9. Mental Health of Children in Immigration Detention

A last resort?

National Inquiry into Children in Immigration Detention

9. Mental Health of Children in Immigration Detention

This chapter addresses the impact of the detention environment on the mental health of children and the measures taken to address their mental health needs. Consistent with the breadth of protection given to the welfare of children under the Convention on the Rights of the Child (CRC), the Inquiry uses the term mental health to describe the psychological well-being of children as well as diagnosed psychiatric illness.

During Inquiry visits to immigration detention facilities, large numbers of children and parents reported on the impact of detention on their psychological well-being. The Inquiry also interviewed former detainee children in focus groups in order to gain an understanding of the impact of detention on their psychological well-being. Many of those children and parents are quoted in this chapter.

As a result of these conversations the Inquiry requested primary records concerning certain children and families who have been held in immigration detention centres.⁽¹⁾The Inquiry sought the fullest possible record regarding the mental health concerns and treatment for certain children in long-term detention. The primary records obtained through this process included Australasian Correctional Management Pty Limited (ACM) medical records, reports by external health consultants, incident reports, High Risk Assessment Team (HRAT) records, and reports from the State child welfare authorities and mental health agencies. Documents from the South Australian child welfare agency, the Department of Human Services (DHS), and Family and Youth Services (FAYS), the section of DHS that manages these responsibilities; and the South Australian Child and Adolescent Mental Health Services (CAMHS) were particularly useful. The case studies used in this chapter are based almost exclusively on those documents.

The Inquiry also received written submissions, oral testimony and research reports from mental health experts, including several senior psychiatrists and psychologists who gave evidence that the long-term detention of children could be expected to have a negative impact on the general psychological well-being of children. The primary records obtained by the Inquiry confirmed that detention did in fact have that effect on certain children. Some of the problems suffered by children in detention include anxiety, distress, bed-wetting, suicidal ideation and self-destructive behaviour including attempted and actual self-harm.

Furthermore, the primary records revealed that in a smaller number of cases children had been diagnosed with specific psychiatric illnesses such as depression and post traumatic stress disorder (PTSD). The records showed that either the cause or the severity of these disorders could be linked to the children's ongoing detention. They also indicate that the quality of treatment they receive is affected by their detention.

The Inquiry does not argue that the children discussed throughout this chapter represent the experience of every child in detention. Indeed the Inquiry readily acknowledges that children who are detained for very short periods of time are less likely to have had the experiences described in this chapter. However the cases and situations described in this chapter demonstrate the connection between long-term detention and the declining psychological health of certain children and this alone is sufficient to find a breach of international law. Furthermore, it is important to keep in mind that, despite the length of this chapter, the text does not fully represent large quantities of evidence received by the Inquiry regarding the mental health of children.

This chapter addresses the following questions:

9.1 What are children's rights regarding mental health and development in immigration detention?
9.2 What policies were in place to prevent and treat the mental health problems of children in detention?
9.3 What factors contribute to the mental health and development problems of children in detention?
9.4 What was the nature and extent of mental health and development problems suffered by children in detention?
9.5 What measures were taken to prevent and treat mental health and development problems in detention?

At the end of the chapter there is a summary of the Inquiry's findings and three in depth case studies demonstrating the impact of detention on the mental health of these children.

9.1 What are children's rights regarding mental health and development in immigration detention?

There are many rights in the CRC which together highlight Australia's obligation to protect the mental health of children.

Article 24(1) requires the Commonwealth to ensure that all children within Australia can enjoy 'the highest attainable standard' of physical and mental health that Australia can offer. The Commonwealth must also ensure that no child in Australia is deprived of access to the health care services necessary to achieve that standard.

States Parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

Convention on the Rights of the Child, article 24(1)

Article 22(1) highlights the obligation to provide appropriate assistance to refugee and asylum-seeking children to ensure that their special needs are addressed. In the context of mental health it is therefore important to address the likelihood that asylum-seeking children may have suffered from trauma in their past. As the United Nations High Commissioner for Refugees (UNHCR) publication, Refugee Children: Guidelines on Protection and Care (UNHCR Guidelines on Refugee Children), states:

Because of the possible damaging effects of trauma that refugee children may have experienced, some children will require specialized services or treatment.⁽²⁾

As discussed in Chapter 4 on Australia's Human Rights Obligations, article 39 of the CRC specifically sets out Australia's obligations when children are suffering from past torture and trauma:

States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child.

There are two important aspects to this article. First, Australia must take 'all appropriate measures' to promote psychological recovery - this applies both to the legislature and the executive. Second the recovery must take place in 'an environment which fosters the health, self-respect and dignity of the child'. In other words, the CRC recognises the extra vulnerability of children who have suffered some past trauma to harsh environments and therefore imposes a special obligation to ensure that children can live in a healthy, happy atmosphere.

Article 6(2) also requires Australia to 'ensure to the maximum extent possible the survival and development of the child'. The right to development includes not just physical growth but a child's mental and emotional development.⁽³⁾

Chapter 8 on Safety explains that children should be protected from physical and mental violence and abuse while in detention (article 19(1)). Furthermore, they must be treated with humanity and respect and not subjected to torture or other cruel, inhuman or degrading treatment or punishment (article 37(a),(c)).

Article 37(a) of the CRC is similar to article 7 of the International Covenant on Civil and Political Rights (ICCPR). In 2002 the UN Human Rights Committee found that the failure to release a man from detention when 'there was a conflict between [his] continued detention and his sanity' amounted to a breach of article 7 of the ICCPR:

the continued detention of [an adult male] when [Australia] was aware of [his] mental condition and failed to take the steps necessary to ameliorate

the author's mental deterioration constituted a violation of his rights under article 7 of the [ICCPR].⁽⁴⁾

Article 3(2) requires that Australia ensures the child has 'such protection and care as is necessary for [a child's] well-being, taking into account the rights and duties of his or her parents'.

The UNHCR Guidelines on Refugee Children note the negative impact that refugee centres or camps can have on the mental health of children and their families:

The emotional development of children may be adversely affected by remaining for years in the artificial environment of a refugee centre or camp where normal life activities are impossible ... Children suffer from the negative effects of extended stays on the well-being of adult family members and the destructive effects on the family unit. Extended residence in a camp may lead to extremes of behaviour in children who may become either passive and submissive or aggressive and violent.⁽⁵⁾

The United Nations Rules for the Protection of Juveniles Deprived of their Liberty (the JDL Rules) also suggest that the mental well-being of children in the juvenile justice system may be best protected if imprisonment is used only as a last resort:

The juvenile justice system should uphold the rights and safety and promote the physical and mental well-being of juveniles. Imprisonment should be used as a last resort.⁽⁶⁾

In other words, the JDL Rules note the connection between the principle of detention as a measure of last resort (CRC, article 37(b)) and the protection of the mental health of children.

The JDL Rules also provide some guidance as to how to protect and promote the mental health of those children who are detained. For example any mental health problems should be noted on admission to a detention facility.⁽⁷⁾ Children should be provided facilities and services 'that meet all the requirements of health and human dignity'.⁽⁸⁾ There should be programs and activities that are designed to foster their health and self-respect.⁽⁹⁾ Medical officers should notify the detention authorities if a child's physical or mental health 'will be injuriously affected by continued detention, a hunger strike or any condition of detention'.⁽¹⁰⁾ Moreover, there should be:

provision of the type of care best suited to the particular needs of the individuals concerned and the protection of their physical, mental and moral integrity and well-being.⁽¹¹⁾

Article 3(1) of the CRC requires Australia's administrative and legislative bodies to take all appropriate measures to ensure the best interests of the child are a primary consideration in all actions that affect children. Given the connection between a child's mental health and his or her best interests, the Commonwealth legislature and executive should ensure that a child's mental health is a primary consideration in all decisions relating to the immigration detention of children.

9.2 What policies were in place to prevent and treat the mental health problems of children in detention?

As with the provision of other services, the Department of Immigration and Multicultural and Indigenous Affairs (the Department or DIMIA) recognises that it has 'a duty of care in relation to the health of all detainees in immigration detention'. It is important to note that with regard to mental health, ACM was contractually responsible for providing mental health services to detainees over the period of the Inquiry.⁽¹²⁾ The Department was responsible for monitoring the provision of that service. ACM emphasised to the Inquiry their view that mental health problems amongst children and their families in detention are often caused by factors beyond their control, and that at times, 'services required to address a particular detainee need cannot be delivered due to locational, situational or other environmental circumstances'.⁽¹³⁾

9.2.1 Department policy on mental health and development

With respect to mental health, the Department states that:

There is a range of psychological services available on site or by referral to specialists. ...

Care needs are attended to by qualified, registered and appropriately trained health care professionals. The Services Provider seeks to employ, where possible, health professionals who have experience in the provision of health care to people who have suffered from torture and/or trauma.⁽¹⁴⁾

The contractual standards with which ACM had to comply regarding mental health services in immigration detention are contained in the Immigration Detention Standards (IDS).

