More Humane Immigration Policies Will Reduce Migrant Trauma: A Conversation with Dr. Alfonso Mercado

Hostile immigration enforcement policies and anti-immigrant actions against refugees and asylum seekers are causing trauma to migrant families and exposing them to dangerous living conditions on both sides of the U.S.-Mexico border. In recent years, stress from the COVID-19 pandemic has compounded the negative effects of these policies on the health of migrants.

In addition to physical health issues, the situation at the border has given rise to an urgent mental health crisis — one that remains largely ignored both by the media and the policy community. With very limited access to mental health services and resources, migrants at the border face the onset of psychological conditions that may be long lasting. 

This policy brief outlines a conversation held with Dr. Alfonso Mercado, a clinical psychologist and associate professor at the University of Texas Rio Grande Valley School of Medicine. He has conducted extensive clinical work in migrant tent encampments at the U.S.-Mexico border, and on Feb. 28, 2023, he met with migration policy experts and community leaders to discuss the detrimental mental health effects of the ongoing migrant crisis there. The conversation focused on the impact of key policies, such as the use of Title 42 on migrants’ mental health and well-being.

Four main areas were discussed, as highlighted in this brief:

1. A historical background of the continuous challenges faced by migrants and refugees at the border,
2. An overview of the effects of Title 42 on asylum seekers and migrant communities,
3. The short- and long-term effects, including the risk of trauma, that the COVID-19 pandemic and current anti-immigrant climate have had on border migrant communities, and
4. Recommendations to address the current mental health crisis affecting migrants at the southern border.

Historical Background: Migration Drivers

Historically, migration patterns to the U.S.-Mexico border can be explained by a combination of factors, including:

• financial insecurity,
• lack of protection from gang- and cartel-related violence, and
• continuous exposure to dangerous living conditions resulting from political unrest, climate change and corruption.

Mercado identified the need for safety, security, and simply guaranteeing survival as primary motivating factors of forced migration. However, migrants also face precarious conditions — which may include sexual assault and kidnapping — throughout the migration process that increase the risk of trauma.

A large proportion of migrants and asylum seekers report being fearful for their lives and the lives of their loved ones if they are forced to return to their home countries. This fear has grown since the start of the COVID-19 pandemic when Title 42 began to be used to significantly restrict the asylum-seeking process.

The Effects of Title 42

Title 42 of the U.S. Code empowers federal authorities to prohibit the entry of people into the United States who may pose a public health risk.[1] Title 42 was intended to be used for public health purposes, not for immigration enforcement. But at the start of the coronavirus pandemic it was invoked to give Border Patrol agents the authority to quickly eject migrants trying to enter the U.S., instead of letting them seek asylum while remaining in the country, as had long been the policy. This re-purposed use of Title 42 effectively changed immigration policy and it remained in place until the national COVID-19 public health emergency ended on May 11, 2023.[2] Going forward, the decades-old immigration laws will again apply to migrants crossing into the United States.

Since Title 42 was introduced as an instrument of immigration enforcement at the border, over 2.6 million people have been expelled from the United States.[3] Against this backdrop, we note that in 2021, only 18% of the 62,500 available spaces for asylum seekers were filled.[4]

Mercado observed that in March 2020, 850,000 immigrant cases were put on hold — this happened before Title 42 began to be used, and later the delays in court processing increased. As of 2023, more than 1,000,000 asylum seekers are still waiting for a court hearing.

Migrants who crossed into the United States and were not immediately expelled to Mexico were detained in U.S. Immigration and Customs Enforcement (ICE) facilities or Customs and Border Patrol (CBP) detention centers without access to asylum-seeking processes, and often suffered family separation. For many migrants at the border, the long wait times, the uncertainty, and the unsafe living conditions have had a detrimental impact on their mental health and well-being. The lack of sufficient humanitarian care and no expedited processes for migrants and asylum seekers has created hazardous living conditions that place these migrant communities under increased risk for mental health issues.

Injustices and Trauma at the Border

Inhumane Conditions in the “Iceboxes.” When working in McAllen, Texas, a city 11 miles from the U.S.-Mexico border, Mercado and his team heard many disturbing reports from migrants being held in Customs and Border Protection (CBP) detention centers. These centers are referred to as “hieleras,” the Spanish term for “iceboxes,” and the accounts detailed how migrants endured freezing temperatures, overcrowding, and a lack of basic human necessities — including food, water, and health care — while in CBP custody. There is also a real risk of physical and sexual abuse. The harsh conditions faced in the CBP facilities retraumatized many migrants who had already suffered trauma in their home country or during their migratory journey.

Forcible Separation of Families. In mid-2018 the Trump administration adopted a zero-tolerance policy towards unauthorized immigration. As a result, many migrants were criminally prosecuted by the Department of Justice, and families were forcibly separated.[5] The family separations were not regulated, and no procedures were established to track children’s locations and to facilitate family reunifications.

Minors who were taken away from their parents were handed over to government agencies such as Child Protective Services or the Office of Refugee and Resettlement (ORR). Although many of these family separations happened in McAllen, afterward families ended up scattered hundreds of miles apart, not knowing where their family members were, with parents unable to trace or contact their children. To this day, not all the separated children are back with their parents, despite the Biden administration’s efforts.

The zero-tolerance approach did not consider the physical and mental health implications of family separation — in contrast, under the previous policy, migrant families were often detained together in CBP custody or were paroled in the U.S. to await hearings.

