Mentally Incompetent and Alone: Detainees Now Fight Without Help

In an immigration detention center in Georgia, 32-year-old Luis sits silently in his cell, staring blankly at the wall. Diagnosed with schizophrenia before his arrest, Luis hasn’t seen a mental health specialist in over a month. He doesn’t understand why he's being detained, doesn’t know the next step in his legal process, and most crucially—he doesn’t have a lawyer. Like thousands of others in U.S. immigration custody, he is mentally incompetent and utterly alone.

As the immigration system becomes more complex and overcrowded, one of the most overlooked and tragic groups within it are the mentally ill detainees—non-citizens who are often incapable of understanding or participating in their own legal proceedings. With no constitutional right to government-appointed counsel in immigration court, many face the threat of deportation, confinement, or indefinite limbo without ever fully understanding why.

A Hidden Crisis Behind Bars

In 2011, the U.S. Department of Justice estimated that at least 15% of immigration detainees have a serious mental health condition. Today, advocacy groups estimate that number may be even higher, fueled by the trauma of migration, poor detention conditions, and limited access to psychiatric care. Diagnoses range from PTSD and bipolar disorder to cognitive disabilities and schizophrenia.

For detainees like Luis, immigration proceedings—often conducted in English, under immense pressure, and with little legal aid—can feel like a maze of confusion. Many are unable to assist in their own defense, communicate with a judge, or even articulate why they left their home country. And yet, unless they are lucky enough to be in a jurisdiction that mandates legal support, they must represent themselves in court.

“The system is simply not designed to accommodate people with severe mental illnesses,” says Sara Klein, an immigration attorney and mental health advocate. “It assumes a level of understanding and engagement that mentally incompetent detainees cannot provide.”

A Patchwork of Protections

While criminal defendants in the United States have the right to a court-appointed attorney if they cannot afford one, immigration proceedings are classified as civil, not criminal. This legal technicality means that even the most vulnerable immigrants—those with severe mental illnesses—do not automatically receive a lawyer, unless they can pay for one or are granted help through rare pro bono programs.

Some progress has been made. In 2013, the Franco-Gonzalez v. Holder case led a California federal court to rule that certain mentally incompetent detainees in Western states must be provided legal representation. That decision led to the creation of the National Qualified Representative Program (NQRP), which provides legal aid to detainees in select states.

But the program is not nationwide. Most of the country’s detention centers fall outside this protection. In places like Texas, Louisiana, and Georgia—where many large-scale detention centers are located—mentally ill detainees are routinely forced to navigate the legal system alone.

“The Franco ruling was a beacon of hope,” says Klein, “but its limited scope means countless people in other states are left behind.”

Stories from the Inside

Advocates and journalists have documented harrowing accounts of mentally ill detainees in ICE custody:

A man with a traumatic brain injury was detained for over a year in Arizona. He had no lawyer, and during hearings, repeatedly answered questions with unrelated words or silence.

A transgender woman with bipolar disorder in a California facility was placed in solitary confinement for weeks. Her medication was stopped without explanation. She missed her hearing because she was too disoriented to attend.

A young Haitian asylum-seeker with schizophrenia was deported without ever having a chance to explain that he fled political violence. He had no legal representation and was unable to describe his symptoms in court.


These cases are not outliers—they are symptoms of a system-wide failure to account for mental health in immigration enforcement.

Medical Neglect as a Legal Barrier

Even beyond the courtroom, conditions in detention centers often worsen existing mental illness. The use of solitary confinement, lack of access to psychiatric medications, and language barriers all contribute to deteriorating health. In some cases, detainees are medicated without proper evaluations; in others, they go months without necessary treatment.

“These centers are not equipped to deal with mental health,” says Dr. Amina Rahim, a psychiatrist who has consulted for ICE facilities. “There’s a revolving door of providers, limited oversight, and high turnover. Patients fall through the cracks every day.”

According to a 2021 report by the ACLU, ICE has no uniform policy for screening and treating mental illness. This leaves each facility to create its own protocol—if any. In many detention centers, mental health screenings are minimal and usually occur only once, upon arrival.

Worse still, when detainees do exhibit signs of severe illness, they are often punished rather than treated. Solitary confinement remains a common tool used against individuals having mental health crises, despite growing evidence that isolation can exacerbate psychiatric conditions.

Legal Limbo and Indefinite Detention

Another consequence of mental incompetency is the risk of indefinite detention. If a detainee cannot be deported (due to statelessness or unstable conditions in their home country), but is also deemed unfit to appear in court, they may remain in ICE custody for months—or even years.

“There is no safeguard to prevent someone from being forgotten,” says Klein. “Without legal representation, they become invisible.”

Some detainees are eventually released, often without treatment plans, housing, or access to care. Others are deported in violation of international human rights norms that prohibit removing individuals with severe mental illness to countries where they face inhumane conditions or abuse.

A Call for National Standards

Human rights groups and legal scholars argue that the U.S. needs federal-level reform to protect mentally incompetent detainees. They advocate for:

1. A nationwide right to counsel for all immigration detainees with diagnosed mental illness.


2. Uniform mental health screening and treatment protocols in all ICE facilities.


3. Limits on solitary confinement, especially for detainees with psychiatric conditions.


4. Alternative-to-detention programs, such as community-based mental health supervision.



Several bills introduced in Congress have aimed to address these gaps, but progress has been slow. Meanwhile, advocates continue to press the Department of Homeland Security (DHS) and Immigration and Customs Enforcement (ICE) to implement internal reforms, including expanding the NQRP and improving medical oversight.

“There is no moral justification for allowing mentally incompetent people to face deportation alone,” says Dr. Rahim. “It’s not just legally flawed—it’s inhumane.”

The Human Cost

At its core, this issue is about dignity. The United States prides itself on due process and equal protection, yet for many detainees with mental illness, these principles remain out of reach.

Luis, still detained and still unrepresented, may eventually be deported—without ever understanding the charges against him, the rights he never knew he had, or the country he’s being sent back to. His story is one of thousands.

As legal systems debate, and politicians delay, the human cost continues to rise.

The question remains: In a system that already pushes the vulnerable to the margins, who will speak for those who can’t speak for themselves?