From Persecution to Prison - Bellevue/NYU Program for Survivors of ...

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V. MENTAL HEALTH OF DETAINEDASYLUM SEEKERSThe Bellevue/NYU-PHR study team documented extremely high levels ofanxiety, depression and post-traumatic stress disorder (PTSD) among thesample of detained asylum seekers interviewed. Furthermore, the level ofsymptom distress worsened the longer individuals were held in detention.These individuals described poignant examples of their suffering while inINS detention. Although many of the detainees had suffered substantialpre-migration trauma and reported experiencing symptoms before detentionin the US, the large majority said that their symptoms grew muchworse while in detention. In fact, the levels of anxiety, depression andPTSD observed in this sample of detained asylum seekers were substantiallyhigher than those reported in several previous studies of refugees livingin refugee camps and asylum seekers /refugees living in the community,further suggesting the detrimental effects of detention. 144Despite the fact that detained asylum seekers presented a strikingly highlevel of psychological distress, access to mental health services in INS facilitiesappears to be quite limited. Although the facilities included in thisstudy had mental health professionals contracted to provide consultation144Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z. Anxiety, depression and PTSDin asylum seekers: Associations with pre-migration trauma and post-migration stressors. Br JPsychiatry. 1997;170:351-357; Begley M, Garavan C, Condon M, Kelly I, Holland K,Staines A. Asylum in Ireland: A Public Health Perspective. Dublin, Ireland: Dept of PublicHealth Medicine and Epidemiology, University College Dublin; 1999; Steel Z, Silove D, BirdK, McGorry P, Mohan P. Pathways from war trauma to posttraumatic stress symptomsamong Tamil asylum seekers, refugees and immigrants. J Trauma Stress. 1999;12:421-435;Cardozo BL, Vergara A, Agnai F. Gotway CA. Mental health, social functioning, and attitudesof Kosovar Albanians following the war in Kosovo. JAMA 2000;284:569-577; MollicaRF, Donelan K, Tor S, et al. The effect of trauma and confinement on functional health andmental health status of Cambodians living in Thailand- Cambodia border camps.JAMA.1993;270:581-586; Allden K, Poole C, Chantavanich S, Ohmar K, Aung NN, MollicaRF. Burmese political dissidents in Thailand: trauma and survival among young adults inexile. Am J Pub Health. 1996;86:1561-1569; Shrestha NM, Sharma B, Ommeren MV, et al.Impact of torture on refugees displaced within the developing world: symptomatologyamong Bhutanese refugees in Nepal. JAMA. 1998; 280: 443-448; Basoglu M, Paker M,Ozmen E, Tasdemir O, Sahin D. Factors related to long-term traumatic stress responses insurvivors of Torture in Turkey. JAMA. 1994; 272: 357-363. Holtz T. Refugee trauma versustorture trauma: a retrospective controlled cohort study of Tibetan refugees. J Nerv Men Dis.1998; 186: 24-34; Van Ommeren M, de Jong J, Sharma B, Komproe I, Thapa S, Cardena E.Psychiatric disorders among tortured Bhutanese refugees in Nepal. Arch Gen Psych. 2001;58: 475-482.MENTAL HEALTH OF DETAINED ASYLUM SEEKERS 55
on a part time basis, researchers were unaware of any of the facilitiesoffering ongoing counseling. Medications for depression, anxiety, or difficultysleeping were apparently more readily available, although a numberof detainees reportedly were not aware of their availability either.Several detainees described suicidal thoughts and two reported havingattempted to commit suicide while in detention. Most of these individualswith suicidal thoughts, however, did not notify detention center staff ofthis, often apparently because of fear of possible repercussions. Manydetainees expressed a concern about how suicidal individuals would betreated by detention center staff (i.e. placement in segregation) while othersfeared that revealing their suicidal ideation might adversely affect theirasylum application (see Narratives).The qualitative data from asylum seekers’ testimonies vividly describehow being imprisoned further worsened their already fragile mentalhealth. Many detainees cited the system’s treatment of them as criminalsas particularly stressful. In addition, many of the specific experiences thatreportedly occurred inside the detention centers further exacerbated theirpsychological difficulties. Several described how a fear of being placed insegregation or the uncertainty of unannounced transfers among the facilitiesweighed heavily on them. Harsh treatment by detention center staff,including verbal abuse, also took an emotional toll on these individuals.Those who eventually won asylum and were released offered examplesof how their mental health improved upon release, but also described lingeringeffects of the detention experience. Finally, several detainees indicatedthat, even when conditions were relatively good, detention wasnevertheless harmful to their mental health.SURVEY FINDINGSPsychological SymptomsOnly two (3%) of the 70 study participants reported having serious psychologicalor mental health problems prior to experiencing persecution/difficultiesin their country of origin. However, 58% reported having poorpsychological health at the time they left their country (i.e., before arrivalinto the United States), suggesting that the traumatic experiences sufferedin their country had a profound impact on their mental health functioning.Fifty-two (74%) of the individuals in this study reported having experiencedtorture, 145 as well as numerous other traumatic events prior to arrivingin the US (See Chapter IV: Characteristics of Study Participants).Rates of anxiety, depression and PTSD symptoms were extremely high145As defined by the UN Convention Against Torture.56 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
Page 13 and 14: Detained asylum seekers participati
Page 15 and 16: persecution, yet most emphasized ho
