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Submission to the National

Inquiry into Children in Immigration Detention from

the Australian Association

for Infant Mental Health (AAIMH)


Prepared by Dr

Rosalind Powrie, BMBS, FRANZCP.

Aims

of AAIMH

Focus of this Submission

Recommendations

References

Acknowledgments


Aims of

AAIMH

The Australian Association

for Infant Mental Health (AAIMH) is the Australian Affiliate of the World

Association for Infant Mental Health. It aims to improve professional

and public recognition that infancy is a critical period in psychosocial

development for infants and the family and to provide a focus for multidisciplinary

interaction and co-operation for those who are involved and interested

in working with infants and caregivers.

In carrying out its

aims the Association prepares reports and submissions to governments,

other authorities, organizations and individuals on matters relating to

infant and family health and welfare. The Association is pleased to take

the opportunity to present such a report to the Human Rights and Equal

Opportunity Commission Inquiry into Children in Immigration Detention

particularly in relation to infants and very young children.

Focus

of this Submission

In keeping with the

submission guidelines and the specific experience and expertise of AAIMH

the following areas relating to immigration detention and children will

be addressed:

1.

The psychological and social well being and development of infants and

young children and their families in immigration detention.

2.

Specific services required for young children and pregnant women in

detention and on their release into the community.

3.

Culture and its influence on the psychosocial well being of infants

and their parents.

4.

The impact of detention on the well being of young children.

5.

The UN Convention on the Rights of the Child in relation to child asylum

seekers.

Recommendations


1.

The psychological and social well being and development of infants and

young children in immigration detention.

The following factors

provide a context for understanding the impact of detention on young refugee

children and their families as they are well recognized as critical for

the healthy emotional and social development of young children.

  • During the first

    three years of life the brain develops to 90% of adult size and is extremely

    sensitive to environmental influences. The human brain is therefore

    most vulnerable to disruptive and traumatising experiences during this

    time (Perry 1996).

  • Fundamental to

    the child's earliest experiences is the attachment relationship with

    his or her primary caregiver(s). In most cases this will be the mother

    initially but may equally involve the father and other close family

    members.

  • A healthy and

    secure attachment during infancy is built by repetitive and finely tuned

    interactions between caregiver and child and there is a critical period

    for its development during the first year of life.

  • Infants are biologically

    programmed to elicit these attachment behaviours from their carers in

    order for them to survive and thrive. Factors crucial in this process

    are the emotional availability of the caregiver to "tune"

    into the infant's signals and cues and respond accordingly. Examples

    include holding and comforting, making eye contact, face to face interactions,

    positive touch, the use of smell, touch and sound, playing, smiling,

    talking with babies.

  • Through these

    sensory interactions with the caregiver the infant learns how to regulate

    his or her emotional state and control distress which is important in

    the development of emotional stability and socialisation.

  • Parental mental

    ill health, overwhelming stress, social disadvantage, and poor education

    or knowledge about child rearing, can all lead to disruption in the

    development of secure attachment relationships, which in turn has an

    effect on the infant's developing brain, sometimes with irreversible

    consequences for the infant's capacity to think, feel and form meaningful

    stable relationships. These consequences can continue on through childhood

    and into adult life.

  • The longer term

    consequences of this disruption or dysfunction in the parent-infant

    relationship can be prevented through targeted early intervention (Kowalenko,Barnett,Fowler,Matthey

    2000).

  • Parents from

    differing cultures rear their children in ways which will best ensure

    their survival and socialisation according to their culture's norms

    and values. This means that healthy child rearing can be accomplished

    in diverse ways and generally occurs when parents themselves are healthy,

    well informed have had adequate parenting themselves and are not harassed

    by poverty or other overwhelming stressors (Wolff 1994).

With this general

understanding of the importance of early care giving on the mental health

and development of children, specific factors for young refugee children

in detention need to be understood.

Mental

health of refugee parents- impacts on young children

In general, refugees

experience very high rates of mental ill health and psychological distress

( RANZCP College Statement #46).

