In this episode of the Psychiatric News Special Report podcast, Dr. Adrian Preda is joined by Dr. Lisa Fortuna, chair of the APA Council on Children, Adolescents and Families, to explore the profound mental health impact of U.S. immigration policy on children and families. Drawing from the August 2025 Special Report, they discuss how policy-driven fear, trauma, and instability affect not only undocumented immigrants, but also U.S.-born children in mixed-status households. Dr. Fortuna underscores the urgent need for psychiatry to move beyond the clinic, recognize immigration enforcement as a public health issue, and provide trauma-informed, culturally grounded care. The conversation highlights structural trauma, intergenerational stress, and the importance of community-based mental health responses.

You can read the Special Report here: https://psychiatryonline.org/doi/10.1176/appi.pn.2025.08.8.19

PsychNews Special Report is a production of Psychiatric News, a media platform dedicated to serving as the primary and most trusted source of information for APA members, other psychiatrists and physicians, health professionals, and the public about developments in the field of psychiatry and mental health that impact clinical care and professional practice. Learn more at psychiatryonline.org/journal/pn.

Transcript

Dr. Adrian Preda (00:12) Welcome to the Psychiatric News Special Report podcast, a monthly podcast produced by Psychiatric News for the APA's Medical Minds channel. I'm your host, Dr. Adrian Preda, Editor-in-Chief of Psychiatric News and Professor of Clinical Psychiatry and Human Behavior at UC Irvine School of Medicine. Today, our goal is to unpack a really profoundly important topic and unfortunately one that's often overlooked. We are talking about the very real human impact of contemporary current US immigration policies and enforcement, specifically on immigrant children and their families. This isn't just abstract legal policy. It's about the deep consequences that policy has on mental health and well-being. Today's discussion is based on the Psychiatric News August 2025 Special Report. To discuss this report, my guest today is Dr. Lisa Fortuna, a professor of psychiatry and neuroscience and chair of psychiatry at UC Riverside, and also the chair of the APA Council on Children, Adolescents and Families, and also the report lead author. To start with, Lisa, I got to say, I'm really impressed with how you pull together in your report such a rich mix of clinical insights, broader epidemiological data, and most importantly, community-based research. to shed light on what's a very complex dynamic between policy and mental health. I'm going to start by telling you that after reading the report actually last night, I read it a couple of times preparing for today's podcast. What impressed me the most is that you're making a very, ⁓ very important argument that considering what's happening, essentially psychiatry, couldn't, shouldn't stay on the sidelines. take what's happening in the policy and in-fortunteria and argue pretty forcefully that this moment demands a fundamental rethinking on how we understand and how we treat both structural and intergenerational trauma. So let's start there.

Dr. Lisa Fortuna (02:16) Yeah, I'm, you know, I thought it was really important in writing this paper that we think about how policy can have a direct impact on the well-being and mental health of communities. So I would say that that's the overarching message that I really framed this around. And in this case, we're talking about immigration policy. And it, my focus was really to take it from not thinking just politically, right? Because that's not really the point of the article, but policy, right? And policies have especially profound impact in my belief on children and adolescents. Children and adolescents and their families, of course. But children are amongst the most vulnerable populations that we have globally. They don't have a lot of rights as we would hope that they would. including in the United States. And when there are policies that directly impact their safety, their rights to be able to have their family and to feel safe in schools and in their family, we have to think about sort of those root causes of distress and how they can impact generations of children.

Dr. Adrian Preda (03:36) Yeah, it's really important to understand that these policies are not just about border control and paperwork, right? They could in fact become immediate mental health threats. And in your report, you highlight how the current policies have become a major source of chronic fear, instability, and frankly, trauma for millions.

