“Better than having no evaluation done”: a pilot project to conduct remote asylum evaluations for clients in a migrant encampment in Mexico

Abstract

Background Asylum evaluations are highly specialized medico-legal encounters to collect physical or mental health evidence for use in immigration proceedings. Although the field of asylum medicine is growing, access to these evaluations is still inadequate, particularly for those in United States immigration detention or other forms of custody, such as under the U.S. Migrant Protection Protocols or “Remain in Mexico” policy. Given advances in telehealth in recent years and growing evidence of similar outcomes with in-person management, it seems prudent to examine whether remote modalities may also be effective for conducting mental health asylum evaluations in hard-to-reach populations. Methods We analyzed the responses of 12 U.S. clinicians who conducted 25 cross-border remote mental health evaluations with clients in Mexico prior to the COVID-19 pandemic, and completed a post-evaluation survey regarding their impressions and experiences of the remote encounter. Data were coded through a process of thematic analysis. Results The average evaluation time was 2.3 h, slightly shorter than might be expected from an in-person encounter. Five themes emerged from the coding process: rapport building, achieving overall goal, comparison of in-person vs. remote, technical issues, and coordination. Clinicians encountered a number of challenges including technical difficulties and a decreased ability to establish rapport. Nearly uniformly, however, clinicians noted that despite difficulties, they were able achieve the goals of the evaluation, including rapport building and diagnosis. Conclusion Remote evaluations appear to achieve their intended goal and may be useful in expanding legal options for hard-to-reach asylum seekers.

Conducting remote medical asylum evaluations in the United States during COVID-19: Clinicians’ perspectives on acceptability, challenges and opportunities

“…A previous study by our team explored the provision of remote mental health forensic assessments across the US-Mexico border and showed the process was acceptable to the clinicians conducting the clinical encounters. 2 …”

“…As clinicians have adapted to remote clinical work, asylum evaluations have increasingly been performed remotely as well, although there is scant published research regarding the logistic barriers and diagnostic efficacy of remote clinical evaluations for this specific purpose and population. 2 , 3 , 4 …”

“… 9 There is considerable evidence showing similar outcomes (diagnostic accuracy, care quality, efficacy, patient satisfaction) between in-person and tele-mental health services in the general population. 2 , 3 , 4 Although the majority of clinical assessments performed remotely have been seen to have similar reliability to in person assessments, the results have been mixed when the assessment requires a visual component. 2 , 3 , 4 Concerns have also been expressed regarding the implications of telepsychiatry on building therapeutic rapport, as well as privacy-related concerns, technological challenges, and an impaired ability to respond to psychiatric emergencies.…”

“… 2 , 3 , 4 Although the majority of clinical assessments performed remotely have been seen to have similar reliability to in person assessments, the results have been mixed when the assessment requires a visual component. 2 , 3 , 4 Concerns have also been expressed regarding the implications of telepsychiatry on building therapeutic rapport, as well as privacy-related concerns, technological challenges, and an impaired ability to respond to psychiatric emergencies. 2 , 3 , 4 Phone interviews have been used and found to be a reliable method to assess individuals for posttraumatic stress disorder and major depressive disorder, 10 which suggests that similar methods can be used to support such assessments in the context of asylum evaluations.…”

Exploratory study on the quality of forensic assessments using the Istanbul Protocol in a virtual versus face-to-face environment.

“…The Covid-19 pandemic has affected models of care and forensic assessment of asylum seekers, which, after initially stalling, have shifted significantly to remote formats com-patible with the total or partial lockdown. Different studies have reported on these changes either in assessments conducted by telephone (Cohen et al, 2021), by video call (Mishori et al, 2021), or using a combination of both methodologies (Green et al, 2020;Pogue et al, 2021). While these studies have generally supported the use of remote assessments alone (Greenhalgh et al, 2020;Pogue et al, 2021), others have recommended a hybrid approach (Gruber et al, 2021).…”