A high-quality forensic evaluation is often the difference between winning and losing a case. Between 2000 and 2004, 89% of 1,663 asylum seekers won their case after receiving medical evaluations from Physicians for Human Rights (a national organization that supports pro bono clinicians) compared to the national average of 37.5% among US asylum seekers who did not receive PHR evaluations. Agencies also indicated that many of their clients could be more effectively represented legally if clients were in regular counseling to help them heal from past trauma, particularly those with humanitarian‐based cases.
Detention – even for a short period of time – is traumatizing and has proven deleterious, long-lasting effects on the mental health and physical well-being of children and adults. Research has confirmed that “children forced to spend time behind bars—enduring the trauma, stress, and uncertainty of detainment—see lasting consequences, even if they are with their parents.” Children who are detained are more likely to experience anxiety, depression, recurrent nightmares, psychological distress, and post-traumatic stress disorder which manifests physically as weight loss, gastrointestinal issues, inability to sleep, and signs of regression in their cognitive skills. Further, medical experts find that detention can have life-long consequences for a child’s academic, economic, and social development. Research has consistently shown that a child’s mental health and well-being is tied to that of their parent or caregiver and the negative impacts of detention are seen clearly in adults as well. One study found that more than three fourths of detained adult asylum seekers were clinically depressed, two thirds were clinically anxious, and one third had symptoms of PTSD.
The two main impediments to obtaining forensic mental health evaluations and counseling services are 1) a lack of experienced clinicians who can offer these services for free or on a “low bono” basis and 2) funding restrictions/limitations that limit an agency’s ability to pay for forensic mental health evaluations and counseling. Mental health agencies have been known to charge $700‐$1600 for forensic evaluations, which is well outside of many immigrants’ ability to pay. This is also a barrier for mental health professionals, who tell us that they need compensation to complete these evaluations due to the time and mental strain of doing this work on a regular basis. Language and cultural competency are also significant barriers, as is the fact that many clinicians limit their practice to adults. There is particular need for experts in children’s mental health.
There are other structural impediments to why there is a lack of capacity within the mental health community for providing these services. In general, Texas mental health professionals do not receive required training in trauma, which is key to being able to serve these clients well. Additionally, many attorneys need training on how forensic evaluations can support an immigrant’s case. Attorneys also often don’t know how to identify the need for counseling in clients as they are focused on case outcome and not client health.