Supporting the Mental Health of Older Immigrants in King County

2 Asian women sitting and talking on a park bench

According to the King County Community Health Needs Assessment for 2018–2019, immigrants and refugees have made up almost half of the population growth in King County over the past 25 years. Supporting immigrants is critically important to ensuring the mental health of all King County residents. Yet, mainstream mental health approaches often fall short, especially for older immigrants.

Factors impacting older immigrant mental health 

Many factors contribute to poor mental health outcomes for immigrant and refugee communities. Unjust and discriminatory immigration policies, difficult migration journeys, and traumatic experiences prior to migration can contribute to mental health struggles like depression, anxiety, and post-traumatic stress disorder.

It is important to note that not all immigration stories are stories of trauma, but some stories can be shaped by it, so mental health care must be attuned to these needs. Other contributors, like pressures to assimilate, economic inequities, racial trauma, or unstable living situations also must inform mental health services.

Older immigrants often experience the most difficult immigration-related transitions yet utilize mental health services far less than their younger and/or native-born counterparts. Immigrants who have migrated later in life may experience changing family roles if they become dependent upon their adult children after immigrating. They may need to increase caregiving responsibilities towards their grandchildren, leading to isolation if they focus primarily on family without the chance to establish new social support networks that were lost in the process of immigration.

While many immigrants must navigate across cultural context, the barriers associated with this are exacerbated for older immigrants. Older immigrants often experience the most demanding cultural transitions after migration as they may face intense challenges to their lifestyles and values.

Lalita Uppala, Executive Director of Indian American Community Services (IACSWA)—one of Aging and Disability Services’ Community Living Connections partners—explains that “… the shift in culture you see as you immigrate, coupled with the fact that you are an aging adult [is challenging] … most of our seniors do not carry a drivers’ license, do not know the navigation of the Metro bus system … [and are] extremely dependent on their adult children for transportation, for social-emotional wellness.”

Ms. Uppala highlights how, for older immigrants in the Indian American community, “the whole systems change is a significant shift, and with everybody busy with work, school, the life that happens in the young family of their adult children and grandchildren, they find that it pushes them into an isolation that is deep, that is extremely detrimental to their wellness, and that leaves them with lasting impacts.”

Overall, older immigrants may experience challenges in coping with new family roles, isolation, rapid cultural changes, or limited social support associated with immigration, factors that can worsen mental health considerably. Therefore, mental health support that addresses these needs is critically necessary.

Possible mental health interventions for older immigrants 

Despite their unique needs, many immigrant communities—especially racialized and otherwise marginalized groups—experience many barriers to adequate mental health support. These include language barriers, cultural stigmas, financially inaccessible services, an inadequate number of diverse providers, and a lack of culturally competent care. Research indicates that older immigrants are at risk of psychological distress and isolation due to a lack of access to appropriate mental health services and because their mental health issues often remain unnoticed.

Sometimes it is difficult to identify psychological struggles when they present only as physical symptoms, so the issue is just assumed to be related to aging, and only symptomatic treatments are addressed. Dr. Eleanor Lee, a medical staff member of Asian Counseling and Referral Service (ACRS)—also a Community Living Connections partner—describes a time when she had a 70-year-old patient who was referred to her from cardiology.

“He lost so much weight,” Dr. Lee said. “He had medical checkups in two separate hospital systems without significant findings because, for each, they would refer him from GI to cardiology to oncology, just make a whole circle … When the patient saw me, I diagnosed him with depression and mild cognitive impairment. Eventually, he gained his weight back.”

Dr. Lee continued, “Sometimes older immigrants need so much help and are constantly in survival mode … . If someone is not moving much, sitting on the couch all day long, people may think that’s normal. But there are problems going on and we are not getting into the best potential of the person.”

Research has demonstrated the benefits of culturally competent services, community-based mental health services, and community systems of care. In navigating the specific mental health challenges associated with immigrant experiences, it is important that mental health practitioners build strong community relationships, understand the complexities of resilience and psychological stress, and engage in holistic approaches that are culturally rooted.

Studies have shown that mental health interventions that are attuned to racial and ethnic differences are effective in alleviating depression and other mental health symptoms. The mental health struggles of older immigrants cannot be addressed without an understanding of systemic inequalities, lived experiences, and cultural contexts.

Collectivist coping strategies where older immigrants bond through shared experiences—embracing religious, linguistic, and other differences—have been effective in mitigating immigration-related stressors. It is also beneficial when older immigrants can provide support to others going through similar situations, as there is a sense of fulfillment gained in the process. Social support is critical in coping with the transitions and hardships associated with immigration, and the establishment of senior-focused programs within immigrant communities has proven to be a strong intervention.