Dr. Lisa Fortuna (03:56) Yes, ⁓ and that's an important word that you're stating in saying trauma, right? Or, you know, trauma, ⁓ very extreme and toxic distress and stress. you know, the authors and myself, one of the things that we wanted to point out is how does this really manifest? And there's a few ways that that can really happen and is happening currently. We can look at this understanding of raids and immigration policy, right? And this, the messaging that people will be removed. But, you for children and families, it really is a message of being separated, potentially, and not having access to work and safe spaces at school and healthcare. You know, what we're seeing, even as we speak, is that, families are living in extreme fear. even families that may have been working on their immigration process, but fearful to be able to even move forward with that because they believe that they might be separated from their families or separated from everything that they know. And that becomes a very distressing thing. And we know that for children and adolescents, feeling that your support systems, your family, your caregiver, your school setting is in threat. and not safe creates a very significant stressor for at least a production of anxiety, depression. And we have even seen in our clinical settings, even suicidality in both parents and children due to the distress of that fear and threat of separation and loss. And when you witness those things within your community actually happening, you know, we have seen in research that it can have a very direct and negative impact on everyone in that community. And so we can talk a little bit more about that, but there's even research on how it can impact citizen individuals that are from that community very negatively, including anxiety, stress, and even low birth weight babies ⁓ increasing among pregnant women that are from that community. because of the level of distress and physiological stress, right, of being able to see these things.

Dr. Adrian Preda (06:26) Yes. So we are talking about really specific things here, like the expansion of enforcement mechanisms, including worksite rates, people being held in detention for longer periods of time, and also an erosion of protections in places that used to be considered safe, like school health clinics. Right. Yes. And you're making this point, which I think is really important, that all this is not just limited to immigrant children themselves, but it also affects millions of U.S. born children. kids living in what's called mixed status households.

Dr. Lisa Fortuna (07:01) Yes, yes, most definitely. You know, these a lot of there are a lot of instances, right, millions of children who are born here in the United States and have mixed status families may have a, you know, status parents, you know, one that has US citizenship and one that does not and has some other status in terms of immigration. And what we have found in the empirical research is that even citizen children, and especially citizen children who may have one parent or a very close relative who is at risk of immigration issues like deportation, have increased rates of anxiety and depression. ⁓ You know, one of my colleagues, Louis Zayas, has a book and also some articles that really did research, research the impact on citizen children of these issues. and found elevated risks of depression, anxiety, even PTSD, and school difficulty. And this was an issue for younger children, but even also adolescents.

Dr. Adrian Preda (08:10) the other part that I think it's important to consider is that in some of these situations and probably in the majority of cases, some of the stress starts before the families even arrive to the United States. In the US, for instance, parents often migrate ahead of their children, perhaps to find work and establish themselves, which then in turn leads to prolonged separations. How does that affect and affect us into the increased risk?

Dr. Lisa Fortuna (08:36) Yes, yes. I mean, that is definitely an issue that comes up a lot in terms of that there are sometimes ⁓ sequential separations, right? Where exactly what you're saying, that family members, parents, for example, mother or father, may come earlier into the United States to be able to work and to set a pathway to be able to bring their family, hopefully, right? And then sometimes, the children will come later and there is this prolonged separation sometimes for many years, maybe sometimes with other, know, having had stayed with ⁓ other relatives like grandparents. And then sometimes there's separations from those caregivers, right? Once they come to the United States, like a grandparent left behind, for example. And then the reunification can sometimes be very challenging. And so that's another area where separation can be very difficult. I think what is happening here is that those children, as well as children who are born here, right, and been born here with their parents here, are all facing different degrees and readjustments around this risk of maybe yet another separation, but now a traumatic separation. That's one of the things that I wanna sort of highlight too. Even though it can be very difficult to have a parent move out of your country to set ⁓ a pathway forward for you in the United States, there's something particularly difficult about what I state is a traumatic separation, right? Where you are in a family with your parents and there is this risk that they will suddenly and traumatically be taken from and maybe taken somewhere that you do not know. And there's a little bit of a increased intensity about that traumatic experience.

Dr. Adrian Preda (10:41) It's really hard to kind of conceptualize this level of stress that is sort of setting up a slippery slope, which then further increases the risk for anxiety, depression, also PTSD. And I would imagine, and I think that's an important factor that we also discuss in your article, the stress is compounded by the effect of the stress on also the parents' mental health themselves.

