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A last resort? - Summary Guide: Mental Health

A last resort?

National Inquiry into Children in Immigration Detention

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    A Last Resort? - SUMMARY GUIDE. A Summary of the important issues, findings and recommendations of the National Inquiry into Children in Immigration Detention

    Mental health

    I felt so bad staying in a place

    surrounded by razor fence. I can’t understand and I always

    asked ‘Why did they take me here?’ … It was scary.

    Unaccompanied child, quoted by Migrant

    & Workers Resource Centre, Refugee Assessment Project

    The traumatic nature of the detention

    experience [at Woomera] has out-stripped any previous trauma that

    the children have had. So it has got to the point where being in

    detention is the worst thing that has ever happened to these children.

    Child psychiatrist who treated children

    at Woomera,

    evidence to the Inquiry

    Under the Convention on the Rights of the Child,

    all children living in Australia - including children held in immigration

    detention - have a right to the 'highest attainable standard of health'.

    The Convention also states that children escaping conflict, torture or

    trauma have a right to special help to recover 'in an environment which

    fosters the health, self-respect and dignity of the child.'

    A child's mental health affects every part of his or

    her life. For instance it can stop children from enjoying healthy relationships

    with family and friends, it can hinder their ability to learn and it can

    undermine their enthusiasm to play. In other words, a child's mental health

    is strongly linked to his or her overall well-being.

    The Inquiry received a wide range of evidence which

    indicated that detention has a significantly detrimental impact on the

    mental health of some children. While children who were detained for short

    periods of time may not have been greatly affected, evidence from the

    primary records of mental health professionals who treated children in

    detention showed that the longer children were held in detention, the

    more their mental health deteriorated.

    Whilst children in detention did receive some support

    and help from mental health professionals, many experts told the Inquiry

    that the detention environment made it virtually impossible to meet the

    mental health needs of children and their families. This was because the

    source of many of the problems was the detention environment itself.

    The Inquiry heard numerous examples where State mental

    health and child protection agencies, as well as independent experts,

    repeatedly recommended that children be removed from detention to protect

    their mental health. By April 2002 most unaccompanied children were removed

    from detention centres following these recommendations - but the recommendations

    were not implemented for children in detention with their parents.

    Mental health experts, many of whom had treated children

    in detention, told the Inquiry that child detainees had experienced, amongst

    other things, clinical depression, post traumatic stress disorder, and

    various anxiety disorders.

    Children in detention exhibited symptoms including

    bed wetting, sleep walking and night terrors. At the severe end of the

    spectrum, some children became mute, refused to eat and drink, made suicide

    attempts and began to self-harm, such as by cutting themselves. Some children

    also were not meeting their developmental milestones.

    Recovery from past trauma

    More than 92% of children in detention have been found

    to be refugees. This means that most, if not all, children in immigration

    detention are likely to have been affected by significant traumatic episodes

    before they arrived in Australia.

    However, the Inquiry received evidence that the trauma

    children experienced before they arrived in Australia does not account

    for the extent of mental health problems they demonstrated in detention.

    In fact, the evidence was clear that immigration detention centres were

    not an environment where they could recover from their past persecution

    and trauma.

    The detention environment

    Children, parents, child protection authorities and

    psychiatrists all agreed that children are deeply affected by witnessing

    violence in the detention centres, such as riots, fires, suicide attempts,

    incidents of self-harm and hunger strikes.

    An atmosphere of fear and violence can cause extreme

    anxiety in children, which can cause them to relive past traumas. It can

    also lead some children to copy the behaviour they see around them.

    Parents expressed concern for

    their 3 year old … [that] he has picked up bad habits from

    what he observes in his environment, including bad language, climbing

    and jumping, violence against himself and others and saying [that]

    he wants to drink shampoo …

    South Australian Department of Human

    Services,

    Woomera Detention Centre Assessment Report, April 2002

    The atmosphere of violence was compounded by other

    factors associated with life in a detention centre, such as living in

    a closed environment and the uncertainty surrounding visa applications.

