Research examining the mental health of refugee claimants in immigration detention has shown the deleterious effects of detention. A thorough review of relevant psychological theory and available research findings from international research has resulted in the following conclusions:
• Detention is a negative socialisation experience.
• Detention exacerbates the impacts of other traumas.
Dudley (2003) estimates that the rates of suicidal behaviours among men and women in these Australian detention centres are approximately 41 and 26 times the national average, respectively. Furthermore, male refugee claimants in detention have rates of suicidal behaviour that are 1.8 times higher male prison rates (Dudley, 2003). Steel et al. (2004) assessed parents and children who had been held in Australian immigration detention centres for approximately two years. All of the individuals met diagnostic criteria for at least 1 current psychiatric disorder; 26 disorders were identified among 14 adults, and 52 disorders were identified among 20 children. Mares and Jureidini (2004) confirmed these high levels of psychological distress among adults and children in detention and noted that there was very little support and few interventions provided in those settings. The detention setting places many obstacles in the way of clinicians servicing detainees and making significant improvements in such an impoverished environment is improbable. Refugees’ experiences of immigration detention have offered compelling evidence that detention has impeded efforts to address their mental health needs.
The Detention Health Advisory Group on which the APS is represented, is developing evidence-based policies and procedures in regard to the health and wellbeing of detainees, particularly around suicide and self harm issues. (Commonwealth of Australia, 2007). Studies examining the experiences of refugee claimants have also shown high rates of trauma, PTSD, and depression among this subgroup (Silove, 2002). One study, in which 51% of the sample had experienced torture, showed that, similar to other studies with refugees, combined PTSD and MDD was associated with considerable psychosocial disability (Silove et al., 2006). A host of other factors, including a number of policy-related variables like conflict with immigration officials, obstacles to employment and delays in processing of the refugee’s application, were associated with psychiatric distress (Silove, Sinnerbrink et al., 1999).
Particular emphasis has been placed on the psychological vulnerabilities of child refugee claimants who have been held in immigration detention. Thomas and Lau (2002) conducted an extensive review of local and international research into the mental health status of children and adolescents who were refugees or were detained in the course of claiming refugee status. Thomas and Lau concluded that symptoms of post-traumatic stress are common amongst child and adolescent refugees. Although symptoms vary across age groups, in preschoolers, they are generally manifested in very high anxiety, social withdrawal and regressive behaviours. In school-aged children, symptoms can include flashbacks, exaggerated startle responses, poor concentration, sleep disturbance, complaints of physical discomfort and conduct problems. In adolescents, symptoms may include acting out, aggressive behaviours, delinquency, nightmares, trauma and guilt over one’s own survival (Thomas & Lau, 2002, p. 3).
The studies they reviewed also offered evidence for a direct relationship between the level of pre-migration trauma to which young people were subjected and their levels of post-migration post traumatic stress. Children who were separated from parents or other caregivers were more likely to exhibit symptoms of depression. Thomas and Lau (2002) found evidence in the reported research for an inverse linear relationship between the time since the traumatic events occurred and young people’s level of post traumatic stress symptoms. Symptoms of traumatic stress decreased over time. However, they noted evidence in the research they reviewed which suggested those parents and other caregivers may underestimate young people’s levels of psychological stress and distress, and that young people’s levels of psychological dysfunction were related to levels of psychological dysfunction within their families. Their literature review provided strong evidence for the existence of co-morbid physical and psychological symptoms amongst young refugee claimants and for family separations and unaccompanied arrival having a negative influence on young detainees’ physical and psychological health and wellbeing.
The Australian Psychological Society’s submission (Allan, Davidson, Tyson, Schweitzer, & Starr, 2002) to the National Inquiry into Children in Immigration Detention reached a similar set of conclusions. The submission maintained that holding young people in immigration detention is a negative socialisation experience, accentuates developmental risks, threatens the bonds between children and significant caregivers, and limits educational opportunities. In addition, the detention experience has traumatic psychological impacts, reduces the potential to recover from pre-migration trauma, and exacerbates the impacts of other traumas.
The National Inquiry into Children in Immigration Detention (Human Rights and Equal Opportunity Commission, 2004) found evidence in the submissions it received and in firsthand accounts of health professionals working with young refugee claimants in detention of: pre-migration trauma; negative impacts on young people of long-term detention; a compounding effect between that trauma and the impacts of detention; destructive effects of detention on families; a relationship between family functioning and young people’s mental health; alarming levels of suicidal ideation and acts of self harm amongst young detainees; alarming levels of MDD and PTSD amongst young detainees; diagnosis of other mental health problems, including anxiety, nightmares, bed wetting, dissociative behaviour, emotional numbing and a sense of hopelessness. Evidence also suggested that the levels of mental health care required by these young people could not be delivered effectively in a detention setting.
The inquiry concluded that: findings [on the incidence of MDD, PTSD and anxiety disorder amongst young detainees in an Australian detention centre] are consistent with the observations of a range of other experts about the impact of detention on asylum seekers. For example, a recent study from the United States finds that prolonged detention has a lasting negative health impacts [sic] on detainees (Human Rights and Equal Opportunity Commission, 2004, p. 392).
Finally, the inquiry concluded that “the education available to children in detention fell significantly short of the level of education provided to students with similar needs in the community”(p.636); that “On-site detention centre schools failed to develop a curriculum suited to the needs and capabilities of children in immigration detention” (p.636); and that “[children were inadequately assessed as to their educational needs, and there was insufficient reporting of [their] educational progress” (p.637).