Immigration Detention: The Mental Health Impacts

Editor’s Note: Rachel Trafford is an employee of the Immigration Advice Service, and Peter Markham works for them writing pieces on a freelance basis. Mad in America accepted this blog for online publication because it raises an issue of interest regarding the criminalization of migrant trauma.

President Donald Trump’s take on coronavirus has consistently been to downplay the number of deaths in the United States from the pandemic. In a tweet in May, he said he expected that up to 100,000 Americans would die from COVID-19 and that the virus was ‘going to go away without a vaccine.’ Since then, he’s shown few signs of sympathy about the more than 220,000 and counting who have now actually died. Furthermore, there has been no real acknowledgement of how his immigration policies have exploded the population in substandard conditions in immigration detention, causing multiple COVID-19 outbreaks and the misuse of solitary confinement in place of actual medical care.

There’s concern that the amount of COVID-19 cases and deaths amongst those held in indefinite immigration detention is being greatly underplayed by US Immigration and Customs Enforcement (ICE). The International Rescue Committee (IRC) says tens of thousands of people are being held in unsanitary conditions in ICE detention centers which have become the perfect breeding ground for potentially ‘superspreading’ levels of COVID-19 infection.

America still runs the world’s largest detention system. It operates more than 200 centers which have an average daily count of more than 50,000 people. They’re a similar size to small towns and those immigrants held in these ICE detention centres are denied access to lawyers, often segregated from their families.

Detainees, many held without charge, are having to wait months if not years to have their cases heard as private companies line their pockets by not setting them free. There are all types of immigrants held here, undocumented as well as documented. Inmates include those seeking asylum who have already endured torture as well as people who may have lived in the US for years, with spouses and children who are American citizens.

The way these centers are financially run is flawed at best and at worst sinister and medically neglectful of the people held inside. Contracts are issued to local governments and private prison companies; a report by Human Rights Watch (HRW) released earlier this year shows that at least 81 percent of immigrants detained are being held in facilities owned and often operated by private companies. Two years ago big private prison companies such as CoreCivic and GEO Group made up to a quarter of their profit from ICE, their largest client.

ICE now has the power to detain anyone who doesn’t have settled status anywhere from the southern border to inside the USA. Forty new detention centers have opened in the past three years alone, evidencing the lucrative incentives to keep people locked up. The vast majority of operations within the facilities are then contracted out, including medical and mental health care.

The medical neglect within these facilities was endemic before Covid-19 took hold due to this troubling lack of oversight. HRW’s report found that 39 adults have died in the past three years whilst being held at centers or just after being released. Independent medical experts say substandard care played a part in these deaths. Suicide whilst in detention accounted for a dozen of those who died. Many centers have no mental health professionals on the pay-roll and there are heart-breaking tales of woeful medical care, with detained immigrants claiming they have had to wait a week to get broken bones set and that essential medication was simply not available.

During this year, there’s been an eruption of serious COVID-19 outbreaks at these facilities that has shone further light on the inequalities and injustices detainees had to endure. Just over 40% of staff members at the Eloy Detention Center in Arizona tested positive for COVID-19. Around 20% of those people held at the Adelanto ICE Processing Center, one of America’s largest facilities, also tested positive. There are serious questions that need answering about the practicalities of social distancing and sanitation within these kinds of centers and the implications not only for physical health but for mental health too.

Some detainees are reportedly being held in solitary confinement for weeks on end because of coronavirus fears. Harrowing reports of solitary confinement amongst detainees were coming in long before the rise of the pandemic. ICE is currently reporting the numbers of people held in ‘isolation or monitoring’ due to Covid, representing 384 individuals as of the 11th of November. Solitary confinement should never be a substitute for medical quarantine and can be an additional cause of such psychological harm on those who may already have experienced substantial trauma. The United Nations has claimed that total isolation of this kind is so inhumane that after 14 days it can equate to torture, in psychological terms.

In three out of the top five private detention facilities for population, up to 68% of the people recorded in solitary had a recorded ‘mental illness’ while they were there. POGO accounted for over 4000 instances of confinement between 2016-2018 for over 14 days and of these, over 25% were known to be struggling with their mental health. An Intercept investigation last year also testified to the thousands of people locked in solitary confinement. Solitary confinement is not a substitute for medical isolation and its conditions are not conducive to care or recovery, but rather a tool to manage and silence those struggling with trauma exacerbated by conditions they are trapped in indefinitely.

It appears to have been used as an inadequate and blunt tool to manage those who are already suffering in centers which do not have adequate mental health support, despite the rise in deaths and suicides in recent years. The incarceration of people, around half of whom have not committed a crime but are struggling with trauma suffered prior to and within detention, is wrongly institutionalising people who should be released. ICE has the power to release those who are not under mandatory detention. Though the detained population is less than half what it was before the pandemic, around 20,000 people remain locked up.

Lack of in-depth oversight procedures that deny human rights and institutionalise people have been endemic to the ICE detention system for years, especially one that has private vested interests in high population numbers for profits. Spreading xenophobia under the guise of public health to support brutal immigration policies is not only immoral but creates a pipeline from over-policed people and communities that lack resources to give the level of support needed. Community care investment and trauma-informed programs must receive adequate funding to sustainably support the thousands that should be immediately released.

Actions within the criminal and immigration systems have taken profound tolls on people’s mental health and emotional wellbeing for decades. The deinstitutionalization movement of the 1960s pushed to reform mental health treatment and shut down facilities that sought to imprison people. However, a lack of community resources resulted in an explosion of the US’s incarcerated population that began in the 1970s. Multiple movements by the Trump administration has made it harder for people to access mental health care. The President has approved of a work requirement being needed to access Medicaid, which could take away cover for many low-income adults and people who can’t work due to mental ill health, also disproportionately affecting immigrant communities.

Mental health facilities in multiple states report questions about people’s immigration status to ICE or other law enforcement agency, arguably a human rights violation and another example of criminalizing those deeply affected by trauma. The pipeline from over-policed communities with lack of support and those that find themselves in desperation at the border, to incarceration and detention is strong for migrants and asylum seekers.

If, as ICE proclaims, the health, safety and well-being of detainees are ‘among its highest priorities,’ the mental health needs of individuals during a global pandemic should therefore come first. However, as long as profit comes before care, it looks likely that little is going to change. The specific plight of those in detention and their treatment shows the need for understanding mental health as a psycho-social need not purely a medical one.

All individuals deserve to have their human right to health, including mental health, protected across all areas of government and policy. A more compassionate response to immigration and the individuals caught up in the system, including trauma-informed community programs must be the priority.

As the American election has (almost) come to an end (we hope), after taking over our global news cycles, the case for demilitarisation and de-incarceration of the immigration system and mental health systems has never been stronger. Being locked down in our homes has been railed as a civil liberties and potential human rights infringement, if not certainly a public health infringement. For those in immigration detention, this has always been the case.

Your understanding of who you are and your ability to cope is created by the multiplicity of social factors that create your environment. From people detained and imprisoned for their national or ethnic identity is state-enacted violence against that person’s understanding of themselves. The specific plight of those trapped in immigration detention is not properly understood, separately from experiences in prisons.

Without data and representation people will be kept in silos, their problems remaining one of ‘medical’ or ‘criminal’ concern, rather than of social and community concern. As COVID-19 continues to rage, the hope for recognition of the need for systems change still burns, dimmed but still flickering.