Mental health care for immigrants, refugees & ethnic-minority communities

Migration, family separation, discrimination, financial and immigration stress, and rebuilding a life in a new country can affect mental health. Sleep problems, persistent sadness, anxiety and grief are common responses, and depression, anxiety and post-traumatic stress are treatable conditions. Stigma can discourage people from seeking care; the privacy rules that apply to therapy are described in the section on privacy.

According to the 988 Suicide & Crisis Lifeline, “The 988 Lifeline is available 24/7/365. Your conversations are free and confidential.” For Spanish, the Lifeline states: “To call a Spanish-speaking counselor, dial 988 and then press 2. To text with a Spanish-speaking counselor, text AYUDA to 988. To chat with a Spanish-speaking counselor, please start a chat in Spanish.” SAMHSA states that “988 call, chat, and text services are available in English and Spanish” and that “[c]all services with interpreters are available in more than 240 languages” (988 FAQ). If someone is in immediate danger, call 911 or go to a hospital emergency department; the obligations of hospitals under EMTALA are described in the next section.

The SAMHSA National Helpline, 1-800-662-HELP (4357), is “a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish).” The Disaster Distress Helpline, 1-800-985-5990, is described by SAMHSA as “available 24/7 to all residents in the U.S. and its territories who are experiencing emotional distress related to natural or human-caused disasters,” and “DDH callers can connect with counselors in over 100 languages via 3rd-party interpretation services.”

CMS explains that EMTALA “imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) ... regardless of an individual’s ability to pay” and that “[h]ospitals are then required to provide stabilizing treatment for patients with EMCs” (emergency medical conditions). A hospital may still bill for emergency care, and Emergency Medicaid, which the October 2026 Medicaid changes do not affect, can pay for it for people who meet the state’s income rules. HRSA states that health centers “[a]djust their fees based on income and family size” and “[s]erve everyone, even if they cannot pay,” and SAMHSA states that certified community behavioral health clinics (CCBHCs) “are required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence, or age.”

In a notice published on 14 July 2025, HHS reinterpreted which programs count as a federal public benefit under the 1996 welfare law (PRWORA) and included health center services. On 21 September 2026 the federal district court in Rhode Island ruled: “The PRWORA Notices are declared unlawful under the APA and are ordered set aside and vacated. Defendants are enjoined from implementing or enforcing the PRWORA Notices or the interpretations contained therein against Plaintiffs by any other means.” The plaintiffs are 21 states and the District of Columbia, including Michigan (decision). The court added that “this injunction does not prohibit HHS, ED, DOL, HUD, and their respective heads from promulgating new rules related to PRWORA after a period of notice-and-comment rulemaking,” and the government may still appeal. The DHS regulatory agenda lists a proposed rule, “Verification of Status for Public Benefit Eligibility,” planned for October 2026, to “facilitate robust compliance with immigration status verification requirements.” Clinic practices on questions about status vary, and a call to a clinic in advance can confirm which documents it requires.

ICE states that a DHS directive of 20 January 2025 superseded and rescinded the 2021 memorandum on protected areas, and that “DHS is not issuing rules regarding where immigration laws are permitted to be enforced.” California and some other states have passed or proposed laws that limit immigration enforcement inside health facilities. A person who is refused care, or asked for documents they do not have, can ask an immigration lawyer or a DOJ-accredited representative whether that was lawful. Free and low-cost legal services are listed on the map of legal services.

Under the HIPAA Privacy Rule, a covered provider “may disclose protected health information” for law enforcement purposes only in specified situations, including “[a] court order or court-ordered warrant, or a subpoena or summons issued by a judicial officer,” a grand jury subpoena, and “[a]n administrative request for which response is required by law.” The rule permits these disclosures; it does not require a therapist to report a client’s immigration status. Other limits on confidentiality, such as a serious threat to safety, are usually explained at the start of treatment, and a client may ask a provider how privacy is protected and what information is recorded.

