The Clinical Case for Keeping Families Together

Two practitioners apply a decade of research on Central American families to understand the impacts of the administration’s new policy.  

An eight year old girl talks about being separated from her father during an immigration family separation protest in front of the Sandra Day O'Connor U.S. District Court building in Phoenix on June 18, 2018. (Ross D. Franklin / AP)

In April, the Trump administration announced that anyone caught crossing into the United States illegally at the southwestern border would be referred for criminal prosecution. When adults are detained, their children are separated from them and sent into government custody or foster care. Since then, over 2,000 children have been separated from their parents in this way.

What happens to the children when they are stripped from their parents? For the past 10 years, we have been investigating the lives and mental-health needs of unaccompanied immigrant children living in New York City while they await deportation hearings. Our research has focused on youth who arrive in the United States as unaccompanied minors, but many of its lessons apply to those purposefully separated from their parents as well, and give some idea of the harms now being deliberately inflicted on these children. In particular, our findings demonstrate unequivocally the importance of family in their lives: Separation from parents does not just cause discomfort and distress; it places tremendous psychological stress on children, compounds the harm caused by other migration adversities, and denies them vital emotional support at a hugely vulnerable moment, often leading to clinically significant anxiety, depression, traumatic stress, and other psychological disorders.

A growing scientific literature is identifying the multitude of stressors to which migrant children from Central America are exposed, whether with or without their parents: victimization in their home countries by gangs who have turned the region into one of the most violent in the world; a perilous journey north along migration routes patrolled by the same gangs who have hounded them from their home countries; detention in frequently inhumane conditions upon their arrival in the United States; and an agonizing period of limbo while they await adjudication of their immigration cases. Each successive traumatic experience increases children’s likelihood of experiencing psychological problems.

Going through this process separated from and without the support of loved ones further amplifies children’s risk of developing mental-health difficulties. In our study assessing the mental health needs of unaccompanied children in New York, over half met full diagnostic criteria for an anxiety or depressive disorder, matching rates of psychopathology observed in child refugees fleeing the most troubled parts of Africa and the Middle East. Other studies of unaccompanied children in U.S. government care have similarly documented high levels of anxiety, depression, psychosomatic complaints, post-traumatic stress disorder, and suicidal ideation.

Many of these children and families are fleeing for their lives. In 2016, Honduras and El Salvador had the highest and second-highest murder rates per capita in the world, according to UN statistics, over 10 times the rate of the United States. This violence is mostly perpetrated by street gangs, known as maras, who specifically target children. Of boys and girls we interviewed for our research, more than a third reported the murder of a friend or loved one by gangs in their home countries and two-thirds had experienced a threat of serious injury or death to themselves or a loved one. One 17-year-old girl described the situation in her neighborhood in El Salvador (like the other subjects of our research, she spoke on condition of anonymity):

In schools, they kidnap girls and they try to draft boys around my age. They ask for “rent” for houses and other places. There are a lot of kidnappings and disappearances if you don’t give them your money. They rape and kidnap girls, and sometimes they’re found dead. Or maybe if you are wearing earrings, they take them from you and they can kill you for that. It is very dangerous. That is why I was scared to take the bus, because if I wore earrings or stuff like that something could happen to me.

For those who attempt to escape towards the United States, the journey brings further dangers. Echoing findings from other researchers, children and families we spoke to described being threatened, robbed, and kidnapped by gangs along the migration routes. They described extortion by local police, encountering other travelers who had suffered terrible injuries while riding the freight trains north, seeing the corpses of migrants whom gang members had pushed to their deaths strewn along the sides of the tracks, and enduring near-death experiences attempting to cross the deserts straddling the U.S.-Mexican border.

Detention in U.S. immigration custody can provide additional traumatic experiences to compound those already suffered by children prior to migration and during the journey to the United States. The current government-issued images of border processing centers showing large numbers of children separated from their families and huddled under space blankets in metal cages lit day and night are disturbing, and reminiscent of the cold, overcrowded, unsanitary conditions described by families in our study. One Honduran mother we spoke to provided further details about the conditions in which her 10- and 14-year-old daughters were held:

The two days in immigration, they were sleeping on the floor there. They gave them foil blankets to cover themselves. The food was terrible, they were sick to their stomach. They would only give them sandwiches with, with I don’t know what, raw things and they are not used to that. The bathrooms were open, without a door. They felt really embarrassed, because everyone could see them. And well, the time they were there they suffered a lot. At the place they were, they didn’t let them sleep because they would call them for whatever information at 10, 12 at night.