    In the early stages of detention, before a primary

    determination is made on a visa application, detainees are generally hopeful

    that their application will be successful and their time in detention

    short. However, as weeks and months pass without any news on their visa

    application, or if the application has been rejected, detainees grow more

    depressed, anxious and fearful.

    There are children who have been

    there for a very long time – two to three years – and

    they have done things that are very distressing, like they went

    up the trees and they wanted to throw themselves, trying to commit

    suicide. There were kids that actually stitched their mouths. Things

    that are so traumatic that we are now having nightmares on a daily

    basis.

    Former detainee boy, Perth focus

    group

    Breakdown of families

    Experts agree that strong, effective parenting is crucial

    to the well-being and healthy development of a child. However, being in

    detention can severely undermine the ability of parents to care for their

    child.

    Parents in detention spoke of their frustration at

    being unable to maintain normal family arrangements in detention, such

    as cooking their own food, providing discipline or celebrating birthdays

    or other special days.

    Parents also said they felt guilty in bringing their

    children to Australia - instead of finding freedom and a new home, they

    were being held in 'a prison'.

    The Inquiry heard that parents in detention who were

    previously very effective and competent became depressed in detention,

    which meant they were unable to play with their children, read to them,

    supervise them or look after their safety. In some cases, parents also

    found it difficult to manage their children's behaviour in the detention

    environment.

    A parent's depression can lead to children taking on

    an 'adult' role - children would care for a parent or younger siblings

    and discuss issues with detention centre staff because they had stronger

    English language skills than their parents.

    Child welfare experts told the Inquiry that it was

    very harmful for children to take on these roles. Not only is the behaviour

    'developmentally inappropriate', it also means they sacrifice their own

    needs and try to offer a level of care to others that they are not really

    able to give.

    My mum was sick always. She was

    very sad. Every night she was crying until one or two o’clock

    because we lost our father … But now we are big and we look

    after her. My mum is always worried about the visa. Sometimes she

    has headaches.

    Afghan former detainee girl, Perth

    focus group

    Mental health problems suffered by children in detention

    Children detained for lengthy periods have experienced

    significant mental health problems. A study by mental health professionals

    (the 2003 Steel report) of 20 children from a remote detention centre

    who had been detained for an average of 28 months found that:

    All but one child received a diagnosis

    of major depressive disorder and half were diagnosed with Post Traumatic

    Stress Disorder (PTSD). The symptoms of PTSD experienced by the children

    were almost exclusively related to experience of trauma in detention.

    Children described nightmares ... and many would scream in their sleep

    or wake up shouting.

    In April 2002, the South Australian child welfare authority

    made the following report on a 13 year old boy who had been detained for

    455 days:

    [He] is very withdrawn and lethargic.

    Since entering Woomera he has been suicidal and very sad. He reports nightmares

    nightly, seeing himself dead, or unable to move with people carrying his

    body. He reports waking screaming and finds trouble falling to sleep.

    He reports a diminished appetite. He has little memory of past events

    and no hope for the future. He refuses to make new friends because he

    believes they will be released but not him. He engages in constructive

    day time activities but spends hours sitting staring vacantly.

    Children in detention also self-harmed - they have

    sewn their lips together, attempted to hang themselves, swallowed shampoo

    and detergents and have cut themselves. Between April and July 2002, one

    child detained at Woomera made four attempts to hang himself, climbed

    into the razor wire four times, went on hunger strike twice and slashed

    his arm twice. Records from April 2002 report this boy saying:

    If I go back to camp I have every intention of

    killing myself. I'll do it again and again ... We came for support and

    it seems we're being tortured. It doesn't matter where you keep me -

    I'm going to hang myself.

    CASE STUDY

    A family - a father, mother and

    10-year old son - arrived at the Ashmore Islands in April 2001.

