- Email: [email protected]
Parental Deportation, Families, and Mental Health
| CLINICAL
PERSPECTIVES
Parental Deportation, Families, and Mental Health Schuyler W. Henderson,
M.D., M.P.H., AND
T
here are an estimated 5.5 million children in the United States whose parents are unauthorized immigrants, and approximately three fourths of these children are American citizens.1 For these children, parental deportation is a real threat. From 1998 through 2007, more than 100,000 parents of U.S. citizen children were deported.2 Since then, immigration enforcement has intensified, with 1.5 million people deported during the first 4 years of the Obama presidency.3 In the first 6 months of 2011 alone, 46,000 mothers and fathers of U.S. citizen children were removed, and there are estimated to be at least 5,100 children in the United States currently living in foster care after the detention or deportation of their parents.4 Fear of deportation is widespread. Fifty-seven percent of Latino respondents from a large national survey reported worrying that they, a family member, or close friend might be deported.5 So what happens to children whose parents are deported or who live in fear of a parent’s deportation? This question is not foreign to our field’s history. Some of the foundational work in child development and psychopathology came from studying children separated from parents (Anna Freud and war orphans, Rene´ Spitz and hospitalized infants). Nevertheless, three fourths of a century later, understanding childhood psychiatric disorders and distress in the context of an obvious social stressor remains a challenge: stressors go hand in hand, vulnerabilities accrue. Deportation offers a case in point. It typically occurs in the context of living liminally in society, ‘‘illegally,’’ and in poverty. It is often associated with criminal activity, insofar as immigration violations frequently come to light from an encounter with law enforcement (although the infraction can be excruciatingly minor). It commonly takes place against a backdrop of exploitation, stigma, and discrimination. Moreover, social marginalization of undocumented immigrants, combined with their frequent wariness of professional and JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 5 MAY 2013
Charles D.R. Baily,
M.S.
(especially) government institutions, makes them a challenging population to help and to study. The current literature on the consequences of deportation and threat of deportation for children is confined largely to a handful of cases documented by journalists and a few qualitative reports by legal advocacy groups. In a two-part report investigating the impact of worksite immigration raids,6,7 family members of children who had experienced the arrest of at least one parent reported behavioral changes in most children, including sleep and eating disturbances, excessive crying, increased fear, and, in older youth, aggressive and withdrawn behavior, frequently persisting past 6 months. In what to our knowledge is the only peer-reviewed, quantitative study in this area to date,8 parents’ vulnerability to deportation affected their emotional adjustment, ability to support their children financially, their relationships with their children, and their children’s emotional wellbeing and school performance. Although families threatened by deportation represent a discrete subpopulation, the wider literature on risk factors for psychopathology in immigrants offers some guidance regarding the mental health concerns of this group. Many factors associated with parents’ undocumented status—poverty, discrimination, acculturation difficulties, parental stress, and unreported domestic violence—increase the risk that immigrant children will develop psychopathology.9 The compounding effect of successive traumatic experiences, including deportationrelated events such as immigration raids and parental detention, places children at risk for the development of a range of disorders, including depression, anxiety, and posttraumatic stress disorder.9,10 Even when separations are voluntary rather than forced, children separated from their parents during the migration process are at greater risk for the development of anxiety and depression symptoms than nonseparated children.11 How should we intervene clinically with children affected by deportation concerns? Clinicians should
www.jaacap.org
451
HENDERSON AND BAILY
recognize that children may react to deportationrelated stress with a multitude of distressed and disruptive behaviors, from enuresis and ‘‘oppositional defiant disorder’’ to irritability and posttraumatic stress disorder. They should be alert to anxieties, worries, and fears that may be a consequence of deportation or the threat of deportation and use cognitive-behavioral techniques and familyand school-based interventions to help children get back on track. Available interventions should capitalize on factors that have been identified as contributing to resilience in immigrant communities, such as strong family and community support networks.9 Clinicians should endeavor to facilitate communication between children and separated parents or at least to inquire about how remaining parents or caregivers envision keeping children in touch with parents who have been deported. Underlying these strategies is a need to elicit a full history. It is not uncommon to hear a case presentation in which a close family member (often a father) is reported to be in another country; however, it is not common to hear an explanation for why the family member is there. In