Coming to a new country can be overwhelming. Immigrants may not know the language, they have to adapt to a new culture and they may not know anyone.
When people struggle to adjust, it can be summed up as culture shock. But migration is not just considered a shock. It’s defined as trauma.
“And that's if it goes as smoothly as it possibly can,” said Mike Romagnoli, executive director of the Community Health Care Clinic in Normal.
This concept of immigrant trauma or migrant trauma is well-researched, and studies have shown mental health conditions are common among immigrants. In McLean County, immigrants account for around 7% of the population. This is according to the Stevenson Center for Community and Economic Development, which studies issues like this.
Not enough counselors
Bloomington-Normal has only a handful of counselors who speak Spanish. It has a smaller amount who speak French or other languages.
Romagnoli and others in the community — including Sarah Mellor, social services director at Normal-based nonprofit The Immigration Project — say this is not enough to meet the demand of non-English speakers, who are often immigrants.
“It's not that hospitals or the free clinics and stuff around here, Chestnut [Health Systems], aren't willing to hire Spanish-speaking therapists,” Mellor said. “It's [that] they don't exist.”
A study conducted between 2014 and 2019 showed the need for Spanish-speaking counselors has increased nationwide. Illinois was found to have one of the highest percentages of Hispanics (as defined by the CDC), but during that four-year span, the number of mental health treatment facilities offering Spanish services went down.
Why bilingual counselors are needed
One service The Immigration Project offers is legal representation for immigrants near Normal and their other location in Champaign looking to gain citizenship.
A component of the litigation process is proving trauma. Without therapists to verify this for the non-English speaking immigrants, Mellor said the process gets complicated.
“A lot of times we need letters from therapists … or psychological evaluations,” she said. “It's hard to get those necessary documents when there aren’t any Spanish-speaking therapists.”
She said this can endanger a person’s case due to lack of evidence.
There are also non-English speakers in the area who need counseling unrelated to litigation, whether it be for migration trauma or something else altogether.
CHCC is one of the local providers trying to help by bringing more bilingual therapy options to the community. Romagnoli said they recently added two Spanish-speaking counselors through a partnership with the Center for Youth and Family Solutions. Both of them already have a waitlist.
He added that the Spanish patient population is around 90% for the clinic.
Prior to when the counselors came in July, Romagnoli said clients had to rely on translators. Romagnoli has played this role before, acting as a go-between for patient and therapist. He said it doesn’t do the patient justice.
“I am very fluent in Spanish, but there is absolutely something lost,” he said. “A medical appointment is one thing, but with the counseling, it's just not the same. I mean, it really isn't the same when there's that third kind of intermediary.”
Romagnoli added that patients will come to Bloomington-Normal specifically for health care at the clinic. In one case, two children from Guatemala reunited with their mother.
“They were both kidnapped, held for ransom, weren't sure if they were going to survive the ordeal, let alone make it to the United States,” he said. “It was 60 days so absolutely terrified, literal, literal fear for your life.”
As a result, Romagnoli said the health care clinic quickly provided them with counseling. They did the same for another woman from Chicago who was shot in the face during a random act of violence. Romagnoli said family in the area recommended the clinic.
“It's miraculous that she survived the ordeal,” he said. “But coming out of that, loss of vision, loss of hearing lots of teeth problems, hundreds of pallets still in her, and because of all that trauma, when she got to us, she was very actively suicidal.”
These are just some of the clients the Community Health Care Clinic sees.
Other bilingual counselors in the area
There are also opportunities for bilingual counseling elsewhere in town.
Migdalia Galue does therapy sessions in English and Spanish. She is currently pursuing further education at Bradley University. She’s also playing multiple roles in the Bloomington-Normal community.
One of them is at YWCA McLean County’s Stepping Stones — a nonprofit that helps survivors of sexual violence — where she offers talk therapy. She also recently started interning with local pay-your-way provider IntegRity Counseling.
Galue said she provides more than communication help.
“Being a bilingual is just not only using the language but getting to know more about the culture, especially with [the] Latino community,” she said.
Stepping Stones Director Jen Golliday said Galue’s need is clear from her schedule.
“She definitely has a full caseload, almost always,” Golliday said, adding that Galue’s client list grows every year. Galue has worked there for a few now.
This matches a trend both Galue and CHCC’s Romagnoli said they’ve noticed an increasing interest among the Hispanic and Latino community for therapy. Having people who can speak Spanish, Galue said, will make the process easier.
It can also be as simple as directing someone to services in a way they immediately understand.
“It’s really needed … really, really needed,” she said.
Outside of CHCC and Galue, little options remain for mental health care.
Based in Bloomington, Eda Flores-Miranda does private counseling in Spanish. There are also three counselors at LifeStance Health in Bloomington who speak either Spanish, Armenian or Bulgarian.
Further restrictions
None speak French, which according to the Stevenson Center is another popular language in McLean County. Spanish speakers account for the majority of the non-English speakers, though.
Mellor of The Immigration Project said these are the folks who are hit the hardest.
“Immigrants that speak languages other than Spanish have an even greater disadvantage because there's even fewer resources,” she said.
YWCA Stepping Stones offers a phone translation service during counseling sessions. Golliday said there are a few clients who use the service and don’t speak Spanish.
Don Mahannah, a co-founder of IntegRity where Galue interns, said they similarly work to meet patients in the middle.
“We've actually done counseling in multiple languages and sometimes used family members to help facilitate because it's rare to find a counselor who can speak both English and a second language,” he said.
Mahannah said people are often willing to do translations to get the help they need when there isn’t a bilingual counselor available.
“We have always found that there are clients who are willing to work with that limitation because they have few options for receiving counseling to begin with,” he said.
Adding to the limited options in the area, Mellor said eligibility can exacerbate the issue.
While IntegRity’s model is open to all, they can only take on so many clients. Other agencies and individual counselors have insurance, costs and other factors to consider. Stepping Stones is meant for survivors of abuse.
A larger issue
But these are all known issues, and it’s not just McLean County that is facing a shortage of bilingual and multilingual counselors.
Unlike with the general behavioral health care workforce shortage, though, it’s not just a pay issue or an incentives issue. It’s not even a location issue.
Mahannah said it’s about the lack of bilingual or multilingual persons pursuing these careers in the first place.
“There's a fair amount of competition for those people because they are in demand and needed not only in our community but in all communities,” Mahannah said.
This is why Galue — on top of her two positions in Bloomington-Normal — is also helping in Springfield.
“They don't have any other Spanish speaker dedicated to survivors of sexual abuse,” she said.
In Champaign, The Immigration Project’s Mellor said they’ve seen this recruitment issue firsthand. The nonprofit previously had a one-year grant for bilingual counselors at its location there and has struggled to find any counselors since.
Mellor said it’s not necessarily any agency or the government’s fault that this is happening. She adds that this is true for everywhere, including Bloomington-Normal.
Organizations can’t force people to learn other languages, but Mellor said schools can help. She suggested they incentivize bilingual and multilingual students to pursue counseling by offering scholarships, for example.
Mahannah said community organizations are brainstorming, but it’s an uncertain road ahead.
“All of the agencies in town are understanding of the need for this and there's a desire to fill this gap, the challenge is finding the right people to be able to help us fill it,” he said.
Romagnoli said CHCC’s two counselors are a step in the right direction.