Although the children we spoke to in our study had been transferred from government custody to family members living in the community while their immigration cases were being adjudicated, many still bore the emotional scars of their pre-migration and migration experiences, were struggling with separation from loved ones and difficulties adjusting to life in the United States, and were feeling fearful and uncertain about their futures. Some described experiencing panic symptoms, flashbacks to gang violence in their home countries, nightmares about their journeys and detention, somatic symptoms such as headaches and blurred vision, and thoughts about suicide.

Despite the many challenges faced by migrant youth from Central America, under the right conditions they show a remarkable capacity for resilience. What helps them? Time and again in the literature, the presence of parents is identified as a key factor in helping these children overcome adversity, resume normal childhood experiences, and build towards constructive, optimistic futures. They do so not only by providing love, reassurance, and emotional support through difficult times, but also by providing a nurturing environment and protecting them in the other ways parents naturally protect their children: by enrolling them in schools and community activities and helping them access other needed services such as health care. One 17-year-old girl we spoke to who had been victimized by gangs and endured years of neglect and abuse from an aunt in El Salvador before being reunited with her parents in the United States explained the importance of being with them in plainer terms:

Over here, I feel calm. I feel alright, like nothing will happen because I have my parents and they look after me. A mother knows how to take care of her kids. Well, I feel safe with her. I feel well here.

This vital role of family in fostering children’s health and wellbeing has been enshrined in international law. The United Nations Convention on the Rights of the Child asserts the rights of all children to be cared for by their parents and for children’s best interests to be a key consideration in all administrative, legislative, judicial, and welfare decisions. The United States used to recognize these standards, if not officially. Despite impasse in many other areas of immigration law and policy, over the last 20 years Congress has passed a number of laws designed to remove children from government custody and return them as quickly as possible to child-friendly environments more conducive to their development while their cases are being processed, including, wherever possible, reunification with family members.

By stark contrast, this administration is deliberately separating child migrants from their families. By doing so, it is not only depriving them of a key protective factor against the impact of the other adversities they have endured, but also adding a considerable additional traumatic stressor to this already-vulnerable group's risk for mental-health difficulties. What is the impact on a child of being torn from his or her parents? What does this do to the parents? What happens next? What are the plans for reunion? Who will support these children, now or down the road?

It is too early to assess directly the full psychological impact of these family separations on children and their families. However, the related literature on children separated from their parents following immigration raids indicates that they will suffer severe psychological consequences, including anxiety, anger, aggression and withdrawal. For parents too, the impact of separations can be devastating, as the case of a Honduran man who killed himself last month in immigration detention after he was separated from his wife and 3-year-old son tragically demonstrates.

The real psychological harm that these separations will cause migrant families is an intended consequence of the government’s policies, designed to serve as a deterrent for other families contemplating fleeing Central America to the United States. However, these crude and callous means are unlikely even to achieve their supposed ends. Decreases in the number of child and family migrants in response to previous deterrence measures employed by the Obama administration in 2014 and Trump administration in 2017 were short-lived.

The depth of the humanitarian crisis in Central America explains why.

A 2014 study by the United Nations Refugee Agency on unaccompanied children detained by U.S. immigration estimated that over half had been forcibly displaced for reasons likely to qualify them for international protection. We found that children and families frequently have multiple reasons for migrating to the United States from Central America, including better economic opportunities and the potential of reunifying with loved ones already in the country, but this does not negate the very real dangers many face if they stay at home. Among Central American families we interviewed for our study, often it took an immediate threat to their children’s lives for families to decide it was worth the risk and uncertainty of attempting to escape to the United States. For one 17-year-old Honduran boy, it was narrowly escaping a shootout at a party where two of his friends were killed. Another Honduran family hurriedly made the decision to send their 16-year-old son to the United States after they inadvertently witnessed a gang murder and feared that the perpetrators would come back to kill him. Using family separation as a deterrent only contributes to the impossible bind in which Central American families trying to protect their children find themselves.

Reasonable people can and do disagree about how many immigrants should be allowed to stay in the United States and under what circumstances. But that does not change the medical, moral, and legal responsibility to safeguard the rights and wellbeing of children while their cases to remain here are being heard, rather than inflicting further harm by separating them from their families.