Children Separated at Border Amounts to 'State-Sanctioned Child Abuse,' Says American Psychiatric Association President

Children separated from their families at the border suffer from “toxic stress,” and some of these children will be significantly impaired for the rest of their lives, APA President Altha J. Stewart, M.D., testified on behalf of APA at a House Appropriations subcommittee today. Some of the factors that she said influence the children’s outcomes are dependent on their age, previous adversity, and the duration of the separation. 

APA was among the first organizations to speak out last spring when it became clear that the administration’s “zero tolerance” policy of referring those crossing the border for federal criminal prosecution would result in the widespread separation of children and families.

“As the physician experts in mental health, we will continue to oppose such family separation policies,” Stewart said. “Children depend on their parents or other trusted adults for their comfort, safety, and support. Any forced separation is highly stressful for children and can cause lifelong trauma, as well as increased risk of mental illness, such as depression, anxiety, substance use, and posttraumatic stress disorder.”

Stewart’s goal in testifying was to give lawmakers an overview of the trauma caused by the forced separation of children and warn of the potential for lasting negative outcomes, she said at the hearing held by the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. She pointed out the need for providing the children with trauma-informed care and access to services and supports for their clinical care after reunification with their families. Trauma-informed care, she said, shifts the dialogue from asking “what’s wrong with you” to “what has happened to you.”

Stewart also explained the concept of Adverse Childhood Experiences (ACEs) and the longstanding body of research about their impact on future health status. Examples of ACEs are physical, sexual, or emotional abuse or neglect; household exposure to mental illness or substance use disorder in parents and caregivers; as well as incarceration itself. “When a child is exposed to such chronic stress and trauma, their underdeveloped brain remains in a very elevated state, and ultimately this consistent exposure to this heightened stress and trauma changes their emotional, behavioral, and cognitive functioning.”

The Flores agreement and subsequent court rulings require the federal government to quickly place immigrant children detained at the border in safe, supportive homes with family members, said Subcommittee Chair Rep. Rosa Delauro (D-Conn.). “Executing this lawful mission has not been this administration’s approach, however,” she said. “Instead, it has attempted to turn Health and Human Services into an immigration enforcement agency.” In fact, she noted, tens of thousands of children have been held for many months, and the average length of child detentions has nearly tripled.

A full report of the hearing and the testimony of other witnesses will appear in a future issue of Psychiatric News.