clinical interviews, it is important to inquire how and why families have become separated, what the contact is, what contact is planned, and what children have been explicitly told. Families may be reluctant to talk about deportation, and clinicians should provide reassurance when eliciting reasons for family separations and asking what the child knows (or is presumed to know) about them. Deportation-specific research is also needed, to inform clinical practice and advocacy. In particular, little is known about the types and rates of mental health problems experienced by children with deported parents or (an even more complicated proposition) whose parents are at risk for deportation. Less still is known about the differences in the impact of deportation based on factors such as children’s age, gender, country of origin, and expectations of reunion. Research should also investigate the influence of deportation threat on parenting and child development. Ultimately, feasible and effective interventions for these children should be developed, including an assessment of the obstacles to health and mental health care that they face. Members of our field doubtless differ in their opinions on immigration policy but may still advocate for more systematic efforts to reunify families affected by deportation. They might also consider supporting legal reforms to make
children’s well-being a central consideration in deportation cases. For example, we may be able to make a valuable contribution to the debate over the proposed Child Citizen Protection Act (H.R. 1176, 2007), which would authorize a judge to decline the order for deportation of the parent of a U.S. citizen child based on an assessment of the child’s best interests, but which has remained stalled in Congress since 2007. Although the ‘‘best interests of the child’’ is a basic standard of protection for children’s rights under international law, U.S. child welfare law, and the immigration law of many other countries, no such protection currently exists under U.S. immigration law.12 Although individuals may apply for cancellation of a deportation judgment based on ‘‘exceptional and extremely unusual hardship’’ to a U.S. permanent resident or citizen parent, spouse, or child, legal appeals have established that ‘‘personal distress and emotional hurt’’ are typical responses to deportation and therefore do not constitute grounds for such cancellation.13 Likewise, children’s decreased access to health care, education, and economic opportunities do not meet the required standard.13 In the absence of legislative or judicial reform, mental health professionals can still play an important advocacy role at an individual level by providing expert testimony that draws attention to the specific hardships deportation would present to a given child or family.9 In the context of migration, whether forced or not, children frequently demonstrate remarkable resilience, and their experiences can even strengthen their developmental trajectories.9 However, the deportation of parents poses a specific problem that deserves to be addressed clinically, in research, and through advocacy, beginning with greater awareness that it is affecting many children whom we serve now. & Accepted January 29, 2013. Dr. Henderson is with New York University. Mr. Baily is with Teachers College, Columbia University. Disclosure: Mr. Baily was the recipient of the Dean’s Grant for Student Research from Teachers College, Columbia University (‘‘Understanding and Addressing the Mental Health Needs of Unaccompanied Children Via Lawyers Representing Them in Their Immigration Proceedings,’’ 2011–2012). Dr. Henderson reports no biomedical financial interests or potential conflicts of interest. Correspondence to Schuyler W. Henderson, M.D., M.P.H., NYU Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016; e-mail: AND [email protected] 0890-8567/$36.00/& 2013 American Academy of Child and Adolescent Psychiatry http://dx.doi.org/10.1016/j.jaac.2013.01.007
JOURNAL 452
www.jaacap.org
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 5 MAY 2013
CLINICAL PERSPECTIVES
REFERENCES 1. Passel JS, Cohn D. Portrait of Unauthorized Immigrants in the United States (Research Report). Washington, DC: Pew Hispanic Center; 2009. Available at: http://www.pewhispanic.org/files/ reports/107.pdf. Accessed December 5, 2012. 2. US Department of Homeland Security: Office of the Inspector General. Removals Involving Illegal Alien Parents of United States Citizen Children (OIG-09-15); 2009. Available at: http://www.oig. dhs.gov/assets/Mgmt/OIG_09-15_Jan09.pdf. Accessed December 5, 2012. 3. US Department of Homeland Security: Immigration and Customs Enforcement. ICE Total Removals Through August 25th, 2012; 2012. Available at: http://www.ice.gov/doclib/about/offices/ero/ pdf/ero-removals1.pdf. Accessed December 5, 2012. 4. Wessler SF. Shattered Families: The Perilous Intersection of Immigration Enforcement and the Child Welfare System (Research Report); 2011. Available at: http://arc.org/shatteredfamilies. Accessed December 5, 2012. 5. Lopez MH, Minushkin S. 2008 National Survey of Latinos: Hispanics See Their Situation in U.S. Deteriorating; Oppose Key Immigration Enforcement Measures (Research Report). Washington, DC: Pew Hispanic Center; 2008. Available at: http://www. pewhispanic.org/files/reports/93.pdf. Accessed December 5, 2012. 6. Capps R, Castan˜eda RM, Chaudry A, Santos R. Paying the Price: The Impact of Immigration Raids on America’s Children (Research Report). Washington, DC: National Council of La Raza; 2007.
