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AN FRANCISCO — President-elect Donald Trump has vowed to deport millions of immigrants who are in the United States illegally. But before they can be sent packing across the border, most will spend time in detention centers.

And those centers are already straining to cope with a crush of detainees suffering from health problems — especially mental illness.

A yearlong STAT investigation, including a review of thousands of pages of court documents and federal government reports and dozens of interviews with immigration attorneys, former detainees, and mental health experts, found that the detention system often fails to protect vulnerable immigrants with psychiatric disorders.

STAT found detainees with mental illness being held in solitary confinement against the advice of prison doctors. The investigation also found immigrants at clear risk of suicide being left alone with the means to make another attempt to end their lives. Others, who were mentally and physically unable to care for themselves, were abruptly released in the US or deposited across the border, without any support network.

“The system is set up to fail these people,” said Linda Brandmiller, an immigration attorney in San Antonio. “We’re just bailing out the ship with a plastic bucket.”

At least 1,900 immigrants now detained pending deportation hearings suffer from mental illness, according to federal officials. Their advocates fear Trump’s planned surge in deportations will have grave consequences — both for the current detainees and for new arrivals in desperate need of therapy, medication, and careful monitoring.

“I don’t think Trump is interested in the minutiae of immigration detention,” said Sarah Sherman-Stokes, an immigration lawyer and instructor at Boston University. “I can’t imagine he’ll give extra resources to mental health care.”

Delays in processing detainees — which are almost inevitable if the caseload explodes — could also put immigrants who had been able to manage their conditions on their own at risk of a mental health breakdown, advocates say.

“Some individuals start out with mental health issues and they’re still competent. The longer they are detained, the more their condition deteriorates,” said Matt Adams, legal director of the Northwest Immigrant Rights Project. “They face life-threatening conditions when they finish.”

“The system is set up to fail these people. We’re just bailing out the ship with a plastic bucket.”

Linda Brandmiller, immigration attorney

The federal Immigration and Customs Enforcement division, known as ICE, says it puts extensive resources into protecting detainees’ physical and mental health.

“Comprehensive medical care is provided from the moment detainees arrive and throughout the entirety of their stay,” ICE spokesperson Brendan Raedy said. ICE employs licensed nurses, mental health providers, physicians, and other health care workers. Last year, the agency provided 90,000 mental health interventions, which can include everything from relaxation exercises to cognitive behavioral therapy to prescription of psychotropic medication.

But the detention system is a patchwork. Immigration lawyers say some facilities do an excellent job assessing and meeting the mental health needs of detainees. Others are notorious for neglect.

And because federal detention centers are often overcrowded, ICE pays local jails across the US to house overflow immigrants. They’re supposed to follow the same policies, but they often have even fewer resources and sometimes contract with private companies to provide health care.

“If Homeland Security is operating the entire thing, it will go like clockwork,” said Jeffrey Gosney, a former behavioral health specialist at two federally run detention centers in Texas.

“When it’s contracted and subcontracted,” Gosney said, “it’s going to get complicated.”

‘They would leave me there for days at a time’

Former detainees with mental illness describe their time in detention as harrowing.

Jose M., who came across the border from Mexico in the late 1990s, said he has been diagnosed with schizophrenia, bipolar disorder, and claustrophobia. He was detained in the summer of 2014 and spent seven months in Adelanto West, a sprawling detention center owned and run by the private prison corporation GEO Group in Southern California. He was then released on bond. Like several other former detainees, he asked to be identified only by his first name.

A side effect of Jose’s condition causes his voice to rise uncontrollably. When that happened during his detention, the guards often put him in administrative segregation, he and his lawyer said. That’s akin to solitary confinement. “They would leave me there for days at a time,” Jose said.

The American College of Correctional Physicians has condemned long-term solitary confinement of inmates with mental illnesses. It “violates basic tenets of mental health treatment,” the organization wrote in 2013.

The Southern Poverty Law Center and other advocacy groups have also urged the federal government to stop the practice.

“DHS should also prohibit the use of disciplinary segregation for individuals with a serious mental illness and instead provide psychiatric care to the individual,” several immigrant advocates wrote this fall in a lengthy letter offering input to to a Homeland Security Advisory Council studying detention policies. “This practice should be a rare occurrence, not a daily practice.”

For his part, Jose said that he can’t stand being in small, enclosed spaces, as he was during his time in segregation. “I start feeling so much pressure, like I’m underwater,” he said.

Like many others immigrants, he’s nervous about how the recent election will impact his future.

“ICE doesn’t mess around,” he said.

‘I didn’t want to live’

It was the summer of 2015. Poncho, who asked that he be identified only by his nickname, had been in custody for two months, awaiting a deportation hearing. He had schizoaffective disorder and he was struggling, plagued by anxiety attacks and bouts of uncontrolled sobbing.

