Beyond access: Psychosocial barriers to undocumented students’ use of mental health services

Little is known about how undocumented immigrants navigate healthcare utilization issues apart from access. We examine a unique population of undocumented immigrants who have access to healthcare - college students at the University of California - to identify how immigration status hinders mental health service utilization in the absence of barriers related to eligibility and insurance coverage. We conducted semistructured interviews between March and July 2017 with 30 undocumented students at a University of California campus. We argue that undocumented immigration status informs mental health-related illness cognitions to negatively affect students' ability to assess their own mental health and need for services. Students expressed low perceived need because they normalized mental strain as a natural product of their unstable immigration status. Many viewed treatment as futile because it could not address underlying immigration-related issues. They also anticipated stigmas associated with mental illness as well as their own undocumented status. Solutions to address utilization disparities must go beyond eliminating formal barriers to health access and address such psychosocial barriers, as well as the larger political and social context that produces them. •Immigration status informs undocumented students' mental health illness cognitions.•Even when insured, service use is low, exacerbating poor mental health.•Low perceived need, low treatment efficacy, and stigma are barriers to service use.•Solutions must address psychosocial barriers beyond formal healthcare access.