Refugee parents may

have experienced torture, imprisonment, persecution and institutional

violence by the political regimes of their country of origin, or have

witnessed a spouse or close family members undergoing such experiences.

Many families prior

to detention in Australia have experienced long and perilous journeys

and been in transit for months or years in refugee camps or in countries

where they have had no citizenship rights, lived in very poor and overcrowded

housing and where basic needs have been barely met. Children are conceived

and born in such situations of deprivation, uncertainty and with minimal

or no health care.

Psychological distress

and poor mental health is often chronic and continues after re-settlement

and acquisition of relative safety. This stems from a myriad of complex

factors including the consequences of traumatic stress, enormous grief

and loss, social and cultural dislocation, language barriers, ongoing

fears for family and friends left behind, physical health problems, loss

of status and acculturation stressors.

Refugees in detention

experience, in addition, ongoing uncertainty regarding their immigration

status. This, of course, impacts on their mental health more acutely.

The effects of these

factors and forces will compromise many refugee parents' capacity to care

for their children.

More specifically

both parental depression and post-traumatic stress disorder (common in

adult refugees) have direct effects on the development of infants and

young children.

Parents experiencing

post-traumatic symptoms are often extremely irritable, have unstable moods

and poorer impulse control. Infants experience these moods and behaviours

as frightening and in turn are unintentionally traumatised by the parents'

symptoms. This sets in train a series of difficult interactions, which

if not alleviated, can lead to an insecure attachment and poorer social,

cognitive and emotional outcomes for the child.

It is well known

that depressed mothers in turn are less sensitive to their infants and

are less likely to talk and look at their infants. In extreme cases this

can result in emotional and physical neglect resulting in the infant's

failure to thrive.

In disadvantaged

populations, depression in mothers (and mothers in immigration detention

are profoundly disadvantaged) has been shown to produce severe disturbances

in the mother-infant interaction (Murray et al 1996).

Parents who are emotionally

unavailable and irritable will experience difficulty managing the normal

oppositional behaviour of toddlers leading to an increased risk of coercive

and abusive discipline. Boys are particularly at risk of later anti-social

behaviour and cognitive impairment in this context (Sharp 1995).

The following anecdotes

illustrate the difficulties in recognition and prompt treatment of mental

health problems of families in detention and the adverse consequences

for their children

"One mother

I saw had a generalized anxiety disorder. Her two and a half year old

was accidentally burnt by her when she spilt a cup of tea on his leg.

The burn was minor but to reassure the mother they were both admitted

to the local hospital. The mother then became even more anxious. The child

refused to walk and would only lie curled up in the foetal position in

the mother's lap. This situation went on for some weeks until eventually

the mother was given counselling and things improved."

(Dr Simon Lockwood, G.P., Woomera Detention Centre)

"A mother

with a 5 month old baby presented with concerns about harming her child.

The baby was removed from her care by child protection services and placed

with another family in detention. The mother was severely depressed and

possibly psychotic. She was finally admitted to the local hospital with

her baby and treated with medication. It was reported she recovered and

is back in detention with her baby."

(Dr Fiona Hawker, Psychiatrist, Rural & Remote Mental Health

Service)

In this case adult

mental health services had recommended an admission to a specialised mother

infant unit which did not occur.

It is not known what,

if any, after-care this mother and her infant were offered. Post-partum

depression with intent to harm oneself or the infant is a medical emergency.

It usually requires

immediate hospitalisation preferably in a specialised mother infant facility

to ensure safety of both, treatment of the mother's illness and also to

prevent separation of mother and child which can be detrimental to the

attachment relationship. In addition, specific treatment for the mother-infant

relationship is usually required, or at least needs to be monitored.

The

Effect of Detention on Parenting

The effects of institutional

living on parents in detention undermines and significantly limits their

already compromised capacity to nurture and protect their children. There

is little privacy for families, individuals are identified by numbers

not name, parents lose their roles and responsibilities, there is regimentation,

constant surveillance and in at least some detention centres, sparse recreation

facilities for families.