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 5 MAY 2013
7.
8.
9.
10. 11.
12.
13.
Available at: http://www.urban.org/UploadedPDF/411566_ immigration_raids.pdf. Accessed December 5, 2012. Chaudry A, Capps R, Pedroza J, Castan˜eda RM, Santos R, Scott MM. Facing Our Future: Children in the Aftermath of Immigration Enforcement (Research Report). Washington, DC: National Council of La Raza; 2010. Available at: http://www.urban.org/Uploa dedPDF/412020_FacingOurFuture_final.pdf. Accessed December 5, 2012. Brabeck K, Qingwen X. The impact of detention and deportation on Latino immigrant children and families: a quantitative exploration. Hispanic J Behav Sci. 2010;32:341-361. American Psychological Association, Presidential Task Force on Immigration. Crossroads: The Psychology of Immigration in the New Century; 2012. Available at: http://www.apa.org/topics/ immigration/immigration-report.pdf. Accessed December 5, 2012. Perez Foster R. When immigration is trauma: guidelines for the individual and family clinician. Am J Orthopsychiatry. 2001;71:153-170. Sua´rez-Orozco C, Bang HJ, Kim HY. ‘‘I felt like my heart was staying behind’’: psychological implications of immigrant family separations and reunification. J Adolesc Res. 2011;26:222-257. Carr BA. Incorporating a ‘‘best interests of the child’’ approach into immigration law and procedure. Yale Hum Rights Dev Law J. 2009; 12:120-159. Thronson DB. Thinking small: the need for big changes in immigration law’s treatment of children. Univ Calif Davis J Juvenile Law Policy. 2010;14:239-262.
www.jaacap.org
453
PERSPECTIVES
Parental Deportation, Families, and Mental Health Schuyler W. Henderson,
M.D., M.P.H., AND
T
here are an estimated 5.5 million children in the United States whose parents are unauthorized immigrants, and approximately three fourths of these children are American citizens.1 For these children, parental deportation is a real threat. From 1998 through 2007, more than 100,000 parents of U.S. citizen children were deported.2 Since then, immigration enforcement has intensified, with 1.5 million people deported during the first 4 years of the Obama presidency.3 In the first 6 months of 2011 alone, 46,000 mothers and fathers of U.S. citizen children were removed, and there are estimated to be at least 5,100 children in the United States currently living in foster care after the detention or deportation of their parents.4 Fear of deportation is widespread. Fifty-seven percent of Latino respondents from a large national survey reported worrying that they, a family member, or close friend might be deported.5 So what happens to children whose parents are deported or who live in fear of a parent’s deportation? This question is not foreign to our field’s history. Some of the foundational work in child development and psychopathology came from studying children separated from parents (Anna Freud and war orphans, Rene´ Spitz and hospitalized infants). Nevertheless, three fourths of a century later, understanding childhood psychiatric disorders and distress in the context of an obvious social stressor remains a challenge: stressors go hand in hand, vulnerabilities accrue. Deportation offers a case in point. It typically occurs in the context of living liminally in society, ‘‘illegally,’’ and in poverty. It is often associated with criminal activity, insofar as immigration violations frequently come to light from an encounter with law enforcement (although the infraction can be excruciatingly minor). It commonly takes place against a backdrop of exploitation, stigma, and discrimination. Moreover, social marginalization of undocumented immigrants, combined with their frequent wariness of professional and JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 5 MAY 2013
Charles D.R. Baily,
M.S.
