The Intersection of Immigration Enforcement, Trauma, and Mental Health: Implications for Nursing Practice
Submitted by Olivia H. Giles, DNP, RN, NEA-BC, AMB-BC
Tags: care clinical fear health mental health nurses symptoms trauma
Introduction
Immigration enforcement activities, including Immigration and Customs Enforcement (ICE) raids and deportations, have intensified in the United States over the past decade. In fiscal year (FY) 2023, Immigration and Customs Enforcement removed approximately 142,580 individuals from the United States (U.S. Immigration and Customs Enforcement [ICE], 2024). Although deportation numbers fluctuate annually, the scale of enforcement continues to affect millions of individuals living in mixed-status households across the country (Migration Policy Institute, 2023).
Immigration enforcement disproportionately affects certain demographic groups. Data indicate that over 90% of individuals deported from the United States originate from Latin American countries, particularly Mexico, Guatemala, Honduras, and El Salvador (Migration Policy Institute, 2023). Men also represent the majority of deportees; historically, over 90% of individuals deported are male, while women account for a much smaller proportion of deportation cases (Transactional Records Access Clearinghouse [TRAC], 2023).
The consequences of deportation extend beyond the individuals removed from the country. Research estimates that millions of children in the United States live in households with at least one undocumented parent, placing families at risk for separation during enforcement actions (Zayas, 2015). Deportation events often disrupt family structures, resulting in financial instability, psychological distress, and long-term trauma among family members who remain in the United States (Menjívar & Abrego, 2012).
In addition to direct exposure to immigration enforcement activities, indirect exposure through media coverage and social networks can exacerbate fear and psychological distress within immigrant communities. Images of immigration raids frequently circulate through television and social media, amplifying fear among individuals who perceive themselves as vulnerable to similar enforcement actions (Hacker et al., 2011).
For nurses and other healthcare professionals, these developments have significant implications. Patients affected by immigration enforcement may present with symptoms of trauma, anxiety, and distrust toward institutions, including healthcare systems (Torres et al., 2018). Fear of detention may discourage individuals from seeking medical care, reporting violence, or accessing preventive health services (Hacker et al., 2011). Consequently, culturally competent and trauma-informed care is essential to address both the physical and psychological needs of immigrant populations.
Impacts of Immigration Enforcement on Mental Health
The United States is home to the largest immigrant population in the world, with immigrants representing approximately 14% of the total U.S. population (Migration Policy Institute, 2023). Given the size and diversity of this population, it is essential that healthcare professionals, particularly nurses, are prepared to provide culturally competent care to communities that have historically experienced barriers to healthcare access.
Recognizing the influence of social and structural factors on immigrant health, the International Organization for Migration urged governments to formally acknowledge migration as a social determinant of health, prompting increased research examining how immigration policies, legal status, and access to services shape health outcomes among immigrant populations (Castañeda et al., 2015).
Psychological Trauma and PTSD
Exposure to immigration enforcement activities, including raids, detention, and deportation of family members, has been associated with significant psychological distress. Individuals exposed to these experiences often exhibit symptoms consistent with post-traumatic stress disorder (PTSD), anxiety disorders, and depression (Pinedo, 2020). For many immigrants, trauma may also accumulate from pre-migration violence, dangerous migration journeys, and post-migration stressors such as fear of deportation (Ortega et al., 2018).
Children are particularly vulnerable to the psychological consequences of deportation. Studies have found that children who experience the detention or deportation of a parent demonstrate higher levels of anxiety, behavioral problems, and symptoms of traumatic stress compared to children who have not experienced such events (Zayas et al., 2015). These psychological impacts can persist long after the deportation event, influencing educational outcomes and long-term mental health (Suárez-Orozco et al., 2011).
Recent research has further emphasized the psychological burden associated with immigration enforcement policies in the United States. Immigration-related policies and enforcement practices have been linked to chronic stress, fear, and psychological trauma among immigrant populations, contributing to increased risk for anxiety, depression, and post-traumatic stress symptoms (Dadras & Hazratzai, 2025).
Community-Level Trauma
Immigration enforcement activities often produce widespread fear within immigrant communities. Raids conducted in workplaces or residential areas can create an atmosphere of uncertainty and fear that extends beyond individuals directly targeted by enforcement actions (Menjívar & Abrego, 2012). Scholars have described this phenomenon as "legal violence," in which policies and enforcement practices create chronic stress and insecurity among immigrant populations (Menjívar & Abrego, 2012).
The psychological effects of immigration enforcement can also spread through social networks and community relationships. Research has shown that immigration raids can cause individuals to withdraw from community life and avoid public institutions, including schools, social services, and healthcare settings (Hacker et al., 2011). Exposure to traumatic events through media can further exacerbate distress. Repeated viewing of immigration enforcement activities through television or social media platforms may reinforce fear and anxiety among individuals who perceive themselves as vulnerable to deportation (Philbin et al., 2018).
Scholars have also noted that immigration policies may produce widespread psychological distress beyond those directly targeted by enforcement actions, contributing to what has been described as "silent trauma" within immigrant communities. This trauma can manifest through persistent fear of deportation, social isolation, and decreased engagement with public institutions, including healthcare services (Dadras & Hazratzai, 2025).
