10:17am Friday 22 September 2017

Policy déjà vu will have a devastating effect on asylum seeker mental health

Professor Louise Newman

Professor Louise Newman

Nauru has previously been the scene of despair, protest and mental illness, with many broken individuals finding themselves in need of long-term psychological treatment when released.

In my own clinical practice, I treat several former detainees who remain preoccupied with their experiences in detention and are constantly troubled by traumatic memories and anxiety. Their chronic post-traumatic stress conditions are persistent, difficult to treat, and severely limit their capacity to work, relate to others, or create.

These mental disorders are related, in large part, to experiences of prolonged detention, increasing hopelessness, lack of resolution of anxiety and feelings of abandonment. Coupled with previous trauma and the need to flee, the risk of mental disorder is high.

Research over the past decade has clearly demonstrated the association between prolonged detention and mental deterioration. In 2004, Zachary Steel and colleagues reviewed the psychiatric status of a group of detainees in a remote mainland detention facility and found that all adults and children met diagnostic criteria for at least one psychiatric disorder.

Worryingly, children were found to have a tenfold increase in psychiatric disorder subsequent to detention. Exposure to trauma in detention was common and most experienced intrusive traumatic images of these experiences and ongoing anxiety. The majority of parents felt they were unable to effectively care for and support their children.

The implications of these findings are clear – prolonged detention (in this study, more than two years) has damaging effects on mental health. This impact is likely to be increased in particularly vulnerable groups such as torture and trauma survivors, children and unaccompanied minors.

The post-traumatic stress that detainees face is persistent and difficult to treat. AAP

Commissioned by the Department of Immigration,Jeanette Green and Kathy Eagar’s 2010 study found a similar relationship between the length of time in detention and health outcomes.

The authors noted that so-called “unauthorised arrivals” facing prolonged detention engaged in more self-harm and had more physical and psychological problems than other categories of detainees, such as “foreign fishers” or visa overstayers.

Again, mental disorder was seen to increase after 12 months in detention. While this relationship and risk is now accepted by government, it has been difficult to limit the period of time in detention and to facilitate community processing of asylum claims.

Recently, overcrowding in centres and lack of offshore facilities have contributed to processing of asylum claims under community arrangements.

Anecdotal reports of poor treatment in immigration detention are common, with individuals’ autonomy and sense of control routinely eroded. Where the asylum seeker feels abandoned and powerless, unrealistic wishes about rapid processing and positive outcomes may compound the situation.

For survivors of torture and trauma, the risk of mental deterioration is exacerbated as the immigration system itself is experienced as tormenting and unsympathetic. Suicidal ideation is common and self-harming behaviour is simultaneously a form of protest and an expression of distress and despair.

Given past experiences in the detention environment and significant evidence of harm, it’s alarming to see a re-enactment of the conditions known to result in behavioural and emotional breakdown.

Conditions on Nauru, as described in the recent Amnesty International review, are harsh and demoralising. There has been rapid development of protest, increasing despair and associated self-harm, hunger striking and serious suicide attempts.

Conditions on Nauru and Manus Island (pictured) are harsh. AAP

The government has focused on maintaining a harsh regime to send a message of deterrence and is seemingly reluctant to negotiate or compromise.

Increasingly we’re seeing a form of political sloganeering from both major parties which chooses to ignore human suffering and even accepts harm to asylum seekers as “collateral damage” necessary for the overall goal of deterrence. Harsh, inhumane and punitive treatment is tolerated in a morally unacceptable system.

The provision of health and mental health services in remote locations is also problematic. Staff face complex ethical dilemmas as they attempt to provide care and support within a traumatising environment to those without hope.

There are real limitations to “treatment” in a setting where recovery relates to resolution of a refugee determination process which may be delayed, halted or protracted. Under the so-called “no advantage” provision, individuals, including children, may spend several years in detention and their mental deterioration is predictable.

The situation on Nauru is best described as highly volatile and is likely to remain so. The cost of off-shore processing is high in both economic and moral terms and takes us to a place where it is not possible to plead ignorance or lack of understanding.

Attempts to argue that this is acceptable on the grounds of deterrence or prevention of deaths are weak and ignore a decade’s worth of evidence. Back to the future.

Louise Newman is Professor of Developmental Psychiatry and Director of the Monash University Centre for Developmental Psychiatry and Psychology. 

This article first appeared on The Conversation


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