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Mental health libraries manage stress for detainees in ICE custody.

The experience of being a non-U.S. citizen detained by the Department of Homeland Security (DHS) Immigration and Customs Enforcement (ICE) is inherently stressful due to multiple factors. Deportation often means leaving one's home, parents, siblings, spouse, children, job and accumulated retirement behind. The Mental Health Library (MHL) established at the DHS ICE Port Isabel Detention Center (PIDC) was created to help reduce detainee stress in an effort to increase individual physical and mental health as well as overall site safety.

The Division of Immigration Health Services (DIHS) serves as the medical authority for ICE, providing physical and mental health care services to detained non-U.S. citizens in ICE custody throughout the U.S. and Puerto Rico. Detainees, referred to as "patients" within the DIHS system, present with the full spectrum ot mental health disorders normally found in any given population sample. Many preexisting disorders are exacerbated by the stress of being detained. Frequently, disorders precipitated by the difficulty of adjusting to the detention environment are seen to emerge. ICE recognizes the importance of stress management within detention. Preventive care in the form of a two-page "Dealing with Stress" handout, translated into various languages, is a mandatory component of the inprocessing packet provided to every detainee upon arrival at an inprocessing site. This official patient education handout explains how stress can manifest in physical, emotional and behavioral ways. Dealing with Stress makes a number of suggestions for managing stress during one's detention stay. Among these suggestions is to "read books," There was no functioning library at PIDC prior to the creation of MHL, and the process for detainees to receive books from outside sources was cumbersome. It seemed natural to consider establishing a detainee lending library to increase the availability of materials aimed at stress management. Prior to the creation of the MHL, patients would frequently say to DIHS staff, "I wish I had something to read."

The Mental Health Library

The MHL began with a few volumes and grew to 723 by early 2010. The first book was checked out on Nov. 20, 2007, and more than 900 books had been borrowed as of Jan. 30, 2010. The library includes books in English, Russian, Chinese, French and Spanish. There is a section containing large print books for detainees with impaired vision. The majority of the books were purchased in small numbers using personal funds from local library resale stores and thrift shops. All genres are included: fiction, non-fiction, religious, poetry, history, self-improvement, humor, health, psychology and even children's books for those who had lower levels of literacy. Only paperback books are included in the MHL for safety reasons. One book can be checked out at a time and for a maximum of 30 days. A tracking system and a master book list was created to catalog new volumes being added to the library, as well as to keep track of volumes that were discarded due to wear and tear and that had never been returned. As the library grew, a few medical staff, outside agency staff and even detainees themselves made contributions. Many patients had strong spiritual/religious beliefs. Because of the prevalence of faith-oriented coping, community Christian organizations were queried for donations of booklets on prayer, family, hope and one's relationship with God. These volumes were added to the MHL.

The MHL is available to all detainees, though most individuals who use the library are patients receiving mental health services. On average, a detainee borrowed two or three books during his or her detention stay, though some individuals borrowed up to 15 prior to being transferred to another facility between 2007 and 2010. Lengths of stay vary depending on whether the detainee is fighting his case or has signed to be deported. All medical staff were briefed on how to use the library. Hard copy instructions for the MHL use were posted beside the library itself. An article was published in the DIHS newsletter, The Rapid Pulse (now renamed The Communicator) in June/My 2008 to share how the MHL was created, as well as the impact it was having on detainee stress based on detainee and staff self-report alike. The article encouraged duplication of the library across all DIHS facilities.

Qualitative self-reported data regarding the library's effect on detainee stress levels has been plentiful from the MHL's inception, from detainees as well as medical and detention staff. All parties reported that the use of the library helped with emotional and behavioral management in the clinic as well as the detainee living areas. A three-question survey was developed in early 2009 to begin gathering quantitative data. The survey was a simple Likert measure aimed at assessing pre-MHL use stress and post-MHL use stress, as well as each MHL user's subjective definition of stress.