Separately from therapy records, CMS announced in November 2025 that it “will share certain information with ... DHS, and its component agency, U.S. Immigration and Customs Enforcement” (Federal Register notice). In California v. HHS, brought by 22 states including Michigan, the federal court in December 2025 declined to block the sharing of “basic biographical, location, and contact information,” and it limited the sharing of the plaintiff states’ data to Medicaid records of people not lawfully residing in the United States, and to their citizenship and immigration status, address, phone number, date of birth and Medicaid ID. In May 2026 the court ordered that “HHS and CMS shall not share ‘any Medicaid information received from plaintiff States with DHS or ICE’” until it resolves the government’s request to clarify the order. On 8 September 2026 the court stated that “the policies at issue clearly do not justify ICE’s receipt or use of data from CMS on citizens, lawful permanent residents, and those with valid and unexpired visas,” and that “[t]he prior restrictions remain in place pending the final approval of any language clarifying the scope of the preliminary injunction.” These orders concern enrollment data and do not change the privacy rules for therapy records. Questions about enrolling in a program in light of these orders can be directed to an immigration lawyer or a DOJ-accredited representative. Free and low-cost legal services are listed on the map of legal services.

Under 45 CFR 92.201, language assistance services in federally funded health programs “must be provided free of charge,” and a covered entity “must offer a qualified interpreter.” The rule permits reliance on a minor child to interpret only in an emergency, and reliance on an accompanying adult only in an emergency or where the individual “specifically requests” it. Meaning, tone, idiom and cultural context are particularly important in mental health care, and a therapist who speaks the client’s language or shares the client’s background may be sought. Some federal language access rules are under revision; the Language access tab describes their current status.

Community mental health centers and federally qualified health centers offer care on a sliding fee scale. The free SAMHSA locator FindTreatment.gov lists treatment facilities by location, payment options and services. The Psychology Today directory allows therapists to be filtered by language and accepted insurance. Open Path Collective states that it offers “therapy with a vetted therapist for only $40-70 per session, plus a one-time membership fee” of $65; sessions with student interns cost $30, and sessions for couples and families may cost up to $80. University training clinics also offer low-cost care. Many immigrant, refugee and ethnic community organizations provide or refer to culturally grounded care; the Directory and the Access map on this site list organizations by service and by language.

Several free directories list therapists by community, language and identity. Mustard Seed Generation describes itself as a “national directory of Korean American mental health professionals.” The Asian Mental Health Collective directory lists “3000+ profiles of Asian therapists across the U.S. and Canada.” South Asian Therapists lists clinicians of “Indian, Pakistani, Bangladeshi, Sri Lankan, Afghani and Nepali heritage” in several countries, so a therapist’s license in the client’s state should be confirmed. The AAPA directory lists Asian American providers. Therapy for Latinx and Latinx Therapy list Spanish-speaking and Latinx clinicians. Therapy for Black Girls, for Black women and girls, and Melanin & Mental Health list culturally responsive providers for Black communities, including African and Caribbean immigrants. Inclusive Therapists allows searches across many identities and languages. Refugees can also ask their resettlement agency about behavioral health services in their language.

Medicaid and CHIP cover many immigrants, including children and pregnant people in many states, and marketplace plans cover mental health and substance use care. The 2025 marketplace rule “excludes Deferred Action for Childhood Arrivals recipients from the definition of ‘lawfully present,’” which has made them ineligible for marketplace plans since 25 August 2025. According to CMS, section 71301 of the 2025 budget law “requires an individual to be an ‘eligible alien’ to be allowed a PTC” (premium tax credit) for “plan years starting on or after January 1, 2027,” which limits these credits to green card holders, Cuban and Haitian entrants and COFA migrants; the 2027 payment rule implements this change.

From 1 October 2026, federal Medicaid and CHIP funding is limited to citizens and nationals, green card holders, Cuban and Haitian entrants and COFA migrants. In its letter to states of 8 April 2026, CMS states that federal funding “will no longer be available for full Medicaid or CHIP benefits furnished to qualified noncitizens who are not also FFP-eligible noncitizens (e.g., asylees, refugees, parolees, or victims of trafficking),” that the change “did not make any changes to coverage of emergency Medicaid,” and that states “must provide advance notice of adverse action, including the right to a Medicaid fair hearing or CHIP review, before terminating coverage.” Children and pregnant people in these groups can retain coverage in the states that cover lawfully residing children and pregnant people. The Office of Refugee Resettlement states that it “will provide up to 8 months of RCA and RMA to eligible individuals” (Refugee Cash Assistance and Refugee Medical Assistance) and that “[t]his change applies to people whose eligibility date for ORR benefits is on or after January 1, 2026” (ORR letter 26-05). Under a proposed Medicare rule, people enrolled in Medicare on or before 4 July 2025 who are not citizens, green card holders, Cuban or Haitian entrants or COFA migrants “will have their coverage terminated effective February 1, 2027,” and “[t]he SSA would provide a termination notice towards the end of December 2026.”