"In detention

parents of young children become completely disempowered…. They cannot

cook for their children or do anything for their kids. They lose their

self-esteem… they stop caring. Most of the parents I see have mental

health problems, many of the mothers are depressed. Mothers of toddlers

often don't care if they turn up for meals or if they wander off….mothers

and children housed outside detention in the community housing project

in Woomera do better. These children are better fed, and clothed, mothers

are able to look after them better."

(Dr Simon Lockwood, G.P., Woomera Detention Centre)

Parents feel helpless,

despairing and enormously guilty because they are unable to help improve

their children's situation. Pregnant women in isolated centres such as

Woomera experience further trauma and loss through the accepted practice

of transferring women at 36 weeks gestation to regional hospitals for

delivery. This vignette describes one such experience for a mother and

her family with young children

A couple with

a 2 year old and a baby aged 5 months repeatedly begged, "Please

take our children, find a place for them away from here. He will change

to a savage not a human. Please do something for a family to adopt him

until we can care for him again. He doesn't trust in us anymore. He can't

play, he won't eat, he can't sleep well".

This family had

spent 9 months in detention and had recently had their application for

refugee status refused. Mrs Z had her first child in the Middle East,

in a normal, uncomplicated delivery and had breastfed him for 12 months.

She was too distressed to tell me about the second child's birth so the

story came from her husband. During the interview she was expressionless

and almost mute, occasionally tears coursing down her face. She cared

for her infant in a mechanically adequate way with no animation. She appeared

helpless in the face of her older son's behaviour.

Her second child

was born in a hospital 200 kms away by caesarian section that she says

she did not understand or consent to. This occurred after a period of

4 weeks enforced bed rest, away from her husband and son, under guard

in the hospital. She did not see her baby for some days and could not

breast feed when she was returned to her. She was returned to the centre

one week after delivery and given no follow up, apart from occasional

visits to the detention centre nurse, who gave her panadol and wound dressings

but did not help Mrs Z dress or clean her wound. The wound continued to

weep for 6 weeks and remains painful. She feels violated and disenfranchised.

The 2 year olds behaviour deteriorated during and after his separation

from her. The parent's relationship was also clearly under stress, "He

says I should be getting better everyday, instead I am getting worse".

The toddler was

indeed angry and disruptive. He threw any offered toys away and spat at

people, he attempted to eat bits of foam that lay on the floor. He repeatedly

tried to

leave the room and when he succeeded, wandered quite far until returned

by a guard. His father said " You see his behaviour ? It is because

we are sad and weeping all the time. He has lost his trust in us…..

His wife had an

air of despair. She attempted to limit her son's behaviour but soon gave

up. She asked to leave the interview to take him back to the compound.

She remained quiet and withdrawn occasionally weeping throughout the interview,

initially placing the baby in his pram in the corner of the room, facing

the wall. She fed her without eye contact… The infant (at a developmental

stage when most babies interact socially at every opportunity), made no

attempt at eye contact and looked profoundly sad. She made little sound

or complaint, but later became more animated when direct attempts were

made by the interviewer to smile at and talk with her.

Mr Z feels unable

to protect his children, impotent and trapped, reduced to less than human

himself and unable to fulfill his role as father and husband. I asked

whether his desire to have the children placed with another family came

out of fear that he might hurt his child, and he said, partly this was

true, relating an attempt to cut his own and his son's throat when their

refugee application was rejected after 8 months of waiting. He says he

was only stopped from hurting himself and his child by other detainees."

(This vignette submitted

by Dr Sarah Mares, Child and Adolescent Psychiatrist )

Safety

of infants and young children in detention

Clearly parents who

are disempowered and depressed are less able to protect their children.

In addition, events in the Woomera Detention Centre and to a lesser extent

other centres have demonstrated without any doubt that detention is a

dangerous place for children. Children of all ages have been exposed directly

to adult violence, riots, hunger strikes, self mutilation and attempted

suicide by other detainees. As there is no separate accommodation for

families children are exposed to the extreme acting out and despair of

adult detainees including in some cases their own parents.

"Three schools

have been burnt down in 18 months, there is no pre-school- any equipment

supplied to younger children is destroyed by the adolescent or adult male

detainees…women and children need to be moved out….they cannot

be protected in detention.

