Advocates urge more mental health services for unaccompanied immigrant children

Andy Paz 13, originally from Honduras, leaves immigration court in Chicago with his mother Sandra Paz Martinez, after learning he will be allowed to stay in the United States until at least July 2015 while he applies for Special Immigrant Juvenile Status. [Photo by William Camargo]

Andy Paz 13, originally from Honduras, leaves immigration court in Chicago with his mother Sandra Paz Martinez, after learning he will be allowed to stay in the United States until at least July 2015 while he applies for Special Immigrant Juvenile Status. [Photo by William Camargo]

As an advocate for immigrant children, Julie Contreras has witnessed firsthand the stress experienced by children who come into the United States unaccompanied by an adult.

When she meets with them, some erupt into tears. Children as young as 2 and 3 years old have told her how much they want their “papeles” [legal papers] so their mothers will stop crying. After leaving tenuous situations at home and enduring a long and difficult journey to the United States from places such as Guatemala and Honduras, reunification with family members they haven’t seen in years can add to the strain.

The stress can build up as children face challenges at every stage of their journey – from dealing with guides paid to help them cross the border, who sometimes exploit them, to the uncertainty and limbo of U.S. immigration court.

Unaccompanied minors face temporary displacement, language barriers and other challenges that can lead to anxiety, depression, post-traumatic stress disorder and other serious mental health problems, according to research. Advocates say more services, such as talk therapy and support groups, are needed to help them deal with the stress and trauma they have experienced.

The children would greatly benefit from mental health counseling, said Contreras, who works for the League of United Latin American Citizens, which provides legal and other types of assistance to immigrants.

“It’s a healing process,” she said.

The majority of unaccompanied immigrant children come from the Central American countries of Guatemala, Honduras and El Salvador. Almost 52,000 children arrived in the Chicago area from the three countries between Oct. 1, 2013 and Sept. 30, 2014, according to U.S. Customs and Border Protection.

Heartland Alliance, an anti-poverty group based in the Midwest, operates nine shelters and provides services for most of the children placed in the Chicago area by the federal Office of Refugee Resettlement. Children 17 and younger receive individual and group counseling in Heartland’s shelters.

Children remain there until they can be reunited with family, typically in 30 to 35 days, said Susan Trudeau, managing director of youth and resident services at Heartland Human Care Services.
Trudeau said: “They’re all exhibiting some symptoms of, at least, trauma and loss – being separated from family. The journey that they took to come to the U.S. is pretty traumatic. Most of the children exhibit some low-level mental health symptoms – trouble eating, trouble sleeping, things like that.”

Trudeau said she sees a need for more community mental health services in Spanish as well as more centers that can work with undocumented families after children leave the shelters. However, only a small number of the children qualify for follow-up services after they leave.

Once the children are released into communities, “there may not be any therapists that speak Spanish,” said Elizabeth Frankel, associate director of the Young Center for Immigrant Children’s Rights, a nonprofit that provides advocates to assist unaccompanied immigrant children.

“There might not be people who are familiar with this population that might understand the specific stressors that they’re under. We find that oftentimes it can be very challenging to find mental health services for kids that really need it.”

Chicago Immigration Court, for the first time, has started to collect statistics on unaccompanied children who arrive in the city. More than 200 unaccompanied children were assigned to the court between July 18 and Oct. 21, 2014, according to the federal Executive Office of Immigration Review. The office began identifying unaccompanied children separately in July because they have become one of its agency’s priorities.

Many children leaving their countries of origin are fleeing violence. While unaccompanied immigrant children are not technically refugees, a study from the United Nations High Commissioner for Refugees reported that 58 percent of unaccompanied children from Central America and Mexico potentially need international protection, meaning they qualify as refugees or should be given access to a process for attaining legal status.

“It’s important to realize the kids have endured trauma at three points: in their countries of origin, in transit and once they reach the U.S.,” said Elizabeth Kennedy, a social scientist and doctoral candidate at San Diego State University, who has interviewed hundreds of the children in El Salvador. “That compounding of trauma can be especially problematic.”

Rebecca Seligman, an assistant professor of anthropology at Northwestern University, said the effects of accumulated trauma are not totally understood, but research suggests that ongoing trauma and stress wear down coping mechanisms. Unaccompanied immigrant children enter an unfamiliar environment, far from family or friends who can provide support.

“All of the things that would help people to cope when dealing with trauma, a lot of those things are lacking,” said Seligman, whose work focuses on transcultural psychiatry.

Kennedy spent 13 months in El Salvador interviewing more than 700 child immigrants. Her research, which was published by the American Immigration Council, showed that more than half of 322 Salvadoran children interviewed listed crime, gang threats or violence as a reason for leaving the country. In an article in JAMA Pediatrics last year, she wrote that “the high level of potential trauma before and during migration may lead to some of the highest levels of mental illness among children in the United States.”

The father of Andy Paz, a teenager that Contreras works with, disappeared in Honduras when he refused to continue working for a criminal organization. Contreras said the 13-year-old, who arrived in the United States in May and is applying for Special Immigrant Juvenile Status, should be focused on having fun with his friends. Instead, he is coping with more serious issues, she said.

“It’s sad to see,” she said.

Contreras also witnesses the stress families go through when unaccompanied children join them in the United States. Sometimes the parents have had more children or started new families since immigrating. Contreras recalls the time a crying child told her that his new siblings with American citizenship were luckier than him because, “they were born with everything.”

Seligman said that mental health care can be a challenge because of issues of cultural sensitivity. But one way to address mental health for unaccompanied children is to make sure living conditions for immigrant children are better after they arrive in the States, lowering their levels of stress and the possibility that a serious mental health problem will develop, she said. Some of the stresses children are exposed to include poverty, uncertainty and loss of a familiar way of life.

If children are given more social support and access to their culture after they arrive, they’re going to do better, Seligman said.

Kennedy said the Office of Refugee Resettlement should solicit best practices from universities where researchers have been developing questionnaires specifically to screen for mental health issues in immigrants and refugees. Frankel said the Young Center brings in trauma experts, usually psychologists who have worked with immigrant children, as part of their advocate training.

“These (treatment) models do exist,” Kennedy said. “Trauma care has been adapted to be culturally sensitive for years now.”

Kennedy praised the work of Heartland Alliance, but said other facilities need to provide more counseling and follow-up services for children.

“There’s a misperception that kids don’t know the risk of the journey, that they’re just haphazardly making decisions, doing something for fun,” she said. “But kids know how dangerous it is for them to leave, and that’s perhaps the biggest sign of their desperation and what they’ve endured. When you acknowledge that and you also acknowledge how dangerous the journey is, it would be crazy to say that they don’t all have at least a short-term need for counseling.”

 

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