Mental Health Crisis in Immigration – Time to Act
An inquiry is urgently needed into the provision of mental health care for refugees and asylum seekers across the immigration system. Mental illness and distress have become endemic with effects for children and adults, with serious consequences. In the past few weeks no less than 9 young people have been transferred to Australia after Federal Court interventions by the National Justice Project and others.
On Tuesday (30/07/18) The WA Coroner in Perth will begin the first of 3 Inquests into the deaths in Australian custody of asylum seekers. Fazal Chegeini was an Iranian Kurd who was found to be a refugee but held on Christmas Island and denied entry to Australia. The contract medical service IHMS noted his physical and mental decline but the Department refused treatment on the mainland. Fazal was found dead in scrub outside the Detention Centre in December 2015. His is a tragic example of failure to provide much needed psychiatric assessment and care and is ultimately a failure to prevent loss of life.
There have been 12 deaths by suicide in offshore processing facilities, and high rates of self-harm including in children as young as 10 years of age. We are witnessing the consequences of a system which fails to acknowledge the vulnerability and mental health needs of this group and contributes in a direct way to mental deterioration and mental illness.
Urgent independent review and oversight is needed to focus on:
1 Standards of overall health service provision and monitoring of care
2 Emergency response and transfer procedures to appropriate psychiatric facilities when clinically indicated ad recommended by clinicians
3 Medical governance – the Commonwealth Government’s response to clinical recommendations relating to refugees and asylum seekers
4 Need to empower clinicians by involving Health authorities with decision making powers regrading medical and mental health treatment
5 Need for independent expert clinical advice on mental health and prevention of mental disorder in vulnerable groups including the needs of women, children and young people
Service providers, medical experts and whistleblowers have all raised growing concerns about mental health issues involving highly vulnerable people. There is an available body of research pointing to the high rates of mental illness in detention and the impact of prolonged detention and lack of resolution on traumatized groups.
The now disbanded independent advisory group to the Immigration Department (DEHAG) provided advice and repeatedly advocated for reform and improved standards of care. In an increasingly politicised area, the needs of asylum seekers are marginalised and clinicians are disempowered and compromised in terms of their caring role. This has direct consequences for the provision of care:
1 Undermining of clinical expertise and lack of action on clinical recommendations
2 Urgent and necessary treatment is being routinely denied and delayed
3 Mental health deteriorates with serious consequences including suicidal behavior, psychosis and child disorders such as Pervasive Refusal Syndrome
There is no process currently to adequately investigate and resolve these issues and no formal review of the impact of delayed treatment and failure to follow medical recommendations. While some of the deaths in offshore detention are subject to coronial processes in Australia and Papua New Guinea, these processes are limited to the circumstances of individual deaths and the need for systemic reform is urgent.
Of particular concern are children and adolescents with acute mental health issues including self-harm and suicidal ideation and the lack of adequate child and adolescent psychiatric expertise within the immigration system
DOCTORS FOR JUSTICE RECOMMENDS
1 Urgent establishment of a special commission of inquiry into the health and mental health needs of asylum seekers and refugees and review of current service provision. This needs to involve the medical and clinical professional organizations and refugee health experts.
2 Reestablishment of an independent oversight and monitoring body to review standards of care in immigration and reporting to health authorities. Health care should be provided and managed by public health services
3 Review by independent specialist mental health clinicians of the mental wellbeing and mental condition of all detainees currently receiving mental health care and support for comprehensive care.
Professor Louise Newman AM FRANZCP
Convenor, Doctors for Justice