Seventy-six surveys were completed by detainees who used the MHL between April 2009 and January 2010. Each survey consisted of three questions:

* Before checking out a book from the Mental Health Library, would you say you felt no stress, a little stress, a moderate amount of stress or a lot of stress?;

* Would you say that having a book to read from the Mental Health Library lowered your stress not at all, a little, a moderate amount or a lot?; and

* In your own words, how do you define stress?

Survey respondents were from a wide range of countries: Africa (Nigeria and Ethiopia), Bahamas, Belize, Canada, Central American (El Salvador, Honduras and Guatemala), Cuba, Grenada, Guyana, Haiti, India, Israel, Jamaica, Mexico, Morocco, Russia, Saudi Arabia and South America (Venezuela and Columbia). The survey respondents ranged in age from 19-65 years old and included three females and 73 males (prior to July 2009, PIDC housed male and female detainees). Initially, the survey was translated into Spanish and both the English and Spanish versions were given to the patient to fill out prior to the end of any particular mental health session. Written administration of surveys changed to oral administration of surveys when it was noticed that there were different interpretations of the words on the survey itself. The desire was to capture data as accurately and consistently as possible. Administering the surveys orally provided the opportunity to consistently define the words used on the surveys across survey participants to better standardize the survey results.


All 76 survey participants responded affirmatively to question 1 on the survey. All reported that they were experiencing at least a little stress overall. Thirteen patients reported that prior to checking out a book from the library, they were experiencing "a little stress," 22 patients reported "a moderate amount of stress," and 41 reported experiencing "a lot of stress." Likewise, all 76 respondents reported that their stress levels had been reduced to some degree through the use of the MHL. Sixteen patients reported their stress levels were reduced "a little," 24 reported the use of the MHL reduced their stress "a moderate amount," and 36 reported their stress had been reduced "a lot" through the use of reading material from the MHL (see Figure 1).


The final question on the survey was used to gather information about each detainee's unique experience of stress. The various definitions of stress were as unique as each respondent. Some patients described stress in emotional terms: worry, thinking too much, helplessness, hopelessness, sadness, loss of control, fear, frustration, nervousness, anger and anxiety. Others described stress in physical terms: headaches, tension, pressure or "weight on my back." Still others described stress in behavioral terms: difficulty sleeping, loss of appetite, feeling tired, unease, urge to fight or urge to isolate. Most respondents combined the emotional, physical and behavioral descriptors when describing what stress meant to them. It was not surprising to find that the detainees' definitions of stress mirrored the symptoms of stress on the Dealing with Stress handout.


This paper does not propose to offer any definitive correlation between the relationship of the MHL's use and reduction in violence toward self or others. The informal survey process used to gather the information demonstrates only that subjective measurement of detainee stress was decreased through the use of the books in the MHL. The precise impact on stress reduction through use of the MHL could not be isolated from the various other stress management techniques simultaneously in use at PIDC, including but not limited to the simple instructions found on the Dealing with Stress handout provided to all detainees upon arrival to PIDC. Thus, there is a relationship between productive use of a detainee's free time and lowered overall stress levels through the use of one stress management technique--that of reading books.


At any one time, there are approximately 33,000 undocumented immigrants in more than 300 ICE-managed detention facilities and contract facilities nationwide. While detained, DIHS is responsible for caring for the health and well-being of these individuals. Detention by its very nature is a highly stressful situation for many reasons. Uncontrolled stress can lead to physical and/or mental illness as well as safety risks for detainee, detention and medical staff alike. The MHL was initiated to serve as an adjunct to other means of stress management available at PIDC. The survey responses of detainees who used the MHL indicated that having books to read was effective in helping them manage their stress.

Julie Niven is a licensed clinical social worker/certified substance abuse counselor for the Department of Defense on Fort Lee Army Post in Fort Lee, Va. For more information about establishing mental health libraries, email Niven at

Author's Note: The views expressed in this article do not necessarily reflect the views of the Department of Defense.
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Title Annotation:CT FEATURE; Immigration and Customs Enforcement
Author:Niven, Julie
Publication:Corrections Today
Geographic Code:1USA
Date:Dec 1, 2011
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