Mental Health as the Cornerstone of Effective Medical-Legal Partnerships for Asylum-Seekers: The Terra Firma Model

• Published in: Psychological trauma 2024-08, Vol.16 (S2), p.S417-S425
• Main Authors: Pineda, Lisa, Punsky, Brenda
• Format: Article
• Language: English
• Subjects: Adult; Advocacy; Asylum Seeking; Ethics; Human; Humans; Legal Processes; Mental Health; Mental Health - legislation & jurisprudence; Mental Health Services - legislation & jurisprudence; Mental Health Services - standards; Mental Models; New York; Physical Health; Refugees - legislation & jurisprudence; Refugees - psychology; Trauma
• ISSN: 1942-9681; 1942-969X; 1942-969X
• DOI: 10.1037/tra0001343

Objective: Challenges and traumas faced by asylum-seekers before, during, and after migration are compounded by the stressors of the asylum-seeking process, potentially compromising mental health (MH). Poor MH outcomes, in turn, complicate asylum-seekers' capacity to navigate the asylum-seeking legal process (e.g., hindering an individual's ability to provide an organized statement of their premigration experiences). Medical-legal partnerships are models of care that address legal problems as social determinants of health. However, when implementing medical-legal partnerships for asylum-seekers, standard definitions focusing on physical health do not appropriately capture the crucial role of MH services. Since 2013, the Terra Firma Program has provided services for asylum-seekers in the South Bronx, New York, by integrating MH, medical, and legal services along with enrichment activities, and concrete services. The present paper describes the benefits of this approach to working with asylum-seekers; highlights the importance of the MH component, including MH staff's dual therapist-evaluator role as a trauma-informed and ethical vehicle to support clients' asylum cases; and advocates for these partnerships to be recognized as MH-medical-legal partnerships. Method: Drawing from Terra Firma's experience with over 800 asylum-seekers, the authors provide a framework for addressing asylum-seekers' needs through MH-medical-legal partnerships. Results: Terra Firma's work with asylum-seeking children and families provides evidence in support of the establishment of MH-medical-legal partnerships and highlights the importance of the MH component in addressing asylum-seekers' legal needs. Conclusions: MH-medical-legal partnerships are proposed as effective models for working with asylum-seekers, with potential benefits to MH, physical health, and legal outcomes. Clinical Impact Statement This paper details the ways in which the inclusion of a MH component in a medical-legal partnership designed to meet the complex needs of asylum-seeking children and families, increases the effectiveness of the medical-legal partnership service model. Collaborating with legal and medical providers toward the goal of overall improvement in health and legal outcomes of the asylum-seeking population, colocated MH staff have the bidirectional role of providing behavioral health services (multimodal MH interventions) and legal advocacy (affidavits, letters of support, testimony). This nove