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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 Australia’s 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 MHCA’s 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 individual’s 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)

Individual

Factors

Family

Factors

School

Context

Life

Events and Situations

Community

and Cultural Factors

Easy

temperament

Supportive

caring parents

Sense

of belonging

Involvement

with significant other person

Sense

of connectedness

Adequate

nutrition

Family

harmony

Positive

school climate

Availability

of opportunities at critical turning points or major life transitions

Attachment

to and networks within the community

Attachment

to family

Secure

and stable family

Pro-social

peer groups

Economic

security

Participation

in church or other community groups

Above-average

intelligence

Small

family size

Required

responsibility and helpfulness

Good

physical health

Strong

cultural identify and ethnic pride

School

achievement

More

than two years between siblings

Opportunities

for some success and recognition of achievement

.
Access

to support services

Problem-solving

skills

Responsibility

within the family

School

norms against violence

.
Community

/ cultural norms against violence

Internal

locus of control

Supportive

relationship with other adult

.
.
.
Social

competence

Strong

family norms and morality

.
.
.
Social

skills

.

.
.
.
Good

coping style

.

.
.
.
Optimism
.

.
.
.
Moral

beliefs

.

.
.
.
Values
.

.
.
.
Positive

self-related cognitions

.
.
.
.

Risk Factors:

(page 16)

Individual

Factors

Family

Factors

School

Context

Life

Events and Situations

Community

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 child’s 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 that’s

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 individual’s

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.


1.

Member organisations of the MHCA are listed at Attachment A.

Last

Updated 9 January 2003.