Framework for accepting cases:
If a case is a little out of the ordinary, ask yourself if (1) the request involves diagnosing a potential psychiatric condition (2) a diagnosis that seems feasible given the preliminary info we have. (3) a clearly articulated legal strategy for how a diagnosis will help an evaluee’s immigration case. When in doubt, run a request by faculty.
Pediatrics:
take special care with coordinating the evaluation of minors. Things to consider: The evaluator needs to have training and/or prior experience evaluating children (or a supervising clinician does, for residents performing evaluations). A guardian has to provide consent on behalf of a minor. You may need this in advance of the evaluation if the person will not be available at the time of the evaluation. Some attorneys may request evaluations of children as part of family/group evaluations. For really young children (< 8 y/o or so) there may be a limited evaluation of developmental milestones that some evaluators are comfortable doing, even if a complete forensic evaluation is not possible. For young children, it may be also necessary to set up interviews between evaluators and sources of collateral information (e.g., extended family acting as guardians; teachers; counselors)
Hardship evaluations:
attorneys may request evaluation/interview of a family member as part of a Cancellation of Removal claim because the attorney needs to establish the exceptional hardship that would result to the family member if the client were deported. Some evaluators will do these, but it is an extra interview to do and letter to write on top of the affidavit, so be clear about expectations up front. The attorney should provide clear goals for the interview of the family member. The family member will need their own REDCap form, and the attorney should make sure to select “yes’ to the following question. It is also helpful to use the “Case Management” form to describe these details.
Advocacy letters:
We are getting requests for letters advocating for ‘humanitarian parole’ of detained clients in light of COVID-19. Often these require the review of medical documents, which may be beyond the scope of a mental health evaluator unless strictly about psychiatric illness. There are MSHRP physical evaluators who can do this. Check in with main clinic CMs.
Remote Physical Evaluations:
If you receive a remote physical evaluation request, defer to the MSHRP main clinic (particularly during COVID-19). We have, on a limited basis, coordinated remote physical exams (mostly scar assessments) for clients who we had already coordinated psych evals for. If someone makes that request, you should be in touch with the main clinic CMs to see which evaluators might be available from their pool. When we make these requests, we use the same language about out-of-state licensure as we do for our remote evaluators. There may be requests for evaluation of scars to supplement a mental health assessment.
Competency evaluations:
Some attorneys, especially those less familiar with us, may request a formal competency evaluation. Most evaluators will not do these -- it is a specialized form of experience. If an attorney is confused, explain that our standard forensic evaluations elicit a trauma history, describe resulting psychiatric sequelae and diagnoses, and explain the relevance of those diagnoses to adjudicators. The affidavit may be able to comment on related findings such as behavioral issues, comprehension, memory, etc. but cannot provide a formal determination of competency.
Severe mental illness:
Severe conditions, including psychotic conditions such as schizophrenia, do not preclude evaluation. However, carefully consider which evaluators are best suited for the evaluation. If a recommendation for prescription of antipsychotic could be a relevant conclusion of an affidavit, that may be more powerful coming from an MD.
MPP (Migrant Protection Protocols i.e. “Remain in Mexico”):
We have worked with one client in Matamoros, Mexico through ABA-ProBar but may be doing more. Evaluations may be geared towards the client being allowed into the US while the immigration case pends, and hopefully are also useful longer term for the immigration case itself. It is important to establish a gameplan with the attorney on the following:
- Where the client will be located for the call. It is best if the client can be in a private location, like a resource center, attorney office, or clinic space to ensure privacy and security.
- What to do in case of an emergency: for clients in Mexico, ‘call 911’ may not be feasible in a psychiatric emergency. Our plan thus far has been to make sure that someone is available (at one of these centers, an attorney, etc) who is familiar with the local resources and could assist in an emergency. In the case of clients with severe psychiatric conditions, it is worth discussing with the attorney in advance any risks of the evaluation triggering an acute mental health crisis, and how to mitigate them.
Of note: this is an evolving area, and this is a particularly important type of case to discuss with faculty if there are any questions.