Submission to the National
Inquiry into Children in Immigration Detention from
Suicide Prevention Australia
TWO AUSTRALIAN NATIONAL POLICIES
ON SELF-INJURY AND SUICIDE: A SUBMISSION TO THE HUMAN RIGHTS COMMISSION
ON CHILDREN IN DETENTION
Lecturer, School of Psychiatry, University of New South Wales and Sydney
Children's Hospital, and Chair, Suicide Prevention Australia
Suicide and self-harm
among the young in Australia
For over a decade
and until fairly recently, expert reports and news stories made Australians
aware of rising Australian male youth suicide rates. Suicide rates for
Australian males aged 15-24 years rose from 9.6/100,000 in 1964-1968 to
28.6/100,000 in 1994-1998. Such trends also have affected young adults
aged 25-34 years, who have shared the highest rates with males over 75
years, though the latter have been falling. One 1999 report indicated
that from 1990-1994, Australia had fourth highest recorded male youth
rate and eighth highest female youth rate in the world [1-3].
These trends are
the tip of the iceberg. For every male suicide there are 30-50 attempts
and for every female suicide there are 150-300 attempts. Fifteen percent
of adolescents have a psychiatric illness at any point, up to 25% of young
people may have suicidal behaviour at any time, and up to 25% of adolescents
have had an episode of depression in the last 12 months [4-6].
Australian male youth
share various risk factors for youth suicide with other Western countries
that have also seen this trend, but some Australian populations are experiencing
elevated rates and may have also more specific risks. Aboriginal and Torres
Strait Islanders (ATSI) have historically had very low rates, but now
young male rates are double that of non-Aboriginal groups . Male youth
suicide rates also rose tenfold in small rural towns over the 35 years
to 1998, compared with metropolitan rises one quarter that amount .
ATSI and rural populations, among others, have been the focus of national
suicide prevention strategies.
government's response to community concern about suicide
The Australian government
responded to wide-ranging community concern about suicide with the National
Youth Suicide Prevention Strategy (NYSPS) (1995-1999, $31 million) [8-10]
& Living is for Everyone (LIFE) program (all ages, 2000-, $66 million).
These programs are umbrellas for national, state and local prevention
initiatives. They are Government, non-government and volunteer based,
and linked with other strategies e.g. violence & crime, drugs, mental
health, homelessness, child & youth health, ATSI well-being. NYSPS
and LIFE have adopted a biopsychosocial model, and a progressive and innovative
public health approach. They aspire to evidence-based practice (or practice-based
evidence), are population-based & individual in scope, and involve
national, state and local interventions with community, consumers and
youth. Partnerships, intersectoral collaboration and sensitivity to cultural
diversity are key philosophical tenets. They heavily emphasise prevention
and early intervention, and work directly with target populations or indirectly
at a community or system level. Their outcome measures may be suicidal
behaviour or mental health & other risk factors for suicide. The programs
are comprehensive and proactive. Very few other countries have promoted
and funded suicide prevention to this degree.
evidence has accumulated from evaluation that significant gains were made
by NYSPS, despite the short time since initiation of the Strategy, problems
with using suicide rates as outcome measure, the absence of measurable
intermediate objectives and lack of baseline and population data, and
confounding factors. A substantial minority of projects demonstrated positive
impacts on individual and environmental risk and protective factors. Significant
reductions in disability occurred for youth attending mental health services.
Access, engagement & capacity-building emerged as major themes .
Male suicide rates for the year 2000 fell in all age groups, except 25-34
years . While it is impossible to prove that this was due to the strategy,
lower rates for two years in succession may signify that the strategy
is working. Thus, this is a story about working together, with some indications
young asylum-seekers in immigration detention centres (IDC's)
A uniquely Australian
group that has not been the focus of the LIFE program is that of asylum-seekers
in immigration detention centres. For decades post-World War II, Australia
willingly accepted immigrants & refugees, but as large movements of
refugees continued, it and many other western governments increasingly
interpreted the UN Refugee Convention (1951) more strictly. Since 1991,
Australia has had a policy of mandatory detention of asylum seekers while
applications for refugee status are processed. From 1997, it toughened
refugee review and appeal processes, abolished family reunion and permanent
visas, and severely restricted access to work, education, social security
and health services for ex-detainees. In the last 18 months, the government
deemed certain offshore islands and reefs to be outside Australia for
arriving boat people, and established certain Pacific nations as holding
points. Recent statistics show that the majority of asylum seekers who
enter Australia's immigration detention system will be found to be refugees
under the 1951 Convention [13-15].
families and unaccompanied children, and processing can take many months
or even years . In November 2001 a total of 521 children under the
age of 18 were in immigration detention and 53 of these were unaccompanied
minors. Ninety four percent of children and families were in remote Immigration
Detention Centres (IDC's), far from family, services & scrutiny .