Dr. Lisa Fortuna (11:10) Yes, absolutely. You know, we know that children and I would say even adolescents, we don't always think about adolescents in this way. When they see that their parents, their caregiver, they're the person that they're looking to keep them in a good place, in a safe space, that very important and primary relationship. When they see that the parents are stressed and reacting to that stress, it really is a message that, you know, things are really going to a very dangerous place and an unsafe place and my core support system is being dismantled, right? And so that it's really the way it reacts, the reaction is psychologically for children and adolescents. And that translates into a real physiological stress, right? You're on the, know, my gosh, I have to be on fight, flight, I have to be vigilant. You know, the main core of the person that keeps me safe and that I care about is at threat here. And, you know, and that's why I, we also bring up in the article that it's that primary space of caregiving that is at risk, which is very stressful. ⁓ And then for some, you know, most children and adolescents, then in that school space, the school community is another place of safety. And when there's messaging that that might not be safe, ⁓ that's very, very challenging. ⁓ So it is compounded. It is compounded. And that stress within the family ⁓ also becomes a significant salient place of stress.

Dr. Adrian Preda (12:50) Yes, and you cite actually talking about adolescence, a US national study where kids aged 11 to 16, if they had a family member detained or deported, they had a significantly elevated ⁓ risk for suicidality, acting out behaviors, and even alcohol use. And for the younger kids, the abrupt loss of a caregiver led to things like sleep problems, appetite changes. difficulty regulating emotions and even developmentary regression like losing skills.

Dr. Lisa Fortuna (13:24) Yes, yes. And as you are, you you're talking about those symptoms or outcomes of those separations, we can, if we step back, we could see that that really sounds like a post-traumatic stress disorder, right? Or a constellation of symptoms that we might fall in that because it is traumatic, right? And it is a reaction that comes from a very traumatic event. And, you know, because we see those in post-traumatic stress. And whether we feel that the youth meets full criteria for PTSD or not, those are constellation of symptoms that we think that happen in those circumstances, right, that are traumatic or disastrous or very difficult and stressful situations. ⁓ And that's what we do see with these kinds of events.

Dr. Adrian Preda (14:12) And thinking about trauma, I think it's important to emphasize that possible separation isn't just a sad event. It's recognized clinically as an adverse childhood experience.

Dr. Lisa Fortuna (14:24) Absolutely. It's one of the most adverse childhood experiences ⁓ that we can think of as loss of a parent. I we may also think about that as death of a parent, right? But loss of a parent where you are unsure of what will happen next or they're ⁓ being reunified, will you be reunified or not? Where will I go? I mean, there's circumstances where children may not have other people to care for them and they worry about, know, am I going to be in foster care? Am I going to be like, what's going to happen to me? ⁓ Adolescents or older adolescents who feel like, am I going to be the caretaker of my younger children? It is really a dismantling of your life, right? All of your support systems, your ⁓ attachment, right? Because we're also talking about a disruption of attachments, especially for younger children. And all these we know can be very traumatic and adverse childhood events and can also really lead to psychological and developmental consequences as you mentioned. It's actually regression and development in part also because we're creating a stressor in that primary attachment relationship.

Dr. Adrian Preda (15:44) and then it's not just the actual separation, it? It's the threat of it too.

Dr. Lisa Fortuna (15:50) Yeah, that was a very important thing that we wanted to bring in this article. I think most people would say, if you see a parent separated from you in such a manner as a raid or something like that, that that would be potentially traumatic for a child or would likely be traumatic for a child. But what we have found, ⁓ I think clinically, absolutely, and definitely in the literature, is the threat, the risk that this may happen to me because I have a parent caregiver who's vulnerable to this happening and where our family is vulnerable to this can in itself be a very significant stressor. And we have seen that, you know, where, you again, in studies of even citizen children in mixed families, that just having the threat or risk of that happening to your family increases and elevates all of these symptoms and disorders that we're talking about.

