A federal judge ordered President Donald Trump’s administration to stop administering multiple psychotropics to children held in immigrant detention without their parents’ consent.

The government was also ordered the release of immigrant children from the Shiloh Treatment Center in Manvel, Texas, unless a licensed psychologist or psychiatrist has determined they pose a risk of harm to themselves or others.

Officials also must stop employing security measures that are unnecessary for the protection of children, like denying access to water, and they must allow children to make private phone calls to their parents.

The orders from the judge come as the Legal Aid Justice Center filed a class action lawsuit [PDF] against the government for requiring “biographical and biometrical information” from adults in an immigrant children’s household before they are released. Adults are afraid to submit fingerprints and other information to Immigration and Customs Enforcement for them to use for deportations.

Judge Dolly Gee found the administration violated the Flores agreement, which established restrictions on the detention of immigrant children, because the “level of security” at the Shiloh Treatment Center is a “locked facility with 24-hour surveillance and monitoring.”

Staff at the Office of Refugee Resettlement signed forms authorizing the administration of psychotropic drugs.

As noted in the decision, Isabella was prescribed “multiple psychotropic medications, including topiramate.” Topiramate is a drug that is used to help control seizures from epilepsy.

“Nobody asked me for permission to give medications to my daughter, even though the staff at Shiloh has always had my telephone number and address,” the mother of Isabella declared.

Her mother further stated, “I have noticed that she is more and more depressed, and she cries too often. She tells me that she doesn’t want to be in the detention center. When my daughter and I lived together in Honduras, we never had mental problems.”

“In 2015, she had her first epileptic seizure but apart from that, [she] was always a normal daughter, never throwing a plate or anything. She laughed, played, and cried like a normal young girl. In short, her childhood was healthy and normal. In my opinion, detention is affecting [her] a lot and she would quickly get better if they were to return her to me.”

Isabella is taking “very powerful medications for anxiety,” according to her mother, but her daughter is “more nervous, fearful, and she trembles.” She has fallen multiple times and hurt her head and arms. She ended up in a wheelchair because the medications were too powerful and she could not walk.

“She complained about the medications to the staff, that they make her afraid of people,” the mother added.

Another child, Mariela, said the medication she was given resulted in nausea and other side effects.

David is taking pills at the facility in the morning and the night. One of the drugs is escitalopram, which is prescribed to treat anxiety and depression. He does not think his mother was ever asked to give the facility permission to give him drugs.

Yet another child, Sofia, was prescribed various psychotropic drugs, including hydroxyzine. Primarily, the drug is used to treat itching that results from allergies, but it can also be used as a short-term treatment for anxiety, which is why Shiloh is administering the drug to children.

The judge ruled officials violated Texas’ child welfare laws and regulations. She acknowledged the treatment center is allowed to give children drugs on an “emergency basis” without parental consent but noted the administration does not seem to be able to identify instances when drugs were administered in emergencies. So, she rejected this blanket defense by the Trump administration.

As detailed by the National Center for Youth Law [PDF], “Many psychotropic medications have limited or no approved uses by the Food and Drug Administration for children and adolescents.” Often these antidepressants carry “black box” warnings for children and warn they may increase “suicidal thinking” and other behavior.

One child at Shiloh, according to the center, was prescribed Prazosin, Quetiapine, Sertraline, and Olanzapine. This amounts to “two antipsychotics, an antidepressant, and an antihypertensive (sometimes prescribed for adults for anxiety or post-traumatic stress disorder).”

“The concurrent administration of more than one antipsychotic medication and/or multiple classes of psychotropic medications conflicts with professional association guidelines,” the center added. “Children administered multiple psychotropic medications at the same time suffer from an increasing number and severity of adverse effects.

“Published research also confirms that the administration of an antipsychotic and antidepressant concurrently to children or youth substantially increases the likelihood that they will develop Type II diabetes and other cardiovascular problems.”

There is evidence that staff at Shiloh “forcibly medicated” children on several occasions and insisted they be “medically compliant” if they wanted to be released from the facility.

One 15-year-old from Honduras was held [PDF] at Shiloh and took medications in the morning, noon and night. The drugs were supposed to help with depression, anxiety, sleeping, and to help them feel better.

“The staff tell me I need to take the medications for my own good. None has given me a diagnosis,” the 15-year-old shared. “No one has told me that I am dangerous. No one has told me that they are worried that I will run away. I don’t have any problems. I haven’t gotten into any fights. No one has given me a document that explains why I am still detained at Shiloh. I don’t think I would feel as sad and anxious if I were living with my dad.”

“No one has given me the opportunity to go to court or speak with a judge,” the 15-year-old added.

Another 16-year-old shared that they had witnessed a youth given an injection he did not want. “A staff member had to grab him first and then give him the injection.”

It seems possible children without epilepsy are being misdiagnosed. One child noted, “Lately, the doctor informed me that I do not have epilepsy, and in fact I have not suffered any attack for three or four months.”

Shiloh, a for-profit center, has a sordid history of abusing children. In 2014, the Houston Chronicle exposed how the facility was responsible for violence, unreasonable and excessive use of restraints and the deaths of children while in custody. They also were administering drugs to children without giving authorities any proper notice.

On top of ordering the government to stop administering drugs without the consent of parents or guardians, the government was ordered to appropriately notify children of why they are detained in facilities like Shiloh.

If a child is detained solely because they reported gang involvement or “displayed gang affiliation while in care,” and the government lacks probable cause to believe the child committed a specific offense, they should be released. This also applies if children revealed past gang involvement prior to detention, but there is no reason to believe any specific offense was committed.