Commission Website: National Inquiry into Children in Immigration Detention
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Submission to the National
Inquiry into Children in Immigration Detention from
the Mental Health Council
of Australia
Postal Address: PO
Box 174
DEAKIN WEST ACT 2600
Telephone: (02) 6285
3100
Facsimile: (02) 6285
2166
Email Address: admin@mhca.com.au
Contact Name:
Ms Carmen Hinkley
Position/Title: Senior Policy Officer
National Inquiry into Children
in Immigration Detention
Terms of Reference
The National Inquiry
into Children in Immigration Detention refers to the adequacy and appropriateness
of Australias treatment of child asylum seekers and other children
who are, or have been, held in immigration detention, including:
1. The provisions
made by Australia to implement its international human rights obligations
regarding child asylum seekers, including unaccompanied minors.
2. The mandatory
detention of child asylum seekers and other children arriving in Australia
without visas, and alternatives to their detention.
3. The adequacy and
effectiveness of the policies, agreements, laws, rules and practices governing
children in immigration detention or child asylum seekers and refugees
residing in the community after a period of detention, with particular
reference to:
- the conditions
under which children are detained;
- health, including
mental health, development and disability;
- education;
- culture;
- guardianship issues;
and
- security practices
in detention.
4. The impact of
detention on the well-being and healthy development of children, including
their long-term development.
5. The additional
measures and safeguards which may be required in detention facilities
to protect the human rights and best interests of all detained children.
6. The additional
measures and safeguards which may be required to protect the human rights
and best interests of child asylum seekers and refugees residing in the
community after a period of detention.
Child
includes any person under the age of 18.
The Mental Health
Council of Australia (MHCA) provides the following information for consideration
by the Inquiry. The focus of the MHCAs concerns is in relation to
the conditions of immigration detention centres and the mental health
impact such conditions have on children, rather than focussing on immigration
policies.
The Mental Health Council
of Australia
The Mental Health
Council of Australia (MHCA) is the peak, national non-Government organisation
established to represent and promote the interests of the Australian mental
health sector. The MHCA constituency includes consumers, carers, special
needs groups, clinical service providers, private mental health service
providers, non-Government organisations, Aboriginal and Torres Strait
Islander groups, and State/Territory based peak bodies [1].
The activities of the MHCA primarily consist of management and coordination
of national projects, representation on national committees, and development,
analysis and evaluation of policies, including drafting of policy position
papers and submissions to various inquiries.
Prevalence of
Mental Illness
The MHCA recognises
the growing burden of mental illness in Australian society. It has been
estimated that currently, over one million Australians experience a mental
illness, and at any particular point in time 3-4% of Australians experience
severe mental disorders which will significantly interfere with their
mental well being and reduce their capacity to participate fully in community
life.
The National Survey
of Mental Health and Well Being (1997) conducted by the Australian
Bureau of Statistics found that almost one in five Australians aged 18
years or over met a criteria for a mental disorder at some time during
the 12 months prior to the survey. Alarmingly, only 38% of those surveyed
with a mental disorder had accessed health services. This suggests a large
unmet need for mental health services. Indeed, this indicates that 62%
of people with a mental illness are either receiving no assistance, or
are depending on informal sources of support usually from unpaid carers
and families. In addition, children and adolescents less than 18 years
make up 25% of the Australian population and in any six month period 15-20%
of this group may have a mental health problem.
The most common disorders
are major depression and related disorders including anxiety. The World
Health Organisation has predicted that by 2020 major depression will be
the second largest health problem worldwide. In 1990, of the ten leading
causes of disability worldwide, five were psychiatric disorders including
unipolar depression. The growing burden of mental illness in Australia
has an enormous economic cost to the Australian population. More importantly,
there is a direct and increasing burden to the individuals with mental
health problems and those who provide care for them, often family and
friends (Mental Health Promotion and Prevention National Action Plan,
1999).
