In the Journals

Rescinding DACA may have ‘dire’ mental health consequences

Eliminating the Deferred Action for Childhood Arrivals program would be detrimental to the mental health of those impacted by the law, according to two authors of an essay recently published in the New England Journal of Medicine.

President Donald J. Trump announced earlier this month plans to rescind the Deferred Action for Childhood Arrivals (DACA) program, which the essay’s authors said gives freedom from deportation and access to work permits for undocumented immigrants who were brought to the U.S. before 16 years of age, a group known as ‘Dreamers.’ The president’s announcement came under fire from many medical groups, including the AAFP, AMA and ACP.

“DACA was never intended to be a public health program, but its population-level consequences for mental health have been significant and rival those of any large-scale health or social policies in recent history,” Atheendar S. Venkataramani, MD, PhD, of the department of medical ethics, University of Pennsylvania, and Alexander C. Tsai, MD, PhD, of the Harvard Center for Population and Development Studies, wrote. “Rescinding DACA therefore represents a threat to public mental health.”

To illustrate their point, the authors described data that indicate since the law’s passage, rates of severe or moderate psychological distress in DACA-eligible patients dropped by almost 40%; and that the rates of anxiety and adjustment among children of DACA-eligible mothers fell by more than 50%.

Venkataramani and Tsai said the 6-month window before DACA’s rescinding presents an opportunity for medical professionals to change the course of history.

“[Health care providers] now have a limited window of opportunity to engage policymakers about protecting Dreamers through legislative action, the public health benefits of doing so, and the potentially dire mental health consequences of failing to enact a definitive legal remedy,” they wrote. “Advocates can also make clear that protecting Dreamers — and other immigrant groups — would have few, if any, economic disadvantages for native-born workers.”

Venkataramani and Tsai outlined an action plan if DACA is indeed repealed.

“Health care and public health institutions will need to work together to ensure that the people under threat do not bear the burden of mental distress alone. In such an environment, organizations would need to proactively reach out to undocumented immigrants to keep open lines of communication and reassure them of ongoing efforts to establish a firewall between health care policy and immigration policy,” the authors wrote.

“Clinicians will continue to ensure the delivery of high-quality health care despite immigration status,” they continued. “Providing Dreamers with information about public resources that can be safely used in the case of severe mental distress will be critical. On a broader systems level, tracking health care utilization and health outcomes will help organizations monitor health at the population level and provide hard data to policymakers seeking to implement other supportive remedies.” – by Janel Miller

Disclosures : Venkataramani and Tsai report receiving grants from the Robert Wood Johnson Foundation outside the submitted work.

Eliminating the Deferred Action for Childhood Arrivals program would be detrimental to the mental health of those impacted by the law, according to two authors of an essay recently published in the New England Journal of Medicine.

President Donald J. Trump announced earlier this month plans to rescind the Deferred Action for Childhood Arrivals (DACA) program, which the essay’s authors said gives freedom from deportation and access to work permits for undocumented immigrants who were brought to the U.S. before 16 years of age, a group known as ‘Dreamers.’ The president’s announcement came under fire from many medical groups, including the AAFP, AMA and ACP.

“DACA was never intended to be a public health program, but its population-level consequences for mental health have been significant and rival those of any large-scale health or social policies in recent history,” Atheendar S. Venkataramani, MD, PhD, of the department of medical ethics, University of Pennsylvania, and Alexander C. Tsai, MD, PhD, of the Harvard Center for Population and Development Studies, wrote. “Rescinding DACA therefore represents a threat to public mental health.”

To illustrate their point, the authors described data that indicate since the law’s passage, rates of severe or moderate psychological distress in DACA-eligible patients dropped by almost 40%; and that the rates of anxiety and adjustment among children of DACA-eligible mothers fell by more than 50%.

Venkataramani and Tsai said the 6-month window before DACA’s rescinding presents an opportunity for medical professionals to change the course of history.

“[Health care providers] now have a limited window of opportunity to engage policymakers about protecting Dreamers through legislative action, the public health benefits of doing so, and the potentially dire mental health consequences of failing to enact a definitive legal remedy,” they wrote. “Advocates can also make clear that protecting Dreamers — and other immigrant groups — would have few, if any, economic disadvantages for native-born workers.”

Venkataramani and Tsai outlined an action plan if DACA is indeed repealed.

“Health care and public health institutions will need to work together to ensure that the people under threat do not bear the burden of mental distress alone. In such an environment, organizations would need to proactively reach out to undocumented immigrants to keep open lines of communication and reassure them of ongoing efforts to establish a firewall between health care policy and immigration policy,” the authors wrote.

“Clinicians will continue to ensure the delivery of high-quality health care despite immigration status,” they continued. “Providing Dreamers with information about public resources that can be safely used in the case of severe mental distress will be critical. On a broader systems level, tracking health care utilization and health outcomes will help organizations monitor health at the population level and provide hard data to policymakers seeking to implement other supportive remedies.” – by Janel Miller

Disclosures : Venkataramani and Tsai report receiving grants from the Robert Wood Johnson Foundation outside the submitted work.

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