Suicide attempts highlight mental health concerns in immigrant detention

A series of suicide attempts reported by detainees and officials at a single New Mexico immigration detention facility are underscoring concerns about mental health treatment outcomes in the system.

Brazilian national Kelsey Vial killed himself at the Torrance County Detention Facility in Estancia, N.M., on Aug. 24, according to the official Immigration and Customs Enforcement (ICE) detainee death report.

Vial’s death came a month before a Department of Homeland Security (DHS) Office of Internal Investigations (OIG) report recommended the facility’s closure due to poor conditions.

In a complaint to federal oversight agencies, advocates with Innovation Law Lab detailed another suicide attempt at the facility on Nov. 30 based on former detainee Rafael Oliveira do Nascimento’s personal account.

Oliveira do Nascimento, also a Brazilian national, has since been released from immigration detention.

“F.,” another detainee at Torrance, which currently holds around 400 people, told The Hill he attempted suicide last month but was stopped by his fellow inmates as he climbed over a railing to jump off a ledge.

F., whose name is being withheld at his request to avoid affecting his immigration process, said the facility’s response to his attempt was to put him in isolation.

“When I was in the cell I told them, ‘Why won’t you turn off the lights?’ That they were treating me worse than el Chapo. ‘Why won’t you turn off the lights?’ and they would leave them on. ‘Why won’t you turn off the lights?'”

Mental care in detention environments

Craig Haney, a social psychologist and an expert on the impacts of isolation in detention, said American prisons and detention centers often use isolation as a response to inmate depression, self-harm and suicide attempts. 

“This is a way to solve a short-term problem: ‘What do we do with this mentally ill detainee?’ But in a way that is very likely to be damaging to [detainees] in the long run. And that’s just not an equation that [detention centers] pay much attention to,” Haney said.

Ryan Gustin, a spokesman for CoreCivic, the private company that operates the Torrance facility for ICE, pushed back against F.’s claim.

“The safety of those entrusted to our care at [Torrance] is our number one priority. If a detainee exhibits or expresses self-harm or suicidal ideations, they are not met with punitive measures, rather they are provided with a high-level of appropriate medical and mental health care,” Gustin said.

“This includes transitioning the detainee to a cell designed with safety in mind. A thorough mental health and physical assessment is performed by our medical staff, and staff can intensively monitor the individual to ensure their safety. The individual would continue to receive monitoring and assessment no longer than necessary to mitigate the risk of imminent self-harm,” added Gustin, noting that CoreCivic uses neither the term nor the practice of “solitary confinement.”

Still, Vial’s death and the two other suicide attempts marked a turn for the worse for ICE detention generally after the agency reported no detainee suicide deaths in fiscal 2021.

That decrease followed a grim fiscal 2020, when six people died by suicide in immigration detention. In fiscal 2019, ICE registered two deaths by suicide, as well as one in fiscal 2018.

According to a 2021 study published in AIMS Public Health, a journal for peer-reviewed papers, the overall suicide rate per every 100,000 people admitted into ICE detention was 0.3 from 2010 to 2019. In 2020, that rate skyrocketed to 3.4 suicides per 100,000 admissions.

That study, authored by academics from Harvard and Stanford universities, theorized that a possible cause for the spike was “increasing lapses in mental health care in ICE detention,” based on a 2020 congressional report that found “major issues in mental health care inside detention centers” which “may result from chronic staffing shortages, as vacancy rates of 37–50% for psychiatrists and social workers have been previously reported in immigration detention.”

Though September’s OIG report praised the quality of health care at Torrance, it found understaffing in the medical office was causing an array of problems.

“In addition to several staff expressing that the low staffing levels were problematic, we observed empty watch rooms and understaffed medical units. Our medical contractors concluded that these medical unit vacancies impacted the level of care detainees received for suicide watch, dental care, and chronic care,” wrote the OIG.

And despite the OIG’s praise, detainees report bleak consequences of seeking mental health care for depression, thoughts of self-harm or suicidal ideation.

“W.,” another detainee at Torrance whose name is being withheld to avoid affecting his immigration case, relayed a harrowing experience after seeking medical help for thoughts of self-harm.

“They put me in a cold room, they took all my clothes, they only gave me a little robe and I lasted Friday, Saturday, Sunday and Monday. Four, five days there. Then they took me out of there, put me for a week in a room, in a tank by myself stuck there. I would send letters [asking] them to let me out of there, to transfer me with more people, but they didn’t want to. It was ‘no’ and all ‘no,’ that they couldn’t do anything for me and things like that.”

“I didn’t have anything to do but to cry and read the word of God and so on. And it was all very, very sad.”

While conditions like those described by W. appear cruel, they may adhere to ICE’s suicide prevention procedures.

W.’s “little robe,” for instance, was likely a “suicide smock,” a tool prescribed by ICE’s National Detention Standards manual that can be used, with or without underwear, if a medical professional determines a detainee could use regular clothing to attempt acts of self-harm.

