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V. Improve Access To And Quality Of Health Services (Including MentalHealth Services) Available To Detained Asylum SeekersDetained asylum seekers, given their prior trauma, and non-criminal status,are a particularly vulnerable population. Refugees and asylum seekersare at increased risk for depression, anxiety and PTSD.DHS should giveincreased consideration as grounds for parole the mental health of asylumseekers and lack of access to specialized services for physical and mentalhealth. It must be acknowledged that the circumstances of detention cansignificantly impede a detained asylum seeker’s recovery from mental distressand/or mental disorders such as PTSD and Major Depression thatthey may be suffering due to traumatic experiences in their country of origin.Likewise, it must be acknowledged, that the circumstances of detentionmay precipitate PTSD and Major Depression among individuals whowere previously coping with traumatic events experienced in their countriesof origin. Indeed, because the conditions of detention are so potentiallydeleterious to the mental health of asylum seekers, significantchanges in the detention system should be undertaken as soon as possible.If the US government continues to insist that asylum seekers be detained,all detained asylum seekers should be provided with humane surroundings,psychosocial support, on-going information about their status, andcontact with families and the outside world (including legal counsel).Given the new Homeland Security measures calling for increased detentionof asylum seekers, one cannot expect anything but deteriorating psychologicalmorbidity among those detained if conditions are not changed.Adequate Mental Health Services Should be Made Available toDetained Asylum SeekersAdequate mental health services should be provided including individualand group counseling as well as appropriate evaluation and prescriptionof medications. Adequate funding for such services must be ensured.Detained asylum seekers should be regularly screened for significant psychologicalsymptoms, including anxiety, depression and PTSD, andreferred for appropriate mental health services based on the findings ofthese evaluations. Detained asylum seekers should be made aware of theavailability of such services. Additionally, nongovernmental organizationswilling to provide psychosocial support for detained asylum seekersshould be allowed appropriate access to detention facilities.Group therapy can be an effective means for providing psychosocialsupport. 402 Issues concerning privacy/safety can be addressed through402Smith, H (2003) “Despair, Resilience, and Meaning of Family. Group Therapy withFrench Speaking Survivors of Torture from Africa.” In R. Carter, B. Wallace (eds). Understandingand Dealing with Violence: Multicultural Perspectives 291-319. Thousand Oaks,California: Sage Press 2003.CONCLUSIONS AND RECOMMENDATIONS 193
appropriate staffing of such groups with trained mental health professionals,adequate screening of potential group members and ongoing monitoringand evaluation.As noted in this report, many detainees reported their perception thatpolicy regarding segregation for suicidal patients, was a disincentive forinforming staff about suicidal thoughts. Such isolation, in fact can exacerbatefeelings of depression and hopelessness. Isolation should only be usedas a last resort, and if needed, only for very limited times.Increased mental health services and greater awareness of the availabilityof adequate and humane mental health services may decrease suicidality.For suicidal patients, thorough psychiatric evaluation, including riskof suicide, need for counseling/medication, and hospitalization should beconducted. A multidisciplinary mental health team treatment approachincluding psychiatry, psychology, social work and nursing is indicated.Detainees Should Have Improved Access to Specialized Health ServicesAppropriate dental care should be provided to all detainees. Other specializedservices including eye care, (including eye glasses) and rehabilitativemedicine services should also be available as needed. If specializedservices cannot be provided, including necessary mental health services,individuals should be paroled so that they can seek needed services at outsidefacilities.Medical Personnel Should Receive Specialized Training in Caringfor Asylum SeekersSuch training should including identifying and responding to survivors oftorture and persecution, cross-cultural issues including language, andaddressing their psychosocial needs.Access to Medical Records Should be ImprovedDHS should ensure that complete medical records are transferred with thedetainee when a detainee is sent to a different facility. When asylum seekersare released from detention, they should be provided with copies oftheir medical records, including any evaluation/treatment the asylumseeker received, to facilitate improved care following release.Ensure Adequate Outside Review of DHS Health Care SystemIn addition to review by national certification associations, the review ofdetained asylum seeker health care should include experts in refugeehealth, trauma and related issues.194 FROM PERSECUTION TO PRISON
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From Persecution to Prison:The Heal
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CONTENTSAcknowledgements . . . . .