(Dr Simon Lockwood, G.P., Woomera Detention Centre)

Toddlers and pre-schoolers

are exhibiting phobias and other forms of traumatic anxiety when exposed

to reminders of violence in Woomera such as fire trucks and tractors.

These anxieties continue on release into the community and cause disability.

For instance, a three year old has, since his family's release to Adelaide,

continued to exhibit phobias from his detention experience - even cyclone

fencing causes him distress. (personal communication, Steve Thompson,

Psychologist, STTARS - Survivors of Torture, Trauma and Rehabilitation

Service).

While symptoms of

trauma and distress may be more obvious in older children, infants only

present with global problems in physical functioning- settling, feeding

or sleeping difficulties, listlessness, apathy or irritability ( Schwartz

et al 1994) which is likely to go unrecognised by staff in detention centres.

2. How is

trauma and developmental harm detected and what services are required

to treat infants and young children

Assessing young children

for trauma related developmental harm and attachment difficulties requires

specialised skills. Prompt access to child mental health services which

can assist and support primary health workers or provide a direct service

to refugee families is essential for such assessment.

Assessments of the

parent's capacity to provide consistent protection, nurturing and stimulation

appropriate to the developmental level of the child need to occur through

direct observation of carer and infant and by assessing the mental health

problems of parents. Parents require prompt access to mental health services

to identify and treat these problems, and support in parenting their children

whilst this occurs.

The child's family

is central to the child's recovery from developmental harm. Refugee families

will require continuing and high level support to assist with the many

and ongoing environmental stressors they experience during detention and

on release to enable the child's safety to be ensured over time.

Interventions targeting

refugee parents and their infants should follow best practice guidelines

in infant mental health this means high quality ante-natal and peri-natal

care including screening for ante-natal and post-natal depression, parenting

education, appropriate language and cognitive stimulation for children,

regular visitation in their place of residence, family support, and the

gamut of well baby care offered in the community.

All of these interventions

must be delivered by services and persons who are culturally sensitive

and inclusive of the values and beliefs of refugee families. Specialist

refugee services, bilingual and bicultural workers should be utilised

and work in collaboration with mainstream health services.

However a fundamental

condition which must be met in order for any intervention to work is the

child's safety. Detention poses, by its very nature ongoing threats to

the physical and emotional health of children and therefore will undermine

any therapeutic interventions and efforts.

3. Culture

and its influence on the mental health of families

Infants begin learning

about their culture from birth through the daily caregiving they receive.

Cultural beliefs and practices give meaning to everyday life. Refugee

families experience enormous cultural loss and bereavement on arrival

in Australia and invariably experience "culture shock", the

disorientation and confusion associated with attempts to understand new

lifestyles, social structures, the geography, and the educational, health,

welfare, legal and government systems which they must negotiate in order

to re-settle.

A strong sense of

cultural identity and maintaining access to one's cultural and religious

community (religious figures, schools, education and other resources)

can enhance resilience and coping in the face of these tumultuous changes.

Detention, by its

institutional nature must severely reduce the opportunities for families

to practise their culture and religion because they simply do not have

access to like communities, places of worship, rituals and activities

of cultural significance.

4. Impact

of Immigration Detention on the well being of children

The evidence previously

cited and the vignettes discussed show that the policy of mandatory detention

of families who seek asylum in Australia has direct and harmful consequences

for families of all children- infants and young children being especially

vulnerable. In summary

  • Infants and young

    children are placed in a physically harsh and restricted environment

    with inadequate space and facilities for safe play and development.

  • The detention

    environment is dehumanizing. For example, children witness their parents

    and themselves being introduced and identified by number not name, and

    subjected to the daily humiliations that detention involves.

  • Children witness

    their parents' powerlessness in the face of the institutional environment.

  • They are exposed

    to adults who are depressed angry and suicidal.

  • Their parents

    are unable to protect them from witnessing the violence and despair

    of adults living with them.

  • The parents themselves

    inevitably feel hopeless and guilty, in part with the recognition that

    they are exposing their children to their own despair and unable to

    make their circumstances better.