As outlined in other chapters, the IDS require the provision of social, cultural, recreational and educational activities, important to the preservation of mental health.⁽¹⁵⁾ They also require that '[e]ach detainee is treated with respect and dignity'.⁽¹⁶⁾The IDS underline the importance of ensuring that staff at immigration detention facilities can recognise and respond to mental illness:

Staff are trained to recognise and deal with the symptoms of depression and psychiatric disorders and to minimise the potential for detainees to do self harm.⁽¹⁷⁾

Furthermore, the IDS require that all staff have an 'appreciation of the anxiety and stress detainees may experience'⁽¹⁸⁾ and that '[m]edical personnel have the capacity to recognize, assess and deal with detainees who have suffered torture or trauma'.⁽¹⁹⁾

The IDS require the assessment of detainees upon their arrival for mental health as well as for physical health needs:

The care needs of each new detainee are identified by qualified medical personnel as soon as possible after being taken into detention. The medical officer has regard not only to the detainee's physical and mental health but also the safety and welfare of other detainees, visitors and staff.⁽²⁰⁾

There are further requirements for the care of detainees who have been identified with a mental illness: . o

Detainees in need of psychiatric treatment have access to such services. . o
Arrangements are made to move detainees who are found to be severely mentally ill or insane to appropriate establishments for the mentally ill as soon as possible.⁽²¹⁾

This chapter will examine whether actions were taken by the Department to ensure the protection of the mental health of children and an adequate level of mental health services.

9.2.2 ACM policy on mental health and development

The ACM Health Services Operating Manual contains the principal policies regarding mental health services in detention. The Manual notes that ACM is responsible for:

The management and provision of clinical services for detainees with acute psychiatric disabilities, or who are at psychiatric risk.
Ensuring seriously mentally ill detainees are assessed by a psychiatric professional; and, when appropriate, referred to local psychiatric hospitals for consideration of admission to a secure hospital as a patient under the Mental Health Act.⁽²²⁾

(a) Assessment on arrival by ACM

ACM policy requires that there is a health review of all detainees within 24 hours of their reception and that this review include a mental health evaluation.⁽²³⁾ The ACM policy regarding the management of detainees at risk of suicide or self-harm, also states that '[a]ll detainees are to be screened and assessed for risk of self-harm or suicide upon arrival at a Detention Centre'.⁽²⁴⁾

(b) External referrals

The ACM policy regarding referral of a detainee to a psychiatric centre states that '[w]here a detainee exhibits behaviour or makes verbalisations suggestive of mental illness, staff or the detainee should seek the assistance of the health care staff'.⁽²⁵⁾The policy goes on to state that based on the outcome of the assessment, ACM health staff should do one of the following:

Refer the detainee for further diagnosis, evaluation and/or treatment.
Place the detainee on the active outpatient case-load of the psychiatric facility or the psychiatric staff on-site.
Determine that no mental disorder is present and inform the referring staff that no psychiatric treatment is indicated.⁽²⁶⁾

(c) Suicide prevention

ACM also has a policy on suicide prevention, the purpose of which is to 'prevent suicidal gestures and attempts through surveillance and monitoring by health care and all other personnel'.⁽²⁷⁾ The policy notes the periods of time when detainees may be at risk, including after a negative decision regarding their application for a protection visa.⁽²⁸⁾ This policy requires that all staff members be trained to recognise potential suicide risk in detainees, that assessments should be conducted by a qualified health care professional, that procedures for monitoring a suicidal detainee should be specified, and that procedures for referral to mental health care providers should be specified.

(d) High Risk Assessment Team (HRAT)

One of the principal means through which detainees with serious mental health problems are managed within the detention environment is through the application of an At Risk Treatment Plan. This is generally referred to by ACM as the High Risk Assessment Team (HRAT).⁽²⁹⁾ The policy requires that detainees determined to be at risk should be closely observed until a Mental Health Status Screening can be conducted. They should then be quickly referred to the appropriate staff member within the centre.⁽³⁰⁾

The At Risk Plans (ARP) are developed by Health Centre staff. They are signed by both the ACM Operations Manager and the ACM Detention Manager. Once a detainee is on an ARP, they are monitored by the HRAT. The HRAT should meet each weekday to review the ARP. Specifically, the review considers:

level of risk
placement of the detainee in particular accommodation
level and conditions of observation to be provided
need for follow up health care
need to contact family and/or friends for special visitation.⁽³¹⁾

The level of risk determines how often a detainee will be observed. Detention officers are responsible for maintaining At Risk Watch Logs, with all logs sighted and signed by the Detention Supervisor. Modification of a detainee's ARP or authorisation for a detainee's removal from a plan is the responsibility of the HRAT.

The policy does not contain specific comments about the management of children deemed to be at risk.

(e) Voluntary starvation

The ACM policy on voluntary starvation (hunger strikes) outlines the procedures that should be followed when a detainee commences a hunger strike, including assessment within the Health Centre, reporting to the Operations Manager and the generation of incident reports.⁽³²⁾ Detainees on hunger strike are to be seen at least once every 24 hours by nursing staff, and at least once every three days by the medical officer in the centre.

The policy contains a specific section on the management of children on hunger strike. It states:

There are occasions when either parents place their children on a hunger strike or children declare they are on voluntary starvation. The management of children in this situation is somewhat different to adults, as dependent on their age they will physically deteriorate more quickly than adults.⁽³³⁾

The policy requires staff to notify State child welfare agencies. Parents must be informed that if the child welfare agency 'considers the child to be at risk they may be removed from the care of the parents'. The child must be seen by both nursing staff and the medical officer once every 24 hours.⁽³⁴⁾

9.2.3 State authority involvement in the mental health of children

As noted above, ACM has a policy of referring detainees with serious mental illnesses to external psychiatric services. These services are usually run by State governments. Furthermore, notification of concerns regarding the mental health and welfare of children are also made to State child welfare authorities.

The Department states that it relies on State authorities for advice on these issues:

State child welfare authorities have expertise in child welfare matters, and are able to advise the Department of different ways in which a child can be managed within a detention facility. This can include assistance to the parents or recommendations in relation to particular developmental needs.⁽³⁵⁾

As outlined in Chapter 8 on Safety, State laws operate in immigration detention facilities where they are not inconsistent with Commonwealth laws on detention. This means that while detainees may fall within a State's mental health laws, the State does not have the power to release the detainee from immigration detention. However, the Department states that:

In practice, where a detainee is found to be mentally incapable and in need of care in a psychiatric institution under State legislation, the Minister approves the psychiatric institution as a place of detention ... [which enables] ... the detainee to receive appropriate psychiatric care whilst remaining in detention at the psychiatric institution.⁽³⁶⁾

The situation is slightly different where a child is not sufficiently ill to be 'declared' under mental health legislation, but where State welfare agencies recommend release for their general welfare. In these cases the Department states that:

In practice the advice of the State agencies is considered and, where possible, implemented by the Department. Where a recommendation is made which cannot be fully implemented (such as a recommendation for release from detention of a child and its parents, where the parents are not eligible for the grant of a visa) the Department consults with agencies to reach a legally possible and mutually acceptable outcome for the child.⁽³⁷⁾

Therefore, while the Department states that it relies on State child welfare agencies for advice on the management of children, there is no legal obligation to actually follow that advice.

The State authorities' reliance on the Department to implement their recommendations marks a substantial difference to their ordinary powers to remove a child from an abusive or neglectful environment. DHS reported to the Inquiry:

So we can't utilise our legislation like we can with the rest of the community to go to the Youth Court of South Australia and get the Court to grant removal of a child.⁽³⁸⁾

See further section 9.5.5 of this chapter for a discussion of the effectiveness of the involvement of State psychiatric services in the treatment of children in detention with mental illness.

9.3 What factors contribute to the mental health and development problems of children in detention?

Children in detention live within an institutional context. It is important to consider both the general impact of institutional living, as well as specific factors that may affect children in immigration detention, when considering the impact of detention on the mental health of children.

The effects of institutionalisation generally on the mental health of children are well understood and documented. For example, Bringing them home, the report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, referred extensively to studies showing the effects of institutionalisation.⁽³⁹⁾ Many other studies have also shown that institutionalised children are at a dramatically increased risk of serious mental and emotional disturbances.⁽⁴⁰⁾ For example, the report of the Inquiry into unaccompanied child migration to Australia during the twentieth century, Lost Innocents: Righting the Record: Report on Child Migration notes the adverse impact of institutionalisation on many of these children.⁽⁴¹⁾Furthermore, the Forde Commission of Inquiry into the Abuse of Children in Queensland Institutions found that incidents of 'unsafe, improper or unlawful treatment of children' had occurred within institutional care settings in that State.⁽⁴²⁾

ACM acknowledges the general impact of institutionalisation, informing the Inquiry that its 'assertion that detention has an impact on detainees ... simply reflects the findings of at least three decades of research'.⁽⁴³⁾

The Alliance of Health Professionals, which includes a majority of the medical colleges in Australia, suggested that:

Current practices of detention of infants and children are likely to have both immediate and longer-term effects on children's development, psychological and emotional health.⁽⁴⁴⁾

More specifically, evidence provided to the Inquiry by children and their families, detention centre medical staff, consultant psychiatrists as well as psychiatric studies on children in detention indicate that a range of factors contribute to the presence of psychological problems in children in immigration detention. Those factors include one or more of:

torture and trauma prior to arrival in Australia
the length of detention
uncertainty as to the visa process and negative visa decisions
the breakdown of many families within detention
living in a closed environment
children's perception that they are not safe within detention
treatment of children by detention staff.

