Federal Judge Orders That Border Families Be Reunited

Marcia Frellick

June 27, 2018

A federal judge in California has ordered that children and families separated because of the Trump administration's zero-tolerance border policy be reunited in the next 30 days.

The American Civil Liberties Union was granted a preliminary injunction by Dana Sabraw, from the Federal District Court in San Diego, in response to the lawsuit it filed to stop the separations. The government is now ordered to reunite parents and children who are younger than 5 years within 14 days, and children who are 5 years and older within 30 days, although it does have the option to appeal.

In issuing the order late Tuesday night, Sabraw cited a brief from the Children's Defense Fund, which reads: "There is ample evidence that separating children from their mothers or fathers leads to serious, negative consequences to children's health and development. Forced separation disrupts the parent–child relationship and puts children at increased risk for both physical and mental illness."

"The psychological distress, anxiety, and depression associated with separation from a parent would follow the children well after the immediate period of separation, even after eventual reunification with a parent or other family," the brief continues.

Some of the separated children are now at the Bellevue Hospital Center in New York City, reported Ruth Gerson, MD, who is director of the children's psychiatric emergency program.

"Being separated from their families in such an abrupt and uncertain way is traumatizing. It also complicates our treatment of them, because it's a trauma that's ongoing," she told Medscape Medical News.

A child involved in an accident can begin healing in a safe place when the initial trauma is over. For children who have been actively separated from their parents by the government, the trauma is ongoing because they don't know where their parents are and whether or when they will see them again, Gerson explained.

"That is a huge psychological strain that makes recovering from a trauma like this extremely difficult," she said.

Psychiatrists in the New York system, which includes Bellevue, are seeing separated children as young as 5 years, she pointed out.

Depression, Cutting, Suicidal Thoughts

"We see depression a lot in young children and in adolescents that may look like irritability or behavior outburst," Gerson said.

"We have seen kids so depressed that they are thinking about suicide or that they are cutting themselves or hurting themselves in some way," she explained.

Some have flashbacks so severe that they report hearing voices or display psychotic symptoms, but "it's important for clinicians to remember that these symptoms can be due to the trauma; it doesn't necessarily mean a child is psychotic," she said.

Psychiatrists are also seeing developmental regression in separated children, such as a toilet-trained child reverting to bed wetting. And treatment is complicated because the foster parents seeking help do not know the child's medical history.

"It's difficult while children are in this transitional state to do real trauma treatment," Gerson said. "We're trying to support them as best we can."

The California order states that the government was not prepared for the mass influx of children.

Order: Government Wasn't Prepared for Influx

"Measures were not in place to provide for communication between governmental agencies responsible for detaining parents and those responsible for housing children, or to provide for ready communication between separated parents and children. There was no reunification plan in place, and families have been separated for months," the order reads.

The May 7 implementation of the Trump administration's zero-tolerance policy for all adults crossing the border illegally resulted in 2300 children being separated from their parents.

The American Medical Association, the American Psychiatric Association, the American Academy of Nursing, the American Academy of Pediatrics, and the American College of Physicians are among the organizations that called on Trump to put an immediate end to the separations.

On June 20, the President signed an executive order aimed at ending the separation of families at the border by detaining parents and children together indefinitely.

As of June 23, US Customs and Border Protection had reunited 522 of those children.

However, an online Medscape poll shows that physicians are divided over the issue. As of today, 58% of respondents strongly agree and 20% strongly disagree with the executive order ending the practice of separating children from families at the border.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick