Behavioral Health in the ED

There has been a lot of news coverage lately on detainees and asylum seekers and their overall well-being during their time in detention. Increasingly, many healthcare workers must face unfamiliar territory when treating patients brought in by Immigration and Customs Enforcement (ICE). Detainees often present with a variety of psychiatric conditions including PTSD, anxiety and depression. At times, detainees are identified that have underlying psychiatric illness which was inadequately addressed or ignored in their country of origin. 

What these stories fail to cover, though, is the reality facing medical staff at ICE facilities which often do not have access to psychiatrist or mental health clinicians

Many facilities including hospitals and ICE facilities are not equipped to handle the mental health needs of these patients, as we have covered in previous posts. Here, again, is a situation where telepsychiatry can step in and offer a solution. ICE has around 130 detention centers in the US, so if a detainee needs mental healthcare, the evaluation and treatment may depend on the “luck of the draw” as to whether a psychiatrist is available at the facility. By using telehealth services though, detainee patients are guaranteed 24/7 access to skilled mental health providers, no matter their location.

Helping Children Face Mental Health Challenges

From the recent media coverage, it is easy to see that many of these detainees and their families are not only coming from high-stress situations but are being placed in them again once they are detained. This can have a major impact on a child’s health. From October 2018 to June 2019, over 63,000 unaccompanied children were apprehended at the border. According to a report from the American Academy of Pediatrics, many of these children experienced traumatic situations in their home country or during their travels to the US. A survey of these children found 77% of them are seeking asylum from violence in their home country.

Given the complex nature of these children’s past, the American Academy of Pediatrics urges pediatricians to keep these traumatic experiences in mind when addressing the children’s health needs. Regardless of their final citizenship status, mental healthcare forms a large part of these children’s overall medical needs.

While the proper physical care can often be given on-site or at surrounding hospitals, detainees’ mental health should not be neglected, no matter their age. Telepsychiatry is easy to set up and does not require a lot of expensive medical equipment. As such, this care can be as easily set up in detention centers or surrounding hospitals in the local community.

Overcoming Language Barriers

Many of these detainees also face a language barrier when it comes to receiving healthcare. While patients are entitled to an interpreter to help them with their care, having a physician or provider who speaks the same language as the patient is always an advantage. MindCare’s team of trained mental health specialists includes providers who are fluent in Spanish to deliver care to a wide range of patients and their needs.

View From the Front Lines

As a psychiatrist with experience covering ICE facilities, detainees are extremely grateful to be able to have their distressing psychiatric symptoms treated. Treatment leads to improved overall functioning which allows detainees the opportunity to more effectively participate in addressing their legal challenges. In addition, I have found ICE officers very accepting and grateful to have a psychiatrist available to assist in assessing and treating detainees in the facility. The availability and presence of a psychiatrist strongly supports the ICE officer who is not trained in identifying or managing psychiatric issues.

Telepsychiatry offers inherent flexibility in mental healthcare delivery. It enables patients around the country to receive high-quality care from properly trained professionals. Care and accessibility that is not restrained by citizenship or legal status. My experience has found that psychiatrists are gratified by being able to play a major role in improving the mental healthcare of detainees, educating and supporting facility staff, and being able to be “part of the solution” in the current complex immigration process.