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

e somatic manifestations of the psychological distress that accompaniessevere trauma. Furthermore, as described previously, the stress of incarcerationas well as limited mental health services may be compoundingthese problems. Thus detainees may frequently present to medical staffwith physical manifestations of their stressful conditions. Such somaticcomplaints are frequently described by health care providers in multiplesettings, not just clinics for incarcerated persons, as difficult to adequatelyidentify (i.e., distinguish from symptoms with an organic etiology) andtreat. This can lead to frustration on the part of both the doctor andpatient. The patient is actually describing mental health problems, whilethe doctor is focusing on a physical health problem.Improved access to mental health services would perhaps result indecreased need for medical services to address psychological symptoms.At the same time, improved access to certain medical services, such as dentaland other specialized care, might also improve the physical and emotionalwell-being of detainees. Furthermore, medical staff may beunfamiliar with the impact of trauma on the health of asylum seekers.Additional training in effective communication skills to better address thepsychosocial needs of these individuals would be beneficial. 148Health Services Available in DetentionHealth services are available on-site at all of the detention facilities whereinterviews were conducted by the Bellevue/NYU-PHR team. At the INS’sElizabeth and Wackenhut contract detention facilities, health services areprovided by staff employed by the US Public Health Services, which is partof the US Dept. of Health and Human Services. Health services in countyjail facilities visited are provided by private contractors. For specialized services,including dental care, individuals are taken to outsidepractitioners/local hospitals. 149Clinics in contract detention facilities and county jails generally operateMonday through Friday during the daytime, although on-call services arealso available. Costs for health services are covered by the INS, andapproval for a number of off-site procedures, such as dental or other specializedcare, is required. The Wackenhut, Elizabeth and York facilitieshave all been accredited by the National Commission on CorrectionalHealth Care (NCCHC), and the Wackenhut and Elizabeth facilities havebeen accredited by the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO).148The INS and health staff responsible for detention facilities have shown willingness to havesuch trainings, and local NGO’s have previously been invited and permitted to conduct trainingsat several INS detention facilities.149Basic information concerning available health services came from general discussions withhealth providers at several different facilities, non-profit organizations working withdetainees, and discussions with detainees themselves.88 FROM PERSECUTION TO PRISON