Dr. Adrian Preda (16:45) Right. the anxiety is the fear of unknown. And this is probably the epitome ⁓ of the fact that nothing could be known in terms of what's going to happen the next day or even in the next moment. And to make things maybe even more complicated, the whole landscape of US immigration policy seems to be constantly shifting, often unpredictably, which must amplify these challenges.

Dr. Lisa Fortuna (17:11) Absolutely. is, you know, one of the things that we have found in both these situations and disaster situations, it's the uncertainty, the threat, the risk of harm to yourself and to your family. And I would say in these circumstances, threats and risks that seem very real. Right. And I think that that's a really important component that we have to highlight here. It's not especially in the current environment, it's not just the imaginations of a child, right, that I might be separated, that we might think in a separation anxiety, right, where, you know, I'm worried that something might happen. There are a lot of things in the environment and fast changing, as you were describing, that make that threat very real and very concrete and very present. And that's one of the things that we wanted to talk about here, because that's where policy is making one of a child's fears a very real impossible reality.

Dr. Adrian Preda (18:16) And it seems like that's something that it's unfortunately contributing to this because we are looking at the context of expanding legal ambiguity. ⁓ It's not very clear who are the targets. It could be a new citizen, lawful permanent residence, people on non-immigrant visas, undocumented individuals. So there is this lack of clarity ⁓ with ⁓ almost like situations where it's not clear if the application is consistent. there is not that much transparency, which then turn intensifies the fear and uncertainty ⁓ within the immigrant communities.

Dr. Lisa Fortuna (18:54) Yeah, absolutely. You know, and I think that that's, you know, that's also leading to the degree of anxiety and fear in the adults, right? A lot of adults in the immigrant community with various immigration statuses, right, have a lot of concern and fear right now of whether protections or ⁓ sort of ways of addressing their immigration status are no longer present. And there's a lot of uncertainty of what might happen to them. And that's creating part of the extreme stress or in fears, especially in adults who are seeing that and understanding that, or in some process, right, of asylum or other immigration status, feeling like that is extremely at threat. And even with adults, working with adults, immigrant populations, when you have uncertainty about your pathway to some kind of safe status, or being able to stay here in this country, asylum seekers who have experienced significant ⁓ issues in their countries of origin, violence included, there is an extreme increase in anxiety, depression, and PTSD in those adults. And when they have children, that is definitely transmitted, right? Children and adolescents see their parents stressed and worried, and they understand the threats. And that creates those tensions that we were talking about earlier within families.

Dr. Adrian Preda (20:21) So this ervasive fear is directly linked to increased symptoms of PTSD and also internal experiences such as anxiety and depression. when it comes to children, you're also making the point that there are behavioral changes.

Dr. Lisa Fortuna (20:35) Yeah, yes, absolutely. You know, because, again, if we take this from attachment, relational anxiety, you know, all the ways that we might think about how children manifest psychological distress and symptoms, you know, that's one of the things that we see in young people is that there are also developmental behavioral consequences. Right. I started this, you know, discussion a little bit talking about the fact that children and adolescents are particularly vulnerable populations, right? They don't have all of the opportunities to make the decisions that adults may have and they're reliant, right, on adults and systems to keep them healthy and to keep them safe. And when some of those things seem at threat, or all of those things seem at threat, a lot of that distress for children may be where they feel like they don't have agency, right? And they're feeling that sort of psychological anxiety and sadness. It can result in acting out and behavioral issues, right? You know, not listening, being hyperactive, not being able to focus in school, not wanting to go to school, becoming aggressive, because it's one of the ways that we know that children may... they manifest that both because they don't have a lot of agency to do a lot of other things. And also because that's the way that they may not understand exactly how to express things ⁓ at a more sort of mature level. And that's why we often see that behavioral issues are really around this dysregulation, right? What we call, you're just feeling really dysregulated and out of sorts and not having an agency to do it any other way and feeling so distressed. Then I have these behavioral problems. And so we have to look at those behavioral problems as not just sort of wanting to do the wrong thing, right? But that it's really a manifestation of feeling really distressed and not right.