Mental health is
influenced by risk and protective factors that occur in the many different
domains of everyday life. Risk factors increase the likelihood that a
mental illness or mental health problem will develop and can increase
the burden of an existing illness or problem. Protective factors give
people resilience in the face of adversity and moderate the impact stress
and transient symptoms have on social and emotional wellbeing, thereby
reducing the likelihood of mental illness or mental health problems (Promotion,
Prevention and Early Intervention for Mental Health A Monograph
2000).
The determinants
of an individuals mental health include a range of psychosocial
and environmental factors such as income, employment, poverty, education,
access to community resources, physical health, and demographic factors
such as gender, age and ethnicity (Promotion, Prevention and Early Intervention
for Mental Health A Monograph 2000). Effective action to promote
mental health, prevent the development of mental health problems, and
intervene early in mental illness is crucial.
The Promotion, Prevention
and Early Intervention for Mental Health A Monograph (2000) lists
the following protective and risk factors for mental health problems:
Protective Factors:
(page 15)
Factors
Factors
Context
Events and Situations
and Cultural Factors
temperament
caring parents
of belonging
with significant other person
of connectedness
nutrition
harmony
school climate
of opportunities at critical turning points or major life transitions
to and networks within the community
to family
and stable family
peer groups
security
in church or other community groups
intelligence
family size
responsibility and helpfulness
physical health
cultural identify and ethnic pride
achievement
than two years between siblings
for some success and recognition of achievement
to support services
skills
within the family
norms against violence
/ cultural norms against violence
locus of control
relationship with other adult
competence
family norms and morality
skills
coping style
beliefs
.
self-related cognitions
Risk Factors:
(page 16)
Factors
Factors
Context
Events and Situations
and Cultural Factors
Prenatal brain damage
Having a teenage mother
Bullying Physical, sexual, and emotional abuse
Socioeconomic disadvantage
Prematurity Having a single parent
Peer rejection
School transitions
Social or cultural discrimination
Birth injury
Absence of father in childhood
Poor attachment to school
Divorce or family break up
Isolation Low birth weight, birth complications
Large family size
Inadequate behaviour management
Death of family member
Neighbourhood violence and crime
Physical and / or intellectual disability
Antisocial role models (in childhood)
Deviant peer group
Physical illness /impairment
Population density and housing conditions
Poor health in infancy
Family violence and disharmony
School failure
Unemployment, homelessness
Lack of support services including transport, shopping, recreational
facilities
Insecure attachment in infant / child
Marital discord in parents
. Incarceration . Low intelligence
Poor supervision and monitoring of child
. Poverty / economic insecurity
. Difficult temperament
Low parental involvement in childs activities
. Job insecurity
. Chronic illness
Neglect in childhood
. Unsatisfactory workplace relationships
. Poor social skills
Long-term parental unemployment
. Workplace accident / injury
. Low self-esteem
Criminality in parent
. Caring for someone with an illness / disability
. Alienation Parental substance abuse
. Living in nursing home or aged care hostel
. Impulsivity Parental mental disorder
. War or natural disasters
. . Harsh or inconsistent discipline style
. . . . Social isolation
. . . . Experiencing rejection
. . . . Lack of warmth and affection
. . .
Multicultural Australia
Australia is a multicultural
society as reflected by 20% of the Australian population represented by
people from non-English speaking backgrounds (National Action Plan
for Promotion, Prevention and Early Intervention for Mental Health, 2000).
In many regions of Australia the proportion of the local population that
is of non-English speaking background is considerably high.
The process of adjustment
for new arrivals to Australia can be stressful, and the experience of
migrating to a new country creates a number of unique determinants of
social and emotional wellbeing. The National Action Plan for Promotion,
Prevention and Early Intervention for Mental Health (2000) recognises
that risk factors for mental health problems for people from non-English
speaking backgrounds living in Australia are increased due to:
- low socioeconomic
status or a decrease in socioeconomic status following immigration;
- inability to speak
English;
- separation from
family and friends;
- prejudice and
discrimination in Australian society;
- lack of recognition
of professional qualifications;
- isolation of others
of a similar cultural background;
- grief associated
with losses;
- traumatic experiences
or prolonged stress before or during immigration; and
- extent of acculturation.
The final report
of the Carers of People with Mental Illness Project (2000) undertaken
by the MHCA and Carers Australia found that mental health services (community
based and in-patient) are significantly under-utilised by communities
of non-English speaking backgrounds. Such underutilisation is due to a
complex range of factors including:
- high levels of
stigma associated with mental illness and psychiatric treatment among
non-English speaking background communities;
- lack of information
about services and how to gain access to them;
- the general lack
of culturally appropriate services; and
- great shortages
in the availability of interpreters and of bilingual and bicultural
mental health professionals in the service system.
This under-utilisation
has important implications for families and particularly for carers, and
suggests a significant proportion of people from non-English speaking
backgrounds with mental health problems, disorders, or illnesses are receiving
either no treatment or inadequate treatment.
The National Action
Plan for Promotion, Prevention and Early Intervention for Mental Health
(2000) identifies people of non-English speaking backgrounds who are
older migrants, adolescents, refugees, and those of low socioeconomic
status as being higher-risk groups for developing mental health problems.
The Action Plan aims to promote mental health, and prevent and reduce
mental health problems, disorders and illnesses among people from non-English
speaking backgrounds through:
- acceptance and
valuing of social and cultural diversity;
- reduced racism
and discrimination;
- enhanced community
capacity to ensure meaningful participation for people from diverse
cultural and linguistic backgrounds;
- mental health
literacy;
- reduced stigma
associated with mental health problems and mental disorders;
- enhanced resilience
and protective factors for mental health problems and mental disorders;
- reduced risk factors
for mental health problems and mental disorders;
- cultural sensitivity
among health care providers; and
- increased access
to culturally appropriate early intervention initiatives and services.
People from culturally
and linguistically diverse backgrounds require access to resources of
mainstream society, whilst still being able to maintain their cultural
and religious integrity. As such, systems and resources need to be easily
accessible and negotiable by all members of the community, regardless
of language and cultural differences. The active participation of all
groups in Australian communities needs to be encouraged, with special
care taken to enable people with language and cultural barriers to fully
participate in community life.
Potential barriers
to effective promotion, prevention and early intervention activities include
language and cultural factors, culturally specific beliefs and understanding
of mental health problems and causes, and stigma and attitudes relating
to mental health problems held by families and communities.
Promotion and prevention
initiatives that are culturally appropriate are necessary to identify
and address difficulties to attaining and maintaining mental health. Combating
such difficulties early will assist in ensuring such difficulties do not
become enduring barriers to attainment of social and emotional wellbeing
for people from non-English speaking backgrounds. Indeed, an outcome of
quality and effectiveness initiatives of the Second National Mental
Health Plan aims for better mental health outcomes for people from
culturally and linguistically diverse backgrounds.
A number of rural/remote
communities have been identified as having a proportionate non-English
speaking background population within the rural/remote community. The
specific mental health needs and risk factors of people from non-English
speaking backgrounds, as outlined above, are greatly increased with the
addition of the mental health needs created by living in a rural/remote
locality. In addition, non-English speaking background communities are
often long established and have a large proportion of elderly people.
This presents additional issues in terms of mental health service delivery
for cultural and age-appropriateness.
Refugees and Immigration Detention
The United Nations
define a refugee as any person who is outside their country of nationality
and is unable to return due to a well founded fear of persecution for
reasons of race, religion, nationality, membership of a particular social
group, or political opinion (UN Convention relating to the Status of Refugees,
1951).
Burdekin (1993) identifies
that given the majority of people from non-English speaking backgrounds
have come to Australia as migrants, the process of migration is a significant
focus in considering prevalence, diagnosis, and treatment of mental health
problems, disorders, and illnesses in different ethnic groups.
According to Burdekin
(1993) Australia receives between 10,000 and 15,000 refugees each year.
This finding may have increased due to recent world events. Burdekin (1993)
also notes that refugees, particularly those who have experienced torture
and trauma, have an increased risk of developing a mental health problem,
disorder, or illness. Indeed, a significant number of refugees experience
both physical and mental health problems as a result of their torture
experience.