A psychiatrist had prescribed him antidepressants, but they gave Poncho debilitating headaches and short-term memory loss, so he’d stopped taking the medication — and had been waiting for weeks to be seen by another doctor. His immigration attorney pleaded with federal officials to release Poncho so he could get care for his mental illness. The officials refused.

And so on that July morning, Poncho stayed behind when the other detainees left the dorm to exercise. Alone, he slammed his forehead against a wall, jammed a pencil into his arm veins, drank a container of cleaning fluid – and then pulled off his pants and used them to tie a noose.

“I wasn’t really thinking,” he said. “The only thing I felt was, I didn’t want to live.”

Mental Health ICE
An intake form for Poncho, filled out by detention center officials. STAT

STAT pieced Poncho’s story together using documents from county sheriff’s offices, jails, and federal government officers, as well as interviews with him and his attorneys.

Born in Mexico City, he first came to the United States unlawfully around 1997, when he was 17. He lived in San Francisco for more than a decade, working odd jobs to provide for himself and, later, his three children.

Then, he was pulled over while driving a friend’s car. Police discovered drugs in the car, and Poncho was later sentenced to 20 days in jail and three years probation. ICE found him in the jail; on Sept. 15, 2008, he was removed from the country.  

Despite being deported, Poncho was legally obligated to report to his probation officer. Police issued a warrant for his arrest when he didn’t show up. Unaware of the warrant, he crossed the border a month later and made his way back to San Francisco.

Poncho found steady work doing food preparation, but he struggled with his mental health. He spent long periods without leaving his house and sometimes heard voices of people making fun of him at work.

“I thought everyone was trying to hurt me. When I would get depressed, I’d lock myself in my room for two or three days,” Poncho told a psychiatrist later, according to court documents.

At one point, he tried to kill himself by slashing his wrists.

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One day in April 2015, Poncho started panicking. He became convinced the television and cable box in his apartment were monitoring him. Either he or a roommate — it’s not clear — called the police; officers showed up at the apartment and arrested Poncho on the outstanding warrant. He posted bail, but several weeks later, two ICE officers arrested him as he was traveling to work.

Poncho, who is now 36, eventually ended up in Rio Cosumnes Correctional Center, a county jail that doubles as an immigration detention center in Elk Grove, Calif.

It was there that he used the pencil and the cleaning fluid to try to kill himself.

Mental Health ICE
An intake form that notes Poncho’s “self-harming behaviors.” STAT

‘Howling in the wilderness’

Appropriate care starts with a detailed intake interview to assess the detainee’s mental and physical health and draft a treatment plan, said Steven Helfand, former vice president of operations at Correct Care Solutions, a correctional health care contracting company.

But detainees and their advocates — and some correctional officers — say that doesn’t always happen.

In October, a group of lawyers filed a complaint against the Yuba County Jail in Northern California, claiming that overuse of solitary confinement and generally poor conditions have led to 41 suicide attempts in the past two and a half years. Half of the county jail’s beds are set aside to house immigrant detainees, under a contract with ICE. An attorney for the county declined to comment, as the case is ongoing.

At the York County Prison in Central Pennsylvania, which holds about 635 immigrants daily, detention officer Denise Keller filed complaints with the jail over a three-year period, from 2013 through 2105. She wrote that she’d observed colleagues falsifying log sheets to make it seem as though they were properly monitoring inmates at high risk of suicide. ICE declined to comment on the allegations.

Lawyers who work with detainees say some federal detention facilities have exemplary health care.

Krome Service Processing Center in Miami, for instance, has a troubled past, rife with allegations of shoddy medical care, but now has set up a dedicated mental health wing. The staff works closely with local health professionals, attorneys, and immigration judges with expertise in the field to address the needs of detainees with psychiatric disorders, said Elizabeth Matherne, an attorney who has represented detainees.

But other facilities have reputations for neglecting mental health. For Californians, one of the most notorious is Adelanto West, where Jose M. was detained.

GEO Group, the private company that runs Adelanto West, takes “standards and safety very seriously,” spokesperson Pablo Paez said in a statement. “We comply with ICE’s rigorous standards and we received perfect accreditation scores from independent third parties.”

Detainees and their lawyers tell a different story. “They don’t do a proper job. It’s easier to get medication than to get help from the psychiatrist,” said Henry Martinez, a 27-year-old former detainee. Martinez came to the US from Guatemala when he was just a baby. He was arrested carrying some marijuana in July of 2014 and was later detained in Adelanto.

“The only way you actually would get help is if you’re talking about suicide,” he said.

“The only way you actually would get help is if you’re talking about suicide.”

Henry Martinez, former detainee

Detention staff treat mentally ill inmates by giving them medication — “and often inappropriate medication,” said Siobhan Waldron, a former staff attorney at the Immigration Center for Women and Children, a nonprofit legal aid group in Los Angeles. “Their policy seems to be to medicate people into compliance.”

When her clients grew disruptive or aggressive, GEO Group guards put them in isolation, Waldron said.

