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A new report detailing how the Trump administration’s “zero-tolerance” policy affected children echoes all the warnings from mental health experts: Migrant kids separated from their families suffered from anxiety, depression, anger, guilt, acute grief, and PTSD, and the effects may be long-term.

The report, published Wednesday by the inspector general for the Health and Human Services department, details the traumatic effects exhibited by immigrant children who were separated from their parents last year— and points to a major factor: The shelters children were sent to weren’t equipped to deal with the mental health issues resulting from the family separation policy.

There were more than 12,000 children in ORR custody in August 2018, the month inspectors conducted most of their interviews. The majority of those children arrived at the border unaccompanied, but approximately 2,500 of them had been separated from their parents at the border, according to government data from last summer.

Many of the children who ended up in the shelters, most of which are run by nonprofit organizations contracted by the Office of Refugee Resettlement, were already traumatized by violence they witnessed in their home countries or on their journey to the U.S. Their mental health deteriorated further after being separated from their parents, the report found. One child, who was just 7 or 8 years old, was convinced his father had been killed and thought he would be next, one program director told investigators.

“Some separated children expressed acute grief that caused them to cry inconsolably,” the report says. “Children who believed their parents had abandoned them were angry and confused. Other children expressed feelings of fear or guilt and became concerned for their parents’ welfare.”

Other children were convinced that every adult — even the shelter staff — were the same immigration agents who separated them from their parents. “Every single separated kid has been terrified. We’re [seen as] the enemy,” another program director said.

The report also shows that the shelters didn’t have the resources to deal with the effects of the zero-tolerance policy. Even though ORR requires each shelter to employ one mental health clinician for every 12 children in its custody, some shelters had clinicians who were managing 25 or more children at a time. And shelters had trouble retaining mental health staff who struggled with low pay, difficult work, and better job offers elsewhere.

Many of the kids were in the shelters for so long that their mental health began to deteriorate further, but they weren’t there long enough to receive significant treatment for their problems.

The reunification process was also fraught with problems, adding to the chaos and exacerbating the trauma many children experienced. “Facilities reported that some reunifications were scheduled with little advance notice, or suddenly canceled or delayed,” the report reads. There was even a case where a girl was moved from a Florida shelter to a Texas shelter that was closer to the ICE detention center where her father was being held, only to be sent back to Florida “in shambles” after the government failed to reunite her with her father.

Some young children who were separated from their families last year were so traumatized by the experience that they didn’t even recognize their own parents after being reunited. “I want Miss. I want Miss,” one 3-year-old girl reportedly cried after being returned to her mom, referring to a social worker at the shelter where she had lived after being taken from her mother.

The family separation policy also had effects on migrant children who arrived in the U.S. unaccompanied, according to the report. Some of those children became resentful of the children whose cases were prioritized because they had been separated from their families. Other unaccompanied kids’ cases took longer to handle because of the sudden influx of separated kids, adding to their distress.

Mental health experts predict the separations could have long-term consequences. “On average, what we see is that this early experience seems to be a major risk factor for mental health problems later on in life,” Columbia University psychology professor Nim Tottenham, an emotional development expert who has studied the effects of being raised in orphanages had on children in Eastern Europe and China, told the LA Times in spring of 2018 as the migrant family separations were happening.