Washington Post Detainee Health Care Series – Day 3

The Washington Post began a four part series on Sunday, May 11th, on detention health care.  The third article in the series focuses on the treatment of mental illness among immigrant detainees, with an emphasis on suicide.

If you are reading this series, you may also be interested in the following:

Myths vs. Facts regarding the May 13, 2008, article:

Myth:  “While tens of thousands of detainees inside immigration detention centers endure substandard medical care, people with mental illness are relegated to the darkest and most neglected corners of the system.”
Fact:  In fiscal year (FY) 2007, DIHS psychologists and social workers have provided 31,697 different types of psychological services and/or patient contacts that impact detainees in a positive manner.  
In the last 12 months, DIHS psychologists and social workers have been successful in managing a daily population of between 1,350 to 2,160 detainees with serious mental illnesses.  In that time frame, there have been no suicides.

Myth:  “Suicide is the most common cause of death among detained immigrants. It accounts for 15 of 83 deaths since 2003, when the Department of Homeland Security's Immigration and Customs Enforcement agency, known as ICE, took over facilities for foreigners whom the government is trying to deport.”
Fact: Since 2003, suicides have accounted for 18% of the deaths of detainees in custody.  Compared to other correctional agencies that serve large populations (California Department of Corrections and the Federal Bureau of Prisons) the suicide rate for individuals detained in ICE custody is much lower.  Over 1.5 million detainees have transited thru the ICE detention system in the last 5 years with a suicide rate lower than comparable-sized correctional systems and lower than the national average of 12 suicides per 100,000 people.  ICE provides effective suicide screening, crisis response and has a strong suicide prevention program. The first suicide prevention program was instituted in 2000. It was revised again in late 2005, and the program is reviewed annually. The suicide prevention program includes guidelines for annual staff training, screening for suicide risk, identifying risk factors for suicide, suicide risk assessment procedures, the place and process of suicide watch and guiding principles in suicide prevention.  Additionally, there has not been a suicide in more than 15 months.
   
Myth: “Inside these out-of-the-way compounds around the country, suicide attempts seem to be on the rise, according to internal documents: 16 in June, 21 in July, 20 in August.”

Fact: ICE detention facilities, not compounds, are not out of the way.  They are strategically placed to support immigration law enforcement programs and/or to facilitate easier removal of detainees to Central American countries.  There are detention facilities in or near every major city in the United States including New York, Philadelphia, Miami, Houston, Chicago, Phoenix, San Diego, Los Angeles, and Seattle.
ICE is concerned for the safety of all detainees.  The first suicide prevention program was instituted in 2000. It was revised again in late 2005, and the program is reviewed annually.  Detention facility staff is specially trained to recognize risk factors for suicide and manage suicidal detainees with appropriate supervision and sensitivity. Information gathered from internal documents is anecdotal and does not reflect scientific analysis or study and is a matter of speculation by outside sources.  An increase in suicide attempts of less than one-tenth of 1 percent over 3 months does not suggest a sustained increase in suicide attempts over time. More importantly, as ICE continues to monitor its suicide prevention program, there have been no suicides in the past 15 months, during which ICE detention capacity has increased from 27,500 to 32,000. 

Myth:  “The ratio of staff to mentally ill detainees is out of balance, with far fewer staff members than in other prison settings, according to Dennis Slate, the top mental health official in the detainee system. In an e-mail to colleagues the morning of last May 31, Slate said the ratio in the Bureau of Prisons was 1 to 400. In prisons for the mentally ill, it was 1 to 10. But in the immigration detention centers, it was 1 to 1,142.”

Fact:  Since December of 2007, significant efforts have been made to increase staffing. Within the next 3 to 4 months ICE will have a mental health professional to detainee ratio similar to the Department of Justice’s Bureau of Prisons.  By the end of the fiscal year, ICE will evaluate the impact of its staffing increases.  If more staff is needed, ICE will move decisively to hire additional mental health staff.  ICE is actively working with the DHS Office of Health Affairs to make sure that DIHS has the appropriate number and type of medical providers.

