Mental health and legal statuses along the path to citizenship: A qualitative study of minority ethnic urban dwellers in Chiang Mai, Thailand

Background Given the lack of legal status, stateless persons often live in precarious situations that put them at risk of mental health problems, especially in urban settings. Moreover, pathways to citizenship may involve navigating different legal statuses over a lifetime, posing additional challenges. Yet, research on the nexus between legal status and mental health remains scant. This study examines the factors that influence the mental health of persons with different legal statuses in a Thai urban context. Methods This study employed a qualitative design. Data were collected through 47 in-depth interviews in Northern Thailand’s largest city in July 2023 using purposive and snowball sampling strategies. The interviews were recorded and transcribed verbatim. Thematic analysis, based on a social determinants of mental health framework, was used to analyse the data. Results Legal status was related to multiple and interdependent conditions of precarity in the city. Together they created a compounding effect that threatened mental health. The more restricted the rights attached to a legal status, the greater the effect. Past negative life events, adversed employment conditions, and discrimination were key factors that led to mental health challenges. Obtaining permanent legal status, on the other hand, alleviated legal uncertainty and provided immediate benefits by enhancing access to fundamental rights, with positive effects on mental health. Yet, it cannot reverse pernicious long-term effects of past deprivations, such as foregone opportunities for education and employment, as well as past traumatic events on mental health. Conclusions The 2024 landmark move of Thailand’s Cabinet to accelerate progress in resolving citizenship problems for almost 500,000 persons should be accompanied by multi-pronged interventions aimed at improving the social determinants of mental health. In addition, access to mental healthcare should be facilitated.