"The Dumping Point"

Detainees with mental impairments lack proper medical evaluation when they enter the federal immigration detention system and don't get adequate medication and access to social services, according to a new study.

Picture, if you will, a Twilight Zone episode in which foreigners are stripped of their mental capacities and thrust into a government-sanctioned delusional purgatory.

But this is no Hollywood script. Every one of these stories is true: A Mexican national diagnosed with schizophrenia is released into Mexico from a detention center earlier than planned and without his family’s knowledge; two years later the man remains missing, though his description fits that of a “John Doe” in a Tijuana morgue. A disoriented man goes missing after his release in Texas and only reaches his family in Maryland with his attorney’s help after wandering for days. Immigrants admitted to the South Texas Detention Center in Pearsall with manic depression and schizophrenia go untreated, though their diagnoses were made before their detention.

The federal government has acknowledged the perils of its current immigration detention policies and, to its credit, is making improvements, according to advocates of detention reform. But the system’s most vulnerable detainees, those with mental impairments, continue to suffer within the system. Those problems and the case studies that substantiate them are included in a yearlong study jointly conducted by attorneys at the Akin Gump Strauss Hauer & Feld law firm and Texas Appleseed, an Austin-based social justice advocacy group, and funded by the Hogg Foundation for Mental Health at the University of Texas. The study, released today, concludes that detainees with mental impairments lack proper medical evaluation upon entering the immigration detention system and don't get adequate medication and access to social services.

Though national in scope, the study focuses heavily on immigration detention facilities in Texas because Texas is “a state with a disproportionately large population of immigrants and immigration detention centers.”

“Texas seems to be the dumping point for a lot of people who are picked up and transferred across the country,” says Brittney Nystrom, a member of the Texas Appleseed advisory committee and the director of policy and legal affairs for the National Immigration Forum in Washington, D.C. “The number of mental health professionals in those facilities is at a non-acceptable low level.”

Indeed, according to the Department of Homeland Security’s own Performance-Based National Detention Standards, the government isn't meeting its own requirements that facilities have an approved mental health program “that provides intake screening for mental health problems … referral as needed for evaluation, diagnosis, treatment, and monitoring of mental illness; crisis intervention and management of acute mental health episodes."

"What did I do to deserve this?"

The immigration detention system can turn someone who is frightened and insecure into someone with an actual mental problem, Nystrom says. “When you are brought in and booked into detention, you might not manifest all the symptoms of a mental health disorder, but as you sit in detention for weeks or months, maybe your medication is adjusted, maybe you are transferred,” she says. “There certainly has been a large number of cases where someone has decompensated if they sit in detention.”

Dr. Allen Keller, the director of the Center for Health and Human Rights at New York University’s School of Medicine and the founder and director of a Bellevue-NYU program for torture survivors, says he's learned through his research that asylum seekers often find environments when they enter the detention system that are similar to those they were fleeing. “Many individuals I cared for after 1996 told me profoundly traumatizing stories — not just about what happened to them in their countries but when they arrived here seeking safety,” he says. “They were brought to prisons."

About 34 percent of immigrants in detention centers in Texas suffer from chronic health conditions and/or mental health impairments, according to the Appleseed study, and that's in line with the national trend. Between 2005 and 2009, Texas held more than 5,180 detainees and issued more than 26,200 prescriptions for psychotropic medications in just five of its detention centers: in El Paso, Houston, Pearsall, Port Isabel and Willacy.

The study comes in the midst of the federal government’s attempt to overhaul the detention system based on recommendations made in an October report by Dr. Dora Schriro, the former director of the Office of Detention Policy and Planning. “The current mental health intake assessment is quite brief and does not lend itself to early identification and intervention,” Schriro wrote.

But progress is slow. “Right now, not all of the medical examinations take place the way that they are supposed to,” Nystrom says. “I think Dora's report points out [those exams are] supposed to happen at 14 days. They are not meeting that expectation currently. And certainly if they are having a challenge in meeting just the basic initial evaluation and examination, any kind of follow-up care is not being identified up front.”

Keller and Nystrom, who've been critics of DHS under presidents Obama and George W. Bush, give its Immigration and Customs Enforcement division credit for working toward the improvements. Keller notes, however, that deficiencies in areas not directly related to mental health compound the problem. “Psycho-social services, visitation, allowing individuals to have English classes and ... easy access to legal representation can go a long way to promoting mental health,” he says. “Whether it’s asylum seekers seeking fleeing persecution or individuals who are looking for a better life, who were put in jail and treated like criminals, there is this disconnect of, ‘What did I do to deserve this?’”

Though they're skimpy on the details, ICE officials contend that the recommendations outlined last fall are coming together. “We’ve implemented a new policy to release arriving asylum seekers from detention who have a credible fear of persecution or torture,” says Adelina Pruneda, a spokeswoman for ICE's regional office in San Antonio, which oversees detention facilities in South Texas. "If they establish their identities and pose neither a flight risk nor a danger, [it is a] mandate that all such arriving foreign nationals should automatically be considered for parole.” The ultimate goal, says Pruneda, is to develop the current incarceration model into a civil detention system.

Yet some argue that the plan to transfer from the current system and address last year’s recommendations by October is too ambitious. “Every [individual] standard in the detention standards model has a list of documents on which it was based,” says Lauren Martin, a member of Texans United for Families. “In the adult system, every single one is based on the American Corrections Association Manual for imprisonment. In order to totally reform the system, we would have to be hiring people that have training in residential services, social workers and people who can teach [English as a Second Language] classes."

Martin was a part of this month’s Austin launch of the Dignity not Detention campaign, whose most recent efforts concerned an inmate hunger strike in Port Isabel protesting unannounced transfers, lack of alternatives-to-detention programs and limited access to legal services.

Pruneda says ICE is sensitive to those issues. “In 20 of [our] facilities, we have already expanded visitation, recreation and legal access for detainees,” she says. “We transitioned the alternatives-to-detention program to a single provider so that we are in line for a better performance and evaluation instead of dealing with different individuals.” ICE has also reduced the number of facilities from 341 to 270 and canceled contracts at 10 facilities due to multiple deficiency ratings, she says, though she won't name which facilities closed or which contracts were cancelled.

“We were looking at everything from how well they are being provided medical services to the way the detainees are being treated inside the facilities,” she says. “They also finalized the performance-based national detention standards from 2010, which means ICE can significantly improve the conditions of confinement for the 55 percent of its population housed in the largest 22 facilities within the next 12 months.”

While they're taking a wait-and-see approach, Keller and Nystrom are keeping an open mind. “We are a great county, and we are a country of immigrants and refugees. We can’t forget that,” Keller says. “I hope and pray that that spirit — that core spirit of us as a great nation of immigrants and refugees — is shown in the reform we get.”

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