Migrant children separated from their parents through the Trump administration’s “zero tolerance” policy experienced more severe mental trauma than children who were not separated, according to a government watchdog report.

Separated children “exhibited more fear, feelings of abandonment, and post-traumatic stress” than children who were not separated, according to a report released Wednesday by the Department of Health and Human Services (HHS) inspector general.

According to the report, some children did not understand why they were being separated and sometimes thought their parents had abandoned them. Mental health staff said some children expressed so much grief and confusion over the separation that they cried inconsolably.

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The report detailed the challenges faced by mental health professionals who were often overwhelmed by the level of trauma faced by children in HHS custody.

As a result of the zero tolerance policy, children stayed in custody longer and there was a more rapid increase in the number of younger children than available shelter.

The policy resulted in thousands of children being separated from parents at the southern border before it was rescinded last June. They were placed into shelters operated by the HHS Office of Refugee Resettlement (ORR).

The proportion of children younger than 12 years old skyrocketed when the policy took effect, and the mental health providers said they were not prepared.

“Staff reported feeling challenged to care for children who presented different needs from the teenagers they typically served,” the report said.

The longer the children stayed in custody, often the worse their mental health became.

For example, one mental health clinician told investigators that “even children who were outgoing and personable started getting more frustrated and concerned about their cases” after 70 days in HHS custody.

“Longer stays resulted in higher levels of defiance, hopelessness, and frustration among children, along with more instances of self-harm” and thoughts of suicide, the report said.

Other policy changes also resulted in children being held for much longer, and exacerbated the problems facing shelter staff.

For example, the administration required potential sponsors of separated children to undergo fingerprint-based FBI criminal background checks. That change meant the average length of stay reached a high of 93 days.

Immigration advocates accused the administration of targeting potential sponsors and trying to trap undocumented immigrants who try to take custody of separated children.

Complicating the situation further was the fact that many children already suffered trauma before even arriving in the country. The report detailed a case where “a medical coordinator reported that a girl had been held in captivity for months, during which time she was tortured, raped, and became pregnant.”

A program director relayed the story of a 7- or 8-year-old boy who was separated from his father, without any explanation as to why the separation occurred. The child believed his father had been killed and thought that he would also be killed. According to the director, the boy ultimately required emergency psychiatric care.

“Every single separated kid has been terrified. We’re [seen as] the enemy,” another program director said in the report, noting that separated children could not distinguish facility staff from the immigration agents who separated them from their parents.

Shelter staff reported that the level of trauma and unique experiences of separated children made it “more difficult to establish therapeutic relationships through which facilities could address children’s mental health needs.”

The report made six recommendations, including telling HHS to assess whether there should be maximum caseloads for individual clinicians, as well as minimize the time that children remain in custody.

HHS, and the agency’s Administration for Children and Families (ACF), concurred with the recommendations

“ACF is equally committed to providing the public with a fair accounting of ORR program operations. To that end, we agree with OIG that significant factors beyond ACF's control contributed to the issues identified in this report,” the agency said in a response included with the report.