Page 17 and 18: In many facilities, the response to
Page 19 and 20: years in detention, she finally got
Page 21 and 22: abuse For example, while being take
Page 23 and 24: They didn’t let me use the phone
Page 25 and 26: intensely personal events they had
Page 27 and 28: Limitations of this study include t
Page 29 and 30: Non-governmental organizations serv
Page 31 and 32: 22 FROM PERSECUTION TO PRISON
Page 33 and 34: the late 1990s ranging from 10 to 7
Page 35 and 36: Historical BackgroundFor most of th
Page 37 and 38: international standards with the 19
Page 39 and 40: apply for asylum make up the majori
Page 41 and 42: tion judge. 57 Yet in many parts of
Page 43 and 44: York and Newark, New Jersey has had
Page 45 and 46: trict began denying parole to them
Page 47 and 48: Correctional Facility in 2000. “[
Page 49 and 50: men of which 750 were detained on i
Page 51 and 52: from that same country from seeking
Page 53 and 54: Detention Facilities in this StudyF
Page 55 and 56: high reliability in numerous langua
Page 59 and 60: York County Prison in York Pennsylv
Page 61 and 62: TABLE 2:Demographic Characteristics
Page 63: TABLE 4:Prevalence of Pre-Migration
Page 67 and 68: Case #1(DK): “Loneliness and Fear
Page 69 and 70: TABLE 6:Hopkins Symptom Checklist-2
Page 71 and 72: TABLE 8:Harvard Trauma Questionnair
Page 73 and 74: think such services were available.
Page 75 and 76: When I am talking to you now it is
Page 77 and 78: After being granted asylum and rele
Page 79 and 80: “Being here is like going through
Page 81 and 82: In my country even though I became
Page 83 and 84: how long they were there - six mont
Page 85 and 86: Thoughts of SuicideSeveral asylum s
Page 87 and 88: here?’ I told the doctor, they br
Page 89 and 90: Another subject reported a positive
Page 91 and 92: substantial distance from their att
Page 93 and 94: eported that her experience in dete
Page 97 and 98: e somatic manifestations of the psy
Page 99 and 100: Case #2 (JG): “Health Care in Cha
Page 101 and 102: TABLE 11:Detainee Perceptions of He
Page 103 and 104: TABLE 13:Availability and Quality o
Page 105 and 106: detainees, or because they did not
Page 107 and 108: Difficulty Obtaining Specialized Ca
Page 109 and 110: Another detained asylum seeker repo
Page 111 and 112: 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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136 FROM PERSECUTION TO PRISON
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TABLE 16:Treatment/Abuses Reported
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“There is no political asylum her
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I was crying. I was so afraid with
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save her life, but was not able to
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Case #5 (CR): “Begging for Mercy
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ehind and told me to sign. He physi
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days and it is now 2 years and four
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viewers asked for additional inform
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y study participants. In evaluating
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trast, under US law, detention of s
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nation for an asylum determination
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very negative effects of detention
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authority to grant asylum and with
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absconding.” 250 Since the passag
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said “[F]reedom from imprisonment
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Standards relevant to this study ar
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“detained person” generally as
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which they are charged and a fair h
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esponse to substantial public press
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specified procedures, provided they
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PunishmentThe Detention Standard on
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any time the detainee complains.”
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while in detention, thus adding to
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Establish a Uniform National Parole
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that effect. These officers should
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Besides their inaccuracy, these exa
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friends so asylum seekers can maint
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appropriate staffing of such groups
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efugees and asylum seekers who win
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of thorough documentation. However,
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Human development is complex and di
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18. Country from which fleeing pers
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9. Being close to death.10. Forced
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Complete for each health problem:5.
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Explain:(Interviewer: Write brief n
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2. Depression SymptomsA How much we
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B. You said that you have experienc
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Explain:13. How was your physical h
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Yes ...........1No............22. W
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Explain:20. At the time of your arr
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