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The Bellevue/NYU Program for Surviv
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don, Miranda Ip, and Meriam Alrashi
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Significant symptoms of depression
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Detained asylum seekers participati
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persecution, yet most emphasized ho
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In many facilities, the response to
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years in detention, she finally got
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abuse For example, while being take
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They didn’t let me use the phone
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intensely personal events they had
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Limitations of this study include t
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Non-governmental organizations serv
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22 FROM PERSECUTION TO PRISON
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the late 1990s ranging from 10 to 7
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Historical BackgroundFor most of th
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international standards with the 19
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apply for asylum make up the majori
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tion judge. 57 Yet in many parts of
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York and Newark, New Jersey has had
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trict began denying parole to them
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Correctional Facility in 2000. “[
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men of which 750 were detained on i
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from that same country from seeking
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Detention Facilities in this StudyF
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high reliability in numerous langua
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York County Prison in York Pennsylv
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TABLE 2:Demographic Characteristics
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TABLE 4:Prevalence of Pre-Migration
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on a part time basis, researchers w
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Case #1(DK): “Loneliness and Fear
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TABLE 6:Hopkins Symptom Checklist-2
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TABLE 8:Harvard Trauma Questionnair
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think such services were available.
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When I am talking to you now it is
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After being granted asylum and rele
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“Being here is like going through
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In my country even though I became
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how long they were there - six mont
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Thoughts of SuicideSeveral asylum s
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here?’ I told the doctor, they br
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Another subject reported a positive
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substantial distance from their att
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eported that her experience in dete
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e somatic manifestations of the psy
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Case #2 (JG): “Health Care in Cha
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TABLE 11:Detainee Perceptions of He
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TABLE 13:Availability and Quality o
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detainees, or because they did not
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Difficulty Obtaining Specialized Ca
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Another detained asylum seeker repo
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One detainee who speaks French and
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Detention Facilities in this StudyS
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even though many reported having ex
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CASE #3 (HN): “SOLITARY CONFINEME
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Here, I’m scared. In [the detenti
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emote control and watch what he wan
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Whenever someone misbehaves, they t
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This subject was himself threatened
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One detainee reported several incid
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Some Process Exists to Respond to R
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There were no witnesses other than
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tion. An INS officer said they put
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There is an Anglican minister who c
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The dentists didn’t explain anyth
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tion between dental age and chronol
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Case #4 (LK): “Fifteen-Year-Old G
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TABLE 16:Treatment/Abuses Reported
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“There is no political asylum her
Page 151 and 152: I was crying. I was so afraid with
Page 153 and 154: save her life, but was not able to
Page 155 and 156: Case #5 (CR): “Begging for Mercy
Page 157 and 158: ehind and told me to sign. He physi
Page 159 and 160: days and it is now 2 years and four
Page 161 and 162: viewers asked for additional inform
Page 163 and 164: y study participants. In evaluating
Page 165 and 166: trast, under US law, detention of s
Page 167 and 168: nation for an asylum determination
Page 169 and 170: very negative effects of detention
Page 171 and 172: authority to grant asylum and with
Page 173 and 174: absconding.” 250 Since the passag
Page 175 and 176: said “[F]reedom from imprisonment
Page 177 and 178: Standards relevant to this study ar
Page 179 and 180: “detained person” generally as
Page 181 and 182: which they are charged and a fair h
Page 183 and 184: esponse to substantial public press
Page 185 and 186: specified procedures, provided they
Page 187 and 188: PunishmentThe Detention Standard on
Page 189 and 190: any time the detainee complains.”
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Page 193 and 194: while in detention, thus adding to
Page 195 and 196: Establish a Uniform National Parole
Page 197 and 198: that effect. These officers should
Page 199 and 200: Besides their inaccuracy, these exa
Page 201: friends so asylum seekers can maint
Page 205 and 206: efugees and asylum seekers who win
Page 207 and 208: 198 FROM PERSECUTION TO PRISON
Page 209 and 210: of thorough documentation. However,
Page 211 and 212: Human development is complex and di
Page 213 and 214: 18. Country from which fleeing pers
Page 215 and 216: 9. Being close to death.10. Forced
Page 217 and 218: Complete for each health problem:5.
Page 219 and 220: Explain:(Interviewer: Write brief n
Page 221 and 222: 2. Depression SymptomsA How much we
Page 223 and 224: B. You said that you have experienc
Page 225 and 226: Explain:13. How was your physical h
Page 227 and 228: Yes ...........1No............22. W
Page 229 and 230: Explain:20. At the time of your arr
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