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Submission to the National Inquiry into Children in Immigration Detention from
the Australian Association for Infant Mental Health (AAIMH)
Prepared by Dr Rosalind Powrie, BMBS, FRANZCP.
Aims of AAIMH
Focus of this Submission
Recommendations
References
Acknowledgments
Aims of AAIMH
The Australian Association for Infant Mental Health (AAIMH) is the Australian Affiliate of the World Association for Infant Mental Health. It aims to improve professional and public recognition that infancy is a critical period in psychosocial development for infants and the family and to provide a focus for multidisciplinary interaction and co-operation for those who are involved and interested in working with infants and caregivers.
In carrying out its aims the Association prepares reports and submissions to governments, other authorities, organizations and individuals on matters relating to infant and family health and welfare. The Association is pleased to take the opportunity to present such a report to the Human Rights and Equal Opportunity Commission Inquiry into Children in Immigration Detention particularly in relation to infants and very young children.
Focus of this Submission
In keeping with the submission guidelines and the specific experience and expertise of AAIMH the following areas relating to immigration detention and children will be addressed:
- Mental health of refugee parents-impacts on young children
- The effect of detention on parenting
- Safety of infants and young children in detention
3. Culture and its influence on the psychosocial well being of infants and their parents.
4. The impact of detention on the well being of young children.
5. The UN Convention on the Rights of the Child in relation to child asylum seekers.
1. The psychological and social well being and development of infants and young children in immigration detention.
The following factors provide a context for understanding the impact of detention on young refugee children and their families as they are well recognized as critical for the healthy emotional and social development of young children.
- During the first
three years of life the brain develops to 90% of adult size and is extremely
sensitive to environmental influences. The human brain is therefore
most vulnerable to disruptive and traumatising experiences during this
time (Perry 1996).
- Fundamental to
the child's earliest experiences is the attachment relationship with
his or her primary caregiver(s). In most cases this will be the mother
initially but may equally involve the father and other close family
members.
- A healthy and
secure attachment during infancy is built by repetitive and finely tuned
interactions between caregiver and child and there is a critical period
for its development during the first year of life.
- Infants are biologically
programmed to elicit these attachment behaviours from their carers in
order for them to survive and thrive. Factors crucial in this process
are the emotional availability of the caregiver to "tune"
into the infant's signals and cues and respond accordingly. Examples
include holding and comforting, making eye contact, face to face interactions,
positive touch, the use of smell, touch and sound, playing, smiling,
talking with babies.
- Through these
sensory interactions with the caregiver the infant learns how to regulate
his or her emotional state and control distress which is important in
the development of emotional stability and socialisation.
- Parental mental
ill health, overwhelming stress, social disadvantage, and poor education
or knowledge about child rearing, can all lead to disruption in the
development of secure attachment relationships, which in turn has an
effect on the infant's developing brain, sometimes with irreversible
consequences for the infant's capacity to think, feel and form meaningful
stable relationships. These consequences can continue on through childhood
and into adult life.
- The longer term
consequences of this disruption or dysfunction in the parent-infant
relationship can be prevented through targeted early intervention (Kowalenko,Barnett,Fowler,Matthey
2000).
- Parents from differing cultures rear their children in ways which will best ensure their survival and socialisation according to their culture's norms and values. This means that healthy child rearing can be accomplished in diverse ways and generally occurs when parents themselves are healthy, well informed have had adequate parenting themselves and are not harassed by poverty or other overwhelming stressors (Wolff 1994).
With this general understanding of the importance of early care giving on the mental health and development of children, specific factors for young refugee children in detention need to be understood.
Mental health of refugee parents- impacts on young children
In general, refugees experience very high rates of mental ill health and psychological distress ( RANZCP College Statement #46).
Refugee parents may have experienced torture, imprisonment, persecution and institutional violence by the political regimes of their country of origin, or have witnessed a spouse or close family members undergoing such experiences.
Many families prior to detention in Australia have experienced long and perilous journeys and been in transit for months or years in refugee camps or in countries where they have had no citizenship rights, lived in very poor and overcrowded housing and where basic needs have been barely met. Children are conceived and born in such situations of deprivation, uncertainty and with minimal or no health care.
Psychological distress and poor mental health is often chronic and continues after re-settlement and acquisition of relative safety. This stems from a myriad of complex factors including the consequences of traumatic stress, enormous grief and loss, social and cultural dislocation, language barriers, ongoing fears for family and friends left behind, physical health problems, loss of status and acculturation stressors.
Refugees in detention experience, in addition, ongoing uncertainty regarding their immigration status. This, of course, impacts on their mental health more acutely.
The effects of these factors and forces will compromise many refugee parents' capacity to care for their children.
More specifically both parental depression and post-traumatic stress disorder (common in adult refugees) have direct effects on the development of infants and young children.