  • The extent of

    untreated trauma and depression in some of these parents puts their

    children at risk of emotional neglect and physical and emotional abuse.

5. The United

Nations Convention on the Rights of the Child and children in Immigration

Detention

The rights of child

detainees in Australia are far from being met under the Convention for

reasons already outlined in this submission. These include the right to

  • family life and

    to be with parents unless separation is in their best interests

  • highest attainable

    standard of health

  • protection from

    all forms of physical or mental violence and the right to recover and

    be rehabilitated from neglect and abuse

  • practise their

    culture, language and religion

  • rest and play
  • primary education

    and secondary education

  • appropriate protection

    and humanitarian assistance

  • not be deprived

    of their liberty unlawfully or arbitrarily with detention only in conformity

    with the law, and as a measure of last resort and for the shortest possible

    period of time.

  • be treated with

    humanity and respect for their inherent dignity and in a manner which

    takes into account their age

  • access to legal

    assistance and the right to challenge their detention

  • not be subjected

    to torture or other cruel, inhuman or degrading treatment or punishment

Recommendations

  • Continued long

    term detention of young children and their families is unjustifiable

    on developmental, medical and mental health grounds. Provision must

    be made immediately for child asylum seekers and their parents to be

    housed in the community and not held in detention centres. Immigration

    detention is directly and indirectly traumatizing for infants, children

    and their families. The impact of living in this environment compounds

    existing problems experienced by parents already compromised by past

    trauma, loss and continuing uncertainty about their future. Mental health

    interventions and services will be ineffectual in this context of ongoing

    trauma.

  • Children and

    their parents must have access to the full range of health services

    available in the community including adult and child and adolescent

    mental health, early childhood and disability services and bicultural

    workers. These are most likely to be available in urban or large regional

    centres.

  • Pregnant refugee

    women must have access to high quality antenatal care which ensures

    they are fully informed and consent to the type of child birth options

    available to them. All efforts must be made to prevent prolonged separations

    from pregnant mothers who have other young children. After delivery

    mothers must have access to perinatal mental health services and mother-infant

    services.

  • State and Federal

    governments must make clear and immediate agreements to ensure that

    the best interests of child asylum seekers are upheld in delivering

    health and welfare services to them.

References

Kowalenko, N., Barnett,

B., Fowler, C., Matthey, S., (2000) The Perinatal Period Early Interventions

for Mental Health. Vol 4 in R Kosky,A Hanlon, G Martin& C Davis (Series

Eds.), Clinical Approaches to early intervention in child and adolescent

mental health. Adelaide: Australian Early Intervention Network for Mental

Health in Young People

Murray, L.,Hipwell,

A., Hooper, R., Stein, A, and Cooper, P., (1996) The cognitive development

of 5-year-old children of post-natally depressed mothers. Journal of Child

Psychology & Psychiatry & Related Disciplines, 37(8).927-935

Perry, B., Pollard,

R., Blakley, T., Baker, W., Vigilante, D. (1995) Childhood Trauma, the

Neurobiology of Adaptation and Use-dependant Development of the Brain:How

states become Traits, Infant Mental Health Journal 16 (4) 271 - 291.

RANZCP (2000) Position

Statement #46 Principles on the provision of mental health services to

asylum seekers

Sharp, D., Hay, D.,

Pawlby, S., Schmucker, G., Allen, H.& Kumar, R.(1995) The impact of

post-natal depression on boy's intellectual development. Journal of Child

Psychology and Psychiatry, 36, 1315-1336

Schwarz, E., Perry,

B.,(1994) The Post-traumatic response in children and adolescents. Psychiatric

Clinics of North America, 17(2): 311-326

Wolff, S., (1994)

The Scope of Infant Mental Health: Pointers to helpful interventions Newsletter

of the Australian Association of Infant Mental Health, Vol 6,4, December

1994.

Acknowledgments

On behalf of AAIMH

I would like to thank Dr. Sarah Mares and Dr. Louise Newman for their

helpful comments and contributions in the preparation of this submission.

Last

Updated 9 January 2003.