Complexities of Forensic Evaluations for Immigrants Facing Trauma

Journal of the American Academy of Psychiatry and the Law | 2025, Vol. 1, p. 2- 10. 

Challenges and Opportunities for Forensic Mental Health in Immigration Courts

Richard Rogers - Regents Professor of Psychology, University of North Texas (UNT), Denton, TX.

Kamar Y. Tazi - Advanced doctoral student in the PhD Clinical Program, University of North Texas (UNT), Denton, TX.

Persons residing in the United States face a daily barrage of polarizing political messages about the increasing influx of refugees and other immigrants. Political wrangling aside, forced immigration constitutes a nearly world-wide pattern with global estimates of forcibly displaced persons set to exceed 120 million by the end of 2024. The number of international migrants in the United States surpassed the combined counts for the next four countries by mid-2020 (i.e., Germany, Saudi Arabia, Russia, and United Kingdom). Resultingly, the southern U.S. border has received a dramatic increase in migrant encounters (i.e., apprehensions and expulsions), reaching an all-time high during December 2023 at nearly 250,000. The influx of foreign-born persons within the broader sociopolitical context of U.S. immigration policy and rhetoric threatens to overwhelm justice and social systems.

Rhetoric aside, the faces of America are literally, as well as figuratively, changing. In the 1970s, America was focused inwardly, with fewer than five percent of its population being foreign born. Within five decades, those born in another country more than tripled (15.6% or 51.6 million persons6), with undocumented immigrants exceeding 10 million. Beyond the literal changes, the seemingly homogenous American society of the 1970s has undergone profound changes in response to globalization and been fueled by exponential increases in forced migration under ongoing threats of violence.

As expressed in its title, this editorial is organized into challenges and opportunities that often represent contrasting facets of the same complex set of concerns. Of its four sections, the first provides a brief overview of the legal questions and processes commonly encountered in immigration courts. The second summarizes three formidable challenges facing forensic psychiatrists and psychologists, specifically the development of evaluation-related legal and empirical knowledge, the adaptation of traditional evaluative methods for immigration referrals (e.g., addressing culture and individual factors), and the risk of retraumatization and vicarious traumatization during evaluations. The third section centers on two major strengths of forensic practitioners, including their expertise with complex traumas as well as their specialized knowledge of response styles, such as malingering. The fourth and final section summarizes concluding thoughts and ongoing opportunities for forensic practitioners.

immigration courts;  asylum evaluations; Franco class; complex posttraumatic stress disorder (C-PTSD); immigration trauma; malingering

“...Asylum evaluations determine whether asylees have a well-founded fear of past or future prosecution based on one or more categories: ‘race, religion, nationality, membership in a particular social group, or political orientation’… 
Conducting immigration court evaluations presents at least three challenges. 

First, forensic practitioners must understand and respond accordingly to the legal criteria stipulated in immigration court referrals. Second, they must adapt assessment methods to consider salient cultural factors... Third, trauma-related needs of examinees [and] evaluators [should] be prioritized… Forensic practitioners conducting immigration evaluations should thoroughly review relevant case law... 

The 2013 Franco-Gonzalez v. Holder lawsuit changed immigrants’ protections in California, Arizona, and Washington with potential plans to apply the protections nationally. Given the civil nature of immigration proceedings, respondents are not necessarily entitled to representation. Eligible members, known as the “Franco class,” are now entitled to representation by a qualified representative in these three U.S. states… The diagnostic basis for membership in the Franco class is relevant to forensic evaluators… six diagnoses may result in eligibility for Franco class membership: psychosis or a psychotic disorder, bipolar disorder, schizophrenia or schizoaffective disorder, major depressive disorder with psychotic features, dementia or a neurocognitive disorder, or moderate, severe, or profound intellectual developmental disorder. Finally, if the presiding immigration judge finds a bona fide doubt of competency, main class membership may be granted” (p. 3- 4).

“...Immigration stressors occur at premigration, migration, and postmigration stages. Professional care during the forensic evaluation should minimize the risks of overwhelming distress resulting from recounting and possibly reliving past traumatic experiences. A “trauma-informed lens” including adequate compassion “is not only ethical, but also likely to enhance data quality” (p. 5).