Each of these factors is discussed in turn in the following sections.

Other contributing factors are noted in a 2003 study (the 2003 Steel Report) of the mental health of detainee children. This report noted that all of the children interviewed (19 children from a remote detention centre) said that boredom, isolation, poor quality food, seeing people self-harm and seeing people attempt suicide were serious problems.⁽⁴⁵⁾ Inadequate recreation and educational opportunities also have an impact on the mental health of children, as discussed in Chapter 12 on Education and Chapter 13 on Recreation.

9.3.1 Torture and trauma prior to arrival in Australia

Since more than 90 per cent of children in immigration detention over the period of the Inquiry have been found to be refugees, it follows that many children in immigration detention are likely to have been affected by prior experiences of trauma.⁽⁴⁶⁾

The Inquiry commissioned a literature review to consider factors affecting the psychological well-being of child and adolescent refugees and asylum seekers.⁽⁴⁷⁾The paper concludes that:

research clearly demonstrates that refugee children and adolescents are vulnerable to the effects of pre-migration, most notably exposure to trauma. It is also apparent that particular groups in this population constitute higher psychological risk than others, namely those with extended trauma experience, unaccompanied or separated children and adolescents and those still in the process of seeking asylum.⁽⁴⁸⁾

The Inquiry received evidence from a range of sources that children in immigration detention may have experienced significant trauma prior to their arrival in Australia. For example, the Australian Association for Infant Mental Health (AAIMH) reported that:

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.⁽⁴⁹⁾

The Inquiry also heard evidence that detainees were more likely than other asylum seekers to have had prior experiences of trauma:

Those who had suffered the most severe persecution are perversely at most risk of detention in Australia. This is not really surprising because these are the people most desperate to leave and hence the most likely to enter 'illegally'.⁽⁵⁰⁾

The Department acknowledges that pre-arrival experiences have a significant impact on the mental health of child detainees:

Of course, some of these people have had a very difficult and perilous voyage to get to Australia and they may well have other predispositions or issues in their life well before any thought of coming to Australia which might also be impacting on their personal circumstances whilst here.⁽⁵¹⁾

However, the Inquiry also received evidence that pre-arrival experience does not exclusively account for the mental health problems of children in detention. In other words, detention itself also had a significant impact on the mental health of children, particularly for those held in detention for prolonged periods.

International experience with refugee children resettled to Western countries indicates that while some mental health conditions from prior trauma may persist, particularly post traumatic stress reactions, children generally display a pattern of recovery and adaptation on arrival and integration in their new home.⁽⁵²⁾

This can be compared with a 2003 report regarding asylum seekers and their children in a remote Australian detention centre, which found that the impact of detention outweighed that of pre-migration experiences on the development of psychiatric illness:

Lifetime assessment of psychiatric morbidity indicated that there was little psychopathology amongst the children prior to arrival in Australia. One child who had witnessed severe domestic violence in Iran had multiple previous disorders. In contrast at the time of assessment, after having spent in excess of two years in detention, all children were diagnosed with at least one psychiatric disorder and most (16, 80%) were diagnosed with multiple disorders, representing a 10-fold increase in the total number of diagnoses identified.⁽⁵³⁾

The Migrant and Workers Resource Centre (MWRC) from Queensland conducted a study of 40 former child detainees and found that '[t]he detention of asylum seekers upon their arrival in Australia has a deleterious psychological effect upon asylum seekers through maintaining or aggravating these pre-existing conditions'.⁽⁵⁴⁾

Furthermore, a psychiatrist who has examined several children detained at Woomera stated that detention was the worst thing that had happened to a number of them:

People are resilient and given appropriate circumstances, people can recover from the most horrible traumas, but on average you would expect a significant proportion of these children to continue to suffer, throughout their life, the effects of the detention experience. Now, that is obviously not the only traumatic experience that many of these children have had, but it is certainly - a number of the families that I've been involved with discussions about,the trauma - the traumatic nature of the detention experience 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.⁽⁵⁵⁾

9.3.2 Length of detention

As explored in Chapter 6 on Australia's Detention Policy and Chapter 7 on Refugee Status Determination, the length of detention is determined by the legislative requirement that all children in Australia without a visa must be detained until they are granted a visa or removed from Australia. This process has, on some occasions, taken several years. Most of the children in detention in late 2003 had been detained for at least two years.⁽⁵⁶⁾

The Department acknowledges that 'mental health issues [are] to do with being long-term in a detention environment'.⁽⁵⁷⁾ The impact of the length of detention is also noted in the Woomera Department Manager's report in May 2002, which states that there is a '[c]ontinued focus on a number of families whose reactions to long-term detention demand increasingly frequent health service and psychologist attention'.⁽⁵⁸⁾

Although ACM emphasises that it has no control over the length of detention, it informed the Inquiry that 'the longer the period in detention the more likely the detainee is to need access to mental health services and support'.⁽⁵⁹⁾ ACM reported that it has:

[o]bserved a relationship between the behaviour of detainees, length of detention, critical immigration decision points and proximity to the exhaustion of visa consideration options (appeals etc).

A child formerly detained at Port Hedland told the Inquiry about the connection between declining mental health and ongoing detention:

There are children who have been there for a very long time - two to three years and they have actually 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 with these things.⁽⁶⁰⁾

Mental health experts provided the Inquiry with substantial evidence that children's mental health deteriorates the longer that they are detained. For example, the Victorian Foundation for the Survivors of Torture reported that:

Children who were in detention for longer periods had significantly higher scores on the stress assessment schedule as 'the effect of length of stay appears to result predominantly from increased exposure to traumatic events within the detention centres ... further exacerbated by feelings of isolation, detachment and loss of confidence that are apparent in children who have experienced high levels of trauma'.⁽⁶¹⁾

DHS in South Australia, and the MWRC in Queensland, provided similar evidence to the Inquiry.⁽⁶²⁾

Several former ACM health staff at Woomera also observed the impact of the length of detention on mental health. For example, a doctor who worked at Woomera on two short term contracts told the Inquiry:

I can only say that the longer that they spent, the worse the effects that I saw. And that was in some way dependant on the age and the support, whether they were an unaccompanied minor or whether they simply still had the support of their parents, or even a parent. But in my experience at Woomera I would have to say that anyone who had been there longer than three months would be at grave risk, I believe, and did develop symptoms.⁽⁶³⁾

A psychologist who worked at Woomera from September 2000 to January 2002 set out the various phases of detention:

Family roles break down significantly. We actually started time-lining the break down of individuals. We classify the first three months as being a state of euphoria, hope, dreams. The next three months, as they are going through all of their interviews and there is anxiety starting to build up. After six months we start to see a deterioration in the emotional and psychological well-being of individuals, a significant start in the increase of self-harm. Be it hunger strikes, emotional anxiety, psychological disturbances developing, increased requests for assistance for sleep, which is an indication of depression, medication for depression, more active involvement in disturbances and in self-harm. So, yes, I have seen people age on a daily basis. I have seen middle aged men become old men in months.⁽⁶⁴⁾

9.3.3 Uncertainty and negative visa outcomes

The Department has suggested that mental health problems in long-term detainees is not related to the length of detention but to the fact that a visa has been refused:

the length of detention is almost always associated with refusal of visa applications ... this itself is likely to have an effect on the detainees' mental health.⁽⁶⁵⁾

The connection between visa refusal, the length of detention and mental health issues demonstrates one of the more serious problems caused by the current detention system.⁽⁶⁶⁾

When in detention, a visa refusal has two consequences for children. First, it leads to uncertainty about their future in Australia. Second, it leads to certainty that the child will remain in detention. This combination of factors understandably places a great deal of stress on children and their parents. The combination also magnifies the impact that either one of these outcomes might have.

