P3.K208: Psychotherapy at the Border: Evaluation of the Accessibility and Appropriateness of Mental Health Support for Migrants in Tijuana

Background: In 2023, Tijuana, Mexico was ranked the second most dangerous city in the world. Migrants in Tijuana report high rates of crime victimization, post-traumatic distress, and adverse childhood experiences. Mental health interventions for humanitarian settings are designed for short-term crisis response, but migrants’ length of stay is unpredictable. This study evaluated the accessibility and appropriateness of mental health support provided to adult and child migrants by a Tijuana-based non-governmental organization.

Methods: Qualitative study of migrants who had received mental health services for themselves or their children in the last 6 months along with their providers. Semi-structured interviews were conducted at the clinic or on the phone, depending on patient location. Transcripts were analyzed by deductive open-coding, verifying interrater reliability. Salient themes were extracted from thematic analysis and compared between groups.

Results: 10 adult patients, 6 parents of pediatric patients, and 4 providers were interviewed. 8 patients were in Tijuana and 8 were in the US. Participants across groups identified a lack of safety and basic needs as primary causes of distress, highlighting improved sleep, an increased sense of hope, and coping skills as major benefits of psychotherapy. Parents of pediatric patients noticed regression and disruptive behaviors as changes in their children’s baseline, but needed referrals by teachers and primary care providers to relate them to mental health distress. They identified psychoeducation and parent-child interaction guidance as essential elements of therapy, and were more likely to engage in therapy for themselves after seeing their children’s improvement. US-based participants identified crossing the border as the most important source of symptom relief, while recognizing a need for continued treatment. Major barriers to treatment included stigma, lack of information, and perceived severity, while facilitators included self-initiative, referrals, and co-located care. Patients suggested longer treatment courses while providers identified this as a source of burnout.

Conclusion: Mental health services offered by Tijuana clinicians are well received by an array of migrants, but support is needed longer term given the protracted nature of migrants’ stays. Potential avenues to improve accessibility for all patients include more frequent visits to migrant shelters by providers, refining triage protocols, and continuity of care beyond Tijuana. Pediatric patients would further benefit from raising awareness among parents, teachers, and primary care providers.