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Submission to the National

Inquiry into Children in Immigration Detention from

The Australian and New Zealand

College of Mental Health Nurses (Qld Branch)


This submission will

comment on the Mental Health and development needs of child asylum seekers

from an analysis of the interview transcripts from nine refugees who have

an experience of detention in Australia. 12th

March 2002

Anthony

Todd Weller

BA. BN. RPN. MPH

President ANZCMHN (Qld Branch)

Deborah

Wenham

RN. BN. MHSc

Member ANZCMHN (Qld Branch)

Rosemary

Chilcott

RPN

Member ANZCMHN (Qld Branch)

ANZCMHN

(Qld Branch)

PO Box Booval

Queensland 4304


Background

to the Submission

Effects

of detention on children

Harshness

of environment

Inadequate provision of basic facilities

for infant care

Inadequate provision of nutrition for the children

Mental

health concerns

Disruption

to the protective behaviour of parenting

Inadequate

provision of healthcare in detention centres

Sexual

abuse of children in detention

After

effects of detention

Conclusion

Recommendations


Background

to the Submission

The Australian and

New Zealand College of Mental Health Nurses (Qld Branch) approved the

need for a formal submission to the Inquiry into Children in Immigration

Detention.

A convenience sample

of nine participants who had been in detention as refugees was recruited

for participation. They were interviewed by two nurses in a health clinic

at a mutually agreed on time. The same translator was used. The interview

procedure was initially standardised however, given the nature the participants'

experiences there was a need for them to discuss their total refugee experience

and were desirous that this information was included. Before the interview

began, information was given to the participant via a translator requesting

their assistance to provide evidence to the Inquiry. All participants

were ensured anonymity and confidentiality.

For the qualitative

analysis of the interview transcripts, a content analysis was completed.

The interview transcripts were transcribed and multiple copies produced

for cross referencing the data.

All of the participants

had personal painful memories of their experience in detention in Australia.

It was important that Counselling was availed to the participants to prevent

retraumatisation. Similarly, the Interviewers and translator were offered

debriefing.

The impact of

detention on the well-being and healthy development of children, including

their long-term development

In the psychological/emotional

area, a number of themes were expressed that included 'emotions' these

included anger, depression, suicidal feelings, feelings of self-harm,

absence of emotions, blocked emotions, numbness, guilt, fear, sadness

and repressed emotion

Effects

of detention on children

Harshness

of Environment

All participants

described a poor physical environment in the detention centres with cramped

inadequate conditions lacking in privacy. There was no provision of recreation

for the children - there was limited place to play and develop self-expression.

There was no provision of education for the children. Participants commented

on the remoteness and isolation of the detention centres.

"I was in

the Port Hedland Detention Centre. There were 200 people in one block.

We were in crowded conditions - very harsh environment. We were locked

in - not allowed to go outside except for one hour in the morning and

one hour in the evening…..We stayed a month in the block. You cannot

see out of the window, and there is no air….We would dream of having

cold water in the heat".

(Female adult

participant)

"At Curtin,

there was a plague of insects - infestations of black ants - flying ants,

flies and king brown snakes. We had no insect protection. Three to four

families would sleep in a 'donga ' ".

(Male adult participant)

Inadequate

provision of basic facilities for infant care

"Because

we only had one change of clothing we needed to wash the clothes of the

children. My daughter was naked while we washed her clothes. There was

only one washing machine between two hundred people and only one fridge.

For the child

they gave me four disposable nappies. When they were finished they gave

me a towel. We had $150 US Dollars, but they said you cannot buy nappies.

We worked as cleaners for $10 a week each and we were able to buy nappies.

It was hard when

they gave me an adult towel to use for a nappy - even with an adult towel,

the child becomes dirty: and we are not able to dry the towel properly

because we cannot go outside to dry the towel. We would leave it to dry

in the kitchen but it would not always dry properly."

(Female adult

participant)

Inadequate

provision of nutrition for the children

"If we talk

about the food. A box arrives with meat, salad and vegetables. When the

box arrives it smells and is spicy - the children cannot eat it. Even

this food, we cannot always get it - if there is a hunger strike or riot

- the food does not arrive.

My daughter cannot

eat this food. In many cases they bring a box of sliced bread and lettuce.

We cannot eat it. Normally the children that age we cook them soup and

cereal. Because I was not eating properly, I was not able to breastfeed.

My milk stopped.

We could not provide

them with milk. They would give us milk that expired in 1999. It was frozen.

When you thawed it, it was like yogurt. When we complained we gave it

to the guard to smell and he grimaced. The guards would say 'that is what

we do in Australia'. Because of bad food my daughter is still sick."

(Female adult

participant)

"There is

no food to eat for the children. They would give us meat once a fortnight.

It is tough and you cannot chew it properly."