The interdependence of visa processing, the length of detention and mental health is noted by a doctor who worked at Woomera from October 2000 to June 2001:

I saw when they came in with the reputation of Australia having such a good human rights track record, they were quite sure that they would be processed quickly, that their application visa would be settled within six to 12 months at the most. When after three months I could see depression set in, and after six months I could see severe depression, anxiety, self-harm and even some detainees having psychotic episodes and in lay terms, it is going mad.⁽⁶⁷⁾

A 2001 psychological report about detainees from Villawood also notes that the mental decline of detainees matches the stages of the visa process combined with the length of detention.⁽⁶⁸⁾ Each of the four successive stages is 'associated with increasing levels of distress and psychological disability':

Non-symptomatic stage: During the early months of detention, before the primary refugee determination decision, the detainee is shocked and dismayed at being detained, but these feelings are mitigated by an unwavering hope that confinement will be short-lived and that their claim will be upheld. ...

Primary depressive stage: This follows the receipt of a negative decision by DIMA and the realisation by detainees that they face a serious threat of forcible repatriation or detention for an indeterminate period, or both. The clinical presentation is consistent with a major depressive disorder, with the severity closely related to pre-existing risk factors, such as premigration exposure to trauma or personal predisposition to depression. ...

Secondary depressive stage: This typically follows the rejection of the asylum seeker's application by the Refugee Review Tribunal, the ultimate administrative level. The timing of this final rejection may vary, but generally occurs between six and eighteen months after first being detained.This stage is associated with a more severe level of psychomotor retardation and/or agitation. There is a marked narrowing of focus to issues of self-preservation and survival and an overwhelming feeling of impending doom. ...

Tertiary depressive stage: At this stage the detainee's mental state is dominated by hopelessness, passive acceptance and an overwhelming fear of being targeted or punished by the managing authorities. Affected detainees become self-obsessed and trapped in their predicament. ... The detainee's life can become dominated by paranoid tendencies, leaving them in a chronic state of fear and apprehension and a feeling that no one, including other detainees, can be trusted. ... ⁽⁶⁹⁾

The Inquiry heard that detainees become extremely preoccupied with their application for a visa. For example, a medical practitioner who worked at Woomera reported the impact of this process on the mental health of parents and their children:

The ongoing understandable obsession with the process of requiring a visa and the lack of transparency that was associated with that, that affects a parent's mental health profoundly and has enormous effects on the children's well-being.⁽⁷⁰⁾

The link between visa uncertainty and mental health was dramatically displayed in January 2002. As set out in Chapter 8 on Safety, the Department's suspension of protection visa processing for asylum seekers from Afghanistan caused hunger strikes and lip-sewing.

The link between these issues is reinforced in an April 2002 DHS report on Woomera:

A general deterioration in detainee ability to cope with the uncertainly of life in the Centre has been noted over the past 4 months. This period has seen an escalation in protests, self-harm, and attempted and actual escapes. Identified factors contributing to the detainee condition:

indeterminate length of incarceration

cycles of raised hope Monday and Wednesday, followed by disappointment when they are not released on Tuesday and Thursday

lack of understanding about the mechanisms/decision making process for visas

rise in mythology about what might speed visas processing eg self harm ...

Continuous exposure to violence and self-harming behaviours is creating an unstable and unsafe environment in which psychological symptomatology such as suicidal ideation, disassociation, depression, restricted ranges of effect and anxiety are appearing in many of the children.

The mental health and personality of many of the children and young people is being severely impacted because parental guidance and authority is being undermined especially by the institutional nature of the facility.⁽⁷¹⁾

9.3.4 Breakdown of the family unit

The Inquiry heard extensive evidence of the breakdown of the family unit within the detention environment, in particular, from Woomera. All of the following comments concern families who have experienced lengthy periods of detention. Two of those families are discussed in detail in Case Studies 1 and 2 at the end of this chapter. Families who were detained for much shorter periods of time are less likely to experience family breakdown to such an extent.⁽⁷²⁾

(a) The impact of detention on parenting generally

Experts generally agree that strong parenting is crucial to the development of children.⁽⁷³⁾ The AAIMH told the Inquiry that detention affects the attachment relationships between parents and their children:

attachment relationships are very much undermined by both the problems of parenting in detention but also doubly undermined by the high rates of mental health problems that parents experience as well.⁽⁷⁴⁾

They also informed the Inquiry that:

... detention has a pathogenic effect on parenting. The institutional experience of parents ... very much undermines their ability to care for their children. They cannot provide for children's emotional needs while they are in a situation of deprivation themselves.⁽⁷⁵⁾

The head of the Department of Psychological Medicine at Adelaide Women's and Children's Hospital agrees that the detention environment has a direct and negative impact on parenting:

One of the systematic effects of detention in such a hostile environment is that ordinary people break down in their functioning, people who are competent to function as parents in a reasonably sympathetic or even an ordinarily hostile environment, in that very hostile environment lose the capacity to exercise their normal parental responsibilities. So effectively they are failing as parents.⁽⁷⁶⁾

In April 2002, DHS highlighted that detention takes away the normal family environment where parents provide food, festivities, income and discipline:

Detention as a process impacts on the ability of people to live normal autonomous and self-directed lives. For families in detention there are ongoing tensions that arise in parenting when everything from discipline, cooking, and family gatherings are controlled by a range of prescribed processes and procedures ordered by artificial timelines. Within this environment parents are significantly deprived of their authority and their independence as family units. Their roles as breadwinner or primary carer is undermined by forced dependence on a system over which they have no control.⁽⁷⁷⁾

DHS gave an example of a toddler's family who had been detained for more than seven months at the time:

Restricted parenting: Length of detention 224 days. The parents expressed concern over their lack of ability to enable the fulfillment of their parenting role, giving examples of their inability to prepare food and there not being adequate spaces for the child to play ... They reported they are often too tired or depressed to play or read to the child.⁽⁷⁸⁾

ACM acknowledges the impact of the detention environment on traditional parenting, stating that:

some detainee parents may have experienced negative effects of institutionalisation, whereby the inherent structures lead to a sense of loss of control over one's environment and increased dependence on that structure.⁽⁷⁹⁾

The Inquiry also heard that parents felt guilty and powerless; they had come to Australia to seek shelter for their children and instead put them in the hands of detention authorities. For example, a psychologist who worked at Woomera told the Inquiry:

I saw parents age daily in detention as a result of the stress of detention. Over time many lost their ability to function effectively as parents and I saw family relationships break down. Parents felt guilt for what they thought they had done to their family in bringing them into this environment.⁽⁸⁰⁾

In some of the families detained at Woomera the father's traditional role disappeared completely:

Mr Z was initially coherent and appropriate but became more and more angry and distressed as the interview progressed. At first firm with his son, he was at one point rough as he dragged him away from the door. His anger and despair about their situation and his guilt about bringing his family into the current situation were palpable. He feels unable to protect them, impotent and trapped, reduced to less than human himself and unable to fulfil his role as father and husband.⁽⁸¹⁾

(b) The impact of the declining mental health of parents on their children

The Inquiry also received evidence that the declining mental health of parents in detention had a significant impact on children in detention. When the mental health problems of parents were so serious that they needed to be hospitalised, children ended up being separated from their parents for a period of time. This separation exacerbated the distress already felt by children.

The effect of depression on the capacity of parents to care for their children has been noted in many case files provided by the Department. Some parents, primarily mothers, have been hospitalised for major depression. Some have made numerous attempts at suicide. Others have become unable to interact properly with children or partners.

A child and family psychiatrist who assessed children detained at Woomera told the Inquiry of the long-term impact that the poor mental health of parents can have on their children:

I think there is a lot of literature which is very clear now on the impact on children of having parents with mental illness and these children are multiply disadvantaged because their parents are almost universally hopeless and despairing, sometimes so guilty about bringing their children to this environment that they feel like they should die and that their children would be better off without them.

She gave an example of a family where:

... the despair in the parents made it quite impossible for them to believe in themselves any longer as having anything to offer their children and so guilty that I think in some ways they did believe other people could offer them something better.⁽⁸²⁾

Parental depression often meant that they lost the interest and ability to keep a constant watch on their children. This exposed children to the risk of assault. In August 2002, DHS noted that:

Some staff have been critical of those parents who do not attempt to control their children's behaviour. However, other officers have said that many of these parents used to be more effective but are now (due to depression and lethargy) unable rather than unwilling to supervise their children in the compound.⁽⁸³⁾

The longer that families are in detention, the further the capacity of parents to care for their children is compromised.⁽⁸⁴⁾

Example one

In September 2002, the Flinders Medical Centre documented the deterioration of a Woomera mother's ability to care for her child:

It also appeared to the interviewer that in terms of responding to and managing her children [the mother] was overwhelmed to the point where her personal and parenting resilience already eroded by the demands of long-term detention had little to draw on. [She] reported 'When I came here I was good' and, on at least two occasions [she] used the image of pressure building in her until it burst. In other words, she described the parenting opportunities afforded to her in detention as beyond her reach. ...