Examples of King County mental health resources for older adults 

IACSWA and ACRS are two of many agencies contracted with Aging and Disability Services to serve older immigrants in our region through holistic support, culturally informed services, and community engagement.

Chalin Pahn, Clinical Manager of the Behavioral Health Program at ACRS, explains that when “a client comes in, they get to see their psychiatrist, they get to see the internal medical doctor, and it’s all in the same location. That’s a systems response that ACRS has to address the unique needs of our clients. Because of the language barrier, when clients go out, they cannot get connected, but when they come here, it’s a one-stop shop for different services.”

ACRS has bilingual and bicultural service providers, wellness groups fostering connection among community members, a cultural competency training manual, and other community-oriented, culturally informed, holistic approaches that meet the needs of the immigrant elders that they serve.

IACSWA is similarly dedicated to culturally nuanced and embedded mental health approaches, with informal support groups to create networks among older immigrants and social support programs that incorporate culturally informed practices. IACSWA employs South Asian mental health counselors that connect with the community to build trusting relationships, offer one-on-one counseling with zero wait time, and collaboratively run structured support groups

Older adult-focused programs at organizations like ACRS and IACSWA, especially those created within immigrant communities, are critical to promoting the mental health of older immigrants in our county.

Structural inequalities, cultural shifts, rapid transitions, and limited social support often shape the experiences of older immigrants, which has negative mental health impacts. The state of older immigrant mental health is often worsened by inaccessible or culturally incompetent mental health services, linguistic barriers, and aging-specific obstacles to adequate care. Yet, community-based programs, culturally rooted approaches, and holistic efforts to improve the lives of older immigrants can drastically improve mental health outcomes.

Senior-focused social support programs developed within and for immigrant communities are especially effective. IACSWA and ACRS are two examples of providers informed by these community-focused practices, but other organizations within and beyond King County are doing incredible work as well. To explore more services relevant to immigrant elders, please visit the following websites:

  • Community Living Connections is a network that helps connect adults facing aging and disability issues with the information and support they need. This includes resources for older adults, adults with disabilities, caregivers, families, and professionals. The network includes partners spanning across King County that specialize in support for linguistically, culturally, and otherwise marginalized or minoritized communities.
  • Neighborhood House provides services to address the needs of families, with a focus on low-income communities, public housing residents, immigrants, and refugees. They serve residents of King County, focusing on early childhood education, youth development, employment, adult education, housing stability, aging and disability services, and community health.
  • Black Emotional and Mental Health Collective is a national training, movement-building, and grant-making institution dedicated to the healing, wellness, and liberation of Black and other marginalized communities.
  • Asian Mental Health Collective aspires to make mental health easily available, approachable, and accessible to Asian communities worldwide.
  • Clinicians of Color is a directory of clinicians of various racial and ethnic backgrounds, as well as training and treatment styles. This program helps match potential clients to a therapist of color that connects with them.

Extended biographies

Lalita Uppala, Executive Director of Indian American Community Services (IACSWA), immigrated from India in the pursuit of graduate studies at the University of Washington School of Public Health in 1990. A community advocate and organizer with over 20 years of experience, Lalita has managed case managers and cultural navigators at IACSWA to provide comprehensive support services for the Asian Indian immigrant community.

Eleanor Lee, ARNP, received her PhD from the University of Washington School of Nursing in 1999 and her post-graduate certificate from Seattle University. She is board certified in Gerontology and Psychiatric Mental Health. She now serves as a medical staff member for Asian Counseling and Referral Service (ACRS) and operates a private practice as a family doctor for adult family homes and nursing homes.

Chalin Pahn, LICSW, received his MSW from the University of Washington and his BA from Antioch University. In his 31 years of service with Asian Counseling and Referral Service (ACRS), he has taught domestic violence information and prevention classes for 10 years, has delivered case management and has provided individual and group counseling services. He served as a clinical supervisor at ACRS for nearly 20 years and is currently Clinical Manager of the Behavioral Health Program.

Saba MirContributor Saba Mir currently holds an internship at Aging and Disability Services, a division of the Seattle Human Services Department that serves as the Area Agency on Aging for Seattle and King County. Saba is an undergraduate student at the University of Washington double majoring in Public Health-Global Health and Law, Societies, and Justice. She has a strong interest in the systemic factors that shape immigrant experiences and related health outcomes. 

This article originally appeared in the September 2022 issue of AgeWise King County