Jul 9, 2019

Child detention is creating a mental health crisis

Illustration: Aïda Amer/Axios

The children who have been detained in overcrowded, squalid migrant camps at the border aren't just facing poor living conditions. They are also facing higher risks of serious mental health problems, some of which could be irreparable.

The big picture: Children are fleeing life-or-death situations in their home countries, and instead of healing their psychological and emotional trauma, federal officials are exacerbating the damage through means that the medical community views as flagrant violations of medical ethics.

The literature is clear: People who seek asylum and are detained in immigration camps, especially children, suffer "severe mental health consequences." Those include detachment, depression and post-traumatic stress disorder, which put them at higher risk for committing suicide.

  • The conditions of today's U.S. detention centers — sleeping on concrete floors, a lack of basic necessities, unsanitary cage holdings and family separations — compound the trauma of migrant children who have witnessed violence and death back home and have endured arduous journeys to escape, according to interviews with pediatricians, child psychiatrists, medical ethicists and researchers.

What they're saying: Medical professionals remain appalled at what they've seen and are raising alarms the U.S. immigration system is still needlessly hurting the already vulnerable mental health of these kids.

  • Marsha Griffin, a pediatrician in Texas, visited the Ursula detention center in late June with colleagues from the American Academy of Pediatrics. She recalled a young boy in a cage crying because his father had been taken to court and he had lost his aunt's phone number. Another child relinquished his space blanket, saying it led to nightmares. "This is child abuse and medical neglect," Griffin said.
  • Gilbert Kliman, a longtime child psychiatrist and psychoanalyst in San Francisco, evaluated dozens of Central American asylum seekers in Texas last year, including kids who saw their fathers violently separated from them. "They experienced what I call deliberate, cruel psychological abuse," Kliman said.

Between the lines: Parents and other adult caregivers are usually the only source of stability for children. Every expert interviewed said separating them in any capacity is psychologically damaging and morally intolerable.

  • "The children who are separated — I'm speechless," said Rachel Ritvo, a child psychiatrist and clinical professor at Children's National Medical Center. "That was what was done in slavery. That's what was done in the Holocaust."
  • Ritvo and more than 800 other doctors and bioethicists recently signed a public letter that condemned the conditions "where the physical and mental health of detainees are being placed at extreme risk."

The bottom line: "Most kids will have lasting scars from what they have seen or are enduring right now," said Wes Boyd, a psychiatrist and bioethicist at Harvard Medical School who has evaluated more than 100 asylum seekers in the past decade. "They're going to need as much medical help as they do legal help."

Go deeper: Growing up, and parenting, as a refugee

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What's happening: The ACLU urged the judge to clarify when family separation should be allowed, as the organization claims children are being separated for "minor alleged offenses," including traffic violations. The ACLU also asked the federal judge to block the Trump administration from continuing to separate families, per its Tuesday press release.

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Go deeperArrowJul 24, 2019