Myth: “When immigration became a national security issue after the terrorist attacks of Sept. 11, 2001, the administration decided to increase raids on workplaces for undocumented workers and to round up convicted felons who had served time but were now deportable, no matter how long they had lived in the United States. This, along with a new requirement that political asylum-seekers must wait out their cases behind bars, created a deluge that the system was unprepared to handle.”

Fact:  In response to the terrorist attacks of Sept. 11, 2001, when the administration placed greater priority on worksite enforcement, the Criminal Alien Program and ending the practice of “Catch and Release”, ICE’s staffing levels and bed space funds increased to support the demand.   Between 2004 and 2008, ICE has increased its on-board staffing levels for the Office of Detention and Removal Operations (DRO) from approximately 4,000 to 6,300 full time employees. During the same time period, funded bed space levels grew from 19,444 to 32,000.  Adequate preparation for the increase in activity and the efficient management of this bed space allowed for over 311,213 individuals to move through ICE custody in FY07. Since October 2007 more than 200 new DIHS staff have entered on duty and more than 200 applicants are in the hiring pipeline.

Myth:  “Belbachir was sent to McHenry County Jail in the far suburbs of Chicago. The jail already had problems with its medical services: Detainees did not receive the required mental health screening, nor the standard screening for suicide risk, a recent review had found. Untrained staff members often did what screenings there were.”
Fact:  ICE detention standards require that detainees undergo a health screening within the first 24 hours of admission to an ICE detention facility. However, on rare occasions beyond ICE’s control, like an unanticipated number of arrests, these standards may not be met for a very short period of time.  In those situations, every effort is made to provide the screenings and examinations as quickly as possible.  This screening includes evaluation of the individual’s medical, dental and mental health status. A health history is taken through an interpreter, if needed. Each ICE detainee also receives a more detailed physical examination within 14 days of admission to an ICE detention facility.

Myth:  “Belsito and her managed-care associates were withholding treatment for many types of care, saving the agency millions of dollars. For mental health services, four denials for treatment of manic-depressive psychosis saved DIHS $18,145.36, according to an itemized record of the savings over a one-year period ending in August 2006. Two denials for care of "unspecified psychosis" saved an estimated $11,668.60. Nine denials for treatment of "depressive disorder not elsewhere classified" saved $43,158.57.”

Fact: The Washington Post has consistently mischaracterized the managed care program.  Requests for specialized care, including mental health services are approved at a rate of 90 percent.  Just like in any managed care program serving U.S. citizens, there is an obligation to make sure that the care is needed and that the costs being charged are reasonable and customary.  DIHS does not deny care for the purpose of saving money. Managed care is a system implemented to assure payment of claims for all off site medical, dental, mental health and inpatient hospitalizations for detainees in ICE’s custody. The detainee benefits package covers both emergency and routine care for those in custody of ICE. The Managed Care Team Case Managers, do not withhold treatment. Requests for care are received through a Treatment Authorization Request (TAR) web system.  All requests are reviewed on a case-by-case basis by weighing several factors.  The cost savings reflect the change in payment of claims, not denials or withholding treatment.  The TAR process is used to approve payment only, and allocation of government funds for off site medical care. The cost savings reflect a savings based on Medicare rates mandated by Congress.  Denials for payment may be for administrative reasons, due to the fact that the detainee is not in ICE custody, or the case managers were never notified of any need for care.

Myth:  “The Elizabeth compound also had no interpreter.”
Fact:  ICE Detention and Removal employees are required to pass Spanish language training at the Federal Law Enforcement Training Center. For languages other than Spanish, ICE does have available interpreter services 24 hours a day, 7 days a week, which are utilized by facilities across the country. Again, ICE detention facilities, are not compounds. They are full-service facilities subject to building, fire and health and safety codes and regulations.  There are inspected annually and continually maintained.

# ICE #
U.S. Immigration and Customs Enforcement (ICE) was established in March 2003 as the largest investigative arm of the Department of Homeland Security. ICE is comprised of five integrated divisions that form a 21st century law enforcement agency with broad responsibilities for a number of key homeland security priorities.