By Christine
Herman, Side Effects Public Media November 26, 2019
When
José moved his family to the United States from Mexico nearly two decades ago,
he had hopes of giving his children a better life.
But now
he worries about the future of his 21-year-old-son, who has lived in central
Illinois since he was a toddler. José’s son has a criminal record, which could
make him a target for deportation officers.
KHN is not using the son’s name because of those risks and is using the
father’s middle name, José, because both men are in the U.S. without legal
permission.
José’s
son was diagnosed with schizophrenia and bipolar disorder last year and has
faced barriers to getting affordable treatment, in part because he doesn’t have
legal status. His untreated conditions have led to scrapes with the law.
Mental
health advocates say many people with untreated mental illness run the risk of
cycling in and out of the criminal justice system, and the situation is
particularly fraught for those without legal status.
“If he
gets deported, he’d practically be lost in Mexico, because he doesn’t know
Mexico,” said José, speaking through an interpreter. “I brought him here very
young and, with his illness, where is he going to go? He’s likely to end up on
the street.”
Legal
Troubles
José’s
son has spent several weeks in jail and numerous days in court over the past
year.
On the
most recent occasion, the young man sat nervously in the front row of a
courtroom in Illnois’ Champaign County Courthouse. Wearing a white button-down
shirt and dress pants, his hair parted neatly, he stared at the floor while
waiting for the judge to enter.
That
day, he pleaded guilty to a criminal charge of property damage. The incident
took place at his parents’ house earlier this year. He had gotten into a fight
with his brother-in-law and broke a window. His father said it was yet another
out-of-control moment from his son’s recent struggles with mental illness.
Before
beginning proceedings, the judge read a warning aloud — a practice that is now standard
to make sure noncitizens are aware they could face deportation (or be denied
citizenship or reentry to the U.S.) if they plead guilty in court.
José’s
son received 12 months of probation.
After
the hearing, he said that his life was good just a couple of years ago: He was
living on his own, working and taking classes at a community college. But all
that changed when he started hearing voices and began struggling to keep a grip
on reality. He withdrew from his friends and family, including his dad.
One
time, he began driving erratically, thinking his car was telling him what to
do. A month after that episode, he started having urges to kill himself and
sometimes felt like hurting others.
In
2018, he was hospitalized twice and finally diagnosed with schizophrenia and
bipolar disorder.
José
said that during this time, his son — who had always been respectful and kind —
grew increasingly argumentative and even threatened to hurt his parents. The
psychiatric hospitalizations didn’t seem to make a difference.
“He
asked us for help, but we didn’t know how to help him,” José said. “He’d say,
‘Dad, I feel like I’m going crazy.'”
José’s
son said he met with a therapist a few times and took the medication he was
prescribed in the hospital. He was also using marijuana to cope, he said.
The
prescribed medication helped, he said, but without insurance he couldn’t afford
to pay the $180 monthly cost. When he stopped the meds, he struggled and
continued having run-ins with the police.
Undocumented
And Uninsured
For people
who are both undocumented and living with a mental illness, the situation is
“particularly excruciating,” said Carrie Chapman, an attorney and advocate with
the Legal Council for Health Justice in Chicago who represents many clients
like José’s son.
“If you
have a mental illness that makes it difficult for you to control behaviors, you
can end up in the criminal justice system,” Chapman said.
People
with mental illness make up only a small percentage of
violent offenders — they are actually more likely, compared with the general
population, to be victims of violent
crime.
Chapman
said the stakes are extremely high when people without legal status enter the
criminal justice system: They risk getting deported to a country where they may
not speak the language, or where it’s even more difficult to obtain quality
mental health care.
“It
could be a death sentence for them there,” Chapman said. “It’s an incredible
crisis, that such a vulnerable young person with serious mental illness falls
through the cracks.”
An
estimated 4.1 million people under
age 65 who live in the U.S. are ineligible for Medicaid or marketplace coverage
under the Affordable Care Act because of their immigration status, according to
the Kaiser Family Foundation. (Kaiser Health News is an editorially independent
program of the foundation.)
Among
them are those who are undocumented and other immigrants who otherwise do not
fall into one of the federal categories as a
lawful U.S. resident. People protected from deportation through the federal
government’s Deferred Action for Childhood Arrivals policy, or DACA, also are ineligible for coverage
under those programs.
For
many people in all those groups, affordable health care is out of reach.
Some
states have opened up access to Medicaid to undocumented children, including
Illinois, California, Massachusetts, New York, Oregon, Washington and the
District of Columbia, according to the
National State Conference of Legislatures. But residents lose that coverage at
age 19, except in California, which recently expanded eligibility through 25.
For
those who can’t access affordable health insurance because of their
undocumented status, medical care is largely limited to emergency services and
treatments covered by charity care or provided by community health centers.
It’s
unclear how many people have been deported because of issues linked to mental
illness; good records are not available, said Talia Inlender, an attorney for immigrants’
rights with the Los Angeles-based pro bono law firm Public Counsel. But estimates from the American Civil Liberties
Union suggest that tens of thousands of immigrants deported each year have a
mental disability.
Inlender,
who represents people with mental disabilities in deportation hearings, said
that when the lack of access to community-based treatment eventually leads to a
person being detained in an immigration facility, that person risks further
deterioration because many facilities are not equipped to provide the needed
care.
On top
of that, she said, immigrants facing deportation in most states don’t generally
have a right to public counsel during the removal proceedings and have to
represent themselves. Inlender points out that an immigrant with a mental
disability could be particularly vulnerable without the help of a lawyer.
(Following
a class action lawsuit, the states of
Washington, California and Arizona did establish a right to counsel for
immigrants with severe mental illness facing deportation. For those in other
states, a federal program is
designed to provide the same right to counsel, but
it’s only for certain detained immigrants.)
Medicaid
For More People?
Chapman
and other advocates for immigrants’ rights say expanding Medicaid to cover
everyone who otherwise qualifies — regardless of legal status — and creating a
broader pathway to U.S. citizenship would be good first steps toward helping
people like José’s son.
“Everything
else is kind of a ‘spit and duct tape’ attempt by families and advocates to get
somebody what they need,” Chapman said.
Critics
of the push to expand Medicaid to cover more undocumented people object to the
costs, and argue that the money should be spent, instead, on those living in
the country legally. (California’s move to expand Medicaid through age 25 will
cost the state around $98 million, according
to some estimates.)
As for
José’s son, he recently found a pharmacy that offers a cheaper version of the
prescription drug he needs to treat his mental health condition — and he’s
feeling better.
He now
works as a landscaper and hopes to get back to college someday to study
business. But he fears his criminal record could stand in the way of those
goals, and he’s aware that his history makes him a target for immigration
sweeps.
José
said his greatest fear is that his son will end up back in Mexico — away from
family and friends, in a country he knows little about.
“There
are thousands of people going through these issues … and they’re in the same situation,”
José said. “They’re in the dark, not knowing what to do, where to go or who to
ask for help.”
Christine
Herman is a recipient of a Rosalynn Carter fellowship for mental health
journalism. Follow her on Twitter: @CTHerman.
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