The end of the Deferred Action for Childhood Arrivals (DACA) program could lead to substantial population-level adverse effects on mental health, according to a perspective paper published in the New England Journal of Medicine.

Since President Barack Obama created the program by executive order in 2012, DACA has provided freedom from deportation and access to work permits for more than 800,000 young undocumented immigrants who came to the United States before 16 years of age. Atheendar Venkataramani, MD, PhD, University of Pennsylvania, Philadelphia, and Alexander Tsai, MD, PhD, Massachusetts General Hospital, Boston, note that the potential mental health fallout from DACA’s termination will be difficult to address through formal health care and public health systems.

“Removing legal protections from deportation will reduce the likelihood that Dreamers will seek help from physicians, nurses, educators, or social workers, given the very realistic fears of coming under scrutiny by immigration authorities,” the authors wrote. “Such fears and isolation will make it difficult to deploy mental health treatment and public mental health resources where they will be needed most.”

A recent quasi-experimental study found that rates of moderate or severe psychological distress among persons who were eligible for DACA fell by nearly 40% after DACA’s passage compared with rates among those who were ineligible for DACA. Additional data from Emergency Medicaid beneficiaries in Oregon showed that among children of DACA-eligible mothers, most of whom were US citizens, rates of adjustment and anxiety disorders fell by more than half after DACA was implemented.

Healthcare and public health professionals will now have a limited window to engage policymakers about protecting Dreamers through legislative action. However, with the termination of DACA in 6 months, if legislation cannot provide DACA’s former beneficiaries with a definitive legal status, clinicians will need to work together to ensure that this population does not bear the burden of mental distress alone.

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“The DACA program in many ways reflects the American ideal: people who first came to the United States as children were given a chance to pursue the American dream,” the authors concluded. “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. Rescinding DACA therefore represents a threat to public mental health, and it is a humanitarian imperative for healthcare providers and public health officials to take an active role in countering that threat.”

Reference

Venkataramani AS, Tsai AC. Dreams deferred—the public health consequences of rescinding DACA [published online September 13, 2017]. N Eng J Med. doi:10.1056/NEJMp1711416