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Submission to the National Inquiry into Children in Immigration Detention from
The Australian and New Zealand College of Mental Health Nurses (Qld Branch)
This submission will comment on the Mental Health and development needs of child asylum seekers from an analysis of the interview transcripts from nine refugees who have an experience of detention in Australia. 12th March 2002
Anthony
Todd Weller
BA. BN. RPN. MPH
President ANZCMHN (Qld Branch)
Deborah
Wenham
RN. BN. MHSc
Member ANZCMHN (Qld Branch)
Rosemary
Chilcott
RPN
Member ANZCMHN (Qld Branch)
ANZCMHN
(Qld Branch)
PO Box Booval
Queensland 4304
Effects of detention on children
Harshness of environment
Inadequate provision of basic facilities for infant care
Inadequate provision of nutrition for the childrenDisruption to the protective behaviour of parenting
Inadequate provision of healthcare in detention centres
Background to the Submission
The Australian and New Zealand College of Mental Health Nurses (Qld Branch) approved the need for a formal submission to the Inquiry into Children in Immigration Detention.
A convenience sample of nine participants who had been in detention as refugees was recruited for participation. They were interviewed by two nurses in a health clinic at a mutually agreed on time. The same translator was used. The interview procedure was initially standardised however, given the nature the participants' experiences there was a need for them to discuss their total refugee experience and were desirous that this information was included. Before the interview began, information was given to the participant via a translator requesting their assistance to provide evidence to the Inquiry. All participants were ensured anonymity and confidentiality.
For the qualitative analysis of the interview transcripts, a content analysis was completed. The interview transcripts were transcribed and multiple copies produced for cross referencing the data.
All of the participants had personal painful memories of their experience in detention in Australia. It was important that Counselling was availed to the participants to prevent retraumatisation. Similarly, the Interviewers and translator were offered debriefing.
The impact of detention on the well-being and healthy development of children, including their long-term development
In the psychological/emotional area, a number of themes were expressed that included 'emotions' these included anger, depression, suicidal feelings, feelings of self-harm, absence of emotions, blocked emotions, numbness, guilt, fear, sadness and repressed emotion
Effects of detention on children
All participants described a poor physical environment in the detention centres with cramped inadequate conditions lacking in privacy. There was no provision of recreation for the children - there was limited place to play and develop self-expression. There was no provision of education for the children. Participants commented on the remoteness and isolation of the detention centres.
"I was in the Port Hedland Detention Centre. There were 200 people in one block. We were in crowded conditions - very harsh environment. We were locked in - not allowed to go outside except for one hour in the morning and one hour in the evening…..We stayed a month in the block. You cannot see out of the window, and there is no air….We would dream of having cold water in the heat".
(Female adult participant)
"At Curtin, there was a plague of insects - infestations of black ants - flying ants, flies and king brown snakes. We had no insect protection. Three to four families would sleep in a 'donga ' ".
(Male adult participant)
Inadequate provision of basic facilities for infant care
"Because we only had one change of clothing we needed to wash the clothes of the children. My daughter was naked while we washed her clothes. There was only one washing machine between two hundred people and only one fridge.
For the child they gave me four disposable nappies. When they were finished they gave me a towel. We had $150 US Dollars, but they said you cannot buy nappies. We worked as cleaners for $10 a week each and we were able to buy nappies.
It was hard when they gave me an adult towel to use for a nappy - even with an adult towel, the child becomes dirty: and we are not able to dry the towel properly because we cannot go outside to dry the towel. We would leave it to dry in the kitchen but it would not always dry properly."
(Female adult participant)
Inadequate provision of nutrition for the children
"If we talk about the food. A box arrives with meat, salad and vegetables. When the box arrives it smells and is spicy - the children cannot eat it. Even this food, we cannot always get it - if there is a hunger strike or riot - the food does not arrive.
My daughter cannot eat this food. In many cases they bring a box of sliced bread and lettuce. We cannot eat it. Normally the children that age we cook them soup and cereal. Because I was not eating properly, I was not able to breastfeed. My milk stopped.
We could not provide them with milk. They would give us milk that expired in 1999. It was frozen. When you thawed it, it was like yogurt. When we complained we gave it to the guard to smell and he grimaced. The guards would say 'that is what we do in Australia'. Because of bad food my daughter is still sick."
(Female adult participant)
"There is no food to eat for the children. They would give us meat once a fortnight. It is tough and you cannot chew it properly."
(Female adult participant)
"Food? - a horrible experience everyday for u - long queues under the sun- midday to 2pm. -one hour in the queue till you go inside. I ask the guard 'Why do you treat us like this?' He says, 'We did not ask you to come. If it is my choice I would throw you into the sea."