    They were immediately taken to the Woomera detention centre. A few

    months later, in August 2001, the family agreed to be separated,

    with the mother and son moving to the nearby Residential Housing

    Project (the rules of the Project do not permit fathers to live

    there).

    In May 2002, South Australia's

    Family and Youth Services (FAYS) noted that the boy was showing

    'clear signs of severe stress: his sleep-talking, nightmares and

    now sleep-walking indicate deep-seated trauma'. In the same month,

    an ACM psychiatric nurse reported that his mental health was deteriorating

    and recommended the family be reunited and released on a bridging

    visa.

    At the end of May, the mother

    and son went back to the Woomera detention centre because they no

    longer wanted to be separated from the father. Between May and November

    2002, the young boy attempted to hang himself twice and self-harmed

    by cutting himself on at least eight occasions.

    Regular psychological assessments

    documented the boy's deteriorating mental health and the urgent

    need for intervention, including immediate release from the detention

    environment. These reports were provided to the Department.

    ‘He is at on-going risk

    of self-harm and his parents are unable to support and help him.

    In fact, he is currently the ‘strong one’ in the family

    – and he is only 11 years old.

    FAYS, June 2002

    He is completely dysfunctional

    for his age and experiences bouts of depression and uncontrollable

    rage … the stresses for a young boy to represent the family

    under these circumstances is pushing him into extreme and dangerous

    behaviours.

    ACM psychologist, June 2002

    [L]ittle can be done to help

    them whilst they remain in the detention situation.

    Psychiatrist, Royal Adelaide Hospital,

    July 2002

    Continued detention increases

    the risk of self-harming behaviour and increased traumatisation.

    Psychiatrist, Women and Children’s

    Hospital (Adelaide), July 2002

    The boy’s self-harm incidents

    have risen in frequency so much that ‘he now seems to be

    disassociated when he cuts himself.’

    Teleconference involving FAYS,

    ACM, the Department

    and Woomera Hospital, October 2002

    Long term detention has had

    a devastating effect on [this] family … Detention of this

    family at the Woomera Detention Centre is no longer an option.

    I strongly recommend that … the family be given alternative

    accommodation, preferably community-based … Anything less

    would be a failure in our duty of care.

    ACM psychologist to Department

    Manager, October 2002

    In November 2002, ACM's Acting

    General Manager wrote to the Department outlining the serious concerns

    of health professionals and recommending that the family be transferred

    from Woomera, at least to a detention centre other than Woomera,

    but preferably to an alternative place of detention. Attached to

    the letter were 18 reports on the family and their health needs.

    In January 2003 the family was transferred to

    the Baxter detention centre.

    [He] remains depressed with

    symptoms of PTSD. He remains at high risk of suicide and the centre

    is clearly unable to provide the appropriate supports to ensure

    his safety.

    SA Child and Adolescent Mental

    Health Service,

    January 2003

    When I asked if there was anything

    I could do to help him, he told me that I could bring a razor

    or knife so that he could cut himself more effectively than with

    the plastic knives that are available (showing me the many scars

    on his arm).

    Psychiatrist, Women and Children’s

    Hospital (Adelaide),

    February 2003

    In December 2003 the family was still in Baxter

    detention centre.

    Image: Family compound at Baxter, December 2002
    Family compound at Baxter, December 2002

    Inquiry finding

    The Commonwealth failed to take

    all appropriate measures to protect and promote the mental health

    and development of children in detention over the period of the

    Inquiry and therefore breached the Convention on the Rights of the

    Child.

    With respect to some children,

    the Department failed to implement the clear – and in some

    cases repeated –recommendations of State agencies and mental

    health experts that they be urgently transferred out of detention

    centres with their parents. This amounted to cruel, inhuman and

    degrading treatment.

    © Human Rights and Equal Opportunity Commission. Last updated 13

    May 2004.

    Comments and feedback welcome. Email: webfeedback@humanrights.gov.au