A Decolonized Approach To Immigration Enforcement for Healthcare Workers

Reframing Our Understanding

Healthcare professionals across the United States are bearing witness to profound suffering in immigrant communities and mixed-status families. University of California, Riverside researchers describe this as a “public health emergency” affecting millions of children and families. As providers, we must ask ourselves: How do we support healing in communities experiencing ongoing structural violence? How do we avoid replicating harm within our own clinical spaces?

This requires us to examine not only what is happening to communities. We must also examine how our own practices, assumptions, and systems may inadvertently contribute to harm.

Naming What We’re Witnessing: Structural Violence and Colonial Continuities

Current immigration enforcement practices do not exist in isolation. They are part of long historical patterns of state violence, displacement, and family separation. These patterns echo colonial practices. For Indigenous communities in particular, current enforcement echoes historical forced removals, family separations through boarding schools, and ongoing dispossession from land.

As mental health providers, we must recognize that immigration enforcement functions as a structural determinant of health, not merely a legal matter. Research published in Psychiatric News by the American Psychiatric Association shows enforcement policies systematically create conditions for trauma. They operate through adverse power dynamics. These are the same dynamics that underlie most interpersonal and structural trauma.

The Scope of Enforcement Impact

Recent documentation shows that enforcement operations affect not only undocumented individuals but also U.S. citizens, lawful residents, and entire communities:

• Congressional members have formally demanded investigations into “a growing pattern of civil rights violations against U.S. citizens during immigration sweeps”
• Federal court filings document warrantless arrests and detentions of U.S. citizens during enforcement operations
• Cases include disabled military veterans, firefighters, Puerto Ricans (who are U.S. citizens), Indigenous peoples, elected officials, and educators
• The American Immigration Council reports that ICE may have deported as many as 70 U.S. citizens over the past five years, though inadequate record-keeping makes precise numbers impossible to determine

Research documents patterns of racial profiling. Enforcement disproportionately targets people perceived as Latino/Hispanic. It also targets those of immigrant background, regardless of actual immigration status.

What Happened to You? Understanding Trauma as Response to Structural Violence

Trauma-informed care shifts our framing from “What is wrong with you?” to “What happened to you?” This seemingly simple shift has profound implications. It locates the source of distress not in individual pathology. Instead, it sees the cause in experiences of violence, oppression, and systemic harm.

The Manifestations of Enforcement-Related Trauma

Research published in The Lancet Regional Health – Americas and other peer-reviewed journals documents specific responses to enforcement-related structural violence:

In Adults:

• Depression, anxiety, and post-traumatic stress responses
• Somatic manifestations of chronic stress
• Suicidal ideation and self-harm
• Cardiovascular impacts from sustained fear
• For pregnant individuals: prenatal stress, preterm labor, and low birth weight

In Children and Adolescents:

• Hypervigilance and constant monitoring for danger
• Separation anxiety rooted in realistic fears of caregiver loss
• Grief, depression, and withdrawal from previously enjoyed activities
• Academic difficulties as cognitive resources are redirected to survival
• Disrupted attachment patterns affecting trust and relationships
• Behavioral changes reflecting overwhelm and lack of safety

Importantly: These are not disorders, they are adaptive responses to ongoing threat. Dr. Kevin Gutierrez (UC Riverside) emphasizes: “When that stability is disrupted, it impacts how they relate to others and see the world.”

Intergenerational and Historical Trauma

For many communities, current enforcement trauma layers onto existing historical and intergenerational trauma:

• For Indigenous communities: Ongoing displacement, forced family separations, and marginalization echo residential school trauma and historical dispossession
• For descendants of enslaved peoples: Policing and detention practices trigger historical trauma related to separation, surveillance, and violence
• For immigrant communities: Pre-migration trauma, migration-related trauma, and post-migration enforcement create cumulative traumatic stress

Decolonizing mental health requires recognizing that Western concepts like “PTSD” may not capture how communities understand and experience this suffering. Many cultures conceptualize distress through spiritual, relational, or communal frameworks rather than individual psychiatric diagnoses.

Examining Our Own Practice: Power, Position, and Potential Harm

Before we can support healing, we must examine how our own positions and practices may replicate harm.

