Expert Commentary

How detention centers affect the health of immigrant children: A research roundup

Researchers have documented and quantified the physical and mental health toll that immigrant children experience during and after detention.

Detention Child Hand Hands

Between October 2018 and June 2019, the U.S. Border Patrol apprehended 234,443 adults; 390,308 family units (which includes all individuals apprehended with another family member); and 63,624 unaccompanied children at the country’s southwestern border, according to the Department of Homeland Security.

After apprehension, migrants are either repatriated or detained by Customs and Border Protection (CBP).

Detention by CBP is intended for the short-term only, according to a July 2, 2019 memo from Jennifer L. Costello, deputy inspector general of the Department of Homeland Security. She writes, “CBP is responsible solely for providing short-term detention for aliens arriving in the United States without valid travel documents.”

After an initial processing, these individuals should then be transferred to other government agencies, such as U.S. Immigration and Customs Enforcement (ICE) or the Department of Health and Human Services (HHS). “Currently, because both ICE and HHS are operating at or above capacity, CBP has experienced increasing instances of prolonged detention in its facilities,” Costello writes. Additionally, CBP facilities are experiencing overcrowding.

On July 18, 2019, Acting Secretary of the Department of Homeland Security Kevin McAleenan reported that on any given day, there are between 10,000 and 12,000 migrants held in custody by CBP.

McAleenan described the overcrowding at CBP facilities in his tweet: “We generally consider 4,000 detainees to be a high number of migrants in custody, and we consider 6,000 detainees to be a crisis level.”

Many of those in custody are children. On June 7, 2019, according to Costello’s memo, there were nearly 2,800 unaccompanied children in CBP custody. By June 25, 2019, the number decreased to fewer than 1,000.

News reports have chronicled the objectionable conditions at detention facilities. At a facility near El Paso, Texas, for example, lawyers say there has been an outbreak of the flu and kids have inadequate food, water and sanitation, the Associated Press has reported. Older children are taking care of younger ones.

Lawyers documented these conditions while observing and interviewing 60 children at a facility in Clint, Texas. These attorneys were tasked with inspecting detention facilities to ensure they comply with the Flores settlement, a 1997 agreement that sets minimal standards to protect the quality of life for detained minors and requires the federal government to return them to their families or licensed programs without excessive delay.

This year, five children have died while in CBP custody.

A policy statement from the American Academy of Pediatrics provides an overview of the practice of detaining immigrant children in the U.S. The statement summarizes research findings on the negative physical and emotional impacts of detention on children, even among those detained only briefly. “There is no evidence indicating that any time in detention is safe for children,” the authors write. “It is the position of the AAP that children in the custody of their parents should never be detained, nor should they be separated from a parent, unless a competent family court makes that determination.”

The statement, published in the journal Pediatrics, recommends “limited exposure” to Department of Homeland Security facilities for children, as well as long-term evaluation of the health impacts for children who have experienced detention. “From the moment children are in the custody of the United States, they deserve health care that meets guideline-based standards, treatment that mitigates harm or traumatization, and services that support their health and well-being,” the authors write. These include education, child care, interpretation and legal services. The authors conclude: “Children deserve protection from additional traumatization in the United States and the identification and treatment of trauma that may have occurred in children’s country of origin, during migration, or during immigration processing or detention in the United States.”

Researchers have documented and quantified the physical and mental health toll that immigrant children experience during and after detention. Post-traumatic stress disorder, depression, anxiety, weight loss and sleep problems are widespread. The following studies describe the prevalence and severity of these conditions and which groups of children are most affected.

Mental Health of Children Held at a United States Immigration Detention Center
MacLean, Sarah A.; et al. Social Science & Medicine, June 2019.

This study uses interviews and survey data to assess the mental health of 425 children between the ages of 4 and 17 held in a U.S. immigration detention center in mid-2018. While in detention, mothers were interviewed in either English or Spanish to assess their children’s behavior. Behavioral scores were assigned to designate whether children were in the “normal,” “borderline” or “abnormal” range. Some children — a subset of 150 who fell between the ages of 9 and 17 years old — completed a post-traumatic stress disorder (PTSD) screening assessment.

The authors found that, based on the mothers’ reports, 32% of children in the study had “abnormal” emotional problems and 14% had “abnormal” peer problems such as preferring to play alone. One in 10 children scored in the abnormal range for every factor measured. Children who had been separated from their mothers were more likely to have abnormal emotional problems than children who had never been separated (49% versus 29%). Children between the ages of 4 and 8 tended to have higher rates of abnormal conduct problems, hyperactivity and total difficulties (including emotional problems, conduct problems and hyperactivity) compared with older children. The authors highlight this as especially concerning given that “Young children are particularly vulnerable to the effects of their environment, and trauma experienced early in life has a significant effect on emotional and behavioral development.”

The PTSD screening results indicate that 17% had a probable diagnosis of PTSD (all four screening criteria were met). Additionally, 19% of the sample met two of the criteria for PTSD, and another 18% met three.

Compared with children in the general U.S. population, detained children had higher rates of emotional and behavioral difficulties and PTSD.

The Impact of Immigration Detention on Mental Health: A Systematic Review
von Werthern, Martha; et al. BMC Psychiatry, December 2018.

This review presents the findings of 26 studies relating to immigrant detention and mental health. To be included in the review, studies had to be published in peer-reviewed journals, include people detained for immigration purposes in various countries, report on mental health problems and measure these outcomes quantitatively. In all, the 26 studies encompassed a sample of 2,099 participants of various ages.