Barriers to Healthcare Access
Immigration enforcement has been associated with decreased healthcare utilization among immigrant populations. Fear of detention or deportation has also been shown to discourage immigrants from seeking medical care, contributing to delayed treatment and poorer health outcomes (Hatzenbuehler et al., 2022; Martinez et al., 2023). This avoidance behavior can worsen health outcomes and contribute to disparities in care.
Immigrants may also be reluctant to report crimes or seek assistance following incidents of violence due to concerns about immigration status (Hacker et al., 2011). In healthcare settings, fear of deportation may discourage patients from disclosing important information necessary for accurate diagnosis and treatment (Ortega et al., 2018). For healthcare providers, these challenges underscore the importance of culturally competent care that acknowledges the broader social and political contexts affecting patient health.
Recommendations
Recommendations for addressing the mental health needs of immigrant populations affected by immigration enforcement must extend beyond individual clinical interventions to include organizational and system-level strategies. Implementing trauma-informed and culturally responsive practices can equip nurses with the knowledge and skills necessary to recognize and respond to the psychological effects associated with immigration-related stress and trauma. By integrating both individual and organizational approaches, healthcare systems can better support nurses in providing comprehensive, culturally sensitive care that addresses the complex mental health needs of this vulnerable population.
Individual Interventions
Trauma-Informed Screening
Healthcare providers should incorporate screening tools for trauma and PTSD when assessing patients from high-risk populations. Trauma-informed approaches recognize the potential impact of violence, fear, and displacement on patient behavior, coping mechanisms, and health outcomes (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Screening tools are commonly administered in clinical settings such as emergency departments, urgent care centers, and primary care visits, and in some cases may be implemented during hospital admission as part of a comprehensive psychosocial assessment (SAMHSA, 2014; U.S. Department of Veterans Affairs, 2022).
When administering these tools, nurses should create a calm, supportive environment and utilize open-ended questions to encourage patients to share experiences in a manner that promotes trust and psychological safety.
Examples of screening tools available to assist nurses in identifying trauma exposure and symptoms of post-traumatic stress disorder in clinical settings include the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), a brief screening instrument frequently used in primary care and emergency settings to quickly identify individuals who may require further mental health evaluation (Prins et al., 2016). The PTSD Checklist for DSM-5 (PCL-5) is another widely used self-report measure that assesses the presence and severity of PTSD symptoms and can also help clinicians monitor treatment progress over time (Weathers et al., 2013). In addition, the Adverse Childhood Experiences (ACE) Questionnaire is commonly used to evaluate early life trauma that may contribute to long-term mental and physical health outcomes (Felitti et al., 1998). When administered in a supportive and culturally sensitive manner, these screening tools can help nurses identify patients experiencing trauma-related distress and facilitate timely referral to appropriate mental health services.
Culturally Responsive Communication
Effective communication with immigrant patients requires cultural awareness and sensitivity. Nurses should utilize trained interpreters when language barriers exist and ensure that patients understand their right to receive medical care regardless of immigration status (American Nurses Association, 2021). The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires hospitals participating in Medicare to provide a medical screening examination and stabilizing treatment to any individual who presents to the emergency department, regardless of insurance coverage, ability to pay, or immigration status (Centers for Medicare & Medicaid Services, 2023). Educating patients about these protections may help reduce fear associated with seeking medical care and improve access to timely treatment.
Mental Health Referral and Support
When trauma-related symptoms are identified, nurses should facilitate timely referrals to mental health professionals who provide culturally competent counseling services. Trauma-focused cognitive behavioral therapy (TF-CBT) and community-based interventions have been shown to reduce symptoms of PTSD among trauma-exposed populations (Pinedo, 2020). Healthcare organizations may also consider embedding automatic referral prompts within electronic health record (EHR) templates following positive trauma screenings to ensure that patients receive appropriate mental health follow-up and support.
Alternatives to Restraints
Patients with trauma histories may experience retraumatization when exposed to coercive interventions such as physical restraints or forceful clinical interactions. Trauma-informed practice recommends minimizing the use of restraints whenever possible and maintaining patient dignity and emotional safety during care (SAMHSA, 2014). Nurses should be mindful of potential triggers and approach care in a calm, supportive manner that prioritizes patient autonomy and emotional regulation. Strategies such as de-escalation techniques, clear communication, and providing patients with choices when appropriate can help reduce distress and promote a sense of control for individuals experiencing trauma-related responses.
Respecting Privacy and Confidentiality
Respecting patient privacy is particularly important when caring for immigrant populations who may fear that their personal information could be shared with immigration authorities. Nurses should reassure patients that healthcare information is protected under confidentiality standards and that clinical care is focused solely on the patient's health needs. Providing clear explanations about privacy protections may help alleviate fear and improve patient engagement with healthcare services.
Patient Education and Trust-Building
Nurses play a critical role in building trust with immigrant patients. Providing clear information about confidentiality, healthcare rights, and available services can help reduce fear and encourage individuals to seek care when needed (Hacker et al., 2011). Active listening, patience, and culturally sensitive communication can further strengthen therapeutic relationships and promote a supportive environment in which patients feel comfortable discussing their concerns and experiences.
