Men stand in an Immigration and Border Enforcement detention center in McAllen, Texas, on July 12 during a visit by Vice President Mike Pence. | Josh Dawsey/The Washington Post via AP, Pool health care Migrant mental health crisis spirals in ICE detention facilities ICE struggles to handle migrants with serious mental illness.

Federal inspectors visiting a California migrant detention center made a shocking discovery last year: Detainees had made nooses from bedsheets in 15 of 20 cells in the facility they visited.

The inspection revealed the extent of a largely unseen mental health crisis within the growing population of migrants who are being held in detention centers in border states. President Donald Trump’s 2017 decision to reverse a policy that encouraged releasing vulnerable individuals while they await deportation hearings has left U.S. Immigration and Customs Enforcement unequipped to deal with conditions ranging from anxiety to schizophrenia.


One estimate puts the number of detainees with mental illnesses between 3,000 and 6,000. Some advocates and lawyers who work with migrants in the facilities say it’s probably more. Many of the migrants with mental illness are not stable enough to participate in their own legal proceedings, so they languish in detention.

While treatment of immigrants has become an explosive national issue, the plight of mentally ill migrants has scarcely registered.

“This is a system that, for a long time, has failed to understand, neglected, and even ignored the mental health needs of folks caught up in it,” said Elizabeth Jordan, director of the Immigration Detention Accountability Project at the Civil Rights Education and Enforcement Center. “But under this administration ... it has gotten so much worse.”

Only 21 of the 230 ICE detention facilities offering any kind of in-person mental health services from the agency's medical staff, according to a 2016 agency oversight report. ICE is ill-equipped to screen and treat a detainee population that’s grown more than 50 percent since 2016, to nearly 53,000.

ICE did not respond to several requests for comment over the past two weeks about the mental health issues at detention centers.

The agency's inspector general and immigrant advocacy groups that work in the detention centers have chronicled how ICE has handled mentally ill migrants. Some have been placed in solitary confinement. Others have reported waiting weeks and months to see a doctor, according to a September 2018 report from the inspector general, the same one that found the nooses made from bedsheets at the ICE Processing Center in Adelanto, California.

The report said that local ICE management hasn’t taken the issue seriously and doesn’t believe it’s necessary to address the issue of detainees making nooses out of bedsheets.

One detainee told the agency interviewers, “I’ve seen a few attempted suicides using the braided sheets by the vents and then the guards laugh at them and call them ‘suicide failures’ once they are back from medical.”

ICE in January opened a 30-bed unit in a Miami detention facility where migrants with mental illnesses are treated by a team that includes a psychiatrist, psychologists, licensed social workers and resource coordinators.

Thirty beds isn’t enough. The care reaches only a minuscule subset of patients — and advocates say it’s not clear who gets access, or why the unit isn’t always at capacity.

The treatment of mentally ill migrants — whose conditions can worsen during detention, which can be prolonged if they can‘t take part in their deportation hearings — has been overlooked in the larger focus on immigrant detention.

Migrants enter detention centers after they are stopped at the border, apprehended within the United States or released from prison. Under the Trump administration, more are staying custody until a deportation hearing is scheduled. One advocacy group’s review of detainee death records found at least seven of 45 migrants that died in ICE custody from 2011 to 2018 were suicides.

Andrew Lorenzen-Strait, who helped develop the 30-bed pilot program at the Krome detention center in South Florida before he left ICE in May, said between 3,000 and 6,000 people in ICE custody are thought to have mental illnesses. Other immigration advocates say the number is far higher — possibly 20 or 30 percent of the total detainee population.

Overcrowding of families is observed by Office of Inspector General at U.S. Border Patrol McAllen Station on June 10 in McAllen, Texas. | Office of Inspector General/Department of Homeland Security via Getty Images

“My only regret is that this important work wasn’t started sooner as the need is so great and the population is so desperate for care,” said Lorenzen-Strait, now director of children and family services at the Lutheran Immigration and Refugee Service.

Lorenzen-Strait said he was influenced in part by migrants with mental health conditions he saw languish in detention because they weren't of sound mind and couldn't move through immigration courts. His group studied how prisons treat mentally ill inmates before coming up with a concept for ICE.

ICE was actively looking at expanding the Krome project before he left, but the idea faces internal resistance, Lorenzen-Strait said. ICE did confirm that the pilot exists, but wouldn’t comment on its plans.

Advocates say that migrants with mental health conditions should get priority and be released while they await immigration proceedings.

“Often detention can be a triggering place for people with mental health conditions,” said Royce Murray, managing director of programs at the American Immigration Council, which filed a complaint in June about medical and mental health care at ICE’s Aurora, Colorado, detention center, which expanded capacity this year to 1,532 beds.

Two immigration lawyers who have visited the Miami pilot project say that it is an improvement over existing mental health care in ICE. Detainees have access to daily counseling in an environment that resembles a residential treatment center.

Still the lawyers are skeptical of the agency’s commitment to the 30-bed facility, saying it’s never been at full capacity.

“Who qualifies for the program is shrouded in a bit of mystery,” said Jessica Schneider, director of the detention program at the Americans for Immigrant Justice. Schneider, who has received a tour of the project, said at one point she spoke with a migrant in the program who said that people who had been in solitary confinement weren’t admitted in the facility, a point she said that she couldn't confirm independently.

ICE didn’t respond to questions about its selection process. An ICE spokesperson said the unit is intended to help stabilize detainees before immigration proceedings. But lawyers say that they have seen people sent there after proceedings were underway or even completed, including some who had been ordered deported.

“There are glitches in the system,” said Randolph McGrorty, executive director of Catholic Legal Services in Miami, which provides Know Your Rights presentations to detainees. “We’re seeing people in the program after they have been through the court system.”

Migrants with serious mental disorders are entitled to lawyers in immigration proceedings as the result of a 2015 class action lawsuit settlement. But an immigration judge must first decide whether they are competent to have their cases heard, and the settlement does not apply across the country.

Meanwhile they languish in a system unprepared to handle them.

Disability Rights California published a report in March that details “punitive, prison-like” conditions at the Adelanto facility, “inadequate” mental health care and underreporting of suicide attempts by GEO Group, the private company that runs the facility. The group documented a case where guards pepper sprayed a detainee attempting suicide.

“The response to people who have a mental health crisis is to punish them,” said Pilar Gonzalez, an attorney with Disability Rights California. “This system is not made to deal with people with intense trauma.”

The GEO Group disputed the claim that it underreports suicide attempts and said in an emailed statement to POLITICO that the facility presents a “humane alternative” to housing immigrants in prisons.

“Investing in mental health services to provide high quality care is one of our top priorities,” said Pablo Paez, the company’s executive vice president of corporate relations.

ICE operates some acute mental health inpatient facilities, including a facility in Columbia, S.C., for detainees who can’t go through immigration proceedings. But once they are stabilized, migrants end up back in a detention center.

Advocates say that the process ends up prolonging overall detention stays and argue that while the Miami pilot program could be an improvement, migrants with mental health conditions shouldn’t be locked up at all.

“Should ICE be in the business of rehabilitating people?” said Hannah Cartwright, supervising attorney at the National Immigrant Justice Center. “At the end of the day, the best way to get their treatment is not to be detained.”