We must address the mental health needs of the unaccompanied immigrant children arriving in Maryland to be reunited with family members and foster parents. While in the custody of the U.S. Immigration and Customs Enforcement, the children receive comprehensive medical and mental health exams. After release from detention, however, they have no meaningful access to medical care of any sort.
Concerns about these children's risk of communicable diseases have been greatly overstated. While generally in very good physical health, these children have a critical need for mental health care. Most have experienced trauma so severe that they felt compelled to embark alone on a perilous journey to the U.S. These children are fleeing unimaginable violence in their countries of origin, in their communities and sometimes in their homes. The journey to the U.S. often adds another layer to these children's experience of trauma. The trip is emotionally and physically grueling, and sexual abuse occurs with tragic frequency.
Those unmoved by the plight of these children should consider the implications of depriving them of mental health care. Since January of this year, more than 2,000 unaccompanied immigrant children have come to Maryland and begun attending local schools. Failing to address any child's mental health needs not only diminishes that child's chance for academic success but also forces teachers to try to balance the needs of that student with those of their peers. Schools will function better for all if immigrant children receive the care they need.
Unfortunately, the current humanitarian crisis compounds an already inadequate pediatric mental health care infrastructure. There is a well-documented shortage of mental health providers generally, and of Spanish-speaking providers particularly. Children rely heavily on school-based therapists, whose services are restricted to insured children.
Maryland should follow the lead of six other states and the District of Columbia in expanding Medicaid coverage to income eligible children, regardless of immigration status. One program, Montgomery County's Care for Kids, provides affordable primary and specialty care to children from low-income families who are not eligible for other state or federal health insurance programs. Care for Kids could be expanded into a state program in order to serve all of Maryland's children.
As the political debate about the fate of these children continues, they remain in limbo. Please advocate on their behalf by writing your representatives in support of the expansion of Medicaid for all income-eligible Maryland children. Speak up for increased funding for a much needed expansion in mental health services.
Consider this excerpt from a call we received from a mother in Essex last month:
"Necesito ayuda (I need help). I am calling because my daughter is being detained by immigration authorities in Chicago. They tell me that she can't join me until a psychiatrist agrees to take care of her in Baltimore. She escaped to the U.S. after a gang killed her grandmother in front of her eyes. I don't know how to get the psychiatrist they require, but I need a paper saying that they will treat her. I am so worried about her — if I can't get the paper, they may deport her. I was told that you can help. Por favor."
We urge health care and mental health care providers to consider providing pro bono services. We at Centro SOL, Center for Salud/Health and Opportunity for Latinos at Johns Hopkins will be happy to connect you with organizations serving children in need. Centro SOL's mission is to promote equity in health and opportunity for Latinos by advancing clinical care, research, education, and advocacy at Johns Hopkins and beyond in active partnership with our Latino neighbors. An interdisciplinary collaborative effort, Centro SOL's core programs are clinical care, research, education, advocacy and global health.
Children are amazingly resilient. These children are likely to thrive in a supportive and nurturing environment, but they need a chance to recover from the trauma most have suffered. There is no benefit, but potentially great harm and expense, in delaying such help to these vulnerable children.
The authors — Drs. Sarah Polk, Kathleen Page and Lisa Ross DeCamp — along with contributors Dr. Adriana Andrade, Dr. Tina L. Cheng and Monica Guerrero Vazquez are all members of the Johns Hopkins' Centro SOL. They may be reached at email@example.com.
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