“Immigrant trauma is often complicated by co-occurring symptoms of trauma, anxiety, depression, and somatic complaints with increased risk of posttraumatic stress disorder (PTSD). Practitioners must carefully consider stressors that are specific to forced immigration and traumatic stressors that precipitate clinical levels of trauma-related dysfunction… During the postmigration stage, continued deprivations and prolonged detainments may contribute to severe emotional distress on both authorized and unauthorized immigrants. Notably, immigrant populations have been subject to “anti-immigrant federal and state policies” that impose restrictions on civil and personal freedoms” (p. 6).

“As forensic practitioners and educators, we have a professional responsibility to improve the quality of services provided to underserved populations, such as persons facing forced immigrations, who often have been subjected to successive traumas extending from preimmigration through postimmigration. The call for forensic psychiatrists and related professionals to conduct immigration evaluations is longstanding, as referrals continue to vastly outnumber available providers” (p.7).

“Cultural humility and cultural competence are essential for working with diverse clinical and forensic populations. Cultural humility is theorized as an ongoing learning process whereby practitioners approach examinees with clear intentions to value their culture and associated beliefs, customs, and norms. Cultural competence is based more on training experiences focused on cultural awareness (i.e., navigating the effects of one’s own culture for clinical work) and cultural knowledge (i.e., learning to identify distinguishing cultural factors). These combine to enhance cultural skills, including the ability to gather clinical data using culturally validated methods.

Forensic practitioners must deepen their knowledge of culturespecific impacts on clinical presentations as part of ‘an ongoing process of learning, not only with the goal of developing a better understand of others’ cultures, but also with the goal of understanding the limitations of one’s expertise…’ 

Forensic practitioners need to implement adaptations, often with translations, to address many evaluations conducted for immigration courts… An evaluator’s use of legalese and specialized terminology may present challenges to translations and cross-cultural understandings. Clear and parsimonious communication becomes a clear priority…” (p. 4).

“...Three recommendations for reducing vicarious trauma, compassion fatigue, and burnout. First, relevant risk factors must be identified within the work settings, such as large and emotionally challenging caseloads. Second, the bolstering of protective factors, such as self-care, may mitigate risks. Third, forensic practitioners should proactively seek clinical interventions, including those specific to vicarious trauma, such as Components for Enhancing Clinician Engagement and Reducing Trauma or (CECERT)” (p. 5).

“From a trauma-informed approach, forensic assessments can implement several precautions. For example, they can address the power imbalances inherent to evaluations. On this point, forensic practitioners can use the informed consent process to communicate respect for examinees and outline the safeguards (e.g., noncoercion) afforded to them. Further precautions include demonstrating empathy without sacrificing the objectivity of the evaluation. Even in unambiguous cases of malingering, many examinees have endured severe and repetitive traumas” (p. 5). 

“Immigration evaluations hold multiple risks of trauma, including both the perils of retraumatizing immigrant examinees and the accumulated risks of vicarious trauma to evaluators. Trauma-informed care describes tailored treatment that accounts for the individual circumstances of trauma experiences and the resulting behavioral, cognitive, and affective dysfunction” (p. 4).

“Forensic practitioners are at risk for vicarious traumas when evaluating immigrants who have experienced severe trauma that may involve entire multigenerational families. For example, asylee and refugee populations may have encountered the ongoing ravages of war or the continued threats of torture and violence without any viable means of escape. Forensic practitioners who work with severely traumatized populations have increased vulnerability to vicarious trauma, compassion fatigue, and professional burnout, all of which negatively affect evaluators and the quality of their work…

Vicarious trauma, also referred to as secondary trauma, describes the ‘negative psychological, emotional, and cognitive effects that result from hearing about the traumatic experiences of others’ with symptoms that may mirror direct trauma exposure (e.g., posttraumatic stress disorder symptoms). The effects of vicarious trauma may be particularly serious among evaluators working with children facing severe and inescapable suffering.

Compassion fatigue debilitates well-being as a result of empathizing with examinee’s hardships and traumatic experiences and has been called ‘the cost of caring.’ For professionals, vicarious trauma and compassion fatigue may culminate in burnout primarily evidenced by decreased engagement in work because of ongoing stressors” (p. 5).

As always, please join the discussion below if you have thoughts or comments to add!

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