Torture and trauma
have a profound, immediate and long-term impact on the physical and psychological
health of those exposed to it. High percentages of torture and trauma
survivors suffer from extreme levels of depression and anxiety which manifest
in a diversity of forms, including sleep disorders, recurring and intrusive
memories, poor self esteem, breakdown in family and personal relationships,
intrusion in the identity development of children and adolescents, physical
injuries which require surgery and rehabilitative treatment, and many
other debilitating consequences.
Refugee children
may have an increased exposure to risk factors highlighted previously
due to the traumatic background in their place of origin, the migration
process, and the conditions in which children are held during the migration
process. Risk factors may also have a cumulative effect.
Furthermore, refugee
children may have an increased risk of developing mental health problems
in later life due to the combined effects of exposure to these risk factors.
A quote received
by the Burdekin Inquiry (1993) highlights the risk factors refugees may
be exposed to:
They are
dispossessed, dislocated, they suffer psychological disintegration and
they arrive in a country where they become disempowered. Ten to twenty
percent of these people have been subject to formal torture and thats
probably an underestimate, but almost all of them have been subjected
to what we call organised violence which is a World Health
Organisation term to cover a wide range of trauma to do with civil unrest,
dispossession, persecution by authorities, famine, war and other forms
of violence carried out in societies that are disintegrating.
(p 725).
The Minister for
Immigration and Multicultural and Indigenous Affairs (http://www.minister.immi.gov.au/detention/women_&_children.htm#children)
states:
- As of 1 February
2002, the total number of women and children in mainland Australian
Immigration Detention Centres is 637 (259 adult women, 224 male children,
141 female children).
- As of 1 February
2002, there were 13 unaccompanied minors in detention.
- In addition, there
are 9 unaccompanied minors placed into alternative care of the South
Australian Department of Human Services provided through Family and
Youth Services.
- There is also
one unaccompanied minor issued with a bridging visa who has been placed
in foster care arrangements in the community.
The recent decrease
of children in immigration detention facilities may be attributed to decreasing
numbers of unauthorised air and sea arrivals to Australia; increase in
persons being released from immigration detention, particularly unaccompanied
minors; and minors turning 18 years of age while in detention.
Children and young
people who are separated from their families, as may often be the case
for refugee children who are identified as unaccompanied minors in detention,
face additional risks as well as those associated with migration, to poor
mental health outcomes.
Immigration processes
and the conditions in which refugees are placed in when awaiting migration
approval should aim to optimise mental health protective factors, and
decrease risk factors associated with mental health problems, disorders,
and illnesses. As previously highlighted, the life events refugees are
exposed to increase their susceptibility and pre-disposition to developing
mental health problems and not dealing with the life events to productive
outcomes. Such effects may be heightened in children who may not have
the developmental ability or support structures to cope with such events.
Refugees may also be experiencing grief associated with the loss of the
country, culture, and friends and family left behind.
As such, conditions
in immigration detention centres should take into consideration the following
points:
- foster family
connection and the maintenance of family units;
- education should
be provided for children and should include teaching the English language
for children and adults;
- adequate health
services should be provided including physical health examinations and
access to counselling services;
- interpreters should
be made available;
- refugees should
be able to maintain their cultural identity and values;
- the physical conditions
of detention centres should prevent institutionalism;
- families should
be housed together;
- mental health
promotion programs should be established within detention centres to
support refugees throughout their period of detention;
- mental health
screening of risk factors should be conducted upon refugee arrival to
Australia;
- mental health
promotion programs should be based on a whole-of-family approach, with
the inclusion of separate programs for unaccompanied children;
- mental health
programs should be designed and monitored by experience mental health
professionals;
- detention centre
staff should undergo awareness and training in promoting the mental
health of detainees;
- arrangements should
be made to ensure early identification of children identified as having
high risk for the development of mental health problems, disorders,
or illnesses;
- best practice
guidelines for protecting and promoting the mental health of children
and adults in detention should be developed as a priority; and
- a range of activities
people can participate in should be made available.
Of particular importance
is promoting refugees to have a sense of pride in their cultural origin.
The ability to accept and include an ethnic identity within an individuals
sense of self is vital, particularly for young people (Promotion, Prevention,
and Early Intervention for Mental Health A Monograph, 2000).