Dr. Adrian Preda (22:39) And then we can see kids avoiding school, dropping their grades, becoming socially isolated. And really with all this missing out on chances for developmental support or mental health help that they might really need.

Dr. Lisa Fortuna (22:54) Exactly and that's something else that we wanted to mention in the article. It's a disruption of you know really those opportunities right. It's not only sort of a direct distress and trauma which is enough of a problem but it is absolutely what you're saying a disruption of opportunity for other healthy experiences and growth and in some cases even education.

Dr. Adrian Preda (23:22) Considering this context, aren't these understandable responses?

Dr. Lisa Fortuna (23:28) Yes, you know, and you know, if we if we think about our humanity, right, when we have this immediate threat to the things that are most important and close to us to react with ⁓ retreat, or agitation, or absolutely sadness and these psychological, you know, distressing symptoms. That's that's what happens to us, right? When when when things that are so who are well-being are a threat. So it's very human and it's very developmentally appropriate and it's what we would expect.

Dr. Adrian Preda (24:06) To bring this all into really sharp focus, you are presenting a case study. It's a mixed case study, but I think it's very informative. It makes a comparing case for how this very complex dynamics play out. Let's talk about Anna. She's 17. She's a US-born high school student living in a mixed status household. and her parents are undocumented immigrants and she comes for her appointment in the clinic. What's happening with Anna?

Dr. Lisa Fortuna (24:41) Yeah, yeah. So Anna, you know, is experiencing a lot of the things that we talked about, you know, and as a sort of a composite vignette of things that we are seeing, you know, clinically, where adolescents are, are very aware of what is occurring in their community and in their family, all these things that we've been talking about, so the risk and the threat, right of deportation, seeing the degree of stress in her parents and be very aware that that only escalates her understanding of the threat because her parents are also very distressed and reacting to that distress. And in the vignette, Anna starts doing some things that are really around expression of her distress, like some self harm, some cutting, which is another thing that we might see because she's trying to hold it together. And she's trying to get to school and not maybe always succeeding in that. But she's trying to hold it together, which is one of the things that we see with especially adolescents where they also don't want to escalate their parents' distress by disclosing their own distress, which is another element of this, right? Where everyone tries to keep it from one another and there's not an opportunity to really fear of talking about it. Right. Which is one of the reasons that clinically we're, we're having families talk about it, right. And plan and see how they could help one another and understanding and that parents can be supportive even within their own distress. The other things that is in the Anna story is that disruption or disconnection from others. Because one of the things that we find is that not only do family members have difficulty sometimes talking about this because it's such a horrible story, right, to talk about together. They start moving away from other resources because of fear, right, of going out, but also not wanting to sort of disclose what's going on. It's sort of a secret. And in the vignette, we talk a little bit about the importance of reconnecting Anna to community, right, to community organizations, to supportive things and institutions that can support her family as well as a unit. to sort of address all these compounded effects that are on families and how it might impact on an adolescent.

Dr. Adrian Preda (27:13) And the other part that I thought was really important in Ana's history is that she shared a really powerful piece of her family history. Her grandmother had fled political violence during El Salvador Civil War, ⁓ which trauma remained largely unspoken in the family, but it shaped her mother's upbringing in the environment. So there is a very important intergenerational is there as well, which tends to be common in this population.

Dr. Lisa Fortuna (27:49) Absolutely. I'm glad you're bringing that up because there is this, you know, we mentioned in the article in a few different ways, this idea of intergenerational, right? And it's not just absolutely just what's happening now, but what has happened historically in the family where there have been circumstances of political violence, separation, and we had talked about before, even loss and death. right of individual family members through through through political violence and other violence in their countries of origin. And so there is this living history of ⁓ fear of loss and death. And again, going back to real threats that have historically happened, and that are potentially happening again, through circumstances and in ⁓ do policy and politics. So and again, it speaks to this idea of what's often unspoken, but living within families, their anxieties, their fears about these things, the trauma that they hold in their history and in their minds and even in their bodies in terms of increased stress hormones and everything else that are activated in situations, right? And so, that relates to how the parents are reacting to these things and their own re-triggering of trauma and how that is transmitted in the... the family unit in terms of distress and stress and how do we manage this? How do we talk about this? How do we find support for this? And I think that's, those are really critical pieces of Anna's story.