Parents experiencing post-traumatic symptoms are often extremely irritable, have unstable moods and poorer impulse control. Infants experience these moods and behaviours as frightening and in turn are unintentionally traumatised by the parents' symptoms. This sets in train a series of difficult interactions, which if not alleviated, can lead to an insecure attachment and poorer social, cognitive and emotional outcomes for the child.
It is well known that depressed mothers in turn are less sensitive to their infants and are less likely to talk and look at their infants. In extreme cases this can result in emotional and physical neglect resulting in the infant's failure to thrive.
In disadvantaged populations, depression in mothers (and mothers in immigration detention are profoundly disadvantaged) has been shown to produce severe disturbances in the mother-infant interaction (Murray et al 1996).
Parents who are emotionally unavailable and irritable will experience difficulty managing the normal oppositional behaviour of toddlers leading to an increased risk of coercive and abusive discipline. Boys are particularly at risk of later anti-social behaviour and cognitive impairment in this context (Sharp 1995).
The following anecdotes illustrate the difficulties in recognition and prompt treatment of mental health problems of families in detention and the adverse consequences for their children
"One mother
I saw had a generalized anxiety disorder. Her two and a half year old
was accidentally burnt by her when she spilt a cup of tea on his leg.
The burn was minor but to reassure the mother they were both admitted
to the local hospital. The mother then became even more anxious. The child
refused to walk and would only lie curled up in the foetal position in
the mother's lap. This situation went on for some weeks until eventually
the mother was given counselling and things improved."
(Dr Simon Lockwood, G.P., Woomera Detention Centre)
"A mother
with a 5 month old baby presented with concerns about harming her child.
The baby was removed from her care by child protection services and placed
with another family in detention. The mother was severely depressed and
possibly psychotic. She was finally admitted to the local hospital with
her baby and treated with medication. It was reported she recovered and
is back in detention with her baby."
(Dr Fiona Hawker, Psychiatrist, Rural & Remote Mental Health
Service)
In this case adult mental health services had recommended an admission to a specialised mother infant unit which did not occur.
It is not known what, if any, after-care this mother and her infant were offered. Post-partum depression with intent to harm oneself or the infant is a medical emergency.
It usually requires immediate hospitalisation preferably in a specialised mother infant facility to ensure safety of both, treatment of the mother's illness and also to prevent separation of mother and child which can be detrimental to the attachment relationship. In addition, specific treatment for the mother-infant relationship is usually required, or at least needs to be monitored.
The Effect of Detention on Parenting
The effects of institutional living on parents in detention undermines and significantly limits their already compromised capacity to nurture and protect their children. There is little privacy for families, individuals are identified by numbers not name, parents lose their roles and responsibilities, there is regimentation, constant surveillance and in at least some detention centres, sparse recreation facilities for families.
"In detention
parents of young children become completely disempowered…. They cannot
cook for their children or do anything for their kids. They lose their
self-esteem… they stop caring. Most of the parents I see have mental
health problems, many of the mothers are depressed. Mothers of toddlers
often don't care if they turn up for meals or if they wander off….mothers
and children housed outside detention in the community housing project
in Woomera do better. These children are better fed, and clothed, mothers
are able to look after them better."
(Dr Simon Lockwood, G.P., Woomera Detention Centre)
Parents feel helpless, despairing and enormously guilty because they are unable to help improve their children's situation. Pregnant women in isolated centres such as Woomera experience further trauma and loss through the accepted practice of transferring women at 36 weeks gestation to regional hospitals for delivery. This vignette describes one such experience for a mother and her family with young children
A couple with a 2 year old and a baby aged 5 months repeatedly begged, "Please take our children, find a place for them away from here. He will change to a savage not a human. Please do something for a family to adopt him until we can care for him again. He doesn't trust in us anymore. He can't play, he won't eat, he can't sleep well".
This family had spent 9 months in detention and had recently had their application for refugee status refused. Mrs Z had her first child in the Middle East, in a normal, uncomplicated delivery and had breastfed him for 12 months. She was too distressed to tell me about the second child's birth so the story came from her husband. During the interview she was expressionless and almost mute, occasionally tears coursing down her face. She cared for her infant in a mechanically adequate way with no animation. She appeared helpless in the face of her older son's behaviour.
Her second child was born in a hospital 200 kms away by caesarian section that she says she did not understand or consent to. This occurred after a period of 4 weeks enforced bed rest, away from her husband and son, under guard in the hospital. She did not see her baby for some days and could not breast feed when she was returned to her. She was returned to the centre one week after delivery and given no follow up, apart from occasional visits to the detention centre nurse, who gave her panadol and wound dressings but did not help Mrs Z dress or clean her wound. The wound continued to weep for 6 weeks and remains painful. She feels violated and disenfranchised. The 2 year olds behaviour deteriorated during and after his separation from her. The parent's relationship was also clearly under stress, "He says I should be getting better everyday, instead I am getting worse".
