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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
to the Submission
of detention on children
of environment
Inadequate provision of basic facilities
for infant care
health concerns
to the protective behaviour of parenting
provision of healthcare in detention centres
abuse of children in detention
effects of detention
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
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)
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)
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.
