Mental health and immigration detention

The number of refugees globally has increased substantially since 2014. The United Nations High Commissioner for Refugees estimates that at the end of 2019,[3] the number of forcibly displaced persons is at 79.5 million, including internally displaced people (IDP; 45.7 million), refugees (26 million), asylum seekers (4.2 million), and Venezuelans displaced abroad (3.6 million), compared to the 51 million of forcibly displaced persons in 2013, which was already the largest number since World War II.[4]

Many countries detain undocumented immigrants, including asylum seekers and non-citizens. In 2017 and 2018, there were 160,504 detained immigrants in the European Union and the United Kingdom.[5] In 2017 the number went rose to 323,591 in the United States in 2017.[6]

Refugees and asylum seekers are already more vulnerable to mental health consequences, given the physical and mental burden of fleeing one's own country. Detention exacerbates immigrants’ psychological condition, especially depression and post-traumatic stress disorder (PTSD). Numerous studies have examined and pointed out acute and long-term psychological distress among detained immigrants, especially children, making them particularly vulnerable.[7]

Immigration detainees commonly report anxiety, depression, and PTSD during and after detention.[2] Pre-detention stressors include exposure to torture, human trafficking, and other kinds of human rights violations,[4] already putting immigrants at risk for mental health issues. During detention, immigrants have to cope with the loss of liberty, the risk of being forced to return to their country of origin, social isolation, and possible abuse from staff, which may resemble their country of origin, triggering their traumatic experiences.[2]

A meta-analysis examined 17 studies on 1168 participants of immigration detainees,[2] including host countries such as the US, the UK, Canada, Australia, Israel, Japan, Switzerland, and Sweden, and countries of origin ranging from Iran, Iraq, Afghanistan, Palestine, Mexico, Cuba, to other countries in Central America. The wide range of countries suggests a universality in the negative mental health impact of immigration detention. Findings suggest that detention adds additional stressors to immigrants and is associated with greater symptom severity. Additionally, detained refugees suffer from greater symptom severity than non-detained refugees.  The duration of detention is linked, the severity of  adverse mental health outcomes . It is stated that “the experience of detention may act as a new stressor, which adds to the cumulative effect of exposure to trauma, leading to an increased likelihood of developing mental health difficulties such as PTSD” (p. 2).[2]

Immigration detention center in Australia used to detain asylum seekers.

The institutionalized use of detention centers began during the 1980s. Before this point, detention was used only in extenuating circumstances, when the state deemed it absolutely necessary. In this context, detainees were held in more improvised locations such as prisons, warehouses, or even hotel rooms.[8] Within the United States, immigration control has been a prominent aspect of national policy since the days of the Chinese Exclusion Act, and even Ellis Island housed a detention center, showing that detention has almost always been part of the US immigration process.[8] In fact, Ellis Island was known as "The Island of Tears" to immigrants.[9] Under Reagan in the 1980s, the Immigration and Naturalization Service (INS) began to earnestly detain migrants from the Caribbean, and built numerous detention centers within the US and in Puerto Rico.[8] A major turning point followed, with the passage of the Immigration Control and Reform Act (IRCA) in 1986. The passage of this legislation ensured that immigration control would stay a high priority in policy, and increased the funding for enforcement and detention activities.[8]

As countries such as the United States have put increasing funding and importance towards immigration detention, private prisons have entered the fold. The first private immigration detention center in the US was also established in the mid-1980s, and many other countries in the global north followed suit. For example, the use of Guantanamo Bay as an offshore detention center served as a precedent for Australia to establish offshore immigrant detention centers in Nauru and Papua New Guinea.[8] Overall, using immigrant detention centers, border patrols, and other control measures is an established practice around the world in order to maintain political and social borders created by dominant social groups.[10]

The most common mental health outcomes observed in detained immigrants are post-traumatic stress disorder, depression, anxiety, and suicidality (including self-harm, suicidal ideations, suicide attempts, and suicide). The following sections will detail the reasons behind these higher rates, including testimony from detained migrants.