(Male adult participant)
Mental health concerns
Some participants' reported persistent stress and anxiety as a result of the asylum official processing. Some described bullying from the guards in front of the children with the use of course language. They witnessed children being separated from their parents in situations when there was disruption due to rioting or breakouts.
There were reports of one [person - words deleted] removing a child from its Mother, with resultant extreme distress. Parents were threatened and intimidated that their children would be taken from them by the Australian Government.
It was difficult for the parents to tolerate the effects of the prolonged negative experience of detention on the children and to witness their loss of hope and expectation. Other themes in regard to mental health concerns include:
- Hopelessness in the future
- Loss of enjoyment
- Misbehaving in ways they would not have done before
- Extreme sadness
- Problems sleeping
- More aggressive
Disruption to the protective behaviour of parenting
Concern was expressed by the participants about their inability as parents to provide adequate protection from
- witnessing self-harm
in others,
- the extreme emotional
despair of other detainees,
- the boredom from
lack of activity,
- isolation,
- the poor environmental conditions,
- the culturally inappropriate food resulting in poor nutrition,
- the lack of access to health care.
- Grief and loss issues
"The children witnessed self-harm and suicide attempts at Bravo/Curtin people tried to hang themselves with a rope on a tree. Children witnessed these hanging attempts. Distressed people would cut themselves on the arms and chests- because of the bad treatment and despair. They had no access to a phone or fax - to write letters to families after months of no contact. They became angry, desperate and mentally ill.'
(male adult participant)
Some participants acknowledged that women often of Iraqi or Afghani background will act out hysterically, screaming, hitting themselves, head butting into walls. They witnessed people cutting themselves and stitching their mouths
"We are silenced - We cannot speak. Why should we eat?"
(male adult participant)
Inadequate provision of healthcare in detention centres
All participants describe poor access to health care. They describe inadequate medical and nursing staffing levels - one doctor for 1600 detainees. They describe poor triaging for the clinics. This triaging is done by the guards. They express concern about the cultural health care needs of women - to have access to female Doctors. This did not occur. Poor antenatal care as pregnant women did not feel comfortable seeing male doctor. Asthmatic children had to wait at the gates to get their inhalant medication. As well as access to medical care, there is a pressing need for specialist psychiatric care given the prior history of trauma that participants described from their refugee experience
Poor access to health care
"There was a clinic and a pharmacy. No one gives us the medication - it is only for display for when the commission comes. You are never given the medicine you need. They tell you to drink water or in an extreme case to take Panadol. Your name is placed on a list. It is published. Twenty people are taken there daily under the sun. There is no shelter or no seating for waiting. If you miss breakfast, lunch etc you will go without food - you don't want to leave the Queue - children are waiting there for other children. If I have an ache in teeth - there is 3-4 months wait."
(male adult participant)
"My daughter had a fever - it was a sudden onset. We needed to take her to the clinic. But the guard said "You have no appointment, you cannot go'"
(female adult participant)
Prior history of traumatic events
"We lived in fear in Iraq. Our family was persecuted because of our religious beliefs. We are Shiite Muslims. Our Uncle was killed by Saddam Hussein. I was an engineer, my wife a teacher of Arabic. We were sacked from our employment because we were related to him."
(male adult participant)
`"The boat was a terrible experience - everyone was tense, fearful - scared and crying. The ocean seemed so large - the rocking of the boat with the large waves. The seasickness and vomiting. Fear of drowning - because they can't swim. Two hundred people on two hulks. Seventy-two hours bailing water. The boat sunk off Lombok … On the second attempt the engine stopped - the ocean was rough. Many fell unconscious. There was a hole in the fishing boat. People were crying and shouting…nobody drowned ….it was traumatic. One child was disabled."
(male adult participant)
Sexual Abuse of Children in detention
What was extremely disturbing were reports from participants that unaccompanied minors are not segregated or protected. Participants who were interviewed report that children are preyed on by older single men - for sex favours. One participant reported concerns of a women's sixteen year old son becoming homosexual after being abused by an older man. Other participants reported their fears and concerns for the young people exposed to such conditions. Sexual abuse of children can result in long term mental health consequences. Whether the abuse is a single event or occurs over many years, the effects can be severe. It is possible that survivors of sexual assault are more likely to suffer mental illnesses such as major depression, and anxiety disorders.
After effects of detention
Sense of self:
Here the predominant after-effects were low self-esteem, self-hatred, shame, humiliation, bad, powerlessness, and low self-worth.
