Psychiatric Resident Participation in an Asylum Clinic: a Single-Institutional Experience.

OBJECTIVE: This study describes the experiences of adult psychiatry residents working in an established faculty-led asylum clinic within a community-based, academic residency program at the Cambridge Health Alliance. METHODS: Eighteen psychiatry residents who participated in the asylum clinic were sent electronic surveys asking about their background and experience. Respondents' responses were collected anonymously. RESULTS: Sixteen out of 18 (89%) trainees responded. Thirteen respondents had a personal history with immigration. Fifty-three percent of residents wanted to utilize their professional standing to advance moral good. Writing up affidavits was noted to be challenging by nine (60%) of 15 trainees. Ninety-four percent (15/16) of trainees noted that they would be willing to perform future evaluations. Most noted that performing evaluations had a significant impact on their clinical practice and their conceptualization of their own roles as psychiatrists. CONCLUSIONS: Participating in asylum evaluations impacts residents' sense of themselves as psychiatrists and expands their views about psychiatrists' roles.

Failing ethics 101: psychologists, the U.S. military establishment, and human rights.

The American Psychological Association (APA) has long maintained a close, even symbiotic, relationship with the Department of Defense (DOD) and the Veterans Administration (VA). Herein we highlight these close ties and describe psychologists' participation in interrogations by U.S. military and intelligence entities. We then review the APA's statements about the permissibility of psychologist participation in the interrogation and torture of suspected terrorists. These issues are significant in and of themselves and because the VA and DOD have been described as "growth careers" for psychologists of the future (1). Additionally, the Health Care Personnel Delivery System allows the drafting of civilian clinical psychologists into military service even in the absence of a general draft. In light of psychologists' extensive involvement in the interrogation process of suspected terrorists, and the possibility that psychologists without prior military experience may be drafted, we wondered how much psychologists have been taught about their ethical duties should they find themselves in military settings. The results of our pilot study of U.S. psychology graduate students, which assessed their knowledge of military ethics, raise concerns that psychologists receive inadequate formal training in these matters. This may leave psychologists vulnerable to misinformation about proper ethical conduct in their future work.

Provider's perspectives on the impact of Immigration and Customs Enforcement (ICE) activity on immigrant health.

INTRODUCTION: Increasing Immigration and Customs Enforcement (ICE) activities such as raids, detention, and deportation may be affecting the health and well-being of immigrants. This study sought to understand the impact of ICE activities on immigrant health from the perspective of health care providers. METHODS: An online survey of primary care and emergency medicine providers was conducted to determine whether ICE activity was negatively affecting immigrant patients. RESULTS: Of 327 providers surveyed, 163 responded (50%) and 156 (48%) met criteria for inclusion. Seventy-five (48%) of them observed negative effects of ICE enforcement on the health or health access of immigrant patients. Forty-three providers gave examples of the impact on emotional health, ability to comply with health care recommendations, and access. CONCLUSIONS: Health care providers are witnessing the negative effects of ICE activities on their immigrant patients' psychological and physical health. This should be considered an important determinant of immigrant health.

The impact of Immigration and Customs Enforcement on immigrant health: perceptions of immigrants in Everett, Massachusetts, USA.

U.S. immigrants have faced a changing landscape with regard to immigration enforcement over the last two decades. Following the passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, and the creation of the Immigration and Customs Enforcement (ICE) agency after the attacks of September 11, 2001, detention and deportation activity increased substantially. As a result, immigrants today are experiencing heightened fear of profiling and deportation. Little research exists on how these activities affect the health and well-being of U.S. immigrant communities. This study sought to address this gap by using community-based participatory research to investigate the impact of enhanced immigration enforcement on immigrant health in Everett, Massachusetts, USA, a city with a large and diverse immigrant population. Community partners and researchers conducted 6 focus groups with 52 immigrant participants (documented and undocumented) in five languages in May 2009. The major themes across the groups included: 1) Fear of deportation, 2) Fear of collaboration between local law enforcement and ICE and perception of arbitrariness on the part of the former and 3) Concerns about not being able to furnish documentation required to apply for insurance and for health care. Documented and undocumented immigrants reported high levels of stress due to deportation fear, which affected their emotional well-being and their access to health services. Recommendations from the focus groups included improving relationships between immigrants and local police, educating immigrants on their rights and responsibilities as residents, and holding sessions to improve civic engagement. Immigration enforcement activities and the resulting deportation fear are contextual factors that undermine trust in community institutions and social capital, with implications for health and effective integration processes. These factors should be considered by any community seeking to improve the integration process.