The public charge rule states: “The final rule is effective on September 18, 2026. This rule applies to applications for admission made on or after September 18, 2026 or applications for adjustment of status postmarked or electronically submitted on or after September 18, 2026. Receipt of means-tested public benefits before September 18, 2026 will be considered consistently with the 2022 Final Rule.” For benefits received before that date, the USCIS Policy Manual provides that “officers will only consider public cash assistance for income maintenance and long-term institutionalization at government expense.” Its examples of means-tested public benefits include “cash assistance, public or assisted housing, financial aid for postsecondary education, food assistance, government-funded health coverage,” and it states that “[c]urrent and/or past receipt of means-tested public benefits alone, however, is not a sufficient basis” for a public charge determination. The Policy Manual lists exempt groups, including “[a]sylees and refugees,” T and U nonimmigrants, and “[s]elf-petitioners under the Violence Against Women Act (VAWA),” and a green card renewal does not involve a public charge review. The Policy Manual also states that USCIS “does not attribute to the alien the receipt of means-tested public benefits if the benefit is received by the applicant’s relatives, including children,” although an officer may consider a household’s income when a child’s benefit is based on it. States, New York City and community groups have challenged the rule in federal court in New York; as of 28 September 2026 no court had paused it. Protecting Immigrant Families explains the change in nine languages.

Consultation with an immigration lawyer or a DOJ-accredited representative is advisable before ending coverage, applying for a benefit, or completing a form that asks about benefits received. Free and low-cost legal services are listed on the map of legal services.

Refugees and asylees may live with trauma from war, persecution, flight and loss. According to CDC guidance, the domestic health screenings for newly arrived refugees, which include mental health screening, “usually occur 30-90 days after the refugee arrives in the United States.” Survivors of torture and severe war trauma can receive specialized care through the National Consortium of Torture Treatment Programs, which reports “38 member centers in 22 states,” and the Center for Victims of Torture. The Office of Refugee Resettlement reports that its Services for Survivors of Torture program has “35 grant programs located in 24 states throughout the U.S.” Resettlement agencies and refugee health programs can make referrals.

Children in immigrant families may experience stress related to separation, a new language and school, discrimination, and concern about family members, which can appear as irritability, withdrawal, stomachaches or difficulties at school. Many schools offer free counseling and employ bilingual counselors or social workers. Support in the family’s language, with respect for its culture, can be requested from schools and clinics, and the 988 Lifeline also serves young people in crisis.

Survivors of domestic violence, sexual assault or human trafficking may qualify for trauma-specific mental health care and for humanitarian immigration protections: the U visa, the T visa, or a VAWA self-petition. The National Domestic Violence Hotline, 1-800-799-7233, describes its service as “Free. Confidential. 24/7.” and offers services “in over 200 languages.” The National Human Trafficking Hotline, 1-888-373-7888, states that its lines are “available 24 hours a day, 7 days a week, 365 days a year” and that “[h]elp is available in English or Spanish, or in more than 200 additional languages through an on-call interpreter.”

USCIS changed its practice in these programs in 2025 and 2026. A USCIS alert of 22 December 2025, “USCIS Restores Integrity to the VAWA, T Nonimmigrant, and U Nonimmigrant Programs After Suspected Fraud,” states that the updated guidance “[e]xplains that the ‘prohibited source’ provisions allow DHS to consider information from a ‘prohibited source’ in certain circumstances” (a prohibited source is, in general, an abuser or trafficker). A policy alert of 8 May 2026 is titled “Deferred Action as an Extraordinary Use of Prosecutorial Discretion,” and a rule proposed in June 2026 would “limit and clarify eligibility for discretionary employment authorization” for people granted deferred action. Many organizations provide free legal help with U visa, T visa and VAWA petitions, and an immigration lawyer or a DOJ-accredited representative with experience in humanitarian cases can review a petition before it is filed. Free and low-cost legal services are listed on the map of legal services.

Distress is expressed differently across cultures and often appears as physical symptoms such as headaches, fatigue or body pain. Family, elders, faith communities and traditional healing practices can work alongside professional care. A provider familiar with a particular culture or community may be requested.

A first step is to contact a community mental health center or to search FindTreatment.gov, stating the language needed and any concern about cost so that a sliding fee can be considered. A first visit is usually an assessment; care can include talk therapy, medication, group support or peer support, alone or in combination. A therapist who speaks the client’s language or shares the client’s background may be requested, a written list of concerns can be brought to the visit, and a client may change providers if the match is not suitable.