IDCs are run by Australian Correctional Management (ACM), a subsidiary
of the American company Wackenhut Corporation, for the Department of Immigration,
Multicultural and Indigenous Affairs (DIMIA). ACM also runs a number of
Australian and overseas (US) prisons.
Media and public
interest in asylum-seekers was sporadic before mid-January 2002, when
explicit suicide threats by adults and children to DIMIA and Australian
media, a 16-day hunger strike at Woomera and other sites, and lip sewing
by hundreds of asylum seekers, captured sustained national attention.
Attempted hangings and poisonings were reported, and one detainee jumped
into razor wire on the Woomera camp perimeter. After negotiation with
the Government's Immigration Detention Centre Advisory Council, the asylum
seekers agreed to end their self harm. Explicit drawings of self harm
and psychological distress were widely reported by media to Australian
community [Sydney Morning Herald, 14th January 2002, and thereafter daily].
At least five suicides
or undetermined deaths due to external causes have apparently occurred
in the last 18 months in the IDC population of about 3,500, making a suicide
rate of somewhere between 100 and 200 per 100,000 per year. These deaths
all occurred among adults (see Table 1). Self-harm remains endemic in
IDC's. There is at least one serious suicide attempt per day in Woomera
IDC, and at the time of writing 60 out of 500 were on suicide watches.
Many adults have made suicide attempts which have almost been fatal. Many
children are suicidal, and have engaged in a range of seriously life-threatening
actions (see Table 2).
Studies of adult
asylum seekers, especially (ex-)detainees, show high levels of depression,
anxiety and post-traumatic stress disorder (PTSD). There is little available
systematic information concerning the mental health of detained children
& adolescents. However, much literature documents the impacts of trauma
and violence [17-20], parental mental illness [21-22] and institutionalisation
and incarceration on children's social and emotional development, and
the long term developmental consequences of such impacts [23-24].
At time of writing,
except in South Australia, no arrangements exist between DIMIA & state
Departments of Health and Family and Community Services for guaranteeing
mental health assessment and treatment for families in need. This is at
odds with the Royal Australian and New Zealand College of Psychiatrists
(RANZCP) Position Statement on Provision of Mental Health Services to
Asylum Seekers , which states that all asylum seekers should be given
full access to mental health services. The Position Statement is committed
to promoting and researching the mental health needs of this population,
and expresses concern about detention of children. Australia ratified
the United Nations Convention on the Rights of the Child in 1990. Its
policy of detaining accompanied and unaccompanied children has been identified
by Amnesty International as breaching our obligations under this Convention:
to provide for children's developmental needs, to protect them from harm,
and to enable them to participate in decision-making about their future.
Access by mental
health professionals to Australia's immigration centres is extremely limited.
Repeated offers from the Faculty of Child and Adolescent Psychiatry and
the Committee of Presidents of the Combined Medical Colleges to assess
need and provide mental health services, have met with inconclusive responses
Knowledge about the
problem of self-harm in detention, its management and prevention derives
from convergent multi-source testimony, scientific literatures in related
areas and from the experience of many who have reported on this issue.
Dr Sarah Mares, Dr Louise Newman, Dr Fran Gale and the author undertook
a series of visits to 2 IDC's between October 2001 and April 2002. Visits
to the centres occurred with the lawyers representing the families interviewed
and we were involved in preparation of medicolegal reports on their behalf.
We were not given permission to interview unaccompanied children, or to
sit in on the interviews conducted by the lawyers representing these children.
Individual family members were announced to us by number not name. Interviews
were held with the assistance of interpreters. In order to protect the
families, family details were altered.
