Ending DACA Could Have Dire Public Health Consequences

September 21, 2017 by · Leave a Comment 

President Obama signed an executive order in 2012 protecting undocumented immigrants who were brought to the United States as children, and studies suggest that this order, known as Deferred Action for Childhood Arrivals (DACA), markedly improved measures of mental health among its beneficiaries and their families. The pending termination of DACA may reverse these mental health benefits for the 800,000 DACA beneficiaries, and trigger a public health crisis, according to an essay in the New England Journal of Medicine, co-authored by Atheendar. S. Venkataramani, MD, PhD, an assistant professor of medical ethics and health policy at Perelman School of Medicine at the University of Pennsylvania.

“DACA was not a public health program by design,” Venkataramani said, “but numerous studies have shown that implementing it had positive effects on mental health that truly rival those from large-scale health policies.”

DACA is meant to cover undocumented immigrants who were born after June 15, 1981, were brought to the U.S. before turning 16, and have lived in the U.S. continuously since 2007. It provides legal access to work permits, which can be renewed every two years, and confers freedom from deportation. Eligible applicants must provide evidence of current school attendance, completion of high school or GED certification, or U.S. military service, and must not have serious criminal records.

Several recent studies, including one by Venkataramani and essay co-author Alexander Tsai, MD, PhD, an assistant professor of Psychiatry at Massachusetts General Hospital, have indicated that measures of psychological stress and mental illness among DACA-eligible immigrants fell dramatically after the policy began. Another study, which used data from the Emergency Medicaid program in Oregon, suggested that DACA’s mental health benefits may have extended even to the children of DACA-eligible mothers—among whom rates of adjustment and anxiety disorders fell by more than half after DACA started.

Given that DACA improved mental health for beneficiaries and their families, its termination is expected to have the opposite effect. That termination will occur in March 2018 if no DACA-preserving legislation is passed by Congress and signed into law by the President.

“Health care and public health professionals now have a limited window of opportunity to engage policymakers about protecting Dreamers through legislative action, with an emphasis on the potentially dire mental health consequences of failing to enact a definitive legal remedy,” Venkataramani said.

If such efforts fail and DACA does expire next year, the health care profession will face a serious challenge, he added. Many former DACA beneficiaries, in the absence of the law’s protections, will not only experience adverse effects on mental health and psychological well being, but will also be less likely—because of their status as deportable illegals—to seek help from health care professionals.

Venkataramani and Tsai argue that if DACA expires, health care and public health organizations will need to proactively reach out to undocumented immigrants, to reassure them of continued access to quality health care and to provide them with information about public mental health care resources.

“On a broader systems level, tracking health care utilization and health outcomes will help organizations monitor health at the population level and provide hard data to policymakers seeking to implement other supportive remedies,” they note.

The Medical Minute: Holidays Often a Challenge for People with Eating Disorders

December 17, 2015 by · Leave a Comment 

With food everywhere you look, difficult relatives and pressure to create perfect memories, the holidays can be a tough time for those who struggle with eating disorders.

People dealing with binge eating or bulimia nervosa may find that the emotional challenges of the season, coupled with extra eating opportunities, can trigger their unhealthy behaviors.

Patients struggling with anorexia nervosa often work to combat perfectionistic tendencies, and the holidays – a time that everyone wants to be perfect but which seldom is – can lead to problems if not handled carefully.

Dr. Martha Levine, director of the partial-hospitalization and intensive-outpatient programs for treatment of eating disorders at Penn State Hershey, says people with eating disorders often find themselves in a double bind.

“People make all this food and say, ‘Eat, eat!’ but then they also make comments about weight and appearances,” she said. “If you really listen to how much we talk about food, you see it can be a challenging time.”

She encourages her patients to seek out a supportive family member ahead of time who can play interference during holiday gatherings when people make comments about filling up plates, weight gained or lost, and the diet they are thinking about trying.

Patients should make a plan to handle unstructured days where the eating never stops or occurs at different times of day. When the festivities and conversation trigger anxiety, Levine’s advice is to breathe, then seek distraction with non-food activities.

“Go for a walk, suggest a game everyone can play, or find something else to do,” she said. “I always tell my patients that emotions are like the weather – if you can just get through them, they pass and the next moment can be very different.”

Family members can help their loved ones who struggle with an eating disorder by providing quiet support. That means not greeting the person with a “You look good!” or “You look healthy!” – both of which are often interpreted to mean “You look fat.”

“It can get overwhelming if too many people are commenting on it,” she said.

Rather than focusing on physical appearance, Levine suggests those wanting to show support use comments such as “You look brighter” or “You look like you have more energy,” which focus on internal qualities.

Guiding conversation to light topics such as books, movies and current events that don’t involve food or appearance can also help.

Families who step up with support during the person’s initial bout with the illness and then back off may also trigger relapses. “The message is almost that they have to stay sick to keep them involved in their lives,” Levine said.

And the focus should always remain on health rather than weight, size or physical appearance. She said, “Look at your body as a tool that you want to make as healthy as possible so that you are able to do more things.”

 

Copyright © 2017 Eastern Group Publications/EGPNews, Inc. ·