Immigration detention and mental health problems

Today’s New York Times includes an article by their asylum beat reporter Nina Bernstien chronicling the journey of Xiu Ping Jiang, a Chinese woman with mental health problems who was held in detention in Florida for some time, and is now living in Brooklyn, free on bail, and seeking asylum based on China’s one-child policy. The article provides a telling glimpse into immigration detention policy, immigration court (including a scene that could have been lifted directly from Kafka), and, if you look for what it doesn’t say, a perspective on the (non-) debate between conservative and liberal views on detaining asylees with mental health problems.

Immigration detention (which is where asylum seekers often go while their case is pending) usually includes no screening or basic treatment for mental health problems (and here I mean something on the order of 95% of detention centers). The studies that have been done show that mental health problems are high among asylum seekers in detention (there was a particularly good one done by Physicians for Human Rights and the program I work for a few years ago–see here). Is this surprising? No, not for anyone. The crux of disagreement between liberal and conservative viewpoints is why it’s not surprising.

For liberals, it makes perfect sense that mental health problems are high among detained asylum seekers because asylees are (1) often fleeing terrible situations in which they have been exposed to trauma and fear for their lives and (2) they are in detention after thinking that they were going to be free in the US (the US is not alone in detaining asylum seekers–see the work of Derek Silove and Zachary Steel for an Australian perspective on mental health among detained asylees). The liberal argument is supported by empirical studies (see above), and basic psychological theory concerning trauma and stressors and distress.

For conservatives, it makes perfect sense that mental health problems are high among detained asylum seekers because asylees are faking it when they talk to outsiders, or at least responding to strong demand characteristics of someone other than detention officials asking them how they are doing. Of course mental health workers find high rates of mental health problems, this line of argument goes, people will say anything to “get out of jail free.” I can tell you from working with this population, the conservative argument does not hold water in most cases, and so probablistically speaking the argument is flawed; I can also tell you, from working with this population, that there are a few cases in which asylees exagerrate or simply lie about their psychological symptoms.

Rarely do these perspectives try to find common ground. The Bernstien article does not question Ms Jiang’s mental illness, and provides an alternative perspective only by providing an Immigration and Customs Enforcement statement that Ms Jiang needed to be in detention because she represented a flight risk as evidenced by jumping from a second story window during detention, and she really just wants to stay in the US. Ms Jiang’s response to the accusation?

“I wanted to stay in the United States,” she said. “I like the United States. China had the sterilization — nothing is good.”

Of course one can have severe mental health problems and want to stay in the US.  And clearly detention is bad for one’s mental health, and clearly the US’s detention system is a mess (this extneds well beyond problems with mental health care). But liberal advocates–and I include myself in this group–need to be clear how to answer the concerns of conservatives that some individuals might “fake bad” in order to bolster their case.

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