A case example
A aged 17 and R aged
15 are brothers, detained with their mother and younger two sisters in
an IDC. The family is known to authorities for their role in IDC riots,
and have been willing for their case to be widely discussed in the media
and elsewhere. They have been in various IDC's for 21 months. When both
escaped in a riot 2 years ago, police returned them, allegedly beating
and kicking them. A was handcuffed in a poorly lit small room for a week,
with no toilet or washing facilities, only a thin blanket and freezing
air-conditioning (which guards refused to turn off). He witnessed a prolonged
beating in which he thought the victim might be killed. Further hunger
strikes and lip-sewing occurred over the progress of visa applications:
A,R and their father were separated from the rest of the family.
In August 2000, 20-25
riot staff allegedly burst in on the family at 5 a.m., and handcuffed
the older members. Different family members were put in separate cells
(one for mother and 2 youngest children, one for father and R, and one
each for A and older brother). The family spent 15 days in cell block.
There were no working showers, no toilet facilities in cells. The younger
children and mother had to use a plastic bag which they found in the cell.
Their mother found this unhygienic and humiliating, and went on a hunger
strike for two days before guards would allow them to use the toilet.
A said that because
the guards didn't allow him to go to the toilet, he started banging the
door. They forced him to the floor, caught him by the throat, and broke
his nose. The family lodged a complaint, but the outcome is unknown. R
in his cell tried to electrocute himself by breaking a light globe, then
went on 4-day hunger strike. He was so weak that he lay on floor, banging
his head against wall and desperately wanted to die. In December 2000,
his mother was worried about R's social withdrawal and death preoccupation.
R had wedged his bedroom door shut so he could cut without detection.
His mother discovered him, guards broke in door, and he had a 2 week psychiatric
admission in Perth where he was diagnosed as depressed and traumatised.
The family's refugee claims were rejected at this time. In March 2001,
R took rope from washing line, and found a place under stairs where he
could hang himself while his parents went to dinner. He was found by chance
by another detainee. He remains a significant ongoing risk of suicide.
A and R's mother
and father both served prison terms for role in riot. Their father has
been in a WA jail for several months on people smuggling charges, which
have been recently dropped. The family was frequently split up, the younger
children sometimes cared for by A, sometimes without any carers. Their
sister cried till 2 a.m. because she had been separated from her mother.
The younger children
have witnessed many episodes of deliberate self-harm and suicide attempts
by other inmates. They suffer from nightmares and panic attacks, tension,
anger, social withdrawal, loss of interest (e.g. in school) and sadness.
They also show extreme emotional distress at any suggestion of threat,
manifesting for example as screaming or running and hiding. They demonstrate
hypervigilance, fears of loud noise and shouting. They are unable to laugh
detention predisposes to youth mental disorder, violence and self-harm
A series of factors
account for youth mental health problems, suicidal behaviour and violence
in IDC's. Families are held behind razor wire indefinitely. This, and
the consuming, legalistic, adversarial nature of the refugee determination
process, makes detention considerably more difficult to endure . Traumatised
children and youth witness ongoing violence, such as suicide attempts
and riots. Their parents often cannot comfort or protect them from these
events, and their own intense hopelessness and depression may at times
be a source of the child's trauma and anxiety.
IDC's are harsh, dehumanising environments. They lack adequate educational
and play facilities, stimulation and organised activities. There is a
lack of autonomy and bureaucratic impediments e.g. parents cannot prepare
their own food and meal times for young children are inflexible. Phones
often do not work, and calls are expensive. Appropriate facilities for
women and children are lacking. Families are isolated from society, children
are separated from parents, and families from relatives and friends. Protest
is punished by coercive disciplinary strategies; there have been reports
of solitary confinement for 'troublemakers' for extended periods (Lateline,
23/04/02). Refugees are often referred to by number rather than name,
and may be stigmatised by demeaning names, such as 'little terrorists'
or 'queue jumpers'. Children are exposed to violence including shock raids,
room searches (often at night), body searches, tear gas and water cannon,
and handcuffs which leave abrasions. In some centres, there are multiple
daily musters and nightly head counts, and a continuous public address
system from 0700 to 2100 hours. Access to lawyers, medical care and visitors
may be arbitrarily restricted.
Despair and protest
are both important as motivations for self-harm in IDC's. Lip-sewing signifies
hunger (and hunger strike), protest that grievances are not heard, and
the symbolism of being 'silenced'. The detainees have few resources to
make their point, other than using their bodies.