Given her circumstances it was not surprising that [the mother] struggled to remain emotionally available to her children in a manner that was responsive to their individual needs. This was evident in her depressed presentation, in what she said about her children and by observations regarding the manner in which she related with them. [She] appeared helpless to assist them in their distress and seemed to have learned that whatever she attempted in their regard was likely to worsen rather than assist their situation.⁽⁸⁵⁾

Example two

A second example concerns a family who arrived in Australia in April 2001. The parents, son (then aged 12) and daughter (then aged 10) were accompanied by an adult daughter with her husband and their ten-week-old baby girl.⁽⁸⁶⁾ A year later, on 11 April 2002, the mother was admitted to the Woomera detention centre medical clinic with anxiety and severe depression. The next day she was admitted to Woomera Hospital and remained there for five months.

A May 2002 psychiatric report regarding this family notes that both children are suffering from psychiatric illness, that the 13-year-old son 'meets criteria for major depressive disorder' and that the 11-year-old daughter 'meets criteria for major depression with significant anxiety symptoms'. The father reported his 'distress and guilt' at not being able to be a better parent:

The father was quite explicit in his acknowledgement that he is unable to be a father to his children at this time. He says that he is 'too old and tired', and too angry and frightened by what he describes as 'this killing place'. He could give no suggestions as to how he might make things better for his children or be more supportive. That is, whilst he has an empathetic appreciation of how distressed his children are, he is unable to respond to their needs because of his own despair. He is aware that he is unable to offer his children adequate care and that he is not offering adequate parenting to his children at present and this adds to his distress and guilt.⁽⁸⁷⁾

The report notes that the poor mental health of both parents and that the hospitalisation of the mother placed the children in the same position as unaccompanied children:

[I]n the present circumstances, and within the detention environment, neither parent is able to offer appropriate parenting to these children. ... Effectively [the children] are in the same position as unaccompanied minors. Indeed, in some respects they are worse off through having constant reminders of their parents inability to care for and protect them. They have effectively already lost their mother, due to the severity of her depression and her need for hospitalisation. Immigration authorities have recognised that it is inappropriate for unaccompanied minors to be in Woomera detention centre. On that basis alone, these children should be removed to a less traumatising environment, and, in order not to compound the trauma that they have already suffered, at least one primary caregiver should go with them.⁽⁸⁸⁾

A chronology of the attempts at self-harm of the boy in this family is included in Case Study 3 at the end of this chapter. Following incidents of self-harm soon after his mother was hospitalised, the son was placed in the detention centre observation units and then was admitted to Woomera Hospital. The father accompanied his son to hospital, while the (then) 11-year-old daughter was left alone in their donga (sleeping quarters), on and off for ten days.

In May 2002, the head of the Department of Psychological Medicine at Adelaide's Women's and Children's Hospital concluded that both the children in this family had:

undergone a significant deterioration in functioning during their year at Woomera, most markedly since the intensification of their mother's dysfunction led to her hospitalisation in Woomera and separation from the rest of the family.⁽⁸⁹⁾

Example three

In a third example, detention contributed to the postnatal depression of a mother detained at Villawood and this, in turn, had a serious impact on the child who was born in detention. The mother was assessed by a psychiatrist in March 2002 who reported that:

[She] appears to be suffering from a severe agitated depression with associated panic attacks and phobic avoidance of [her daughter]. She has become profoundly anorexic and has ceased virtually all oral intake resulting in dehydration and hypotension. She also has signs of sepsis. The combination of major depression, physical compromise and infection is potentially life threatening and requires urgent treatment in a medical facility. She needs ongoing psychiatric care and management of her post-partum condition and relationship with [her child].⁽⁹⁰⁾

A doctor who assessed the mother in April 2002 recommended that:

Regardless of whether this family is to leave Australia or not, mother and infant should be discharged from hospital only when suitable care in the community has been arranged. They should not return to the detention centre.⁽⁹¹⁾

In May 2002, the NSW Guardianship Tribunal noted the connection between detention and her depressive symptoms:

[The mother] was experiencing some depressive symptoms prior to her delivery. Her daughter was born in detention and her symptoms were greatly exacerbated after delivery and with exposure to various stressors. ... [She] was reviewed by a number of doctors at Villawood prior to her admission to [hospital] ... [she] was emaciated and self-harming while in detention ...

[The mother] has depressive and anxiety symptoms based on fear of detention and fear of return to Iran. This is a persisting condition and the symptoms place [her] at risk as well as placing her child at risk.⁽⁹²⁾

A psychiatrist further noted that returning her from hospital to Villawood detention centre would exacerbate her symptoms:

If [the mother] was to return to Villawood she would be at grave risk of self harm. The response to provide intensive support to [the mother] in the detention centre environment would be to institute a suicide watch and surround her with more guards which would only serve to exacerbate her symptoms and distress. ... ⁽⁹³⁾

The psychiatrist said that he believed that the mother would attempt suicide on return to Villawood. He quoted a suicide note from 14 May 2002 in which she states: 'I am not able to live any more in that place, 'Detention Centre'.⁽⁹⁴⁾

At the same time the mother reported the following:

[The mother] advised that it was very difficult for her to live in the detention centre and that she could not imagine being sent back there. She advised that for the whole year she was there, she had no appetite to eat and she cried all the time. She advised she cried at night when her husband and her baby were asleep and eventually, she would fall asleep exhausted only to have nightmares. She advised she was very worried about her baby whilst she was in the detention centre and she experienced problems overfeeding and underfeeding her baby. She was humiliated in having to ask visitors to bring clothes for her child.⁽⁹⁵⁾

The mother's poor mental health and her temporary separation from her child when hospitalised both had a significant impact on the child. The Director of the Office of the NSW Public Guardian reported to the Inquiry:

there were questions as to whether there were very, very early signs of some concerns about the relationship between the mother and the child, basically, because the child had been separated and the child hadn't fully bonded to the mother.⁽⁹⁶⁾

On 30 May 2002, the NSW Guardianship Tribunal concluded the following about the connection between detention, the mother's health and the impact it had on her parenting:

[The mother] is currently suffering from a mental illness in the form of a significant and chronic depression which is extremely exacerbated by the circumstances of her detention and the prospect of her having to return to reside in a detention centre. ... [She] has a mental illness creating a fragile mental condition whereby she is unable to adequately work through and separate the complex problems of detention, the care of her child and her plans for the future without serious effects on her mental health.

The evidence before the Tribunal on this occasion was that a return to a detention centre would almost certainly precipitate another episode of self-harm. Further, any reasonable steps that could be implemented to avoid another attempt at self-harm are only likely to exacerbate [the mother's] condition.⁽⁹⁷⁾

Example four

In a fourth case, a family, composed of a father, mother and five young children and a baby, were detained at Woomera for 12 months. When their refugee application was rejected staff were concerned that the parents' distress might lead to some harm to the children.⁽⁹⁸⁾ Both parents were isolated (the father in Oscar Compound, the mother initially in the medical centre's observation room and then Oscar Compound) and their nine-year-old daughter was left to look after her five little brothers, under the observation of ACM officers with child care experience.⁽⁹⁹⁾

Following the separation, ACM records indicate that supervised and limited contact between the mother and children was facilitated for the most part on a daily basis.⁽¹⁰⁰⁾However, the separation itself and the manner in which the separation was managed appear to have caused distress to the nine-year-old girl.

According to the South Australian child welfare authority, who were visiting Woomera at the time, when the mother and father were taken by security staff to the medical centre there was no interpreter present to explain to the younger children what was going on.⁽¹⁰¹⁾ ACM staff reported the end of the child's visit as follows:

[The girl] was informed of mother's detention in observation rooms of medical, when she returned from a day trip by officers. When she was brought to medical to see her mother she was crying profusely. Officers took the child to observations after she expressed fears of being locked in. Once in with her mother they were both crying and sobbing. As the distress levels rose it was decided to remove [the girl] from the observation room. This required four female officers and [the girl] was screaming and resisting.⁽¹⁰²⁾

The Department asked FAYS if they would support contact between the children and their mother if it was properly supervised, and FAYS readily agreed:

DIMIA decided that just [the nine-year-old daughter] and mother could meet that afternoon and 'if they didn't get upset and refuse to part from each other' then further access would occur. FAYS advised [the DIMIA Deputy Manager] that the child would be upset during contact with the mother regardless (this was normal) and that the child would not part from mother if she didn't know when she would next see her...

Despite this advice - and [the DIMIA Deputy Manager's] verbal agreement at the time - subsequent information from the Psychologist indicated that conditions about 'behaviour' were placed upon this child before her first contact.⁽¹⁰³⁾

ACM records also show that on another occasion the daughter was prevented from visiting her mother because of the child's 'bad behaviour'.⁽¹⁰⁴⁾

The Department notes that the family were only separated for a short time and that it took a number of key steps to ensure the unity of the family. These included encouraging the daughter to attend school and encouraging positive behaviour by the mother. However, as FAYS concluded, 'the decisions and actions by staff in relation to this family caused significant trauma to these children'.⁽¹⁰⁵⁾

The four examples set out above demonstrate that the impact of ongoing detention on parents also has an impact on the mental health of children. Sometimes the mental health problems of parents declined to the point that they were hospitalised, placed in observation rooms or separation compounds. In these cases the children were separated from one or more of their parents. While the Department and ACM sought to maintain some level of contact during these periods the separation appears to have created additional stress for children. The detention environment clearly contributed towards family breakdown and this had an impact on children.

