by Nicole Einbinder

As the Trump administration scrambles to reunite children with their parents, immigration lawyers and psychologists have raised another concern: whether the government is equipped to deal not just with lasting trauma to children, but also their parents in detention.

The American Academy of Pediatrics said in June that the toxic stress caused by the policy could lead to lifelong health consequences for children. But it has also taken a toll on their parents.

Donna Peters, a licensed clinical and forensic psychologist who has evaluated more than 1,000 immigrants throughout her career who are applying for relief in the U.S., said that since the separation policy began, detained parents who lost their children have shown increased levels of trauma.

“The trauma of the separation from their children is first and foremost for them, even over and above some pretty horrific sexual trauma and physical assault trauma,” Peters said. “What we are seeing are high levels of post-trauma symptoms, we’re seeing high levels of depression, high levels of anxiety.”

Immigrant detention centers have already come under scrutiny for failing to meet detainees’ needs — and in some cases allegedly subjecting them to abuse. In June, Human Rights Watch released a report highlighting substandard medical care in immigration detention facilities, based on publicly-released government investigations of 15 deaths that occurred in immigration detention between December 2015 and April 2017. The organization found evidence that 14 of those patients received subpar treatment, like unreasonable delays and botched emergency responses, and noted that shoddy medical care contributed to eight deaths. More people died in fiscal year 2017 than any year since 2009, the report added.

Now, experts say these centers face the additional challenge of addressing the trauma experienced by detained parents who were separated from their children. Their concerns come as President Trump looks to expand the use of these facilities to detain immigrants. The administration requested around $2.8 billion for the 2019 fiscal year to hold 52,000 immigrants — a 36 percent increase from the 38,106 people held on average in fiscal year 2017, according to a U.S. Immigrations and Custom Enforcement (ICE) spokesperson.

“The medical care at these facilities was substandard in most cases, meaning that they were not treated promptly, there were not adequate assessments,” said Luis Zayas, dean of the school of social work at the University of Texas at Austin. “And now, we’re talking about detention centers that have the same inadequate or substandard medical care with a population that has far more mental and medical needs because now the government has ripped these children and families apart.”

ICE referred questions about how it’s dealing with exacerbated trauma among families to the Department of Justice and the Department of Homeland Security. The Department of Justice declined to comment, and the Department of Homeland Security referred FRONTLINE to the Department of Health and Human Services, which oversees the Administration for Children and Families, which is tasked with caring for unaccompanied minors.

An Administration for Children and Families spokesperson said that children in ORR care provider facilities are given a minimum of one counseling session by a clinician once per week, and more care if their needs are greater. None of the departments offered information on mental health care for adults in detention.

Immigrants who enter the U.S. face a kind of “triple trauma,” said Elizabeth Jordan, an attorney with the Civil Rights Education and Enforcement Center, a nonprofit organization investigating medical and mental healthcare in immigration detention facilities. There’s the trauma that pushed them to flee, the trauma of the journey itself, and the trauma of detention.

“Now, they’ve added on this extra layer of the acutely distressing situation of having your child taken away from you and not knowing where they are or if they’re doing okay,” she said.

In May, a Honduran father imprisoned in Texas killed himself after being separated from his wife and child, the Washington Post reported. It was later revealed that the man, Marco Antonio Muñoz, was seeking asylum in the U.S. with his family after his brother-in-law was murdered in Honduras, and they feared for their lives. In a statement to the Washington Post, U.S. Customs and Border Protection (CBP) said that the circumstances of Muñoz’s death were under review.

In early June, even before the family separation cases began dominating the headlines, The American Immigration Lawyers Association and the American Immigration Council, two non-profit organizations, filed a complaint to the federal government alleging that the Denver Contract Detention Facility in Aurora, Colo., has mistreated detainees by failing to provide adequate medical and mental health treatment.

The complaint describes the stories of nine detainees at the facility who were allegedly mistreated, including two people who died in detention. It also urges the Department of Homeland Security to “immediately investigate the provision of medical and mental health care at Aurora and assess whether it provides the level of care required by law.”

Among the detainees in the complaint: A man suffering from post-traumatic stress disorder who wasn’t provided sufficient treatment and was later placed in solitary confinement, where his symptoms worsened. A pregnant woman who sought medical attention for chest pain, cramps, and spotting but wasn’t taken to a hospital until weeks later — at which time she was diagnosed with tuberculosis and shackled to her hospital bed while receiving treatment. And, a man who submitted multiple requests for medical attention after his testicles swelled to the size of a handball eventually saw a doctor and was recommended to see a urologist, but was instead given ibuprofen to treat the pain.

In a statement, Geo Group, Inc., the private prison company contracted with U.S. Immigration and Customs Enforcement (ICE) to operate the Colorado facility, said the allegations are false. “Members of our team strive to treat all of those entrusted to our care with compassion and respect,” the company said.

An ICE spokesperson told FRONTLINE in June that it was in the process of reviewing the allegations.

Laura Lunn, Detention Program Managing Attorney at the Rocky Mountain Immigrant Advocacy Network, said that her organization has identified around 50 parents at the Denver Contract Detention Facility with worsened medical and mental health symptoms due to the family separation policy.

She said one client, a 26-year-old woman, suffered a dramatic decline in her health when her five-year-old son was taken from her. “She’s so distraught. She can’t sleep. She can’t eat. All she does is worry about him,” Lunn said. “And, it’s very hard for somebody to fight their legal case when all they’re thinking about is the wellbeing of their child.”

Her son was returned after around two months apart, and now struggles to sleep through the night. Lunn said that when mother and son were reunited, he blamed her for their separation.

President Trump issued an executive order stopping the practice of family separations at the border in June. Since then, on the orders of a federal judge, the Trump administration has been working to reunite children with their parents. However, despite a court-ordered deadline to reunite families by last Thursday, more than 700 children remain separated and in government shelters because “the adult associated with the child” was not eligible for reunification or not available to be released from custody, according to a court filing.

Even for families who have been reunited, experts say the trauma of separation will have health ramifications on parents and their children for years to come.

“When you reunite them, that’s fine and that’s going to help, but the damage has already been done,” Zayas, of the University of Texas, said. “We are creating a mental health crisis that’s going to affect these families for a lifetime, whether or not they remain in the U.S.”

Correction: The original version of this story mischaracterized the status of the individuals that Donna Peters has evaluated. She has seen over 1,000 immigrants, not all of whom were detained at the time.