US health system failing unaccompanied immigrant children

By Helen Albert, Senior medwireNews Reporter

Unaccompanied immigrant or "alien" children arriving in the USA with no papers or family often receive no or inadequate mental healthcare, says the author of an article published in JAMA Pediatrics.

Elizabeth Kennedy (San Diego State University, California, USA) explains that unlike unaccompanied refugee minors (URMs) who are entitled to immediate access to a variety of medical and social services on entering the country, access to medical services is limited for children classified as unaccompanied alien children (UAC).

Within 72 hours of detention, UAC are sent to one of 63 shelters subcontracted by the Office of Refugee Resettlement (ORR). Despite these children often having experienced traumatic circumstances such as violence or natural disaster before leaving their home countries, no mental health assessments are carried out prior to this transfer, notes Kennedy, even though over half of the detention facilities are better equipped to deal with such problems than the majority (80%) of ORR-affiliated UAC shelters.

UAC children, who largely come from Central and South American countries, are legally entitled to a health screening within 24 hours of arriving at their designated ORR shelter, but these check-ups are with general practitioners who may not pick up signs of mental health problems during a single visit. Even if such a diagnosis is made, these shelters often do not have adequate facilities or resources to deal with mental health disorders.

Kennedy says that as ORR-affiliated UAC shelters do not have uniform education requirements and because healthcare providers do not report how frequently mental healthcare workers visit the shelters it can be difficult to find out about how mental healthcare is managed for UAC.

However, a congressional study published in 2008 found the majority of UAC do not receive therapy. According to the authors, there was no evidence of group counseling in 75% of the children and no evidence of individual counseling in 56% of cases.

Kennedy emphasizes how important early mental healthcare is for these children, as unlike URMs, who generally receive healthcare until the age of 21 years regardless of living situation, UAC lose access to state supplied healthcare or associated services on release into the community (to family or community members willing to take on long-term sponsorship), which typically occurs within 6-8 weeks of arrival at the ORR-affiliated shelters.

"More must be done to diagnose and treat UAC's mental illness while in ORR care, especially given the limited treatment opportunities once released," writes Kennedy.

The numbers of UAC arriving in the USA are on the increase and in 2012 reached 14,500. Kennedy suggests that any additional costs accrued in providing a better mental health service for these children are likely to balance out future healthcare and criminal justice system costs associated with unmet mental health needs, such as those connected to substance use disorders.

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