(Female adult

participant)

"Food? -

a horrible experience everyday for u - long queues under the sun- midday

to 2pm. -one hour in the queue till you go inside. I ask the guard 'Why

do you treat us like this?' He says, 'We did not ask you to come. If it

is my choice I would throw you into the sea."

(Male adult participant)

Mental

health concerns

Some participants'

reported persistent stress and anxiety as a result of the asylum official

processing. Some described bullying from the guards in front of the children

with the use of course language. They witnessed children being separated

from their parents in situations when there was disruption due to rioting

or breakouts.

There were reports

of one [person - words deleted] removing a child from its Mother,

with resultant extreme distress. Parents were threatened and intimidated

that their children would be taken from them by the Australian Government.

It was difficult

for the parents to tolerate the effects of the prolonged negative experience

of detention on the children and to witness their loss of hope and expectation.

Other themes in regard to mental health concerns include:

  • Hopelessness

    in the future

  • Loss of enjoyment
  • Misbehaving in

    ways they would not have done before

  • Extreme sadness
  • Problems sleeping
  • More aggressive

Disruption

to the protective behaviour of parenting

Concern was expressed

by the participants about their inability as parents to provide adequate

protection from

  • witnessing self-harm

    in others,

  • the extreme emotional

    despair of other detainees,

  • the boredom from

    lack of activity,

  • isolation,
  • the poor environmental

    conditions,

  • the culturally

    inappropriate food resulting in poor nutrition,

  • the lack of access

    to health care.

  • Grief and loss

    issues

"The children

witnessed self-harm and suicide attempts at Bravo/Curtin people tried

to hang themselves with a rope on a tree. Children witnessed these hanging

attempts. Distressed people would cut themselves on the arms and chests-

because of the bad treatment and despair. They had no access to a phone

or fax - to write letters to families after months of no contact. They

became angry, desperate and mentally ill.'

(male adult participant)

Some participants

acknowledged that women often of Iraqi or Afghani background will act

out hysterically, screaming, hitting themselves, head butting into walls.

They witnessed people cutting themselves and stitching their mouths

"We are silenced

- We cannot speak. Why should we eat?"

(male adult participant)

Inadequate

provision of healthcare in detention centres

All participants

describe poor access to health care. They describe inadequate medical

and nursing staffing levels - one doctor for 1600 detainees. They describe

poor triaging for the clinics. This triaging is done by the guards. They

express concern about the cultural health care needs of women - to have

access to female Doctors. This did not occur. Poor antenatal care as pregnant

women did not feel comfortable seeing male doctor. Asthmatic children

had to wait at the gates to get their inhalant medication. As well as

access to medical care, there is a pressing need for specialist psychiatric

care given the prior history of trauma that participants described from

their refugee experience

Poor access to

health care

"There was

a clinic and a pharmacy. No one gives us the medication - it is only for

display for when the commission comes. You are never given the medicine

you need. They tell you to drink water or in an extreme case to take Panadol.

Your name is placed on a list. It is published. Twenty people are taken

there daily under the sun. There is no shelter or no seating for waiting.

If you miss breakfast, lunch etc you will go without food - you don't

want to leave the Queue - children are waiting there for other children.

If I have an ache in teeth - there is 3-4 months wait."

(male adult participant)

"My daughter

had a fever - it was a sudden onset. We needed to take her to the clinic.

But the guard said "You have no appointment, you cannot go'"

(female adult

participant)

Prior history

of traumatic events

"We lived

in fear in Iraq. Our family was persecuted because of our religious beliefs.

We are Shiite Muslims. Our Uncle was killed by Saddam Hussein. I was an

engineer, my wife a teacher of Arabic. We were sacked from our employment

because we were related to him."

(male adult participant)

`"The boat

was a terrible experience - everyone was tense, fearful - scared and crying.

The ocean seemed so large - the rocking of the boat with the large waves.

The seasickness and vomiting. Fear of drowning - because they can't swim.

Two hundred people on two hulks. Seventy-two hours bailing water. The

boat sunk off Lombok … On the second attempt the engine stopped -

the ocean was rough. Many fell unconscious. There was a hole in the fishing

boat. People were crying and shouting…nobody drowned ….it was

traumatic. One child was disabled."

(male adult participant)

Sexual

Abuse of Children in detention

What was extremely

disturbing were reports from participants that unaccompanied minors are

not segregated or protected. Participants who were interviewed report

that children are preyed on by older single men - for sex favours. One

participant reported concerns of a women's sixteen year old son becoming

homosexual after being abused by an older man. Other participants reported

their fears and concerns for the young people exposed to such conditions.

Sexual abuse of children can result in long term mental health consequences.

Whether the abuse is a single event or occurs over many years, the effects

can be severe. It is possible that survivors of sexual assault are more

likely to suffer mental illnesses such as major depression, and anxiety

disorders.

After

effects of detention

Sense of self:

Here the predominant

after-effects were low self-esteem, self-hatred, shame, humiliation, bad,

powerlessness, and low self-worth.

