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Fourth Circuit Holds Immigrant Children’s Mental Health Care Should Be Up to Professional Standards

The court’s January 12, 2021 decision was issued in an appeal brought by a class action lawsuit alleging the Shenandoah Valley Juvenile Center (SVJC) in Virginia failed to provide unaccompanied immigrant children a constitutionally adequate level of mental health care due to its punitive practices and failure to implement trauma-informed care.

The district court granted SVJC summary judgment after finding it provides adequate care by offering access to counseling and medication. The class appealed. The appellants were children who fled Honduras, Guatemala, Mexico, and El Salvador “after experiencing appalling horrors,” the Fourth Circuit said in citing to the record on appeal. “Some have been brutally assaulted, including by their own families. Others have seen their friends and families murdered before their eyes,” as they entered the United States as minors without parents or guardians.

Under federal law, they are unaccompanied children who fall into the custody of the Department of Health and Human Service’s Office of Refugee Resettlement. The appellants were placed at SVJC, which has a “high percentage” of children who have experienced trauma and the facility admittedly has a “high need for mental health treatment.” Staff are trained to engage those who suffer from trauma. Residents receive about an hour of one-on-one counseling each week and can request additional visits with clinicians, but those requests are usually denied or ignored.

Despite these offerings, “SVJC acknowledges that the facility does not have ‘the internal capacity to deal effectively with the needs of unaccompanied kids who have severe mental illness’ because it lacks the treatment capabilities of ‘a residential treatment center or hospital.’”

To deal with children who are unruly or who self-harm, SVJC imposes various forms of discipline. This includes verbal reprimands, removal from programs, and room confinement. Staff are authorized to apply “physical restraint techniques” that include “full nelson.” Restraint chairs are used until the children wear themselves out.

The Fourth Circuit found it was proper to apply the Youngberg v. Romeo, 457 U.S. 307 (1982) standard. Youngberg held that “liability may be imposed only when the decision by the professional” represents a “substantial departure from accepted professional judgment.”

The Fourth Circuit’s precedents applied Youngberg to both involuntarily committed psychiatric patients and pretrial detainees. It held that standard should apply to the class because federal law requires these children “be promptly placed in the least restrictive setting that is in the best interest of the child,” and any facility housing them must be “capable of providing for the child’s physical and mental well-being.”

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Related legal case

Doe v. Shenandoah Valley Juvenile Ctr. Comm’n