Organizational Interventions
Healthcare organizations should implement system-level strategies to address trauma associated with immigration enforcement. Implementing these types of interventions can strengthen trust between healthcare institutions and immigrant communities while also improving patient engagement and access to care. Ultimately, these strategies contribute to improved health outcomes and organizational effectiveness in serving populations that are often underserved and marginalized within the healthcare system.
Trauma-Informed Organizational Culture
Healthcare systems should adopt trauma-informed policies that promote patient safety, trust, and emotional support across all departments (SAMHSA, 2014). Examples of such policies include implementing trauma-informed screening protocols, establishing clear confidentiality protections for patient information, developing de-escalation procedures to minimize the use of restraints, and creating welcoming clinical environments that reduce fear and stigma for immigrant patients. Additionally, organizations may develop guidelines that educate staff about the social determinants of health affecting immigrant communities, including fear of deportation and barriers to accessing care.
Staff Training and Cultural Competence
Training programs that emphasize cultural competence and trauma-informed care can improve healthcare providers' ability to respond effectively to immigrant patients experiencing psychological distress (American Nurses Association, 2021). Educational initiatives should focus on helping nurses recognize signs of trauma, understand the impact of immigration enforcement on mental health, and provide culturally responsive care. Innovative educational approaches, such as virtual reality simulations and scenario-based training, can allow clinicians to experience simulated patient encounters that highlight cultural and trauma-related considerations. Additionally, providing flexible training opportunities, including online modules, brief in-service sessions, and interdisciplinary workshops, can help ensure staff education is accessible and integrated into everyday clinical practice.
Community Partnerships
Healthcare institutions should collaborate with community organizations, legal aid groups, and immigrant advocacy organizations to provide comprehensive support services for affected individuals and families (Philbin et al., 2018). Partnerships with trusted community organizations can improve outreach efforts and strengthen connections between healthcare systems and immigrant populations. For example, mobile community health clinics or health vans can bring healthcare services directly into neighborhoods where immigrant populations live and work, reducing transportation barriers and increasing accessibility. In addition, the use of digital health technologies and community outreach platforms can help healthcare organizations communicate health information, appointment reminders, and available services in culturally and linguistically appropriate ways.
Expanded Mental Health Services
Organizations serving immigrant populations should prioritize access to culturally competent mental health services, including counseling programs that address trauma, family separation, and stress related to immigration enforcement (Ortega et al., 2018). Expanding mental health access may include integrating behavioral health specialists into primary care clinics, establishing trauma-informed counseling services, and developing referral networks with community mental health providers. Telehealth platforms can also improve access to mental health care by allowing patients to connect with providers remotely, which may reduce barriers related to transportation, work schedules, or fear of visiting healthcare facilities. Additionally, mobile health initiatives can extend mental health services into underserved communities and increase access to culturally responsive care.
Implications for Nursing Practice
Nurses often serve as the first point of contact for patients experiencing psychological distress related to immigration enforcement. Therefore, nursing practice must incorporate trauma-informed principles that recognize the complex social determinants affecting immigrant health. Integrating trauma-informed assessments into routine clinical practice can help nurses identify symptoms of stress, anxiety, and post-traumatic responses associated with immigration-related experiences.
Additionally, culturally responsive nursing care that acknowledges the social, legal, and environmental challenges faced by immigrant populations can improve patient trust, engagement, and overall health outcomes (Valero, 2025). Emerging evidence highlights the importance of trauma-informed healthcare responses to immigration-related stressors. Healthcare professionals, particularly nurses, play a critical role in recognizing the psychological consequences of immigration enforcement and implementing supportive care practices that address the mental health needs of immigrant populations (Dadras & Hazratzai, 2025).
Key implications for nursing practice include integrating trauma screening into routine patient assessments, improving cultural competence among healthcare providers, and advocating for equitable healthcare access for immigrant populations (American Nurses Association, 2021). Nurses are uniquely positioned to recognize the psychological and social impacts of immigration-related stressors and to respond using trauma-informed and culturally responsive care approaches.
Additionally, nurses can play an important role in educating colleagues and policymakers about the health consequences of immigration enforcement and advocating for policies that support the health and well-being of immigrant communities. Moral distress may also arise for nurses navigating the ethical complexities of caring for vulnerable populations within systems that may not fully support equitable access to care.
Conclusion
Immigration enforcement activities such as ICE raids and deportations have far-reaching consequences that extend beyond immigration policy. The psychological impact of these events can manifest as trauma, anxiety, depression, and reduced healthcare engagement among affected populations. For nurses, understanding the intersection between immigration enforcement and mental health is essential to delivering culturally competent care.
Trauma-informed nursing practice can help identify individuals experiencing PTSD and provide interventions that address both physical and psychological health needs. As immigration enforcement continues to shape the experiences of immigrant communities in the United States, healthcare professionals must remain attentive to the broader social determinants influencing patient health. Through culturally responsive and trauma-informed care, nurses can play a vital role in supporting resilience and healing among individuals and communities affected by immigration-related trauma.
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