‘We Can Begin To Heal the Wounds.’ Inside the Efforts to Provide Mental Health Care to Families Separated at the U.S. Border

When Mari and her teenage son, Jesus, were confronted by Border Patrol agents, they did not know they had already crossed the border from Mexico to the U.S. and were now on American soil. To this day, Mari—an asylum seeker from Guatemala—says she doesn’t know where they entered the U.S., only that the agents arrested them and drove them to a facility where dozens of other women were crying. It wasn’t until the agents took Jesus away from her that Mari understood why they were crying.

“Do you know that you are committing a crime?” Mari says an agent who worked at the facility asked her. “‘No,’ I told him, ‘I’m running away.'”

Mari recalls that the date was May 12, 2018, just five days after then-Attorney General Jeff Sessions announced publicly the implementation of “Zero Tolerance” policy, which resulted in the U.S. government separating more than 5,500 children from their parents at the southern border. The exact number of separated children remains unknown.

The agents told Mari she would be detained at the facility, while her under-age son would be sent to a shelter. They told her they didn’t know when she would see him again. Inside of detention, surrounded by dozens of other women in tears, Mari began to weep. “There wasn’t a single woman who wasn’t crying,” she says in Spanish. “They took our children. When you don’t have your children, when your children are taken, it feels like dying.”

Mari, a 48-year-old mother of five, says she fled Guatemala in 2018 to get away from her abusive husband. She took Jesus, her youngest child, and planned to join her daughter, who had arrived in the U.S. more than a decade earlier. Mari has since been reunited with her son and they are both living with her daughter in Santa Ana, California. Her three other grown children remain in Guatemala.

Mari spoke to TIME under the condition that TIME only publish her first name, for fear of being located by her husband. Her son’s name Jesus is a pseudonym for the same reason.

Mari and Jesus experienced severe trauma from their experience of being separated and detained without knowing when or if they would ever be reunited. Though their family is together again, mental health experts say the trauma of family separation may linger for a lifetime. They are now among over 230 families to request free mental health care as a result of a court order that requires the government to pay for it.

Connecting families to mental health services

In November 2019, a court ordered the U.S. government to cover the cost of mental health care until January 2021 for any families who experienced separation at the U.S.-Mexico border. The court order came after three immigrant mothers who experienced separation sued the federal government in 2018 on behalf of all separated parents to ask the government to pay for mental health services. Because of the COVID-19 pandemic, that deadline was pushed back to June 2021. Now organizations are working to connect families to these services.

In March of this year, Seneca Family of Agencies, a nonprofit organization based in California, was awarded a $14.5 million contract by the government to begin providing free mental health services to the families who experienced separation. Through a program titled Todo Por Mi Familia (All For My Family), Seneca collaborates with several other nonprofit organizations to locate families who could benefit from the court order. Some of those, like the ACLU, Al Otro Lado, Catholic Legal Immigration Network and Kids in Need of Defense, provide legal assistance, while others like Justice in Motion are assisting with the search for parents.

“We had all the data, we knew all the information, we knew the ramifications of separating these families, and yet these actions were done,” says Cheryl Aguilar, founder and lead therapist at the Hope Center for Wellness in Washington, D.C., who has provided therapy for families who experienced separation. “We know that once trauma occurs, there’s a mark for a very long time, if not for the rest of your life. That’s what has been done to these kids and these families. The damage is done.”

Read more: President Trump Won’t Say How 545 Migrant Children Still Separated From Their Parents Will Be Reunited

Paige Chan, the director of Seneca in southern California, says it was clear from the start that her organization would be faced with three primary logistical challenges. The first is finding the parents and children in the first place, she says. The U.S. government often did not keep proper contact information for the parents when they were separated from their children. Roughly 545 parents have still not been located by parties involved with the search. (NBC News reports that the number is higher, with 666 parents remaining at-large). In some cases, parents and children choose not to be reunited in-person, depending on their individual immigration cases. Some parents who have been deported without their children, for example, choose to allow their children remain in the U.S. and pursue a claim for asylum.

The second challenge, Chan says, is building trust with the families, many of whom do not want to be found or contacted by anyone perceived to be associated with the government given their experience of family separation and for fear of being deported. Seneca must also assure families that the services provided are confidential and anything they say to a therapist will not be shared with government officials. Cultural stigmas about mental health care can also create additional barriers to recovery.

Third, and last, Chan says, Seneca must build a network of mental health care providers who can provide culturally sensitive therapy in the right language, either in Spanish or in indigenous languages. The therapist could ideally be able to help address the trauma of separation, along with the trauma of the migration journey to the U.S. and whatever pushed the person to flee their country in the first place. The organization is currently working with 230 providers nationwide.