The toddler was indeed angry and disruptive. He threw any offered toys away and spat at people, he attempted to eat bits of foam that lay on the floor. He repeatedly tried to leave the room and when he succeeded, wandered quite far until returned by a guard. His father said " You see his behaviour ? It is because we are sad and weeping all the time. He has lost his trust in us…..
His wife had an air of despair. She attempted to limit her son's behaviour but soon gave up. She asked to leave the interview to take him back to the compound. She remained quiet and withdrawn occasionally weeping throughout the interview, initially placing the baby in his pram in the corner of the room, facing the wall. She fed her without eye contact… The infant (at a developmental stage when most babies interact socially at every opportunity), made no attempt at eye contact and looked profoundly sad. She made little sound or complaint, but later became more animated when direct attempts were made by the interviewer to smile at and talk with her.
Mr Z feels unable to protect his children, impotent and trapped, reduced to less than human himself and unable to fulfill his role as father and husband. I asked whether his desire to have the children placed with another family came out of fear that he might hurt his child, and he said, partly this was true, relating an attempt to cut his own and his son's throat when their refugee application was rejected after 8 months of waiting. He says he was only stopped from hurting himself and his child by other detainees."
(This vignette submitted by Dr Sarah Mares, Child and Adolescent Psychiatrist )
Safety of infants and young children in detention
Clearly parents who are disempowered and depressed are less able to protect their children. In addition, events in the Woomera Detention Centre and to a lesser extent other centres have demonstrated without any doubt that detention is a dangerous place for children. Children of all ages have been exposed directly to adult violence, riots, hunger strikes, self mutilation and attempted suicide by other detainees. As there is no separate accommodation for families children are exposed to the extreme acting out and despair of adult detainees including in some cases their own parents.
"Three schools
have been burnt down in 18 months, there is no pre-school- any equipment
supplied to younger children is destroyed by the adolescent or adult male
detainees…women and children need to be moved out….they cannot
be protected in detention.
(Dr Simon Lockwood, G.P., Woomera Detention Centre)
Toddlers and pre-schoolers are exhibiting phobias and other forms of traumatic anxiety when exposed to reminders of violence in Woomera such as fire trucks and tractors. These anxieties continue on release into the community and cause disability. For instance, a three year old has, since his family's release to Adelaide, continued to exhibit phobias from his detention experience - even cyclone fencing causes him distress. (personal communication, Steve Thompson, Psychologist, STTARS - Survivors of Torture, Trauma and Rehabilitation Service).
While symptoms of trauma and distress may be more obvious in older children, infants only present with global problems in physical functioning- settling, feeding or sleeping difficulties, listlessness, apathy or irritability ( Schwartz et al 1994) which is likely to go unrecognised by staff in detention centres.
2. How is trauma and developmental harm detected and what services are required to treat infants and young children
Assessing young children for trauma related developmental harm and attachment difficulties requires specialised skills. Prompt access to child mental health services which can assist and support primary health workers or provide a direct service to refugee families is essential for such assessment.
Assessments of the parent's capacity to provide consistent protection, nurturing and stimulation appropriate to the developmental level of the child need to occur through direct observation of carer and infant and by assessing the mental health problems of parents. Parents require prompt access to mental health services to identify and treat these problems, and support in parenting their children whilst this occurs.
The child's family is central to the child's recovery from developmental harm. Refugee families will require continuing and high level support to assist with the many and ongoing environmental stressors they experience during detention and on release to enable the child's safety to be ensured over time.
Interventions targeting refugee parents and their infants should follow best practice guidelines in infant mental health this means high quality ante-natal and peri-natal care including screening for ante-natal and post-natal depression, parenting education, appropriate language and cognitive stimulation for children, regular visitation in their place of residence, family support, and the gamut of well baby care offered in the community.
All of these interventions must be delivered by services and persons who are culturally sensitive and inclusive of the values and beliefs of refugee families. Specialist refugee services, bilingual and bicultural workers should be utilised and work in collaboration with mainstream health services.
However a fundamental condition which must be met in order for any intervention to work is the child's safety. Detention poses, by its very nature ongoing threats to the physical and emotional health of children and therefore will undermine any therapeutic interventions and efforts.
3. Culture and its influence on the mental health of families
Infants begin learning about their culture from birth through the daily caregiving they receive. Cultural beliefs and practices give meaning to everyday life. Refugee families experience enormous cultural loss and bereavement on arrival in Australia and invariably experience "culture shock", the disorientation and confusion associated with attempts to understand new lifestyles, social structures, the geography, and the educational, health, welfare, legal and government systems which they must negotiate in order to re-settle.
A strong sense of cultural identity and maintaining access to one's cultural and religious community (religious figures, schools, education and other resources) can enhance resilience and coping in the face of these tumultuous changes.