Resilience is Affected by Separation. Mercado emphasized the general resilience of migrant communities, largely stemming from protective factors such as family and social networks and their cultural values.[6] He noted, however, that family separations disrupt these networks and deprive migrants of this source of resilience. For this reason, he urged legislators, policymakers, service providers, and community advocates to fight against family separation, especially when minors are involved, and to ensure that government officials act accordingly.

Long-lasting Post-Migration Trauma

The effects of trauma are long-lasting and associated with multiple health and functional concerns. Even after release from immigration detention, migrants continue to face trauma resulting from their exposure, when in custody, to hazardous living conditions and systemic oppression. Mercado and his team have identified concerningly high rates of trauma among recently immigrated youth and adults that are associated with high levels of distress.

Associated effects of trauma include disruption of family relations, interference in building support networks, increased internal psychosocial conflict, diminished performance at work or school, engagement in high-risk behavior (e.g., substance use), and ill health.[7] These conditions are exacerbated by the lack of access to health care and human services programs, including those that could provide legal protection. All of these factors increase the risk of trauma and lasting mental health issues for these migrants.

Discussion: What Can Policy Do?

Mercado noted that immigration policy and legislation need to recognize the historical and ongoing trauma that migrants face and implement training and supervision of enforcement practices aimed at protecting human rights of this vulnerable, yet resilient migrant community.  The aim is to create a safe and respectful environment between enforcement officers and migrants, and the following three policy recommendations will address and reduce migrant trauma.

1. Prevent Family Separations. A policy against separation of families is key. For humanitarian reasons, every possible effort should be made to prevent the separation of children and young people from their parents.
2. Facilitate Rapid Reunification. Where family members become separated during the migratory journey or upon arrival at the border, the policy should be to facilitate rapid reunification.
3. Support Trauma-informed Care. Finally, proactive policies in support of trauma-informed practices, processes, services, and care for migrant communities are crucial. This includes enforcing trauma-informed practices in facilities that hold migrants in detention as well as training personnel so that anyone who comes into contact with this migrant population, including law enforcement and Border Patrol agents, avoids behaviors or practices that can increase harm.

In general, policies should:

• Increase awareness of behaviors and settings that may lead to re-traumatization, with the goal of reducing risk and creating safe spaces for trauma victims.
• Highlight the importance of fostering interpersonal interactions that are respectful, empathic, and humane.
• Ensure humane housing spaces that are safe from violence while migrants await court hearings.
• Provide access to “safe reporting.” This gives individual migrants opportunities to safely notify law enforcement about crimes or acts of violence committed against them without fear of legal, financial, or other repercussions.

Endnotes 

[1] John Gramlich, “Key facts about title 42, the pandemic policy that has reshaped immigration enforcement at U.S.- Mexico border,” Pew Research Center, April 27, 2022, https://www.pewresearch.org/fact-tank/2022/04/27/key-facts-about-title-42-the-pandemic-policy-that-has-reshaped-immigration-enforcement-at-u-s-mexico-border/.

[2] While Title 42 itself remains in existence, the Biden administration confirmed that the end of the public health emergency would end the Title 42 policy at the border: https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf.

[3] Muzaffar Chishti and Julia Gelatt, “Imminent End of Formal U.S. Pandemic Emergencies Marks New Era in Immigration Realm,” Migration Policy Institute, February 23, 2023, https://www.migrationpolicy.org/article/us-pandemic-emergency-end-border-immigrant-benefits; American Immigration Council, A Guide to Title 42 Expulsions at the Border, modified May 25, 2022, https://www.americanimmigrationcouncil.org/research/guide-title-42-expulsions-border.

[4] Nicole Ward and Jeanne Batalova, “Frequently Requested Statistics on Immigrants and Immigration in the United States,” Migration Policy Institute, March 14, 2023, https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#refugees-asylum.

[5] Southern Poverty Law Center, “Family separation – a timeline,” March 23, 2022, https://www.splcenter.org/news/2022/03/23/family-separation-timeline.

[6] Luz M. Garcini et al., “Lessons Learned from Undocumented Latinx Immigrants: How to Build Resilience and Overcome Distress in the Face of Adversity,” Psychological Services 19 (Suppl 1) (2022): 62–71, https://doi.org/10.1037/ser0000603.

[7] Alfonso Mercado et al, “Trauma in the American asylum process: Experiences of immigrant families under the migrant protection protocols,” Psychological Trauma: Theory, Research, Practice, and Policy, October 2022, https://doi.org/10.1037/tra0001368; Alfonso Mercado et al, “‘Remain in Mexico’: Stories of trauma and abuse,” Health Affairs 40 (2021): 7, 1170–1173, https://doi.org/10.1377/hlthaff.2020.02331; Luz M. Garcini et al, “Dealing with distress from the COVID-19 pandemic: Mental health stressors and coping strategies in vulnerable Latinx communities,” Health and Social Care in the Community 30 (2022): 284–294. https://doi.org/10.1111/hsc.13402.

This report is part of the “Conversations on Migration” series from the Baker Institute Migration Initiative. The series intends to provide insight into current migration developments with the goal of informing advocacy and policy efforts and facilitate the expansion of collaborating networks from experts across varied disciplines.

This material may be quoted or reproduced without prior permission, provided appropriate credit is given to the author and Rice University’s Baker Institute for Public Policy. The views expressed herein are those of the individual author(s), and do not necessarily represent the views of Rice University’s Baker Institute for Public Policy.