(c) The connection between detention and children taking on adult roles

As demonstrated above, after extended periods in detention, some parents are unable to continue actively looking after their children. This sometimes leads to children taking on the adult role.

Dr Louise Newman of the NSW Institute of Psychiatry describes this as inappropriate for children:

I think sadly we are seeing, particularly in the young children, almost a situation where the children try, developmentally inappropriately, to parent the parents. The children are sometimes dealing with immigration officials and guards in a direct way, making requests because sometimes the children have better English.

They take on emotionally an undue burden of responsibility and care. So we've seen that on numerous occasions with quite young children exhibiting what we would call a role reversal in their relationship with their parents ... Ultimately that's very harmful for children because they're sacrificing their own needs. So some pseudo mature behaviour in a lot of these children is quite common, children five, six, seven looking after younger siblings and other little children as best they can because sometimes parents are not able to do that themselves.⁽¹⁰⁶⁾

A teenage Afghan girl told the Inquiry that:

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 and she was crying. But now we are big and we look after her. My mum is always worried about the visa. Sometimes she has headaches.⁽¹⁰⁷⁾

One mother told the Inquiry of how her toddler attempted to comfort her when she was distressed:

... my friend got a psychiatrist to come in from outside to do an assessment and they give me a report. And having the report, I realised how stressed [my child] was, because she's taking the role, when I'm like upset, she's taking the role of the mother, she's comforting me and that is not for a [little child].⁽¹⁰⁸⁾

At Woomera, an ACM officer noted that the nine-year-old girl, described in the previous section on separation, was providing much of the care for her five younger brothers. She described the impact on the child as follows:

Resident [nine-year-old girl] is becoming increasing[ly] withdrawn, her attitude towards staff is becoming progressively more negative. She lacks a confidant[e] and has no effective outlet to express her emotions. She appears tired and depressed. She provides much of the fundamental child care needed for her 5 younger brothers and lacks the support she needs in order to effectively cope with such responsibility. It is my recommendation that these matters be reported to FAYS so that [she] may obtain the assistance she requires and be provided with an avenue of self expression external to ACM.⁽¹⁰⁹⁾

In another family, an 11-year-old boy was preoccupied with caring for his parents:

[the child] told me ... that he wanted someone to look after him as he was caring for both his mother and father himself. He said that he stayed up all night by drinking coffee so that he could keep watch over them.⁽¹¹⁰⁾

ACM informed the Inquiry that it had been greatly concerned about the mental health of this family for over 12 months and that:

Following exhaustive external psychological and psychiatric assessment, professional opinion unanimously declared that little could be done to help this family whilst they remained in the detention environment.⁽¹¹¹⁾

This family is discussed further in Case Study 1 at the end of this chapter.

9.3.5 Living in a closed environment

The environment in which a child lives is closely connected to their mental health. Children, parents, child protection authorities and psychiatrists all expressed concern to the Inquiry that the closed environment of the detention centre was detrimental to the mental health of children.

Many children and parents described to the Inquiry the impact of being surrounded by fences and razor wire:

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.⁽¹¹²⁾

A father in detention said that the continuous locking and unlocking of gates sent the children 'crazy':

You should also realise that what kind, what a situation is going on with us. From the gate you came here, until here how many doors they opened for you? Is it humanity that they have made that many doors? They open and close, open and close. It's made the children crazy - mentally they are affected. Every day they go to the gate, they open the gate and close the gate and just the noise of those chains and the locks can make them crazy.⁽¹¹³⁾

Although the Inquiry heard evidence about the impact of the prison-like environment from all centres, the most consistent comments were regarding the new Baxter facility. One father said:

It is like a prison here. There is a fear in us when we see the cameras everywhere and the doors are all electronically opened. They only gave us a room with a toilet inside, like an ensuite. We don't have anything to have a good time with. It is only a land with grass and all around us there are rooms that other people live in. We can only see the sky and the grass.⁽¹¹⁴⁾

Family compound at Baxter, December 2002.

The Inquiry also received evidence about the impact of security practices at Woomera. In April 2002, the South Australian child protection agency described the security environment at Woomera as follows:

Centre staff controls all contact with the outside world, and movements, social engagement, religious practice, access to health care, and recreation within the facility. The constraints of security procedures ... results in much of the day to day control of detainee behaviour including that of children and young people within the facility resting with centre staff.⁽¹¹⁵⁾

In August 2002, DHS found that security needs at Woomera took priority over the needs of children:

The children at Woomera are living within an environment that is controlled and regulated. Most of the people they see are in uniform, including medical staff. The day-to-day administration of the centre is not flexible enough to minister to the needs of the children in any consistent way. Security needs take priority over everything else. ...

The major concern about the circumstances of children in this environment is that their needs are only addressed when possible, rather than as a matter of priority. The issues of centre security and safety of staff always take precedence, as one would expect within a detention facility. There is no argument with this.

However, it then follows that children within such a facility will never have their educational, developmental and emotional needs adequately met unless security and staff safety needs are compromised. This is the insoluble dilemma when children are held in a detention system designed for adults. [emphasis in original]⁽¹¹⁶⁾

A 2001 psychological study on the impact of long-term detention also described the security environment at Villawood, as intimidating:

The physical environment at Villawood is intimidating in a number of respects. Each compound is surrounded by multiple layers of high fencing topped and grounded by razor wire. All visitors must pass through high security checkpoints. Within the detention centre, there are multiple daily musters and nightly head counts, which may occur at 2am and 5.30am. The public address system, which operates almost continuously from 7am to 9pm, is also disturbing.⁽¹¹⁷⁾

The security environment is discussed in further detail in Chapter 8 on Safety.

9.3.6 Safety

The Inquiry frequently heard that children are particularly affected by witnessing violence in the centres. Chapter 8 on Safety discusses the threats to the safety of children in detention, including the exposure to violence, riots and self-harm including hunger strikes. This section considers the impact of that exposure on children's mental health.

The Inquiry heard expert evidence about the impact of trauma for children in detention. A psychiatrist who consulted and treated some children detained at Woomera told the Inquiry that witnessing violence can reactivate past trauma:

The other thing I would say is that one of the families that I spoke with in Woomera who are still in detention, it is not 5, 6 months, it is like 17, 18, you know, two years in detention. What had occurred for them was that witnessing the riots or the fires in Woomera and the experiences with the guards had actually reactivated for them experiences of war or trauma in their country of origin and they had believed, for example, that their parents were dying in the compound that was on fire and they felt unable to either get away from it or do anything. So there was a kind of exaggeration or re-activation of previous trauma.⁽¹¹⁸⁾

DHS described a child whose behaviour was severely affected by witnessing violence at Woomera:

Length of detention: 12 months. Parents expressed concern for their 3 year old. They believe that he is abnormal. They state that he is very active and 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 he wants to drink shampoo. They indicated they found him hard to control, which they attributed in part to the deprivation of normal parental responsibilities that occur in the centre. The child has begun wetting the bed again and sometimes screams in his sleep.⁽¹¹⁹⁾

Detainee parents also reported the impact of witnessing violence or severe disturbances on the psychological well-being of their children. The mother in a family detained at Port Hedland told the Inquiry:

The mental disturbance of our children happened since last May when the guards in uniform raided our home, our living quarters, and the children were asleep and when they woke up and realised that they have raided in, and with seeing that uniform, from then on they were very much disturbed.⁽¹²⁰⁾

A father from another family detained at Port Hedland reported that his 'children are impacted upon by this violence. It causes mental impact on them, mental disturbances'.⁽¹²¹⁾

The mother of a family detained at Woomera reported that:

Because children are for a long time detained in here and all the time they see a bad view like suicide, guard, batons, tear gas, bad things, abusing, insulting, so it's made the mentality of them so worse than before.

My little child and particularly this one, in midnight they are suddenly woke up and see bad dreams all the time he is stick himself with me, all the time he is sleeping with me, he get my hand 24 hours a day. In mid-night he woke up, screaming, always frightened, something when happen inside the compound, he is really afraid like, a day before yesterday, he was really scared and he is really depressed and not comfortable in here.⁽¹²²⁾

The Department stated that it:

is deeply concerned that children do on occasions witness violence. It makes every effort to prevent undesirable actions occurring and to ensure that children are not exposed to them.⁽¹²³⁾

9.3.7 Treatment by detention staff

The Inquiry received evidence that the manner in which children were treated by some detention staff caused distress to certain children. The evidence raises three specific factors:

disrespect shown to children by some detention staff
calling children by number rather than name
detention staff were not generally trained to work with children.