Acknowledging Power Dynamics

The provider-client relationship inherently involves power imbalance. Research on trauma-informed care emphasizes that traumatic events often represent a loss or lack of power, making power dynamics in healthcare settings particularly significant. We must:

• Recognize that our professional authority, citizenship status (if applicable), language fluency, and institutional backing all create power differentials
• Understand that for many clients, any interaction with official systems, including healthcare, may feel threatening
• Acknowledge that asking questions about birthplace, family, or documentation can be retraumatizing
• Recognize that standard clinical practices (taking notes, asking personal questions, setting treatment plans) can mirror interrogation if not done collaboratively

How Healthcare Systems Can Retraumatize

Standard healthcare practices may inadvertently cause harm:

• Lack of choice or voice in treatment: When providers make unilateral decisions
• Absence of transparency: When expectations, diagnoses, or documentation aren’t clearly explained
• Deficit-focused approaches: Emphasizing pathology, diagnoses, and problems rather than strengths and resilience
• Cultural mismatch: Imposing Western psychiatric frameworks without acknowledging other healing traditions
• Mandatory reporting requirements: That may endanger clients or families
• Physical settings: Waiting rooms with heavy security, institutional aesthetics, or triggering imagery

A Decolonized, Trauma-Informed Approach

Core Principles

1. Start with Strengths and Resilience

Communities facing enforcement are not simply “traumatized populations”, they are demonstrating extraordinary resilience, courage, and creativity. Dr. Lisa Fortuna states: “I find hope in communities, their resilience, their support for each other, and their refusal to give up.”

Begin by recognizing:

• The courage it takes to seek help in threatening circumstances
• The survival skills people have developed
• The strength of family and community bonds
• The resourcefulness shown in navigating hostile systems
• Cultural practices that provide meaning, connection, and healing

2. “Healing” Not “Treatment”

Indigenous mental health frameworks emphasize that Western mental health approaches focus on “eliminating symptoms or behavioral-based interventions” as only “one piece of a larger, holistic puzzle.” Dr. Grace Kyoon-Achan (University of Manitoba) explains: “When your soul is sick, what you need is not a pill, it’s to go back into that place of connection to family, to homeland, to knowing who you are.”

Shift from:

• Diagnosing disorders → Understanding responses to structural violence
• Treating symptoms → Supporting healing journeys
• Expert fixes → Collaborative exploration
• Individual pathology → Family, community, and societal context

3. Flatten Hierarchies and Share Power

Trauma-informed care requires actively working to flatten inherent power imbalances:

• Collaboration over prescription: “What would be most helpful to you?” rather than “Here’s what you need to do”
• Choice in all aspects: Let clients choose where to sit, whether to make eye contact, what to share, and when
• Transparency: Explain what you’re writing, why you’re asking questions, what will happen with information
• Empowerment: Position clients as experts on their own experience
• Informed consent: For everything, clearly explaining options and respecting decisions

4. Recognize Multiple Ways of Knowing

Western psychiatry is not the only valid framework for understanding distress and healing. Indigenous, Latino, Asian, African, and other cultural frameworks offer sophisticated understanding of wellness that predate and exist alongside Western medicine.

• Spiritual practices: Connection to the sacred, prayer, ceremony
• Land-based healing: Relationship with place and natural world
• Community and relational healing: Extended family, community gatherings, collective healing
• Traditional healers: Curanderas/os, medicine people, elders, faith healers
• Ancestral wisdom: Storytelling, traditional knowledge, cultural practices
• Somatic and embodied practices: Dance, movement, traditional bodywork

Ask: “What has helped your family through difficult times before?” “Are there cultural or spiritual practices that bring you strength or peace?” “Who in your community do you turn to for guidance?”

5. Address Social Determinants and Basic Needs

You cannot heal without safety. Before discussing processing trauma or managing symptoms, we must help address:

• Physical safety from enforcement
• Food, housing, and economic security
• Legal support and know-your-rights information
• Connection to community and social support
• Access to education and healthcare

Research on Indigenous mental health emphasizes that “basic needs of individuals must be supported to achieve positive mental health.”

Clinical Practices

Begin with Positionality and Cultural Humility

Cultural humility requires ongoing critical self-reflection and recognition of power imbalances. Consider sharing (when appropriate):

• Your own position: “I want to acknowledge that as someone with citizenship/professional credentials/institutional authority, I hold power in this relationship”
• Your limitations: “I don’t know what it’s like to experience what you’re experiencing”
• Your commitment: “My role is to support you however is most helpful to you”

Use Trauma-Informed Assessment Language

Replace potentially threatening questions:

• “Where were you born?” → “Is there anything about your background or history I should know to support you better?”
• “Tell me about your trauma history” → “Would you like to share anything about experiences that have shaped you?”
• “Do you have legal status?” → (Don’t ask unless absolutely necessary for care, and explain why)
• “What’s your diagnosis?” → “How would you describe what you’re experiencing?”

Always ask permission: “Would it be okay if I asked about…?” “You don’t have to answer anything you’re not comfortable with.”