Dr. Adrian Preda (29:26) So, know, yes, I found Anna's story emblematic of a broader pattern of structural harm. Her mental health isn't just shaped by what happened to her individually, but by generations of history, current policies, and then these fundamental social conditions of whether she feels like she belonged or she was excluded.

Dr. Lisa Fortuna (29:51) Absolutely. And it's the reason that, you know, the recommendation, I think that's implicit with ⁓ Anna's story is having an opportunity to talk about those things and supporting the entire family and that idea of reconnection, right? Where in my community, where in my circumstances do I have a community of adults? culturally appropriate understanding that can help us, right? Because that idea of isolation is one thing that has to be addressed. And the other thing that has to be addressed is that there can be a lot of internalization by children and adolescents that there's wrong, inherently wrong about them and how they're reacting and how they're responding. And one of the things that we have to do is transmit or transform that narrative. into you're not the problem, it's the situation, right? That's the problem. And then we have to address that together, we have to support you through this problem, right? As well as take care of your emotional distress, but we need to sort of make clear that the narrative is about what's happening, right? And we have to address those things with you.

Dr. Adrian Preda (31:10) So it's almost like we're looking at not only complex but sort of a layered set of not trauma but traumas. I think maybe that's a better way to understand it. And then in your article, you argued that this set of traumas directly affect the brain and the body.

Dr. Lisa Fortuna (31:28) Absolutely. We know that very distressful situations and perhaps in stages of development, children and adolescents, that you're talking about increased stress hormones, elevated stress hormones ⁓ more chronically, impacting brain structures that we associate with PTSD, post-traumatic stress. amygdala, hippocampus, we know that those areas are negatively affected by elevated stress, acute and or chronic. ⁓ And that those areas also have an impact on development, right? And learning, as well as, you know, sort of associating with other parts of the brain that have to do with learning. And so when those things are elevated, it's very difficult. It can have a significant impact on the ability to learn, right? At least in that moment. And that's why we see in the literature that that's one of the things that might be an outcome of post-traumatic stress or these very distressful situations where there are difficulties in school and in learning and a sense of ⁓ well-being and identity formation, right? Because there is this ongoing risk and threat. So it's very, it's very significant. And it's why we really wanted to talk about it. ⁓ in this article looking at it from a child and adolescent perspective because it is a very clear policy and structural stressor that can have impact on children and adolescents development for some time. And it's something that we can address structurally.

Dr. Adrian Preda (33:14) Yes. And with that, it's important to acknowledge that standard treatments like maybe SSRI medications or trauma-focused therapy could help. But it's really important to consider the broader context and ⁓ medications or psychotherapy really are not enough on their own in this situation.

Dr. Lisa Fortuna (33:36) Yes, I mean, you I would say you have to if you you diagnose a child with PTSD because of these circumstances and again, it could be because of cumulative things like we've been talking about, you know, past other traumas and threats and then now this and they do have PTSD and they meet criteria, treat the PTSD and we have good evidence based treatments for treating PTSD, but not not stopping there. because these are situations where we have to think about the context, as we've been talking about, like what's happening to the family? Has someone been separated? Is there a potentially risk of the child not having a place to stay or be with, or they're gonna be displaced from their family home and to be with someone else because of what's happening? Are they having problems with being connected to their school? Are they becoming isolated? we have to think about those situational, circumstantial, environmental factors that are gonna perpetuate the distress that they have. And so that's why we have to a little, let's take a step beyond the clinical ⁓ setting, our office, and thinking about these other environmental issues that we might have to address. And we don't have to address them alone. And I would say it's very unlikely we can address them alone, which is why we really we try to tell clinicians that one of the important things to do is to build relationships with organizations and community-based organizations, for example, or churches and other things that might be areas and places of support, or working with families to identify these other places of support. Because what's happening is not only internal, it's not just internal, it's environmental, right? It's social. And we have to think about what are the things that we can bring to support children in those other realms, school, family, community, church, those places that can hold them and help them through this.