Particularly over the past few decades in the United States, family separation has been used as policy of deterrence against migrants. Policies such as expedited removal and the general criminalization of immigrants crossing the border without proper documentation, as well as Trump's Zero Tolerance Policy, have effectively created the conditions under which family separation occurs in the United States.[17]

Through recent research, family separation has been strongly linked to negative mental health outcomes, particularly for migrants who have experienced prior trauma such as refugees or asylum seekers. Interviews with several refugee families after their resettlement in the United States showed that family separation was a major stressor. In this case, family separation concerns include fearing for family members that may still be in danger, feeling powerless to help separated family members, and lacking important social, emotional, and cultural connections through family. The same study applied several established measures of mental health and quality of life to the families they interviewed and found that those who were experiencing family separation had higher anxiety, depression, and PTSD levels, and lower quality of life measures compared to those not separated from family members.[18] Psychological recovery after being released from detention hinges heavily upon the stability of the detainee's family, meaning that family separation can have long-term effects even after detention ends.[17]

Detention center in Texas, USA

Under typical circumstances of family separation, the parent(s) are criminally detained and investigated while the children are held separately. In US detention centers, parents may be forcibly removed from holding cells with their children without warning or a chance to say goodbye, and no knowledge of if or when they will be reunited. Because of the already adverse effects of immigration detention, separating parents from children causes even greater trauma to parents, and disrupting their ability to care for their children even after reunification.

"Lidia expressed difficulty connecting with her son out of fear that, if immigration authorities separate them again via detention or deportation, being attached would potentially contribute to re-traumatization. This reflects the great impact the trauma of separation continues to have on Lidia and her ability to provide secure attachment to her son." – personal accounts from staff at the Terra Firma Program in New York [17]

Furthermore, family separation has profound impact on the psychological health of children, which will be discussed in a later section in greater detail.

Long term stressors that may affect refugees and immigrants include acculturation difficulties, isolation, discrimination, poor living conditions, poor healthcare, etc. However, deleterious effects of detention, compounded by the length of detention, may continue to exist long after release from centers. Even if detention is temporary, its consequences are not. It is important to note that not all immigrants develop depression, anxiety, PTSD, or other psychological disorders. An Australian study examining 241 Arabic-speaking immigrants have found that after a mean of 3 years following release from detention centers, more than half of those who were detained for more than 6 months still show clinical depression, nearly doubling the percentage of those who were detained for 1–5 months. This is independent of past traumatic experiences.[24] Future studies are needed to determine more substantial long-term effects of immigration detention

Alternatives to detention refers to a set of policies and procedures related to immigration that does not rely on detaining and confining migrants, refugees, and asylum seekers. Alternatives to detention come in several forms such as parole, bail, family or community detention, case management, electronic tracking, house arrest, and voluntary return incentives.[25] Currently, alternatives to detention are becoming codified into law and practice to an extent in countries around the world. Most member countries of the European Union have incorporated laws that provide alternatives to detention. The United States has a risk assessment tool used to determine if vulnerable migrants are allowed to be placed in alternatives to detention.[26]

One of the leading theoretical models for detention alternatives is the Community Assessment and Placement model. The basis of this model lies in the concept that detention is not necessary in the first place, and that migrants should be allowed freedom of movement. Based on the individual's health, identity, vulnerability, etc., the next step is to find a safe community setting. Ideally, this would include legal and interpretation services, accommodation and food, and case managers. Finally, any additional control measures can be put in place in the community if found to be necessary–with detention only being used if absolutely necessary.[26] Alternatives to detention such as the CAP model, and other models based on meeting migrant needs, have positive effects on mental health. On the other hand, heavy surveillance requirements can have negative mental health impacts. For particularly vulnerable populations such as children, even community detention can result in physical and psychological harm.[25]

Ultimately the push towards alternatives to detention is a shift away from criminalizing immigrants, and towards a human-rights centered treatment of migrants. According to various studies on the topic, individualized case management and public services are important parts of a successful model. In areas where money is directed towards private detention centers, funding may need to be redirected to social services and public resources instead. However, some migrant rights advocates argue that alternatives to detention still represent confinement and incarceration in less overt ways. Freedoms and rights of migrants are still policed and restricted under alternatives to detention, so other solutions may need to be investigated further.[27]