"The guards

would say to me: 'Australians don't want you. Australians hate you.' They

want you to go home.' I

felt such a sense of shame - that when I came out from detention I was

confused when people wanted to help me. I thought I was a bad person."

(Female participant

aged 13)

"The guards

would follow me to the toilet, and they would request that I left the

door open. It was so humiliating for me - that I feel.. I have no…that

I have lost my dignity. Surely you can understand in my culture such a

thing does not happen?"

(male adult participant)

Relations to others

No trust, hostility,

distant relations and fear were the negative themes expressed in their

relations to others as a result of their detention experience. All of

the participants expressed a sense that their experience of detention

had alienated them from others. They had an acute sense of disappointment

with officials and the government and their desire to over comply with

orders in a situation they had no control over and no power. They felt

prejudiced against.

"For so long

you are not believed. You are questioned. People say they will help you

put your trust and faith in them. You are given promises but, nothing

comes of them. That you feel in your self - that is how I am seen by Australians

too. They do not trust me. I have to remind myself to trust in myself,

for they do not trust me".

(male adult participant)

All those interviewed

reported the experience of detention as negative. Many stated that they

had lost the ability to trust, lost their self-esteem or part of their

selves, had difficulties with relationships, lost the sense of how to

become a person, or how to develop a sense of self. Some expressed guilt

for being a refugee.

Conclusion

It is evident from

the interviews that the impact of being in a detention centre in Australian

has had an extremely negative impact. This will affect any transition

to community integration. Therefore, assistance with community integration

needs to be prioritised.

In a variety of ways,

participants talked about communicating their genuine willingness to develop

relationships and contribute to the community that they are living in.

Yet they felt constrained by their lack of certainty, a loss of hope and

a sense of fear in trusting others that was resultant from their detention

experience.

Effective treatment

and support processes are needed and should be offered to deal with the

all-encompassing aspects of the negative after effects of detention. There

is a pressing need for a group process where these negative after effects

could be closely explored in both individual and group therapy. Yalom

(1985) describes the curative factor of universality in group therapy.

This could provide the needed identification and validation with others

who have had a negative psychological experience as a result of detention.

This would help to reduce or eliminate the senses of isolation/aloneness

and other negative effects.

It is clear from

the content and themes of the refugee interviews that children will be

negatively affected by what they have witnessed in detention centres.

Children are our

future and strategies that promote their mental health resilience need

to be addressed.

Recommendations

Recommendation

one

Close down detention

centres that foster negative institutional experiences. Provide alternative

models of community detention.

  • Enhance factors

    that contribute to a positive environment that are protective in regard

    to at risk mental health conditions

Recommendation

two

Improve treatment

for mental disorders and the emergency response and provision of follow-up

support for incidents of attempted suicide and self-harm within detention

centres

  • Provide access

    to mental health specialist services to enable early identification

    and effective treatment for refugees and refugee children at risk of

    mental disorders, particularly depression.

  • Build effective

    and transparent links between services responding to incidents of attempted

    suicide and self-harm, including emergency departments, ambulance services,

    police, community mental health services, general hospital, psychiatric

    inpatient, drug treatment and prevention services

  • Provide appropriate

    training and support to detention centre staff and department of immigration

    staff in responding to suicide, self-harm or mental health crisis to

    enable them to respond in culturally appropriate ways and take into

    account issues of history of trauma, age and gender.

  • Improve the quality

    and consistency of data on incidents of attempted suicide or self-harm

    during detention and following release.

  • Enhance self-capacity

    skills of refugees.

Recommendation

three

Promote strategies

and fund services to reduce the risk of suicide and self-harm among people

upon release from the detention centres with, or at high risk of, mental

disorder

1. Increase access

to appropriate and non-stigmatising mental health support and promote

early intervention for refugees with mental disorders

2. Enhance detention release protocols and improve community support

and follow-up after release from the detention centres with mental health

symptoms.

3. Review, disseminate and implement protocols for suicide risk assessment

within detention centres.

4. Develop, implement and review protocols and procedures to reduce

and respond to incidents of suicide and self-harm within detention centres.

Recommendation

four

Provide mental health

promotion and prevention programs that are grounded in transcultural appropriateness

1. Parenting support

programs to enhance parenting resilience

2. Provide mental health literacy on refugee impact issues.

Recommendation

five

Increase Community

Acceptance of and support for marginalised groups, people with risk factors

for mental illness

1. Establish media

reference groups on refugees to provide expert advice on media strategies

2. Media strategies that address understanding of the refugee experience

that promote a positive portrayal of refugees and foster supportive

attitudes towards this marginalised group.

3. Fund programs that support 'connectedness' to increase a sense of

belonging.

Recommendation

six

Address Child

Abuse

1. Work with other

services in child protection to identify those children who have been

abused and provide appropriate supportive therapy.

Last

Updated 9 January 2003.