For those desperate
enough to engage in self-harm or suicide attempts, there is a high risk
of their being caught in a process of malignant alienation from any support.
Despite the LIFE strategy, negative community perceptions of self-harm
are still widespread: those engaging in it, and attending hospital casualty
departments, for example, are often regarded as 'just attention-seeking,
The community stereotype
about self-harm is linked with the community's negative perception of
asylum-seekers by the Minister, his spokespeople and ACM staff, who generally
adopt a disciplinary policy towards self-harm and a negative attitude
to those engaging in it. For instance, 18 people on a hunger strike at
Port Hedland IDC were allegedly restrained and handcuffed, placed in isolation
after slashing their wrists with razor blades, and chemically restrained
by intramuscular injections [Age, 9/5/98, and HREOC report 'Those who've
come across the seas']. A 27 year old Palestinian man on a hunger strike
was placed in solitary confinement for 3 months in Woomera IDC, and then
because of repetitive self-harm, spent 5 months in isolation at Maribyrnong
[SMH, 27/03/01]. A man who tried to hang himself at the Curtin detention
centre was cut down and beaten for hours by ACM, according to allegations
in a draft confidential report prepared by HREOC [SMH, 5/4/01]. After
a man in his 20's tried to immolate himself in Woomera IDC in April, he
was charged with destroying property, and this precipitated a further
overdose (Lyn Bender, personal communication). Eleven unaccompanied Afghani
children aged 14 to 17 who threatened mass suicide and passed notes to
the media were allegedly punished by having their English classes withdrawn
[Australian Financial Review, 29/1/02]. The Minister apparently equates
self-harm with crime and manipulation or terrorism, requiring counter-terrorist
tactics. He allegedly asserted in the recent Woomera action that parents
helped children to sew their lips, despite lack of evidence for this [SMH,
07/02/02, p6]. He was quoted as saying that the Government might be judged
in future as having been too soft on asylum-seekers [SMH, 25/01/02].
about suicidal people and about refugees dovetail with the present Australian
government's on-shore asylum-seeker policy, which expressly aims to deter
would-be 'boat people' and people-smugglers, by denying access to mainland
Australia and punishing those who actually arrive by keeping them in prolonged
detention. Thus, it can be plausibly argued that the Australian state
knowingly and wilfully re-traumatises stateless and traumatised people,
in furtherance of this policy. The official position that government won't
be influenced by suicidal behaviour and it is a manipulation, is also
of concern. It gives a dangerous message to suicidal people in the general
community, about official perception and response to their needs.
The goals of the
LIFE program include enhancing resilience and protective factors and reducing
risk factors for suicide, supporting those affected by suicide, ensuring
'Whole of community' approaches and 'Partnerships', addressing stigma,
implementing effective parenting skills and support programs, and providing
timely access to accurate and up-to-date data. IDC's represent the antithesis
of those goals. Approaches to managing self-harm in IDC's typically focus
on end point interventions and/or treatments, rather than prevention.
Individual but not systemic problems are addressed. Components of government
do not communicate with each other. This is a situation where no amount
of individual 'anger management', 'cognitive behavioural therapy', and
antidepressants, can undo the extreme effects of the environment. Thus,
these centres attack their inmates by denuding them of their culture,
identity and humanity.
What must be done
Australia and the Alliance of Professionals concerned about the Health
of Asylum-Seekers and their Children, have recommended that children should
be removed from detention centres with their families, and unaccompanied
children to the care of appropriate foster carers as soon as possible.
Children should not be separated from their parents if at all possible.
They have called on the Australian Government to revoke the policy of
detaining asylum seekers, as international experience shows it is unnecessary
for processing refugee status claims and because psychological harms associated
with detention are unacceptable. They have also called for an external
group of child and adolescent mental health consultants to independently
review the needs of these groups, and advise the ministers of immigration,
health and community services.
suicide and engaging in self-harm should be treated as people. Their behaviour
should be taken seriously and as communications of distress rather than
regarding them as behaving badly or as simply manipulative. Suicidal threats
require humane, empathic responses and amelioration of immediate environmental
stresses. As suicidality & mass self-harm in detention centres is
unprecedented in Australia, the prevention of future self harm should
also be addressed expertly and collectively to ensure the safety of those
involved. Links need to be forged between the Immigration Detention Centre
Advisory Group, the National Suicide Prevention Advisory Council and other
national mental health advisory bodies, to ensure the best expert advice
is available in handling this unprecedented situation.
