The Role of Immigrants in Mental Healthcare Services

Since the start of the Covid-19 crisis, ample attention has been paid to the value and demand for frontline healthcare workers such as doctors, nurses, respiratory technicians, and care aides. However, as the nation enters into its seventh month dealing with Covid-19, other forms of healthcare services are seeing upticks in demand. The trauma and stress of the year has put mental health care, substance abuse care, and various forms of counseling services under significant strain. Similar to the healthcare industry in general, immigrants also play a critical role in mental health care services, not only as psychiatrists, but also as therapists, counselors, technicians, and aides, providing relief and support to millions of Americans.

  • More than 60% of all counties in the United States—including 80% of all rural counties—do not have a single psychiatrist. As previously documented by NAE, in rural counties, just 590 psychiatrists serve more than 27 million Americans. Numbers also vary significantly among states: There are more than 612 psychiatrists per 100,000 residents in New York, whereas rural Idaho has less than one psychiatrist for every 100,000 people.
  • Nearly one third of all psychiatrists are educated outside the U.S. According to the American Medical Association, as of 2015, nearly a third of all psychiatrist positions were filled by doctors who graduated from a foreign medical school. The number is even higher in certain states: In New Jersey close to 55% of all psychiatrists received their medical training abroad, and foreign-educated professionals make up more than one in three psychiatrists in 16 states, including Kansas, Missouri, and Wisconsin.
  • In 2018, almost one in 10 mental health care workers overall in the United States were immigrants. This category of workers includes clinical psychologists, mental health counselors, therapists, substance abuse and behavioral counselors, psychiatric care technicians, and psychiatric aides. 
  • In some mental health occupations, immigrants make up an even greater share of the workforce. For example, almost 15% of all psychiatric care aides as well as 12.6% of all psychiatric care technicians were immigrants in 2018. Meanwhile, 11.0% of all substance abuse and behavioral counselors and all marriage and family therapists were immigrants in 2018 as well. 

Table 1: Mental Healthcare Occupations by Number and Share of Foreign-Born Workers, 2018

Occupation Number of Immigrant Workers Immigrant Share of All Workers
Psychiatric Aides 9,800 14.8%
Psychiatric Care Technicians 8,900 12.6%
Marriage and Family Therapists 2,600 11.0%
Substance Abuse and Behavioral Counselors 10,300 11.0%
Mental Health Counselors 10,000 9.2%
Clinical and Counseling Psychologists 2,300 8.8%
Counselors, misc. 20,300 8.7%
Other Psychologists 11,800 8.0%
Rehabilitation Counselors 1,900 7.4%
School Psychologists 2,200 4.8%
Total 80,100 9.5%
Source: 2018 American Community Survey, 1-Year Sample. Numbers may not total due to rounding.
  • Immigrants also make up significant shares of the workforce at mental care facilities. More than 1 in 6 workers at individual and family services providing centers were immigrants in 2018, and more than 1 in 9 workers at psychiatric and substance abuse hospitals were immigrants. 

Table 2: Immigrant Workers Employed in Mental Healthcare Services, 2018

Industry Number of Immigrant Workers Immigrant Share of All Workers
Individual and Family Services 204,400 16.9%
Psychiatric and Substance Abuse Hospitals 13,300 11.0%
Source: 2018 American Community Survey, 1-Year Sample.
  • In some states, immigrants make up even higher shares of the mental health care workforce. In Florida and Maryland, nearly 1 in 5 (18.7% and 18.5%, respectively) mental health care workers were immigrants in 2018, while in California, 17.7% were immigrants. Other states, like New York (16.7%) and Arizona (13.1%) were also not far behind. 

Table 3: Top 5 States for Immigrant Mental Healthcare Workers

State Number of Immigrant Workers Immigrant Share of all Mental Healthcare Workers
Florida 8,800 18.7%
Maryland 3,600 18.5%
California 20,200 17.7%
New York 11,600 16.7%
Arizona 2,200 13.1%
Source: 2018, American Community Survey, 1-Year Sample.

The important role immigrants play in psychiatry and psychology helps communities meet the increased demand for mental health services that are culturally component and language accessible. As studies have shown, immigrants are particularly affected by the health and economic impact of the COVID-19 pandemic. In order to help all residents cope with the challenges of this crisis, various local governments have acted to connect immigrant residents with accessible mental health resources. In Minneapolis, the city established a COVID-19 Emergency Mental Health Fund to provide services to communities experiencing increased stress related to COVID-19, including immigrants and refugees. The local government of Santa Clara, CA created a Mental Health Guide for Immigrants which outlines how to access mental health resources. And in Los Angeles, the Department of Mental Health has published multilingual materials with advice on how to cope with stress and anxiety during the pandemic.

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