“While we can never fully undo the damage done by the separations, we can begin to heal the wounds of these families and bring them back together,” says Ken Berrick, Seneca CEO.

Impact of COVID-19

Each of those challenges were made worse in March 2020, shortly after the organization finalized their outreach plan, when cases of COVID-19 began to surge in the U.S. “The world was turned upside down and we had to dramatically adjust all the work that we were doing,” Chan says. Work that would previously have been done in person in the states with the highest amount of reunified families to build trust within communities would have to turn remote.

Instead of locating families through community programs and going door-to-door to speak to people in person, the Seneca outreach coordinators would have to try and build trust through a phone call.

“This is already a population or a demographic that’s going to be really skeptical of strangers calling them for several reasons,” says Johanna Navarro-Perez, program director at Todo Por Mi Familia. “They are perhaps fleeing something in their home country that was challenging or dangerous, and then in this country, at the hands of the government, experienced another sort of intentional trauma… So making that call, being that outreach coordinator, that’s a really tenuous call that you have to be extremely careful and thoughtful about. It’s hard to connect with folks and to be disarming over the phone.”

One of those people making calls is Karina Acosta an outreach coordinator at Todo Por Mi Familia. Through contact information provided by lawyers and other nonprofit organizations who are locating the families, Karina makes the phone call and introduces herself. “Nadamas le quería avisar de los servicios que estamos ofreciendo a las familias que fueron detenidas y separadas en la frontera,” she tells them in Spanish, I just want to let you know about the services we’re offering to families who were detained and separated at the border.

Depending on how the person responds, Acosta might try to engage them with questions about if their children’s behavior has changed, or share general anecdotes about how other families have benefited from mental health services.

Irreparable damage

According to the American Academy of Pediatrics, which has long spoken out against family separation and child detention, the experience can case irreparable damage to a child’s developing brain, which could lead to both short-term and long-term health impacts. “Even if the family separation did not occur because of the parent—in this case the Administration ripped families apart—a child whose brain hasn’t fully developed and who is not able to make sense of this experience may interpret that information as ‘I was abandoned,'” says Aguilar, who is among the 230 mental health care providers working in partnership with Seneca.

Aguilar says that her experience working with immigrants specifically, plus understanding what happens to a child psychologically when they are removed from a caregiver helps inform the treatment she provides. “When a family separation occurs and that attachment is disrupted, what happens when families are reunified is that the families need to be able to have the tools to healthily and happily come back together,” Aguilar says.

In many cases, people do want to talk and are ready to and eager to speak to a therapist. Most have accepted Seneca’s offer of free mental health services. But outreach coordinators do find themselves up against cultural stigmas and misunderstandings of mental health care.

Cultural stigmas

There are also some families who don’t want to take up the services, or remain skeptical even after speaking with an outreach coordinator. Acosta says she doesn’t pressure families who turn down mental health services—according to court documents 176 families declined services as of November 2020—but she does try to inform families of what mental health services are and that the resource is available until June 2021 if they change their mind.

For Mari, accepting mental health services provided by Seneca was easy once she was made aware of what mental health really means, she says. In her household growing up in Guatemala, she says crying was seen as weakness, and could be met with a spanking. But her understanding of therapy changed once she began treatment after being connected with Seneca.

More than two years after Mari and Jesus were separated, Mari can recall how she felt panicked, confused and devastated by the separation. Jesus was 15 when they were separated, which lasted a few weeks. During that time they only spoke on the phone twice, both times in tears. When they finally were reunited, they found it a challenge to speak to each other. Now with the help of a therapist, Mari says, Jesus has started to talk to her more and go outside.

“I feel like he’s getting better,” she says. “Sometimes, I’d watch him and he’d start crying. I’d ask him why but he wouldn’t tell me. Like he didn’t want to express himself. But the therapist has worked with him, and I see the changes he’s been able to make…I can see that he’s overcoming everything that we have lived.”

Mari says she too has benefited from therapy. Her therapist has been able to help her address the separation as well as years of domestic abuse. Mari now uses breathing techniques when she feels sad or overwhelmed, finds it easier to talk about family separation and says she now feels strong after years of internalizing insults from her abuser.

“I believed him when he said I was trash. I thought I was trash, and after everything I experienced on the way, everything that happened to me, I believed it and I had bad self esteem,” Mari says. “But I succeeded. I was done, done, done with abuse, I was tired, and I couldn’t take it any more, so I made the journey, and that’s why my therapist tells me I’m very strong.”