(especially) government institutions, makes them a challenging population to help and to study. The current literature on the consequences of deportation and threat of deportation for children is confined largely to a handful of cases documented by journalists and a few qualitative reports by legal advocacy groups. In a two-part report investigating the impact of worksite immigration raids,6,7 family members of children who had experienced the arrest of at least one parent reported behavioral changes in most children, including sleep and eating disturbances, excessive crying, increased fear, and, in older youth, aggressive and withdrawn behavior, frequently persisting past 6 months. In what to our knowledge is the only peer-reviewed, quantitative study in this area to date,8 parents’ vulnerability to deportation affected their emotional adjustment, ability to support their children financially, their relationships with their children, and their children’s emotional wellbeing and school performance. Although families threatened by deportation represent a discrete subpopulation, the wider literature on risk factors for psychopathology in immigrants offers some guidance regarding the mental health concerns of this group. Many factors associated with parents’ undocumented status—poverty, discrimination, acculturation difficulties, parental stress, and unreported domestic violence—increase the risk that immigrant children will develop psychopathology.9 The compounding effect of successive traumatic experiences, including deportationrelated events such as immigration raids and parental detention, places children at risk for the development of a range of disorders, including depression, anxiety, and posttraumatic stress disorder.9,10 Even when separations are voluntary rather than forced, children separated from their parents during the migration process are at greater risk for the development of anxiety and depression symptoms than nonseparated children.11 How should we intervene clinically with children affected by deportation concerns? Clinicians should
www.jaacap.org
451
HENDERSON AND BAILY
recognize that children may react to deportationrelated stress with a multitude of distressed and disruptive behaviors, from enuresis and ‘‘oppositional defiant disorder’’ to irritability and posttraumatic stress disorder. They should be alert to anxieties, worries, and fears that may be a consequence of deportation or the threat of deportation and use cognitive-behavioral techniques and familyand school-based interventions to help children get back on track. Available interventions should capitalize on factors that have been identified as contributing to resilience in immigrant communities, such as strong family and community support networks.9 Clinicians should endeavor to facilitate communication between children and separated parents or at least to inquire about how remaining parents or caregivers envision keeping children in touch with parents who have been deported. Underlying these strategies is a need to elicit a full history. It is not uncommon to hear a case presentation in which a close family member (often a father) is reported to be in another country; however, it is not common to hear an explanation for why the family member is there. In clinical interviews, it is important to inquire how and why families have become separated, what the contact is, what contact is planned, and what children have been explicitly told. Families may be reluctant to talk about deportation, and clinicians should provide reassurance when eliciting reasons for family separations and asking what the child knows (or is presumed to know) about them. Deportation-specific research is also needed, to inform clinical practice and advocacy. In particular, little is known about the types and rates of mental health problems experienced by children with deported parents or (an even more complicated proposition) whose parents are at risk for deportation. Less still is known about the differences in the impact of deportation based on factors such as children’s age, gender, country of origin, and expectations of reunion. Research should also investigate the influence of deportation threat on parenting and child development. Ultimately, feasible and effective interventions for these children should be developed, including an assessment of the obstacles to health and mental health care that they face. Members of our field doubtless differ in their opinions on immigration policy but may still advocate for more systematic efforts to reunify families affected by deportation. They might also consider supporting legal reforms to make
