At the American Psychiatric Association’s 2019 Annual Meeting in San Francisco on May 21, Rachel Yehuda, PhD, director of Mount Sinai’s Traumatic Stress Studies Program, and Adriana Feder, MD, director of Mount Sinai’s Trauma and Resilience Program, chaired a session on separating migrant families and the impact it has on mental health and resilience.
Dr. Adriana Feder presenting findings from a child separation case study at APA 2019 in San Francisco.
Dr. Yehuda opened the session by stating that the current immigration policies create an untenable situation that leads to lifelong mental health complications for the victims of family separation. She recommended focusing efforts on prevention of trauma-related consequences, since obtaining mental health care can be challenging for even the most privileged in our society.
She also posed ethical questions concerning whether mental health providers have an obligation to align professional and personal values when it comes to advocacy and fighting injustice, as well as the role of the mental health provider in the face of trauma occurring outside the context of traditional practice. “Many of us have had mental health training in which specific values have been instilled: wait for the patient to make the first move, maintain objectivity with compassion, take a non-judgmental stance, and provide support from the sidelines,” she said. “This contrasts with ideals like finding people that need help and making the initial contact, and acting out of a conviction of social justice to fix broken policies rather than just pick up pieces from inadequate and ill-advised systems.”
A case study
Dr. Feder’s segment covered results of a cross-sectional study of asylum-seeking families that took place at a U.S. Immigration and Customs Enforcement center in mid-2018, overseen by Craig Katz, MD. Sarah MacLean, a student at the Icahn School of Medicine at Mount Sinai, and two other students spent two months speaking with more than 400 mothers about the mental health of their children who were being detained with them. A subset of the mothers had been separated from their children and sent to separate facilities across the United States, then reunited before the students spoke to them. Ms. MacLean and her colleagues reported a high rate of emotional problems and total difficulties in the children that had been separated compared to those who remained with their mothers. They also assessed a subset of the older children by directly giving them a PTSD questionnaire, and found that the rate of a probable PTSD diagnosis was 17 percent, which is almost four times higher than the lifetime prevalence in the United States.
In a video recording, Ms. MacLean states that the findings highlight the need for immediate mental health treatment for long-term wellbeing, specifically comprehensive mental health screening and culturally responsive and trauma-informed mental health care. “I think the efforts of Sarah and her colleagues exemplify how psychiatry can be more proactive, community-oriented, and public health oriented,” said Dr. Katz. “We as psychiatrists need to get out there in the world and not wait for the world to come to us.”
A Canadian perspective
Rachel Kronick, MD, professor of psychiatry at McGill University, spoke about recent research on the effects of immigration detention in Canada. Her research showed that children living in detention and experiencing separation from their parents, even when very brief, exhibited depression, sleep difficulties, developmental regressions, anxiety, PTSD, and even selective mutism while in detention, and often after release. “Trauma has long-lasting effects, and when we are doing nothing, we are doing something,” she said. Ultimately, she recommends protecting children from mental health harm by prohibiting the detention of children and families, as well as the separation of children from parents.
Taking action
Alicia Lieberman, PhD, professor of psychiatry at The University of California, San Francisco, covered the developmental stages of early childhood and how the lack of a clear reunion plan, chaotic shelter environment, and lack of physical touch contribute to psychiatric conditions, and even early mortality. She emphasized that children need external resources to help them cope with fear, such as stable caregivers and safe and predictable routines, and described her work with the National Child Traumatic Stress Network (NCTSN). The NCTSN has 13 centers working with separated or unaccompanied children, such as onsite mental health clinics on either side of the border in Las Cumbres, New Mexico. They provide trauma-informed, mental health interventions for children and families post-migration, including child-parent psychotherapy, dialectical behavior therapy, art therapy, and child-centered play therapy.
In the discussion that followed these presentations, Dr. Yehuda challenged the audience to consider whether mental health providers are mandated to respond to policies that create mental health casualties, or whether it is the job of the provider to try to reduce the emotional impact of harsh environments however they are caused. After a thoughtful debate, it became clear that it is certainly possible for mental health providers to have constructive discussions about best mental health practices that are independent of political leanings. Dr. Yehuda concluded the session by summarizing the general consensus of the group. “Psychiatry has entered a new era and the provision of humanitarian mental health aid to those unable to access or prioritize mental health is a moral imperative,” she said. “Social justice advocacy through primary prevention of trauma can be a powerful prophylactic for PTSD and other mental disorders.”