Fleeing an abusive stepfather in El Salvador, Gabriela headed for Oakland, California, where her grandfather had promised to take her in. When the teenager reached the U.S. border in January 2017, she was brought to a federally funded shelter in Texas.
Initially, staff described her as receptive and resilient. But as she was shuttled from one Texas shelter to another, she became increasingly depressed. Without consulting her grandfather, or her mother in El Salvador, shelter staff have prescribed numerous medications for her, including two psychotropic drugs whose labels warn of increased suicidal behavior in adolescents, according to court documents. Still languishing in a shelter after 18 months, the 17-year-old doesn’t want to take the medications, but she does anyway, because staff at one facility told her she wouldn’t be released until she is considered psychologically sound.
Gabriela’s experience epitomizes a problem that the Trump administration’s practice of family separation exacerbated: the failure of government-funded facilities to seek informed consent before medicating immigrant teenagers. Around 12,000 undocumented minors are in custody of the U.S. Department of Health and Human Services’ Office of Refugee Resettlement. The majority crossed the border unaccompanied, while more than 2,500 were separated from their parents while Trump’s “zero tolerance” policy was in effect from April to June.
Emotional distress and mental health issues are prevalent among these children, sometimes a result of traumatic experiences in their home countries, at other times triggered by being separated from parents at the border, or by fear that they will never be released from ORR facilities. Former shelter employees, and doctors and lawyers working for advocacy groups say the shelters lack sufficient counselors and too often turn to powerful psychotropic drugs when kids act out.
Under most states’ laws, before a child is medicated, a parent, guardian, or authority acting in the place of the parent—such as a court-appointed guardian ad litem— must be consulted and give informed consent. But in these shelters, the children are alone. Shelter staff may not know the whereabouts of the parents or relatives, and even when that information is available, advocates say that the shelters often don’t get in touch. Nor do they seek court approval. Instead, they act unilaterally, imposing psychotropic drugs on children who don’t know what they’re taking or what its effects may be.
“These medications do not come cost-free to children with growing brains and growing bodies — psychotropic medications have a substantial cost to a child’s present and future,” said Dr. Amy Cohen, a psychiatrist who has been volunteering in border shelters. “A person whose sole concern is, what is in the best interest of a child — a parent or a guardian ad litem — that role is desperately needed now.”
Gabriela is one of five immigrants under age 18 who are plaintiffs in a class-action lawsuit filed last month in federal court in Los Angeles against Alex Azar, the head of HHS, and Scott Lloyd, director of ORR. The suit alleges that children are overmedicated without informed consent. Another plaintiff, 16-year-old Daniela, became suicidal after being separated from an older sister who accompanied her from Honduras to the U.S. border. She has been given Prozac, Abilify, Clonidine, Risperdal, Seroquel, and Zyprexa in various shelters as staff have been unable to settle on a diagnosis, detecting at different times bipolar disorder, generalized anxiety disorder, PTSD, and major depressive disorder. Her older sister was released from custody and allowed to stay in the U.S., but wasn’t consulted about whether Daniela should take those medications, which have side effects including weight gain, uncontrolled spasms, and increased suicide risk. The lawsuit doesn’t disclose the last names of the plaintiffs. Another ongoing class action lawsuit in the same court, against the U.S. Department of Justice, alleges the U.S. is inappropriately medicating immigrant minors as young as 11 years old, violating standards established in a 1997 legal settlement.
In legal filings, Justice Department lawyers have said that the shelters are acting appropriately, in accord with state laws on informed consent. “There is good reason for this Court to conclude that ORR’s provision of such medications complies fully with ‘all applicable state child welfare laws and regulations,’” the department said. State and local authorities, rather than the court, are best positioned to determine whether shelters are in compliance, it also argued.
Reports of overmedication extend beyond the lawsuits. At the Northern Virginia Juvenile Detention Center, which has a program for unaccompanied immigrant teenagers, at least 70 percent of the residents were on antidepressants, anti-anxiety medications and sleep aids, often taking multiple pills, according to two former employees. The two staffers, who left the facility a few months ago, worried that the adolescents were over-medicated. Although the shelter offered group therapy, many teens didn’t participate.
Most of the teenagers had crossed the border alone, but often had family members in the U.S. who were seeking to sponsor them. Even in cases where a child had a mother or father living in the U.S., the parent was never contacted for permission to medicate, said the former employees, who asked for anonymity for fear of affecting future employment.
By law, when an unaccompanied minor crosses the border, the Department of Homeland Security must transfer the child to ORR within 72 hours. Children who arrive with parents can’t be held in a detention center for more than 20 days. The Bush and Obama administrations typically would release the family with an appointment to show up in court, while the Trump administration decided to separate the family, with the parents remaining in detention.