Dr. Adrian Preda (35:38) Yes, and I think that's such an important point that when it comes to treatment is not just about individual patients, but it's important to engage families and systems to make the point that the relational care is key. And also you discuss the importance of narrative and culturally grounded therapies that help restore meaning and connection.

Dr. Lisa Fortuna (36:03) Absolutely, because you want to speak the cultural and literal language of the experience of what communities. so we know, especially in situations of extreme distress, we go to those core things about who we are. And we know under distress, it's very difficult to talk about things in your first language. We sort of go to our primary language of ⁓ expression of what we're feeling, very difficult to do through interpreter services alone, even though that is very helpful. There's nothing else. And to understand the cultural context of everyone's experience, right? This is not only impacting Latino communities, it's many other communities that are impacted, for example, and we have to understand all of the things that we're talking about. What is the cultural context of how these things are spoken? What are the historical situations of communities and how can these things be best expressed that are very difficult to express at all and therefore have to be at least expressed in one's primary dominant language.

Dr. Adrian Preda (37:10) so much in here. How about the workforce development and policy advocacy?

Dr. Lisa Fortuna (37:17) Yeah, we need more of that. I know a lot of places are, you know, trying to increase our workforce of mental health providers. Absolutely, we need that. We do not have enough bilingual, bicultural across different communities. Again, not just speaking about Spanish. Available for a lot of communities to be able to do this. There is a big movement in some states to also have paraprofessionals, workforce development, like promotoras, community health workers that are trained in understanding mental health and can be the front line in terms of engagement. And also working with other organizations like community based organizations, we mentioned churches, to be able to have outreach, right around these mental health issues, engaging people in reaching out for support, addressing issues of stigma, ⁓ trying to address this issue of silence and isolation. And so we need workforce at all the different levels from psychiatrists to psychotherapists, psychologists, social workers, and also these community health workers in the community helping. And there are initiatives around the country. I think we need more because we definitely need that diverse workforce.

Dr. Adrian Preda (38:35) And we need to keep naming immigration enforcement as a mental health issue, which means documenting it, researching it, publishing on it. Psychiatry must bear witness and not from the sidelines. I think that's a very important point that your report is making.

Dr. Lisa Fortuna (38:54) Yes, yes, we have to definitely look at this as a determinant of mental health in communities, immigrant and citizen. It is a very negative and powerful traumatic force right now for a lot of communities. And we have to name it, right? We have to go upstream, as we say, right? It was determinants of the health and the public health of our communities. Absolutely.

Dr. Adrian Preda (39:19) Lisa, as we close, what's one key message you'd like to leave with our listeners?

Dr. Lisa Fortuna (39:24) I would like to leave our listeners, especially our psychiatrists and mental health professionals know that your work is ⁓ exquisitely needed right now. We have to be able to open our minds in understanding how the things that ⁓ we think may not be in our realm as healthcare providers, as mental health providers, and just in policy are absolutely in our realm. And we're called to action right now to speak when we know that things in our country are negatively impacting our patients and our communities that we are called to serve. We have to move outside of this, clinical realm, because actually this is in our clinical realm, right? It is a direct determinant of the well-being, especially when we serve children and adolescents and families.

Dr. Adrian Preda (40:14) Lisa, thank you so much for this urgent and illuminating conversation. Your work powerfully reminds us that mental health care must be both clinically precise and socially aware. Yes. To our listeners, thank you for joining us for this episode of the Psychiatric News Special Report podcast. For more in-depth coverage of this topic, we encourage you to read the full article ⁓ in the August 225 issue of Psychiatric News or online at psychnews.org. We've posted a link to the article in the episode description. If you enjoyed this episode, please take a moment to subscribe, rate, and review the podcast. It helps others discover these important conversations. Until then, stay informed, stay compassionate, and take care. This is Dr. Adrian Preda signing off.

Dr. Lisa Fortuna (41:05) you