"The guards would say to me: 'Australians don't want you. Australians hate you.' They want you to go home.' I felt such a sense of shame - that when I came out from detention I was confused when people wanted to help me. I thought I was a bad person."
(Female participant aged 13)
"The guards would follow me to the toilet, and they would request that I left the door open. It was so humiliating for me - that I feel.. I have no…that I have lost my dignity. Surely you can understand in my culture such a thing does not happen?"
(male adult participant)
Relations to others
No trust, hostility, distant relations and fear were the negative themes expressed in their relations to others as a result of their detention experience. All of the participants expressed a sense that their experience of detention had alienated them from others. They had an acute sense of disappointment with officials and the government and their desire to over comply with orders in a situation they had no control over and no power. They felt prejudiced against.
"For so long you are not believed. You are questioned. People say they will help you put your trust and faith in them. You are given promises but, nothing comes of them. That you feel in your self - that is how I am seen by Australians too. They do not trust me. I have to remind myself to trust in myself, for they do not trust me".
(male adult participant)
All those interviewed reported the experience of detention as negative. Many stated that they had lost the ability to trust, lost their self-esteem or part of their selves, had difficulties with relationships, lost the sense of how to become a person, or how to develop a sense of self. Some expressed guilt for being a refugee.
Conclusion
It is evident from the interviews that the impact of being in a detention centre in Australian has had an extremely negative impact. This will affect any transition to community integration. Therefore, assistance with community integration needs to be prioritised.
In a variety of ways, participants talked about communicating their genuine willingness to develop relationships and contribute to the community that they are living in. Yet they felt constrained by their lack of certainty, a loss of hope and a sense of fear in trusting others that was resultant from their detention experience.
Effective treatment and support processes are needed and should be offered to deal with the all-encompassing aspects of the negative after effects of detention. There is a pressing need for a group process where these negative after effects could be closely explored in both individual and group therapy. Yalom (1985) describes the curative factor of universality in group therapy. This could provide the needed identification and validation with others who have had a negative psychological experience as a result of detention. This would help to reduce or eliminate the senses of isolation/aloneness and other negative effects.
It is clear from the content and themes of the refugee interviews that children will be negatively affected by what they have witnessed in detention centres.
Children are our future and strategies that promote their mental health resilience need to be addressed.
Recommendations
Recommendation one
Close down detention centres that foster negative institutional experiences. Provide alternative models of community detention.
- Enhance factors that contribute to a positive environment that are protective in regard to at risk mental health conditions
Recommendation two
Improve treatment for mental disorders and the emergency response and provision of follow-up support for incidents of attempted suicide and self-harm within detention centres
- Provide access to mental health specialist services to enable early identification and effective treatment for refugees and refugee children at risk of mental disorders, particularly depression.
- Build effective and transparent links between services responding to incidents of attempted suicide and self-harm, including emergency departments, ambulance services, police, community mental health services, general hospital, psychiatric inpatient, drug treatment and prevention services
- Provide appropriate training and support to detention centre staff and department of immigration staff in responding to suicide, self-harm or mental health crisis to enable them to respond in culturally appropriate ways and take into account issues of history of trauma, age and gender.
- Improve the quality and consistency of data on incidents of attempted suicide or self-harm during detention and following release.
- Enhance self-capacity skills of refugees.
Recommendation three
Promote strategies and fund services to reduce the risk of suicide and self-harm among people upon release from the detention centres with, or at high risk of, mental disorder
1. Increase access to appropriate and non-stigmatising mental health support and promote early intervention for refugees with mental disorders
2. Enhance detention release protocols and improve community support and follow-up after release from the detention centres with mental health symptoms.
3. Review, disseminate and implement protocols for suicide risk assessment within detention centres.
4. Develop, implement and review protocols and procedures to reduce and respond to incidents of suicide and self-harm within detention centres.
Recommendation four
Provide mental health promotion and prevention programs that are grounded in transcultural appropriateness
1. Parenting support programs to enhance parenting resilience
2. Provide mental health literacy on refugee impact issues.
Recommendation five
Increase Community Acceptance of and support for marginalised groups, people with risk factors for mental illness
1. Establish media reference groups on refugees to provide expert advice on media strategies
2. Media strategies that address understanding of the refugee experience that promote a positive portrayal of refugees and foster supportive attitudes towards this marginalised group.
3. Fund programs that support 'connectedness' to increase a sense of belonging.
Recommendation six
Last Updated 9 January 2003.Address Child Abuse
1. Work with other services in child protection to identify those children who have been abused and provide appropriate supportive therapy.