(a) Treatment with respect

Detention officers clearly fulfil a demanding role. ACM informed the Inquiry that:

The demands and behaviour of detainees can be extremely challenging, particularly when the reasons relate to detainee dissatisfaction with Government policy and Departmental decision-making.

ACM also reported that the majority of staff employed at Woomera were highly committed to assisting detainees, worked hard in difficult circumstances, and were often the target of detainee frustration with the processing of protection visa applications.⁽¹²⁴⁾

A psychologist who worked at Woomera for seven months during 2001 told the Inquiry that:

From my observation, staff generally treated children appropriately. Sometimes they were stressed, but I regarded them as doing their best for the main part.⁽¹²⁵⁾

The Flood Report also acknowledged the difficult task of detention officers and found that they were sometimes misunderstood by the Australian community:

The management of people in detention centres is an incredibly complex and important task. There are many dedicated Australians - nurses, doctors, detention officers, teachers, welfare counsellors, managers and public servants - helping in this process, often in remote localities, and sometimes encountering misunderstanding in the community for their part in administering policies determined by successive governments and laid down in relevant legislation. There needs to be greater public appreciation for the important and demanding work that they undertake.⁽¹²⁶⁾

A detention officer gave the Inquiry an example of the unnatural dynamic created by the detention environment. The officer explained that during large disturbances the children who were their friends the day before were suddenly throwing stones at them. On the other hand, children would say that the officers that were their friends one day were standing opposite them in riot gear the next.

Thus, while the Inquiry accepts that most staff were doing their best to treat children appropriately, it is clear that there was sometimes a tense relationship between detainee and detainer.

A DHS report expressed concern regarding the attitude of some ACM staff towards children:

[T]he increased tension in the centre environment and the deterioration in the behaviour of some of the older children are factors that can deplete the ability of staff to maintain a balanced and compassionate attitude to the detainees in general and the 'difficult' children in particular. Some officers have managed to find this balance but others have not.

The general negativity about the detainees expressed by many officers would be an issue of major concern for management if it were occurring in, for example, a FAYS residential facility [for South Australian state wards].⁽¹²⁷⁾

One mother from Woomera told the Inquiry in January 2002 that ACM officers frightened her children:

Very bad treatment, they treat very bad, they frighten them. If the kids play, officers shout at them very loudly.⁽¹²⁸⁾

Another mother described the treatment as inhumane:

What I can say is that their behaviour and treatment of the children is not humane. Once he was hungry and I took him to ACM and said he was hungry. The ACM officer said, 'what can I do? If you want I can give my shoes for him to eat.⁽¹²⁹⁾

The community organisation ChilOut described ACM staff throwing food at children:

On occasion, when children were given fruit, guards would throw the fruit at them, as if the children were animals, rather than hand it to them. On one occasion a guard threw an apple to an adult detainee. The detainee threw it back again and a fight broke out. A group of children witnessed this event and began throwing food at the guard.⁽¹³⁰⁾

Former detainee children provided another example regarding food:

Once a woman asked one of the boys to get her some milk for her small child. The boy went to an ACM officer who said, 'Sure you can have some milk', and tipped the whole bottle of milk out on the ground in front of him.⁽¹³¹⁾

The Inquiry also received evidence of ACM officers using obscene language when speaking to detainees. For example, the Port Hedland Department Manager's report for the final quarter of 2000 states that:

A number of allegations were received from several sources, including DIMA staff, that some ACM staff had used offensive language or were behaving in a rude manner towards detainees. These matters were brought to the attention of ACM management for investigation and rectification.⁽¹³²⁾

An unaccompanied refugee child detained at Port Hedland during 2001 told the Inquiry that he learned English swear-words from detention officers:

One of the officers was swearing at me all the time, she was an officer from our area, she was continuously insulting us - I cleaned there - so I learnt all the words, didn't know any before. She called me 'dickhead', 'little bastard' and 'pimp' a lot, even to my brother 21 years old, she swore at him too.⁽¹³³⁾

The parents of three young boys at Woomera told the South Australian child welfare authority that:

[T]he boys have developed behaviours e.g. swearing, being aggressive to each other, which is inconsistent with the parents' values e.g. they say 'fuck' because (it is alleged) they have learnt from custodial staff.⁽¹³⁴⁾

A nurse employed at Woomera for more than 18 months from 2000-2002 described the derogatory language used by some ACM detention officers as follows:

Behaviour which was quite common, in fact almost every time a guard opened their mouth to speak to a detainee or to speak about a detainee, they would use derogatory remarks toward them, including the women and children. This included using words like 'scum, wog/s, cunt, little cunt, slut, trash, vermin, asshole/s, boaties, rezzies'. Not every guard spoke this way to [or] about the detainees, but many did, and this included speaking to them like this to their face and also in front of them as if they didn't exist (in the 3rd person).⁽¹³⁵⁾

This evidence is supported by the Flood Report that noted:

Credible witnesses have told me of derogatory remarks to detainees, humiliation of people in room searches and people sworn at in an abusive manner. I am satisfied on the basis of the credibility of these witnesses that these claims are valid. They apply to a small minority of detention officers.⁽¹³⁶⁾

ACM admitted the possibility that:

a small percentage of staff, do from time to time, display behaviours that are professionally unacceptable or that are not in accordance with the code of conduct. Where ACM is aware of such behaviour appropriate disciplinary action is taken.

ACM further informed the Inquiry that it:

understands institutional environments and the corresponding potential impact for some staff. This does not excuse or condone the type of behaviour described. Nor does this prove that this conduct was systemic or condoned by ACM.⁽¹³⁷⁾

(b) Calling children by number

The Inquiry received a great deal of evidence that children in detention have been called by number rather than name, and that this had a negative impact on them.

The Government's Specific Responses to Flood Report Recommendations, made in February 2001, stated that it was 'no longer practice in detention centres for ACM or DIMA staff to refer to detainees by registration numbers'.⁽¹³⁸⁾ However, during the Inquiry visit to Woomera in January 2002, the ACM Centre Manager advised, and the Inquiry observed, that all detainees at Woomera were referred to by number, not name.

A teacher who worked at Port Hedland in early 2001 told the Inquiry:

You know, there was a Christmas concert that was held in mid-December and I think some local church groups had donated some nice little presents for the children. And one officer stood up and started to call the children for their presents but called them by their numbers. And the ACM Centre Manager ... called this officer aside and said, 'Look we have visitors in the centre. You cannot call them by number. Call them by their names'. And the officer replied he didn't know what their names were. So the actual present giving ceremony was abandoned because they weren't aware of the names of the kids.⁽¹³⁹⁾

Unaccompanied children formerly detained at Curtin said the use of numbers made them feel 'like animals' and 'like you have a cow tag or something on you'.⁽¹⁴⁰⁾ Another child told Inquiry officers that 'they have made me forget that I have a name'. An unaccompanied child stated that:

I often asked myself and so did the others 'why did we come here?' ... My parents would regret their decision. ... I feel like I did something wrong, like I was being punished. ... Sometimes I feel like the ACM staff treated us like animals. They don't know how much my mother loves me. ... They yell for us to line up, do this, do that. They call you by your number.⁽¹⁴¹⁾

The Inquiry acknowledges that given the wide variation in the spelling of detainees' names, often within the same document or file, the use of numbers may well be good record-keeping practice. One father told the Inquiry that numbers were the only way to ascertain that detainees got the correct medication, and that nurses working with names only had given medication to the wrong person.⁽¹⁴²⁾ However, it is a completely different matter when children, and the adults around them, are routinely addressed by a number rather than a name.

ACM acknowledged to the Inquiry that:

In some detention centres, a practice occurred of referring to detainees by number. When ACM Senior Management became aware of the practice, despite the explanation that this was the preferred address by some detainees or the practice resulted from an inability to correctly pronounce detainee names, directions were issued to cease the practice.⁽¹⁴³⁾

The Minister for Immigration and Multicultural and Indigenous Affairs (the Minister) acknowledged in April 2002 that children should not be called by name and referred to his direction that this should not occur.⁽¹⁴⁴⁾ During visits to immigration detention facilities later in 2002, the Inquiry observed that the practice of calling detainees by their numbers had ceased.

(c) Training on how to treat children

The Inquiry was concerned to determine whether ACM staff were appropriately trained and qualified for working with children. Although some of the professional staff have child welfare qualifications, the majority of ACM staff are 'Detention Officers' (guards) without specific training or expertise in working with children.

A qualified youth worker, employed at Woomera from May 2000 to January 2002, told the Inquiry that:

No training in child management was made available to staff upon employment in the centre. Some staff, such as myself, had experience and qualifications in relation to working with children, but others did not. One hour of our induction dealt with mandatory reporting requirements in relation to child abuse and harm. I regarded this training as inadequate.⁽¹⁴⁵⁾

Another ACM officer with child protection experience, employed at Woomera in 2000, said that:

Staff at [Woomera] were mostly from a prison background and not appropriately trained to care for children. They did not understand the developmental stages and psychosocial educational needs of children, or how best to talk with and manage them. It was apparent that many did not understand the cultures or experiences of these particular children and no training was given to help them deal with these issues.⁽¹⁴⁶⁾

In August 2002, the Perth detention facility conducted a refresher course on 'Children in Detention'.⁽¹⁴⁷⁾ While this is a welcome development, it is hoped that the training will also occur in facilities where children are normally detained.

