When the government announced immigration raids earlier this month, targeted communities in 10 cities across the country struggled to choose their next steps. But there was no easy way to deal with the psychological fallout of this experience in the process.

“Some clients will no longer leave their homes to attend counseling sessions or doctor's appointments, or even to go to the grocery store,” said Leslie Peña-Sullivan, a New York-based therapist who works primarily with immigrants and refugees who’ve experienced trauma, in an email.

As the U.S. Immigrations and Customs Enforcement (ICE) has increased raids in people’s homes in recent years, the effect on a family’s sense of safety and mental health may be more profound**.** Though ICE can only enter a home with a signed warrant, the New York Times described several arrest attempts last week, including one in which a teenager in New Jersey refused to let agents into her home, following the directions she’d seen in a ‘know-your-rights’ post—like this one—on Instagram.

The most recent raids yielded 35 arrests, fewer than expected, but Peña-Sullivan said the threat itself is a major source of difficulty for her clients. “From what I have observed, there is not a difference in the psychological effect of the threat of the raid and experiencing a raid in real life. The psychological impact was just as significant as anticipated, if not more so,” she said. Meanwhile, her clients have been cancelling appointments at the highest rate she’s seen, instead opting for a phone call to talk about their exacerbated symptoms of depression, anxiety, and PTSD.

Mental health centers in the targeted cities told VICE they’d seen no increase in patient or client intakes. Instead, they “in the past few months have seen an increase in people seeking 'basic know-your-rights information',” said Nicole Bañales, a case manager at Juntos, a Philadelphia-based advocacy organization that works with Latino immigrant communities. She attributed the uptick to the trust the organization has built in the community.

A survey study published in February found that mental health, social, and legal-aid agencies in border communities in Texas and New Mexico perceive that people with undocumented family members are using their services at lower rates since 2017 for fear of being exposed.

When they do get help, Bañales said, it’s usually recent migrant parents seeking help for their children in dealing with the trauma they’ve experienced at the border. In these kinds of cases, she often sees children who are unwilling to leave their parents’ presence.

“We know that early life stress can have very devastating effects for children,” said Dylan Gee, a psychologist focused on childhood development at Yale University. The threat of the raids themselves can contribute, she said, to toxic stress: a sustained, overactivation of the body’s stress response that has been shown to increase risk for several chronic-health and chronic mental-health conditions without intervention.

A 2017 report from the Urban Institute, a policy think-tank in Washington, D.C., estimates there are more than 5 million children with at least one undocumented parent living in the U.S. And for those millions of families, “this is a public health crisis," Gee said, pointing to a growing body of literature. “Immigration raids themselves are a form of psychological trauma, but really so is threat of them."

The anticipation of deportation can create a chilling effect in which those vulnerable may be reluctant to seek resources outside their immediate communities for fear that disclosing any information about their status could lead to deportation, said Carole Tosone, a professor of social work at New York University.

Coverage of the raids, which has been tinged with a sense of uncertainty as the announced timelines have shifted, has highlighted the fear of leaving one’s home. That unpredictability itself, according to Gee, is likely compounding the sense of anxiety many feel: “Given the nature of the potential for immigration raids,” she said, “a lot of that policy seems to be almost designed to induce fear.”

“Immigration raids themselves are a form of psychological trauma."

That fear is perhaps stoked by reports of conditions for those attempting to cross the U.S.-Mexico border. For both children and adults who have been sent to detainment centers, conditions have been reportedly bleak. An article in The Atlantic raised that the ‘no hugging policy’ at immigration detention centers’—the article links to audio on which two siblings, ages 10 and 6 are told they cannot comfort one another by hugging—may have lasting psychological impact.

On Sunday, Politico reported that ICE is already “struggling” to handle detainees with severe mental health problems. While ICE did open a center for detainees with severe psychiatric problems in Miami, it only has room for 30 patients. In contrast, 3,000 to 6,000 people in ICE’s custody are estimated to have severe mental health problems.

As uncertainty grows in light of shifting immigration policy, Gee said there is potential for intervention and change. In at least two cases, one in Houston and one in the Nashville area in Tennessee, neighbors intervened (by sending a warning in the first case and forming a protective human chain in the second) and kept ICE from detaining anyone—keeping fears from being realized, even if their source is still at large.