number could be much more significant because we know that all have had problems,” Conte says. “But they already have their ways of defending themselves. So unless [the person is dealing with] a serious wound that has to stop, the rest of the demand is very low in comparison with what it should be.”

Conte is conscious of the usefulness of defense mechanisms for migrants, but her work is to attend to migrants’ health holistically, which includes mental health, she says.

Although no replacement for professional care, these defense mechanisms may be the healthiest option for migrants in transit who cannot consistently access mental health assistance, Fuentes says. If they stopped to think about all they have gone through and all that could happen to them on the journey, they might decide not to continue. This would be counterproductive for those whose objective is to reach the U.S.

Fuentes recommends that the migrants she cares for seek psychological help when they arrive at their destinations or at least join support groups. But she acknowledges that once migrants have arrived in their new country, they may not have many opportunities to reflect on what may have happened on the journey or to seek help. They will be busy trying to establish a new life.

“I also do not know whether they have time to think about all that has happened,” Fuentes says. “Moreover, they have to even look for a job. If you ask yourself to see your emotions, everything that happened, I believe it will also be affecting them in that moment, and what they need is to work.”

Although the struggles of migration have frequented the media, coverage has been shallow about the diverse issues that Central American migrants who enter Mexico illegally face as they try to settle in the country or travel north. Mayela Sánchez, senior reporter for GPJ's Mexico News Desk, spent one month along Mexico's southern border delving into the nuances of employment, health, violence, gender justice and various human rights issues that push people to migrate and confront them along their journeys. GPJ featured this series on the first Wednesday of October, November and December. This marks the final installment in the series.

GPJ translated this article from Spanish.