Validate Responses as Adaptive

“Your body and mind are doing exactly what they should do to keep you safe in an unsafe situation. These responses make sense given what’s happening.”

Normalize: fear, hypervigilance, difficulty sleeping, intrusive thoughts, feeling on edge, avoiding situations, protecting family, not trusting systems

Offer Psychoeducation About Power and Oppression

Help clients understand that their distress is a response to structural violence, not personal failing:

• “What you’re experiencing is a normal response to very abnormal circumstances”
• “When systems are oppressive, feeling anxious, angry, or shut down makes sense”
• “Your nervous system is responding to real danger”

Support Community Connection

Healing happens in relationship and community. Help clients:

• Identify supportive people in their lives
• Connect with community organizations and mutual aid networks
• Access culturally specific services and traditional healing practices
• Maintain cultural practices that provide meaning and connection

Recognize Limitations of Your Role

You cannot fix structural problems through individual therapy. Name this honestly:

“I can support you through this, but I can’t make the enforcement stop or make the system just. What I can do is…”

This honesty builds trust and avoids false promises.

Supporting Specific Communities

Indigenous Communities

• Recognize that enforcement on Indigenous lands represents ongoing colonization
• Acknowledge the historical trauma of forced removal and family separation
• Support connection to land, ceremony, language, and community
• Work with tribal authorities and traditional healers when requested
• Understand that wellness frameworks may center balance, harmony, and relationship rather than absence of symptoms

Resources: Native-specific mental health programs that integrate traditional healing practices show higher treatment completion and lower relapse rates than mainstream services

Naturalized Citizens and Long-Term Residents

Communities report that naturalized citizens now carry passports due to fear of having their citizenship questioned, despite no legal requirement to do so. This represents:

• Psychological burden of constantly proving belonging
• Hypervigilance and restriction of daily activities
• Racialized surveillance and profiling
• Anxiety about being treated as “suspect” in one’s own country

Mixed-Status Families

U.S.-born children experiencing realistic fear about parents’ detention or deportation are American citizens living with ongoing threat. This is not “immigration-related” trauma for them—it’s trauma from state actions against their family.

Healthcare Workers and Essential Workers

Documented cases of detained firefighters, healthcare workers, and other essential workers highlight that enforcement doesn’t distinguish based on community contribution, creating fear throughout workforce.

Advocacy as Part of Trauma-Informed Care

Trauma-informed care recognizes that healing requires addressing root causes, not just symptoms. Research emphasizes that providers can “transform secondary trauma, grief, and anger into action” through advocacy.

Healthcare providers can:

• Document: Track the health impacts you’re witnessing
• Educate: Help the public understand health consequences
• Advocate: For policies that support family integrity, community safety, and health equity
• Organize: With other providers, community organizations, and affected communities
• Testify: Share clinical insights with policymakers and media
• Build coalitions: Across disciplines to address structural issues

Critical caveat: Center community leadership. Your advocacy should amplify community voices, not replace them.

Preventing Vicarious Trauma and Burnout

Bearing witness to ongoing structural violence affects providers. Supporting your own wellbeing is not self-indulgence—it’s necessary to sustain the work.

• Acknowledge secondary trauma: Naming it reduces shame
• Access clinical supervision and peer support: Regular spaces to process
• Recognize limits: You cannot solve systemic problems alone
• Engage in collective action: Reduces sense of helplessness
• Maintain boundaries: Sustainable engagement requires self-protection
• Access your own healing practices: Whatever supports your wellbeing

Moving Forward: Questions for Ongoing Reflection

• How do my own positions (citizenship status, race, class, language, professional authority) shape my clinical relationships?
• In what ways might my standard practices inadvertently replicate power-over dynamics?
• Whose knowledge and healing practices do I value? Whose do I marginalize or dismiss?
• How can I create more space for clients to define their own needs and solutions?
• What systemic changes am I working toward beyond individual clinical work?
• How do I distinguish between supporting clients and imposing my own values or solutions?

Conclusion: Healing as Liberation

Dr. Jesse Valentin (Diné, social worker and consultant) teaches: “Decolonizing mental health is a relational worldview. It requires being open to understanding that spiritual forces need constant and careful attention.”

Our work is not simply to treat symptoms, but to create conditions for healing in the context of ongoing harm. This requires:

• Examining our own practices and positions
• Recognizing multiple valid frameworks for understanding distress and wellness
• Flattening power hierarchies in clinical relationships
• Supporting community connection and cultural practices
• Addressing structural determinants of health
• Advocating for systemic change

The communities we serve demonstrate extraordinary resilience. Our role is to support their healing journeys in ways they define, while working to dismantle the systems causing harm.

