The Limits of Advocacy

Jul 15, 2019

Migrant children were being endangered, with potentially devastating effects on their mental health and development, and we requested policy changes.

COMMENTARY

Over the past two years, psychiatrists, mental health professionals, and other health professionals have challenged the Trump administration’s migration policies, especially relating to family separation and child detention, using evidence based on decades of research of adverse childhood events.1

American Psychiatric Association (APA) President Altha Stewart, MD issued a statement noting that “The APA recommends an immediate halt to the policy of separating children from their parents.”2 Appearing on CNN, Colleen Craft, MD, President of the American Academy of Pediatrics, said that the policy “amounts to child abuse.”3 The American Public Health Association made 26 specific recommendations, including prosecuting human rights violations to the fullest extent of the law.4

Many journalists and advocates continue to report on child deaths in detention, child abuse in detention, and families who are still not reunited. New policies speak of refusing to provide migrant youth in detention with education or recreation.

We all knew that children were being endangered, with potentially devastating effects on their mental health and development, and we did what we thought was our job: we stated our opposition publicly, we referred to the evidence, and we requested policy changes.

We had little effect. In addition to the damage being done to migrant children and families, what kind of damage is being done to health professionals and health institutions?

We have shown ourselves to be ineffective witnesses. Writer and photographer Teju Cole5asked, “Who counts as people?”5 We have not been successful in answering that question or making the case that the people we advocate for “count.” And so, the question forces us to ask if we have been colluding when we allow ourselves to be ineffective witnesses and ineffective advocates.

When suffering is just something that happens, is just another image on a screen, is something we passingly object to, or is coolly turned into a matter of victimization and “trauma,” then the people we advocate for cease to count. Only when we see, hear, feel, and touch them do they matter as people; only when we speak of them as people who see, hear, feel and touch do we count as witnesses.

Our research has proven itself to be ineffective in guiding policy. Yes, our research provides us with abundant evidence to describe bad outcomes from trauma, abuse, and separation-but we need new evidence on interventions to support youth and families, to prevent trauma and abuse, to provide alternatives, and to add something meaningful other than expressing our concerns.

Our professional organizations should call upon donors to support research that will answer these urgent questions.

Our cautious interventions into the political discourse makes us ineffective advocates. When it comes to standing up for our principles and the populations we represent, we need to understand that this is not a marketplace of ideas in which we have respected standing as experts; this is a bar room brawl, and we need to stand up and fight for those to whom we have dedicated our lives.

Lone professional societies do not have the power to take on powerful political interests. “Recommendations” are unimpressive and are easy to ignore. Instead, we need to work in league with other professional and advocacy organizations to speak across disciplines and to make statements informed not only by the evidence but also by our professional acts of witness and community.

We need to be clear about what we are seeing and where we stand, as professionals working in the most human of sciences. They said the point of harming children was “deterrence” even when research conducted by the Center for American Progress and others has demonstrated that this alleged deterrence does not work.6 If deterrence cannot justify the policies, or was never the point, then what is the message other than, “You do not count as human?” We cannot accept this.

In a world of 65 million forcibly displaced persons,7 and cruel or inept government policies guiding the care of children, these issues are not going away. We need to recognize that the limits of our advocacy are largely limits of our own making. If now is not the time to challenge these limits, to think about who we are as a mental health professionals, and to make our voices count, when will it be?

Dr Weine is Professor of Psychiatry and Director of Global Medicine at the University of Illinois at Chicago, Chicago, IL. Dr Henderson is Associate Professor of Clinical Psychiatry at the New York University School of Medicine, New York, NY. 

Disclosures:

The authors report no conflicts of interest concerning the subject matter of this article.

References:

1. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE)Study. Am J Prev Med. 2019;56:774-786.

2. Stewart A. APA Statement Opposing Separation of Children from Parents at the Border. American Psychiatric Association. May 30, 2018. https://docs.house.gov/meetings/IF/IF14/20180719/108572/HHRG-115-IF14-20180719-SD005.pdf. Accessed July 8, 2019.

3. Wise J. American Academy of Pediatrics president: Trump family separation policy is ‘child abuse.’ The Hill. June 18, 2018. https://thehill.com/latino/392790-american-academy-of-pediatrics-president-trumps-family-separation-policy-is-child. Accessed July 8, 2019.

4. American Public Health Association. APHA Opposes Separation of Immigrant and Refugee Children and Families at U.S. Borders. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/separation-of-immigrant-and-refugee-children-and-families. Accessed July 8, 2019.

5. Cole T. Migrants are Welcome. Verso. September 7, 2015. https://www.versobooks.com/blogs/2226-teju-cole-migrants-are-welcome. Accessed July 8, 2019.

6. Wong TK. Do Family Separation and Detention Deter Immigration? Center for American Progress. July 24, 2018. https://cdn.americanprogress.org/content/uploads/2018/07/23131244/FamilySeparation-brief1.pdf. Accessed July 8, 2019, 2019.

7. United Nations High Commission for Refugees. Global Trends: Forced Displacement in 2017. 2018; Geneva, Switzerland. June 25, 2018. https://www.unhcr.org/5b27be547.pdf. Accessed July 8, 2019.

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