ICE’s manual describes in detail “suicide-resistant cells,” prohibits excessive deprivations for detainees in those cells, and mandates one-to-one observation and a medical treatment plan.

Advocates, however, say the ICE manual’s regulations are often not followed.

According to a November report by Humanitarian Outreach for Migrant Emotional Health, (H.O.M.E.), which reviewed the health care records of seven Torrance detainees, the files lacked detailed descriptions of symptoms, wellness goals, treatment plans and psychotherapy notes for interactions between patients and caregivers.

“The most striking feature of these records was their sparsity,” wrote Jenifer Wolf-Williams and Judy Iwens Eidelson, executive director and clinical adviser at H.O.M.E, respectively.

CoreCivic says its medical staff follows ICE regulations, earning Torrance’s health services accreditation from the National Commission on Correctional Health Care (NCCHC), an independent agency supported by an assortment of medical, law enforcement and corrections associations.

“All detainees have daily access to sign up for medical care, including mental health services. Our clinic is staffed with licensed, credentialed doctors, nurses and mental health professionals who contractually meet the highest standards of care as verified by multiple audits and inspections,” Gustin said.

Whether or not regulations are consistently followed in dealing with depressed or at-risk detainees, they say a perception of punitive treatment has created a culture of distrust at Torrance.

‘Critically important symptom’

Another detainee, “B.,” told The Hill that veteran detainees will advise newcomers not to seek institutional help for depression, thoughts of self-harm or suicidal ideation or risk being put into the “cold rooms” or “torture rooms.”

B. has since been deported, according to advocates — his name was withheld for fear of persecution in his home country.

“​​Without exception, when a detained migrant disclosed suicidal thoughts to a H.O.M.E. evaluator, they also noted their unwillingness to discuss these thoughts with [Torrance] staff, including internal healthcare professionals,” reads the H.O.M.E. report.

“Their consistent reason for hiding this critically important symptom was fear of the inevitable detention center response: solitary confinement and its associated humiliations.”

Reached for comment, Jenny Burke, a spokesperson for ICE, said first-hand accounts can provide an unreliable metric to measure whether protocol is being followed.

But Burke said ICE “is committed to ensuring that all those in its custody reside in safe, secure, and humane environments under appropriate conditions of confinement.”

“There are multiple avenues available for detainees to report allegations of substandard care or misconduct — all allegations are taken seriously as agency personnel are held to the highest standards of professional and ethical behavior. When a complaint is received, it is investigated thoroughly to ensure comprehensive standards and policies are strictly maintained and enforced,” she said.

In late February, a coalition of human rights advocates led by Innovation Law Lab, New Mexico Immigrant Law Center, Las Americas Immigrant Advocacy Center and the Santa Fe Dreamers Project delivered a letter and a report to officials within DHS, detailing the conditions described to them in conversations with more than 100 detainees at Torrance.

That report details the accounts of at least 50 men who said they had been put in the “torture rooms,” and, upon exit, isolated from their previous acquaintances and friends.

Isolation can be devastating for any individual in such a setting, but for those experiencing a mental illness, it often aggravates their existing conditions.

“It is an extra layer, and it could not be more inappropriate,” Haney said.

“In a mental hospital, for example, people are not in isolation. In fact, quite the opposite. … One of the things you do as a form of treatment for having mental health problems is engage in various forms of socialization.”

Loss of self

Haney added that isolation can cause or aggravate depression and lead to anxiety in detainees, including social anxiety that can make it hard for formerly isolated individuals to interact with other people, even years after the fact.

A third effect is a loss of self, which Haney compared to an experience many people had while living in lockdown during the pandemic.

“And what happens is, it destabilizes people’s identity. They can’t ground themselves and their feelings in their connectedness to other people and in the reactions that other people have to them. And it loosens people’s grip on reality. Even normal healthy people will report that they begin to wonder who they are,” Haney said.

The effects of detention and isolation are also aggravated by the uncertainty faced by non-criminal immigration detainees, according to advocates and mental health experts.

A majority of ICE detainees nationwide are not charged with a crime and do not have a criminal record, and detention times for immigration proceedings are indeterminate — detainees can remain in ICE facilities for days or years.

That uncertainty and last-minute changes to deportation plans or transfers between different detention facilities often take a toll on detainees’ mental health.

Advocates say those stress factors have existed for decades — essentially, that they are a feature, not a bug, of U.S. immigration policy.

“It’s part of an overall framework of U.S. immigration policy that is oriented around policies that are cruel and intended to, quote, unquote, ‘deter’ future migration,” said Heidi Altman, director of policy at the National Immigrant Justice Center.

“You cannot speak to one person who has gone through immigration detention, but doesn’t have the scars of dehumanizing treatment, of having been harassed by guards, of having been strip searched, of having been thrown in solitary because of their mental illness. The list goes on.”

—Updated at 11:44 a.m.