mass self-harm in detention centres is unprecedented in Australia, and
represents a convergence of (child) health, protection and human rights
concerns. The problem, management and prevention of self-harm in refugee
detention is intimately related to the extremity of detention environment
& to the politics of detention. Federal government (and until very
recently, federal opposition) policy regarding mandatory detention of
on-shore asylum-seekers is the antithesis of the Australian government's
LIFE program for the reduction of youth suicide. This is a contradiction
to the 'whole of government' approach announced in the LIFE document.
It is argued in this paper that the Australian government, to further
its deterrence policy, is engaging in state-sponsored trauma. Community
stereotypes, negative attitudes and ignorance, together with lack of community
and professional leadership have made this possible. Violence and self-harm
flourish when we see fellow humans as 'the Other', as objects rather than
subjects, and we regard our own responses to mutually socially challenging
situations as more reasonable than theirs . The situation of children
and families in detention is one such example.
I thank Ms Lyn Bender for input concerning self-harm in Woomera IDC, Ms
Jonine-Penrose-Wall for work concerning SPA's position on this issue,
and Drs Sarah Mares, Louise Newman and Fran Gale for discussions concerning
children's attachment relationships in detention centres.
SUICIDE DEATHS RELATED TO IMMIGRATION DETENTION
sex age DOD
Method IDC nationality Story
reported in media [source]
52 21/12/00 Jumping 2 Tonga Worked
17 yrs illegally to provide for family in Tonga. Detained August
2000. Climbed basketball pole in IDC, in bid to avert threat of
deportation. Taunted by guards. [Age, 2/1/01; 30/12/00]
? 28/07/01 hanging 1 Nigeria,
on Sth African passport
At Sydney airport, had visa cancelled immediately, transferred to
IDC. Bewildered, asking why he'd been detained. Hung self from bedsheets
3 F 20's 26/09/01 ?over-dose 1 Thailand
from work in a brothel to IDC. Alleged heroin addict in withdrawal,
locked up for 2 days. Asking where she was, and why she was in IDC.
Made suicide threats when released for an hour. Found dead in a
pool of vomit 6 hours later [SMH, 29/9/01].
30's 13/01/02 Jumping 1 Vietnam Overstayed
student visa. Sent to psychiatric ward for wrist slashing, escaped
and was returned to IDC. Shouting and crying on balcony, 'send me
back to my country' [SMH 15/01/02]
5 M 47 2/04/01 Burns N/A Pakistan Set
self alight outside Parliament House, Canberra, over delay bringing
family to Australia [The Age, 30/05/01]
DOD = date of death
IDC code. 1 = Villawood,
2 = Maribyrnong
TABLE 2: EXAMPLES
OF MEDICALLY SERIOUS SUICIDE ATTEMPTS BY CHILDREN AND YOUTH IN IDC'S
M 17 06/01/01 Throat-slashing 2 Iraqi Occurred
when ACM refused to let his father attend a dentist without handcuffs
[Age, 8/01/01, Illawarra Mercury 09/01/01]
M 15 March
Hanging 5 Iraqi Major
depression, conflict with ACM guards, hospitalised in Perth [PK,
unaccompanied children, demanding to be released into foster care
M 14 07/02/02 Lip-sewing,
3 ? Occurred
during recent Woomera hunger strike [SMH 07/02/02]
M ? Hanging 3 ? Occurred
during recent Woomera hunger strike [SMH 07/02/02]
M 13 Early
3 Iranian Unaccompanied
minor, previously 'compliant' [PC]
Hanging 3 Both
M 13 Early
Hanging 3 Iranian [PC] M 18 Hanging
(multiple attempts) & cutting
1 Afghani PTSD
and psychotic depression [SMH 17/04/02]
F 10 8/04/02 Hanging 2 Iranian PTSD
and severe depression. Successful hanging narrowly averted by sister
alerting parents [PK]. Hospitalised.
code. 1 = Villawood, 2 = Maribyrnong, 3 = Woomera, 4 = Curtin, 5 = Port
PC = personal communication
[Ms Lyn Bender]
PK = author's personal
knowledge of case
PTSD = post-traumatic
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