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Resources for Healthcare Professionals

Professional Organizations:

• American Psychiatric Association – Undocumented Immigrants
• National Alliance on Mental Illness (NAMI) HelpLine: 1-800-950-NAMI
• National Immigrant Justice Center (NIJC)
• American Civil Liberties Union (ACLU): 1-877-328-2266

Crisis Support:

• 988 Suicide & Crisis Lifeline: Call or text 988 (Spanish available)
• SAMHSA National Helpline: 1-800-662-4357

Client Resources:

• Informed Immigrant
• Immigration Advocates Network
• USAHello
• Therapy for Black Men
• Therapy for QPoC

Trauma-Informed and Decolonizing Resources:

• SAMHSA Trauma-Informed Approach
• Trauma Informed Oregon
• Center for Victims of Torture – Indigenous Perspectives

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References

American Immigration Council. (2025). ICE may have deported as many as 70 US citizens in the last five years. Retrieved from americanimmigrationcouncil.org

American Psychiatric Association. (2025). Special report: U.S. immigration policy and the mental health of children and families. Psychiatric News. Retrieved from psychiatryonline.org

Blodgett, C., & Lanigan, J. D. (2018). The association between adverse childhood experience (ACE) and school success in elementary school children. School Psychology Quarterly, 33(1), 137-146.

Capital & Main. (2025). Border Patrol and ICE agents are arresting U.S. citizens in immigration raids. The American Prospect. Retrieved from prospect.org

Crushing Colonialism. (2025). Indigenous spirituality: Resilience in decolonizing mental health. Retrieved from crushingcolonialism.org

Fortuna, L., & Gutierrez, K. (2025). Child mental health crisis tied to immigration enforcement. UC Riverside News. Retrieved from news.ucr.edu

Goldman, D., et al. (2025). Congressional demand for investigations into ICE’s detention of U.S. citizens. Retrieved from goldman.house.gov

Kimberg, L., & Wheeler, M. (2019). Trauma and trauma-informed care. In Trauma-Informed Healthcare Approaches. Springer.

Kyoon-Achan, G., et al. (2018). Toward decolonizing mental health research in Indigenous contexts. Journal of Indigenous Wellbeing, 3(2), 45-62.

Lewis, M. E., Hartwell, E. E., & Myhra, L. L. (2018). Decolonizing mental health services for Indigenous clients: A training program for mental health professionals. American Journal of Community Psychology, 62(3-4), 330-339.

National Immigrant Justice Center & ACLU of Illinois. (2025). Federal court filing on unlawful ICE arrests during Operation Midway Blitz. WBEZ Chicago. Retrieved from wbez.org

Ninomiya, M., et al. (2022). Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach. BMC Health Services Research, 22, 348.

Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma informed care in medicine: Current knowledge and future research directions. Family & Community Health, 38(3), 216-226.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884.

Sundararaman, S., et al. (2025). The silent trauma: U.S. immigration policies and mental health. The Lancet Regional Health – Americas, 33. doi: 10.1016/j.lana.2025.100658

Valentin, J. (2023). Decolonizing mental health & moving towards harmony & balance: An Indigenous perspective on wellness. Center for Victims of Torture. Retrieved from cvt.org

Waapihk Research. (2024). Decolonizing mental health and wellbeing. Retrieved from waapihk.com

Yohani, S., & Hagen, K. (2019). Refugee youth & trauma: What helpers need to know. In Decolonizing Healing Through Indigenous Ways of Knowing (pp. 145-168). Springer.

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Frequently Asked Questions

What is trauma-informed care for immigrant communities?

Trauma-informed care for immigrant communities recognizes that immigration enforcement functions as structural violence and creates ongoing traumatic stress. It shifts from asking ‘What’s wrong with you?’ to ‘What happened to you?’ and emphasizes safety, choice, collaboration, trustworthiness, and empowerment while honoring cultural healing practices.

What does decolonizing mental health practice mean?

Decolonizing mental health means recognizing that Western psychiatric frameworks are not the only valid approaches to healing. It involves honoring Indigenous and traditional healing practices. It examines power dynamics in provider-client relationships. It acknowledges historical and intergenerational trauma. It supports community-defined solutions rather than imposing external expert models.

How can healthcare providers prevent vicarious trauma?

Providers can prevent vicarious trauma by accessing regular clinical supervision and engaging in peer support. They should maintain professional boundaries and participate in collective advocacy to transform feelings of helplessness. Practicing self-care and accessing their own healing practices are important too. Acknowledging secondary trauma reduces shame and supports sustainable engagement.

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