children’s well-being a central consideration in deportation cases. For example, we may be able to make a valuable contribution to the debate over the proposed Child Citizen Protection Act (H.R. 1176, 2007), which would authorize a judge to decline the order for deportation of the parent of a U.S. citizen child based on an assessment of the child’s best interests, but which has remained stalled in Congress since 2007. Although the ‘‘best interests of the child’’ is a basic standard of protection for children’s rights under international law, U.S. child welfare law, and the immigration law of many other countries, no such protection currently exists under U.S. immigration law.12 Although individuals may apply for cancellation of a deportation judgment based on ‘‘exceptional and extremely unusual hardship’’ to a U.S. permanent resident or citizen parent, spouse, or child, legal appeals have established that ‘‘personal distress and emotional hurt’’ are typical responses to deportation and therefore do not constitute grounds for such cancellation.13 Likewise, children’s decreased access to health care, education, and economic opportunities do not meet the required standard.13 In the absence of legislative or judicial reform, mental health professionals can still play an important advocacy role at an individual level by providing expert testimony that draws attention to the specific hardships deportation would present to a given child or family.9 In the context of migration, whether forced or not, children frequently demonstrate remarkable resilience, and their experiences can even strengthen their developmental trajectories.9 However, the deportation of parents poses a specific problem that deserves to be addressed clinically, in research, and through advocacy, beginning with greater awareness that it is affecting many children whom we serve now. & Accepted January 29, 2013. Dr. Henderson is with New York University. Mr. Baily is with Teachers College, Columbia University. Disclosure: Mr. Baily was the recipient of the Dean’s Grant for Student Research from Teachers College, Columbia University (‘‘Understanding and Addressing the Mental Health Needs of Unaccompanied Children Via Lawyers Representing Them in Their Immigration Proceedings,’’ 2011–2012). Dr. Henderson reports no biomedical financial interests or potential conflicts of interest. Correspondence to Schuyler W. Henderson, M.D., M.P.H., NYU Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016; e-mail: AND [email protected] 0890-8567/$36.00/& 2013 American Academy of Child and Adolescent Psychiatry http://dx.doi.org/10.1016/j.jaac.2013.01.007
JOURNAL 452
www.jaacap.org
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 5 MAY 2013
CLINICAL PERSPECTIVES
REFERENCES 1. Passel JS, Cohn D. Portrait of Unauthorized Immigrants in the United States (Research Report). Washington, DC: Pew Hispanic Center; 2009. Available at: http://www.pewhispanic.org/files/ reports/107.pdf. Accessed December 5, 2012. 2. US Department of Homeland Security: Office of the Inspector General. Removals Involving Illegal Alien Parents of United States Citizen Children (OIG-09-15); 2009. Available at: http://www.oig. dhs.gov/assets/Mgmt/OIG_09-15_Jan09.pdf. Accessed December 5, 2012. 3. US Department of Homeland Security: Immigration and Customs Enforcement. ICE Total Removals Through August 25th, 2012; 2012. Available at: http://www.ice.gov/doclib/about/offices/ero/ pdf/ero-removals1.pdf. Accessed December 5, 2012. 4. Wessler SF. Shattered Families: The Perilous Intersection of Immigration Enforcement and the Child Welfare System (Research Report); 2011. Available at: http://arc.org/shatteredfamilies. Accessed December 5, 2012. 5. Lopez MH, Minushkin S. 2008 National Survey of Latinos: Hispanics See Their Situation in U.S. Deteriorating; Oppose Key Immigration Enforcement Measures (Research Report). Washington, DC: Pew Hispanic Center; 2008. Available at: http://www. pewhispanic.org/files/reports/93.pdf. Accessed December 5, 2012. 6. Capps R, Castan˜eda RM, Chaudry A, Santos R. Paying the Price: The Impact of Immigration Raids on America’s Children (Research Report). Washington, DC: National Council of La Raza; 2007.
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 5 MAY 2013
7.
8.
9.
10. 11.
12.
13.
Available at: http://www.urban.org/UploadedPDF/411566_ immigration_raids.pdf. Accessed December 5, 2012. Chaudry A, Capps R, Pedroza J, Castan˜eda RM, Santos R, Scott MM. Facing Our Future: Children in the Aftermath of Immigration Enforcement (Research Report). Washington, DC: National Council of La Raza; 2010. Available at: http://www.urban.org/Uploa dedPDF/412020_FacingOurFuture_final.pdf. Accessed December 5, 2012. Brabeck K, Qingwen X. The impact of detention and deportation on Latino immigrant children and families: a quantitative exploration. Hispanic J Behav Sci. 2010;32:341-361. American Psychological Association, Presidential Task Force on Immigration. Crossroads: The Psychology of Immigration in the New Century; 2012. Available at: http://www.apa.org/topics/ immigration/immigration-report.pdf. Accessed December 5, 2012. Perez Foster R. When immigration is trauma: guidelines for the individual and family clinician. Am J Orthopsychiatry. 2001;71:153-170. Sua´rez-Orozco C, Bang HJ, Kim HY. ‘‘I felt like my heart was staying behind’’: psychological implications of immigrant family separations and reunification. J Adolesc Res. 2011;26:222-257. Carr BA. Incorporating a ‘‘best interests of the child’’ approach into immigration law and procedure. Yale Hum Rights Dev Law J. 2009; 12:120-159. Thronson DB. Thinking small: the need for big changes in immigration law’s treatment of children. Univ Calif Davis J Juvenile Law Policy. 2010;14:239-262.
www.jaacap.org
453