Detention, by its institutional nature must severely reduce the opportunities for families to practise their culture and religion because they simply do not have access to like communities, places of worship, rituals and activities of cultural significance.
4. Impact of Immigration Detention on the well being of children
The evidence previously cited and the vignettes discussed show that the policy of mandatory detention of families who seek asylum in Australia has direct and harmful consequences for families of all children- infants and young children being especially vulnerable. In summary
- Infants and young
children are placed in a physically harsh and restricted environment
with inadequate space and facilities for safe play and development.
- The detention
environment is dehumanizing. For example, children witness their parents
and themselves being introduced and identified by number not name, and
subjected to the daily humiliations that detention involves.
- Children witness
their parents' powerlessness in the face of the institutional environment.
- They are exposed
to adults who are depressed angry and suicidal.
- Their parents
are unable to protect them from witnessing the violence and despair
of adults living with them.
- The parents themselves
inevitably feel hopeless and guilty, in part with the recognition that
they are exposing their children to their own despair and unable to
make their circumstances better.
- The extent of untreated trauma and depression in some of these parents puts their children at risk of emotional neglect and physical and emotional abuse.
5. The United Nations Convention on the Rights of the Child and children in Immigration Detention
The rights of child detainees in Australia are far from being met under the Convention for reasons already outlined in this submission. These include the right to
- family life and
to be with parents unless separation is in their best interests
- highest attainable
standard of health
- protection from
all forms of physical or mental violence and the right to recover and
be rehabilitated from neglect and abuse
- practise their
culture, language and religion
- rest and play
- primary education
and secondary education
- appropriate protection
and humanitarian assistance
- not be deprived
of their liberty unlawfully or arbitrarily with detention only in conformity
with the law, and as a measure of last resort and for the shortest possible
period of time.
- be treated with
humanity and respect for their inherent dignity and in a manner which
takes into account their age
- access to legal
assistance and the right to challenge their detention
- not be subjected to torture or other cruel, inhuman or degrading treatment or punishment
Recommendations
- Continued long term detention of young children and their families is unjustifiable on developmental, medical and mental health grounds. Provision must be made immediately for child asylum seekers and their parents to be housed in the community and not held in detention centres. Immigration detention is directly and indirectly traumatizing for infants, children and their families. The impact of living in this environment compounds existing problems experienced by parents already compromised by past trauma, loss and continuing uncertainty about their future. Mental health interventions and services will be ineffectual in this context of ongoing trauma.
- Children and
their parents must have access to the full range of health services
available in the community including adult and child and adolescent
mental health, early childhood and disability services and bicultural
workers. These are most likely to be available in urban or large regional
centres.
- Pregnant refugee
women must have access to high quality antenatal care which ensures
they are fully informed and consent to the type of child birth options
available to them. All efforts must be made to prevent prolonged separations
from pregnant mothers who have other young children. After delivery
mothers must have access to perinatal mental health services and mother-infant
services.
- State and Federal governments must make clear and immediate agreements to ensure that the best interests of child asylum seekers are upheld in delivering health and welfare services to them.
References
Kowalenko, N., Barnett, B., Fowler, C., Matthey, S., (2000) The Perinatal Period Early Interventions for Mental Health. Vol 4 in R Kosky,A Hanlon, G Martin& C Davis (Series Eds.), Clinical Approaches to early intervention in child and adolescent mental health. Adelaide: Australian Early Intervention Network for Mental Health in Young People
Murray, L.,Hipwell, A., Hooper, R., Stein, A, and Cooper, P., (1996) The cognitive development of 5-year-old children of post-natally depressed mothers. Journal of Child Psychology & Psychiatry & Related Disciplines, 37(8).927-935
Perry, B., Pollard, R., Blakley, T., Baker, W., Vigilante, D. (1995) Childhood Trauma, the Neurobiology of Adaptation and Use-dependant Development of the Brain:How states become Traits, Infant Mental Health Journal 16 (4) 271 - 291.
RANZCP (2000) Position Statement #46 Principles on the provision of mental health services to asylum seekers
Sharp, D., Hay, D., Pawlby, S., Schmucker, G., Allen, H.& Kumar, R.(1995) The impact of post-natal depression on boy's intellectual development. Journal of Child Psychology and Psychiatry, 36, 1315-1336
Schwarz, E., Perry, B.,(1994) The Post-traumatic response in children and adolescents. Psychiatric Clinics of North America, 17(2): 311-326
Wolff, S., (1994) The Scope of Infant Mental Health: Pointers to helpful interventions Newsletter of the Australian Association of Infant Mental Health, Vol 6,4, December 1994.
Acknowledgments
On behalf of AAIMH
I would like to thank Dr. Sarah Mares and Dr. Louise Newman for their
helpful comments and contributions in the preparation of this submission.
