Sociology

Refugee

Social science

Criminology

Agency (philosophy)

Mental health

Psychiatry

Political science

Psychology

Convention

Paranoia

Medicine

Journal of Paediatrics and Child Health

An 8-year-old Central American boy presented to an emergency department after being separated from his father at the US/Mexico border, placed in a detention camp, and within days flown to a foster agency in a distant American city, experiencing a traumatic whirlwind of displacement and loss. On evaluation, he exhibited poor reality testing while identifying some inanimate objects as his missing family members, and others as weapons threatening to kill him. The paranoia, emotional dysregulation and loss of touch with reality are common manifestations of severe post-traumatic stress disorder (PTSD).1 The forced separation of migrant children from their families by US federal law enforcement at the US border, and the many experiences such children experience under the socio-economic conditions that drive migration, classify as ‘directly experienced trauma’,2 predisposing children to a lifetime of physical and mental health disorders, even in the tender years of childhood and adolescence.3 In recent years, the number of families and unaccompanied children fleeing Mexico and the Northern Triangle of Central America has increased in response to the region's worsening sociopolitical instability. Some4 have dedicated months to travelling through this region, documenting the harrowing journey that migrant children suffer through to reach the USA. The United Nations Convention on the Rights of the Child specifically seeks to prevent such international human rights violations5; the USA is the only member state of the United Nations to have not ratified the convention. Trauma- and stressor-related disorders as described in the fifth edition of the diagnostic and statistical manual of mental disorders are more prevalent in migrant children.6 Children fleeing from Northern Central American countries are fleeing from ruthless poverty, famine and organised gang violence and murder. Upon experiencing such brutality in their home country, they are then greeted with further trauma in the form of family separation at the US/Mexico border.6 Cohort studies researching trauma in populations under 18 have found a strong association between exposure to trauma in childhood with psychiatric co-morbidities.3 People who did not develop PTSD after trauma exposure are at a higher risk of developing psychiatric illnesses other than PTSD, and those who did develop PTSD are at an even higher risk of developing psychiatric illness. Trauma exposure places children at risk for self-harm, suicide attempts, violent and aggressive behaviour, major depressive disorder, substance use disorder and anxiety disorders.1 Survivors of trauma may express their pain in the form of hypervigilance and mistrust, erratic behaviour and aggression. According to the US Substance Abuse and Mental Health Services Administration, there is an overrepresentation of children with mental illness among those who enter the juvenile justice system.7 We believe that the criminalization of maladaptive expressions of one's trauma further punishes and marginalises children in need, hindering their access to education and financial stability. Legal systems must treat children's expressions of trauma as signposts identifying a need for care, especially in lieu of the same government's practices which fail to adequately protect migrant children from traumatic experiences. While the USA played a key role in the creation of the CRC's text, its paradoxical decision to not ratify it into law has allowed thousands of migrant children like our patient to experience traumatic violations of their personhood by separating children from their parents, sparking long-term consequences stunting their development and acculturation into their new home country. Socio-economic systems which drive migration must also be addressed through increased global cooperation and national and international policies aimed towards decreasing capitalist exploitation and increasing universal human rights among our world's inhabitants. As long as a child is within US borders, regardless of legal status, it is the duty of the American government to uphold child welfare standards and the inalienable human rights of the child, as they proposed 30 years ago.

Psychiatric consequences of detaining migrant children at the US/Mexico border