“Overall,” the authors write, “these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention.” Mental health symptoms were elevated in immigrants who were detained as compared with immigrants who were not detained. Symptoms were also more severe for immigrants detained for longer durations, and among those with greater exposure to trauma prior to detention.

The Mental Health of Children and Parents Detained on Christmas Island: Secondary Analysis of an Australian Human Rights Commission Data Set
Mares, Sarah. Health and Human Rights, December 2016.

Non-citizens arriving in Australia by boat without valid documentation are subject to mandatory, indefinite detention until immigration authorities make a decision regarding whether to grant a visa. From July 2013 through December 2014, some of these immigrants were detained on Christmas Island, located in the Indian Ocean northwest of Australia. Of the 1,717 total detainees on Christmas Island, 356 were aged 17 and younger.

This study looks at data collected through a 2014 Australian Human Rights Commission inquiry into the detention of children on Christmas Island. The data analyzed includes surveys completed by children and responses solicited from parents. The sample comprises 129 children ages 17 and younger. Children in the sample had been detained for an average of seven months.

Of the 35 children between the ages of 12 and 17 for whom a psychiatric distress assessment was completed, 85.7% scored as likely to have a severe mental disorder. Only one child scored as likely to be well. The rest of the children scored as likely to have either a mild or moderate mental disorder. Most children experienced at least some symptoms of anxiety and depression.

Parents, and possibly some adolescents, completed a strengths-and-difficulties questionnaire for 70 children between the ages of 3 and 17. Half of the children had abnormal total difficulty scores; another quarter had borderline scores. Abnormal emotional symptoms were present in 71.5% of the children.

Parents of children aged 4 and younger reported concerns about their children’s mental and emotional health – two-thirds believed detention had an effect. Specific concerns included sleep problems, anxiety, incontinence, self-harming and poor eating.

Stories from Unaccompanied Children in Immigration Detention: A Composite Account
Zwi, Karen; Mares, Sarah. Journal of Pediatrics and Child Health, July 2015.

This study is also a product of the 2014 Australian Human Rights Commission inquiry into the detention of children on Christmas Island. The authors spoke to over 40 unaccompanied children between the ages of 14 and 17, the majority of whom had been in detention for six to eight months.

Issues that surfaced during the interviews included the mental distress the children experienced in detention, lack of education and activities, and concerns about being transferred to adult detention facilities.

A sampling of their comments:

“Detention isn’t good for all children and adult (sic) – especially unaccompanied minors like me with no parents. I feel so sad without them. I leave them in horrible country and every time I’m so worried about them. Though I’m safe – I’m more stress than before because my family are in danger. And I don’t have even a little hope … and I don’t know where is my future?” said an unaccompanied 17-year-old who had been detained for 8 months.

“I cry all the time. I can’t sleep. I cry all the time in my room. I’m afraid of what’s going to happen next.”

“Of all the bad things that have already happened now, I feel I wish I died at sea instead of then dying slowly here.”

Asylum-Seeking Children’s Experiences of Detention in Canada: A Qualitative Study
Kronick, Rachel; Rousseau, Cécile; Cleveland, Janet. American Journal of Orthopsychiatry, 2015.

This study analyzes responses from in-depth interviews of 20 immigrant families — including parents and children — while they were detained in Canada between March 2011 and June 2012. The families were asylum seekers and failed refugee claimants — people who sought, but were denied, refugee status. At the time of their interviews, families had been detained for 56.4 days, on average.

Researchers also observed participants in immigration holding centers for one day a week for six months.

Common behavioral and emotional responses in children included anxiety, mood changes, sleep difficulties and decreased appetite. “I was traumatized,” said one 13-year-old girl who had been detained for 48 hours.

“In summary, children’s reactions, including those of infants and older teenagers, suggest that the constraining and frightening environment of detention constitutes an acute stress,” the authors write. “Even very brief detention appears to be acutely distressing for children.”

After detention, most families reported that their children experienced ongoing emotional and behavioral issues, including separation anxiety, fear of people in uniforms, sleep problems, PTSD symptoms, selective mutism and regression of developmental milestones.

The Mental and Physical Health Difficulties of Children Held Within a British Immigration Detention Center: A Pilot Study
Lorek, Ann; et al. Child Abuse & Neglect, September 2009.

This study looks at the experiences of 24 children between the ages of 3 months and 17 years held in a British immigration detention center in 2006 for between 11 and 155 days. The researchers analyzed assessments of the children and their parents or guardians that had been conducted by either a pediatrician or psychologist or both.

Of the 11 children assessed by a psychologist, all reported symptoms of depression and anxiety. These children all reported problems with eating (e.g., poor appetite) and confusion, disorientation or fright at being in a detention facility. Other common problems included behavioral difficulties, trouble sleeping, headaches and abdominal pains.

Of the 20 children assessed by a pediatrician, eight lost weight while detained. Two children had to go to the hospital – one for pneumonia, and one for vomiting, loose stool and irritability. Six children had missed medical appointments while detained, such as appointments for dental care or follow-up care for spina bifida. For the eight children between the ages of 1 and 4, all mothers raised developmental or behavioral concerns, including frequent crying, food refusal and regression to bedwetting, with the clinician.

The authors conclude: “This study’s findings indicate that the experience of detention, even for a relatively brief period of time, has a detrimental effect on the mental and physical health of children.”

Looking for more? Journalist’s Resource has a related research roundup on how family separation affects children, as well as tips on covering immigration and summaries of studies about immigrants’ mental health

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