Many health care professionals have protested the Trump administration's zero tolerance immigration policy, which includes incarcerating children apart from their parents, saying such separation can cause lasting emotional and physical harm. The government detained an unprecedented 70,000 unaccompanied migrant children last year, a 42% increase over 2018. Seven have died in custody.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General last September acknowledged mental health problems among detained migrant children, citing among many causes the experience of violence and trauma in fleeing their home countries to travel to the United States and subsequent, unexpected separation from their parents. The HHS report offered several recommendations: address trauma in short-term therapy, help facilities hire and retain qualified mental health clinicians, consider reducing clinician caseloads, increase therapeutic placement options for children needing intensive treatment, and minimize the time unaccompanied children spend in the custody of the HHS's Office of Refugee Resettlement (ORR).

There has been progress on the last recommendation; the amount of time migrant children spent in ORR custody, which averaged 93 days in November 2018, declined to 48 days in April 2019. While improved, the situation at child detention centers is still at odds with federal law set in 1997 that limits the time most children can be held in border custody to 20 days. The limit was established by a consent decree known as the Flores agreement, which the Trump administration sought last year to replace with new regulations allowing indefinite confinement and also removing Flores requirements for federal authorities to ensure humane holding conditions.

The American Psychiatric Association joined 19 other organizations in condemning the new regulations, citing evidence of lasting health consequences for children forcibly separated from their families. Research has shown that toxic stress increases risks of depression, anxiety, heart disease, stroke, cancer, and early death.

A federal judge subsequently blocked the new regulations last September, upholding the Flores agreement. Another federal judge, ruling in a different case last November, said the government must provide mental health services to migrant parents and children who have suffered psychological harm as a result of the family separation policy. And, in a related reversal, the administration bowed to public outcry and reinstated the so-called deferred action policy, granting immigrants, including children, reprieve from deportation while undergoing lifesaving medical care.-Lucy Wang Halpern