Detaining Care, Part One: Mental Hell

The detainee at the South Texas Immigration Detention Facility was put on suicide watch after she cut herself with a razor and tried to strangle herself with a shoelace. A physician’s assistant recommended hospitalizing her.

Instead, the chief physician put the physically disabled woman in an isolated cell and took away her crutches, according to inspection reports that don’t name the woman. She was strip-searched and denied feminine products. For days, the woman slid around the floor of the cell on scraped knees, covering herself and the cell in menstrual blood.

When inspectors with Immigration and Customs Enforcement (ICE) came out to investigate the 2007 incident, they found not a single psychiatrist on staff and a facility poorly equipped to provide mental health treatment to its nearly 1,500 detainees.

The South Texas facility, one of several federally monitored Texas lock-ups for immigrants awaiting deportation hearings, is hardly the only one with mental health staffing problems. A Texas Tribune review of five of these facilities found just three had a staff psychiatrist, despite housing a combined 5,500 detainees.

The problems extend to detention centers around the country, and to the hundreds of state and county jails that house 70 percent of detained immigrants.  A report released by the human rights group Amnesty International this year found detainees nationwide struggle to get timely — or any — treatment for their medical needs.

Immigration detention officials say they’re working hard to improve health care – including mental health services – for people in their custody. Last month, Homeland Security Secretary Janet Napolitano announced plans for a new medical classification system to hone in on detainees’ mental health problems as soon as they enter custody.

And they say the ratio of psychiatrists to detainees isn’t as bad as it looks, because mentally ill detainees are taken to see mental health workers at area medical centers. 

“If a detainee discloses or demonstrates a mental health issue, he or she can expect to receive further assessment and intervention at any point during their detention,” ICE spokesman Carl Rusnok said.

Immigrant rights advocates say this is an exaggeration at best, and that detainees rarely receive mental health care inside or outside of detention centers. 

Detainees’ problems are compounded by having complex psychiatric needs. They have been separated from their families and thrust into institutional lock-ups, facing language barriers and an unfamiliar legal system. The estimated 15 percent of detainees suffering from mental illness often get misdiagnosed or miss doses of medicine, advocates say. 

Though the average length of stay is 38 days, advocates say some detainees are held for months or even years.

“These facilities were not set up for long term care,” but rather as a holding center for short periods, said Lee Teran, director of the immigration law clinic at St. Mary’s University in San Antonio. “Instead, [detainees] are fighting their cases. And they have long term mental health problems they’re getting virtually no care for.”