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Editor's Note: David M. Perry is a journalist and historian. He is a senior academic advisor in the Department of History at the University of Minnesota. Follow him on Twitter. The opinions expressed here are those of the author.
(CNN) - When violence forces people to flee their homes and cross borders, legally or illegally, seeking asylum or other forms of refuge in a peaceful place, they carry their traumas with them. That is certainly true for many of the Central American immigrants who have tried to emigrate to the United States in recent years. Many of them have witnessed or suffered horrors such as rape, torture and murder.
In addition, many of them - including children and adolescents - have been forced to participate in acts of violence before fleeing. When they arrive in the United States, they are taken into custody, thanks to the relatively new policy approved by Scott Lloyd, the former director of the Office of Refugee Resettlement (ORR) of Trump. As part of an agreement ordered by the court in 1997 that sets minimum standards in the detention of minors, those children and adolescents are told that they need to seek therapy; They are required to meet with therapists.
According to the explanation offered to Congress by Steven Wagner, who then supervised the ORR, children are told that it is essential to be honest about themselves with their therapists. But under the Trump administration, according to a recent report by The Washington Post, officials from the US Immigration and Customs Enforcement Service. (ICE) takes the notes of therapists and uses them as a weapon against adolescent migrants. According to Wagner, therapists must submit a report no more than four hours after their sessions that will be delivered to ICE in less than a day. Teenagers are told that what they say can affect their status, but they are also told that it is "essential" to be honest in these mandatory meetings, according to The Washington Post.
- Quaden Bayles, harassed at age 9, paid his price for the effusive support
This supposed practice may be legal, but it is not an ethical position in which to place adolescent migrants who desperately need therapeutic support. In fact, it is an atrocious violation of the central confidentiality base that makes effective therapy possible and is another horror inserted into the immigration system by Trump officials who abuse the most vulnerable.
Someday, when we are lucky enough to be in a post-Trump era, we will have to confront what government officials did to the most vulnerable on behalf of the American people. We cannot move forward unless we judge the past and hold those responsible accountable for the misery they cause.
It is not clear at this time how much therapists should be blamed, although the American Psychological Association has called for an immediate brake on the practice of sharing therapist notes with ICE. Without a doubt, the revelations require two immediate steps for any therapist. First, they do not promise confidentiality to people in danger of state persecution. Second, if the U.S. Immigration and Customs Enforcement Service does not give you any other option but to share your notes, do not take notes.
The revelations about the misuse of therapy notes emerged in a story from The Washington Post by Hannah Dreier that was published earlier this month. The Washington Post reported that some of the therapists in shelters are aware of the policy and say they are actively working to protect children's privacy, having two sets of clinical notes or omitting things altogether. In a shelter in New York, some therapists retain disturbing artistic work because of the risk of being misunderstood as violent in the official archives. The newspaper also noted that it is highly likely that some shelter therapists are promising a certain level of confidentiality with children that the policy will not allow them to comply with.
Dreier's note told the story of Kevin, a teenager who found a therapist whom he could trust while being held at an ORR shelter in Texas. He told the newspaper that his therapist told him: "This is your chance to tell us your story" and assured him that his conversation would be kept private unless he described harm to himself or others. Following the fact that he told the therapist that he was forced to participate in gang activities, ORR transferred him from the shelter to a more secure detention center.
Kevin felt betrayed, but he still needed therapy. In detention, he eventually met another therapist and gradually learned to trust him, spreading more and more of his history.
- 350 migrant children remain in the custody of the Office of Customs and Border Protection, says the Department of Homeland Security
CNN contacted ICE, which said in a statement that the agency "prioritizes public safety threats when carrying out compliance with immigration regulations and making custody determinations" and explained that the "Customs Immigration and Control Service from the USA has closely complied with the legal protocols in this case. ” A spokesperson also said that ICE did not find any incorrect data on the Washington Post report and referred any questions about the ORR's own policy to the ORR. The current deputy director for children's programs at the ORR told the Post - emphasizing his interest in community welfare - “we accommodate children for child welfare, but these children should not be in our care forever; They should go out. ” She also said that the ORR plays the role of legal guardian for children in their custody; As parents, she said they have the right to see the children's records and share them as they deem necessary. Eventually, a judge granted Kevin asylum, but ICE appealed the decision based on the notes of that first therapist. Kevin is still jailed.
People fleeing violence in Central America have suffered trauma that is unimaginable. Tina Vázquez, who has reported on immigration for various media for years, told me that "therapy - or access to mental health care - arises consistently with many people detained or detained and with whom I have been in contact." She says that "many immigrants, especially women and LGBTQ people, also suffer sexual violence of a sexual nature on the way to the US."
“In detention, many people suffer abuse or, at least, suffer depression and anxiety. Many asylum seekers suffer from posttraumatic stress disorder. Their time in the immigration system only exacerbates the mental health issues they suffer. ” They need mental health care and the idea that these instances in which children like Kevin finally get access to the “care they need”, so that it is then “used as a weapon against them. It is an incredible violation of their trust, their rights and their dignity. ”
Therapy is an important recovery tool after trauma, something I know firsthand. I see a therapist when I can tolerate him emotionally, although sometimes (as now), I have to take a break because the sessions are exhausting. I work after decades of depression and thinking about suicide, the pain of losing my mother, my fears for the worsening of my father's health, and the development of techniques to participate in the world in a conscious way. The idea that the things I talk about in therapy, the moments when I investigate my worst thoughts and experiences, could be used as evidence of my bad character go against the whole idea of therapy as a space for honesty, introspection and work.
Why would a therapist take notes that would endanger the future of his client? Agustina Vidal, director of the mental health program and advocacy group The Icarus Project, and herself an immigrant from Argentina, says we can't just blame ICE and ignore the therapists themselves. She has known from her own experiences with immigration not to trust that medical information is kept confidential from the government. She says that therapists in all circumstances “should operate under the presumption that their records can be cited judicially and should have diagnostic and registration practices that ensure that, if confidentiality is broken, their records will not cause harm to their clients. " Any court can cite therapy records, but Vidal says that “it is different for immigrants because the mental health diagnosis affects immigration status. The vicious circle is that untreated emotional issues also increase the risk of deportation. ”
Vidal believes that, although the therapists behaved without doubt according to the law, they do carry a certain degree of guilt. From their point of view “they violated the code of ethics (of the American Therapy Association) by not providing informed consent, by not explaining the risks and limits of confidentiality to clients. Since the clients, in this case were migrant children in custody, "seeing the required legal and ethical basis of all therapists, it is difficult to see how the therapist failed to perceive and communicate the risks."
When I read about these therapists, I hope they don't give them the same impunity granted to others who have fundamentally violated the doctor's oath of "not doing harm." In the most extreme example - the doctors involved in the CIA's use of torture during the Bush administration - to my knowledge, no doctor or therapist lost his enrollment (there were general demands and convictions, but his complicity did not prevented in any way their ability to call themselves professionals). Regardless of the severity of the final outcome of the violation, there has to be a line where the practice ends and complicity begins.
We need to know who decided to collect these therapy notes and make sure they never supervise the detained children again. We have to know if someone tried to protect the children and in fact if individual therapists took all possible ethical steps to protect their clients, and yes, perhaps some of them should be accountable in their profession. We will not know until we have all the facts. It will take a presidential investigation and courageous leadership to break through all the people who will say they "carried out orders" in order to find those facts.
Meanwhile, if you are a therapist and the US Immigration and Customs Enforcement Service comes and asks for your confidential notes, you say no. Then burn them, quit, or charge with complicity for the rest of your life.
ICE
