Advocacy for Asylum Seekers at U.S. Border: Psychiatrists’ Role in Promoting Justice

With an air of hypervigilance common to female detainees, Maria voiced the horrors of extortion, rape, and death threats that had compelled her to flee her home country and traverse the U.S. border in search of refuge. Yet on the other side, she encountered dismal living conditions, sexual abuse, and lack of medical care. At the Central Texas detention center where I conducted her psychological asylum evaluation, her gaunt face informed me that she had lost everything—her mental stability, her vitality, and the hope of reuniting with her family. Despite my duty to remain neutral toward outcomes during my forensic evaluation, I could not ignore the tinge of anger about the lack of access to mental health care and dignity available for this fellow human.

The challenges faced by asylum seekers in the United States are tremendous. In addition to the anti-asylum stance of the past administration, the immigration system is plagued by years-long backlogs, limited funding for courts, delays due to COVID-19, and corrupt detention management systems. Given these barriers, the chances of being granted potentially lifesaving asylum are slim. For reference, Maria was one of 210,752 individuals pursuing a defensive asylum case in 2019 of which 18,865 were granted, a task complicated by high rates of PTSD (31.46%), depression (31.5%), and anxiety (11%), and often without access to legal representation.

Psychiatrists can step in to improve the mental health outcomes of asylum seekers by formulating medico-legal documentation attesting to the context and demeanor of the psychiatric presentation, as well as the consistency of the trauma narrative. Access to a psychological evaluation can raise the chance of granted asylum from 37.5% to 89%. The key to success is lending credibility with as much objectivity as possible, as guided by the international standard for evaluation of torture and ill treatment set by the Istanbul Protocol. Advocacy groups such as Physicians for Human Rights additionally provide regular, free asylum evaluation training and networking support for clinicians.

APA has consistently called upon the administration to provide humane care for asylum seekers at the border, including a call to properly identify and treat detainees for mental health problems, integrate psychiatry into leadership, and educate staff to provide culturally competent and trauma-informed care. Additionally, we must call on the Biden administration to end expansion of punitive detention centers by the U.S. Immigration and Customs Enforcement and cease anti-asylum policies that perpetuate racism, investing tax dollars instead into community programming.

As doctors with a duty to relieve suffering, we must (1) become informed about the humanitarian crisis at the southern U.S. border, (2) take a role in the asylum evaluation process, and (3) participate in federal and local advocacy efforts for human rights protections and resisting policies that harm people on the basis of their identity.

Maria’s case was adjudicated in the month following her evaluation and she is reunited with her children in South Texas. Unfortunately, this is not the norm. We must make it so. ■