As highlighted in
the Promotion, Prevention, and Early Intervention for Mental Health
A Monograph, (2000), the re-establishment of safety, autonomy,
and control is essential for traumatised refugees and care must be taken
to not reflect further trauma on such groups.
The MHCA has provided
the above information with a focus on highlighting optimal conditions
for mental health, and identifying conditions which increase risk factors
for the development of mental health problems, disorders, and illnesses.
The MHCA submission notes the conditions of immigration detention centers
and the mental health impact such conditions have on children, rather
than forming a view on immigration policies.
ATTACHMENT A
MHCA MEMBER ORGANISATIONS
Association of Relatives
and Friends of the Mentally Ill (ARAFMI)
Australasian Society
for Psychiatric Research
Australian &
New Zealand College of Mental Health Nurses
Australian Association
of Occupational Therapists
Australian Association
of Social Workers
Australian Board
of Certified Counsellors
Australian Infant,
Child, Adolescent and Family Mental Health Association (AICAFMHA)
Australian Medical
Association (AMA)
Australian Mental
Health Consumer Network
Australian Psychological
Society (APS)
Australian Rotary
Health Research Fund
Australian Transcultural
Mental Health Network
Carers Australia
Catholic Health Australia
GROW
Institute of Australasian
Psychiatrists
Lifeline Australia
Mental Health Coordinating
Council
Mental Health Foundation
of Australia
Mental Illness Education
Australia
National Aboriginal
Community Controlled Health Organisation (NACCHO)
National Rural Health
Alliance
Network of Australian
Community Advisory Groups (NOAC)
Ramsay Health Care
Royal Australian
& New Zealand College of Psychiatrists
Royal Australian
College of General Practitioners
Royal Flying Doctors
Service of Australia
SANE Australia
Schizophrenia Fellowship
Council of Australia
The Queensland Alliance
of Mental Illness and Psychiatric Disability Groups
VICSERV
Western Australian
Association for Mental Health
HREOC National Inquiry
into Children in Immigration Detention 10
REFERENCES
Australian Bureau
of Statistics (1997). The National Survey of Mental Health and Well
Being.
Australian Health
Ministers, Mental Health Promotion and Prevention National Action Plan,
Mental Health Branch, Commonwealth Department of Health and Family Services,
1999.
Australian Health
Ministers, Mental Health Statement of Rights and Responsibilities,
Mental Health Branch, Commonwealth Department of Human Services and Health,
March 1991.
Australian Health
Ministers, National Mental Health Policy, Mental Health Branch,
Commonwealth Department of Health and Family Services, April 1992.
Australian Health
Ministers, National Standards for Mental Health Services, Mental
Health Branch, Commonwealth Department of Health and Aged Care, December
1996.
Australian Health
Ministers, Second National Mental Health Plan, Mental Health Branch,
Commonwealth Department of Health and Family Services, July 1998.
Australian Medical
Workforce Advisory Committee, The Specialist Psychiatry Workforce in
Australia, 1999.
Commonwealth Department
of Health and Aged Care 2000, National Action Plan for Promotion, Prevention
and Early Intervention, Mental Health and Special Programs Branch,
Commonwealth Department of Health and Aged Care, Canberra.
Commonwealth Department
of Health and Aged Care 2000, Promotion, Prevention and Early Intervention
for Mental Health A Monograph, Mental Health and Special Programs
Branch, Commonwealth Department of Health and Aged Care, Canberra.
Mental Health Council
of Australia (2000), Enhancing Relationships between Health Professionals
and Consumers and Carers Final Report, Canberra, ACT. Commonwealth
Department of Health and Aged Care.
Mental Health Council
of Australia (2001) Promoting the mental health of all Australians
A 2001 Federal Election Submission.
Monash, D. (August
2001) Access to Rural Mental Health Services, National SPGPPS Forum,
3 August 2001, Canberra.
Raphael, B. (2000).
A population health model for the provision o f Mental health care.
National Mental Health Strategy. Commonwealth of Australia.
Member organisations of the MHCA are listed at Attachment A.
Last
Updated 9 January 2003.