Two of the legal aid group’s mentally ill clients have been released into the the barren high desert town of Adelanto without warning, lawyers from the center said. One of them was found wandering along the road and the other was never heard from again.

And those were clients lucky enough to have lawyers. Most don’t.

Jillian Kong-Sivert, an immigration lawyer in Phoenix, said she receives constant pleas for help from detainees. She can only take a fraction of them. “That leaves a whole lot of people howling in the wilderness,” she said.

‘There appear to have been breakdowns’

At Rio Cosumnes, Poncho told a social worker that he heard his children’s voices. He had crying spells and disturbed sleep patterns; he reported feeling worthless and guilty.

His lawyer, Frances Kreimer, a San Francisco based immigration attorney, repeatedly petitioned ICE to transfer Poncho to a secure facility for detainees with mental health issues. “From the beginning, in every facility, we told them this is someone who has attempted to commit suicide recently,” Kreimer said.

Mental Health ICE
Poncho’s lawyers repeatedly petitioned ICE to transfer him to a facility where he could get mental health care. STAT

ICE protocols require require detainees to be provided with a mental health professional who speaks their native language.

Instead, Poncho was interviewed in English, a language he doesn’t speak fluently, by jail staff who seemingly neglected to ask him about the scars lining his wrists from the suicide attempt he had made before his detention.

He asked to see a doctor. Two weeks passed. No one came to see him. “I felt really bad,” he said.

His lawyers continued to press for better treatment for his psychiatric disorders. Instead, detention officers would warn Poncho, “don’t advocate for yourself because they‘ll send you to a much worse place,” said Kreimer, his lawyer.

ICE officials declined to comment on Poncho’s treatment, as his immigration case is still open.

The noose Poncho tied that summer day didn’t work, and for the second time in a matter of months, he found himself surrounded by medical personnel after attempting suicide. Guards brought him to the medical wing; he was transferred out of the facility shortly after.

A few days later, Kate Mahoney, a court-appointed attorney, wrote an email to the American Civil Liberties Union, ICE, and several other agencies explaining that she’d looked into his case.

Mahoney concluded a number of things went wrong with Poncho’s treatment during his detention. By federal court order, the intake screening process cannot rely “solely on self-reported history of mental illness.” ICE and the detention facility have to accept relevant information and documents from family members, social workers, or treatment providers. Poncho’s lawyers repeatedly tried to provide that type of information about his mental illness, but were rebuffed.

”It appears that [Poncho’s lawyers] provided credible information about the detainee’s mental health that should have triggered a linguistically competent [Mental Health Assessment],” Mahoney wrote, concluding that “there appear to have been breakdowns in training, screening, and information-sharing in this case.”

Poncho, meanwhile, had been sent to Adelanto West. When he had arrived, he had another intake interview. He recalls telling the psychiatrist, “I want to kill myself.”

The response? “They put me in solitary for two weeks,” he said.

“The worst place to receive treatment was Adelanto. There was one psych for all of the people,” Poncho said. They prescribed him medication, but didn’t explain how long it might take to start working, or how to manage side effects. Other psychiatric patients he spoke to had similar experiences. “I don’t think anyone was getting real help,” he said.

Every week, he said, all psychiatric patients were brought into a cell to wait their turn to see a mental health provider. “You see him for five minutes and he asks you how you are. I would say ‘bad,’ and that’s it,” he said.

Eventually he stopped going because it was too frustrating.

GEO Group said it complies with all ICE detention standards.

Poncho stayed in Adelanto for about four months until he was released on bond paid by a family friend.

After he was released, Poncho started going to therapy at a mental health clinic in the Mission District of San Francisco, and the several medications he was prescribed in detention were reduced to one. He started working again, in construction. In person, he’s powerfully built and clean-cut. His mental illness is almost unrecognizable.

“At the end of all of this,” he said, “I learned a lot of things. There are a lot of people like me.”

This fall, ICE reinstated the deportation order it had first filed against Poncho in 2008. His lawyer is appealing and he remains free pending a resolution of that case.

If he loses, he will be back in detention.

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  • From a Buddhist perspective, the mental health system is failing because it ignores the basics – that hate, greed and ignorance are the reasons individuals and societies fall apart. The Boston Globe, like other news organizations, is failing in the mission of news agencies to point out the real failings of government policies and provide reasoned alternatives. See
    http://shakugoukaku.com/re-examing-the-mental-health-system/
    for more info. Thank you

  • The whole system is in high gear giving ( taxpayer paid) help to the millions of criminal illegal invaders, while forgetting/ignoring/dismissing the pain and suffering
    of our poor, hungry, homeless, under and unemployed, including our own Veterans.
    The invaders are mexico’s responsibility, not ours!! Deport them all, for they do not belong here and We the People do not want them. Period.

  • These people are criminals. Why are they OUR problem? Oh, that’s right, their home doesn’t want them so they come here looking for free stuff and ruin our cities. You either come here the right way or you need to go. Period!

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