9.3.8 Findings regarding the factors leading to mental health and development problems for children in detention

It is no secret that the institutionalisation of children increases the risk of mental health problems.⁽¹⁴⁸⁾ Evidence from current and former detainee children and their parents, former ACM medical staff, Department Manager reports, State child protection agencies, State mental health agencies, independent mental health experts, torture and trauma services and community groups involved with current and former detainees all confirm the detrimental impact that long-term detention of children has on their mental health.

While there are a number of factors that contribute to the mental health problems found in children in detention, all of those factors are either a direct result of, or exacerbated by, the long-term detention of children and their families.

In no particular order of importance, some of the important factors that can contribute to the mental health and development problems of children in detention include:

prior torture and trauma
the length of detention
uncertainty and negative visa outcomes
breakdown of the family unit
living in a closed security environment
exposure to violence.

Pre-arrival experiences of torture and trauma can have a significant impact on the mental health of child detainees. However, mental health experts have found that at best long-term detention 'exacerbates' those conditions and at worst it 'out-strips' that past trauma.

The Department, ACM, mental health experts and children themselves agree that the longer the period of detention the more likely it is that children will have mental health issues.

Negative visa outcomes impact on the psychological well-being of children and their parents in two ways. First, it leads to uncertainty and disappointment about a family's future in Australia. Second, it leads to a longer time in detention. The combination of factors magnifies the impact of each.

Long-term detention also has a significant impact on the family unit. Case Studies 1 and 2 at the end of the chapter, and the examples discussed above, demonstrate how serious this problem can be. Detention not only takes away the normal family environment where parents have autonomy and control of the day-to-day life of a child, it can have a serious impact on the mental health of parents. These factors diminish the supportive role that parents would normally play for their children. In some cases this has led to role reversal, with children inappropriately taking on the supportive role. In other cases the poor mental health of one or more parents has resulted in hospitalisation, medical observation or security separation. This has led to separation of children from their parents. While efforts have been made to provide opportunities for contact, the separation has exacerbated the stresses already facing children.

A living environment whereby children are surrounded by fences, razor-wire, locking and unlocking gates and detention officers has also impacted on children as has the violence that sometimes erupted around them.

The Inquiry has not received evidence suggesting a systemic and direct link between the treatment of children by detention staff and mental health concerns - in particular, children - and therefore finds that this was not a primary cause of the mental health problems found in children in detention. Nevertheless, while detention officers worked in difficult conditions, and while most detention staff did their best to treat children appropriately, some did not treat children with the respect that they deserved. Several children and parents described the inappropriate language that they had learned from detention officers. Until 2002, staff in some detention centres referred to children by number rather than name, which has a dehumanising effect on children. The Inquiry has not received evidence that detention staff received training regarding the treatment of children other than in August 2002 in the Perth detention facility (where no children are detained).

9.4 What was the nature and extent of the mental health and development problems suffered by children in detention?

The Inquiry received evidence regarding the range of mental health problems suffered by children from a variety of sources, including individual psychiatric reports on children in detention, reports from State mental health agencies who treated children in detention and psychiatric studies regarding children in detention. All of these sources indicate that some children in detention have experienced significant mental health problems, particularly those children who have been detained for lengthy periods of time. Some of those problems were diagnosed mental illnesses and others were more general problems affecting the psychological well-being of children in detention. At the same time, the Inquiry acknowledges that many children, particularly those detained for shorter periods of time, did not suffer significant harm to their mental health.

The Inquiry has not attempted to draw precise conclusions regarding the statistical prevalence of mental illness caused by the detention experience. However, there have been several recent studies conducted by psychiatrists and psychologists in Australia which have examined the impact of detention on the mental health of sample groups of child detainees. The South Australian child protection and mental health authorities have conducted several assessments of children in Woomera over 2002. Those assessments suggest that the prediction of the Alliance of Mental Health Professionals regarding the adverse impact of detention on children's development, psychological and emotional health was correct (see section 9.3).

For example, a study of 33 detainees at the Villawood detention centre in 2001 describes the range of psychological disturbances experienced by children in detention as follows:

A wide range of psychological disturbances are commonly observed among children in the detention centre, including separation anxiety, disruptive conduct, nocturnal enuresis, sleep disturbances, nightmares and night terrors, sleepwalking, and impaired cognitive development. At the most severe end of the spectrum, a number of children have displayed profound symptoms of psychological distress, including mutism, stereotypic behaviours, and refusal to eat or drink.⁽¹⁴⁹⁾

A more recent study of the mental health of children in detention was completed in early 2003 by health professionals from five institutions (the 2003 Steel Report). The study considered 20 children from the same ethnic background in a remote detention centre between 5 September 2002 and 13 February 2003. The average period in detention of these children was 28 months. The study found that all 20 children were suffering from psychiatric illness:

All but one child received a diagnosis of major depressive disorder and half were diagnosed with PTSD. The symptoms of posttraumatic stress disorder experienced by the children were almost exclusively related to experience of trauma in detention. Children described nightmares about being hit by officers, and many of the children (13, 65%) were described by their primary caregiver as having episodes where they would scream in their sleep or wake up shouting.

Half of the children manifested separation anxiety disorder, whilst the majority of other children experience persistent symptoms of separation anxiety but at a level that did not warrant a diagnosis of this disorder.

Over half of the children in the target age group for enuresis (5 to 12 years of age) suffered from the disorder, regularly wetting themselves three or more times a week. Almost half the children assessed had developed behaviour consistent with a diagnosis of oppositional defiant disorder. More than half of the children regularly expressed suicidal ideation, many thought it would be better if they were dead and made statements such as "there is no point in life, one must die, I wish I was not in this world." A quarter (5) had self-harmed either by slashing their wrists or banging their heads against walls (2).⁽¹⁵⁰⁾

The authors of this report acknowledge the small sample group but note that this was 'an almost complete population of detained families (10 or 11 families) from one language group in a single detention facility'. They find a clear link between detention and mental health with the level of psychiatric illness in those children increasing tenfold over the period of detention.

The reliability of this study has been criticised by both the Department and ACM. The study itself recognises its strengths and weaknesses in coming to its findings and the Inquiry has taken these into account in assessing it.⁽¹⁵¹⁾ The Inquiry notes, however, that the findings of the study are consistent with the findings and observations of a range of other experts about the impact of detention on asylum seekers. For example, a recent study from the United States finds that prolonged detention has a lasting negative mental health impacts on detainees.⁽¹⁵²⁾

Other experts have also reported mental health problems in detainee children, particularly those who have been detained for lengthy periods of time. For example, the CAMHS summary report regarding 14 children and their families referred from Woomera, between January and July 2002, provides an overview of the kinds of mental health problems experienced by children in detention.⁽¹⁵³⁾ The summary presents a disturbing picture of the mental health of certain children detained at Woomera during this period of time:

Summary of Children and Families in Woomera IRPC Referred to and Assessed by Child and Adolescent Mental Health Services, January to July 2002

Children under 5 years: These 4 children aged 11 months, 2 and 3, 3 years have all spent at least half their lives in immigration detention. They present with various symptoms related to exposure to violence and chronic parental depression that include delay in expected milestones, particularly language and behavioural regulation (including continence). One has phobic symptoms related to exposure to riots in the centre.

Children aged 7 to 17: 10 children (mean age 12.9 years): A decision was made to include pre adolescent children in this section of the report because of their very similar presentations.

The severity of symptoms related to thoughts of, and actual self harm in preadolescent children is extremely unusual in other populations, and very concerning.

All of these children expressed recurrent thoughts of self harm. At least 7 of the 10 childrenhave acted on these impulses, cutting or hurting themselves, attempting to hang themselves, drinking poisons or refusing food for many days as a suicidal act. At the time of writing, self destructive behaviour amongst this group of children has escalated to daily cuttings, hanging attempts and provocation of conflict with ACM staff, which can in itself be understood as self destructive.
All were troubled by intrusive memories and thoughts of adults, including their parents,self harming. This included graphic witnessing of attempted hangings, slashings and self-poisoning. Most fulfilled criteria for a diagnosis of post traumatic stress disorder [PTSD]. Some also reported intrusive memories of traumatic events prior to arriving in Australia.
All reported a sense of futility and hopelessness, for some this was predominantlyassociated with anger, (including current acting out and provocation of ACM staff), for others despair and withdrawal. All were troubled by recurrent thoughts of death and dying. Those who have not yet self harmed reported feeling afraid they would be unable to stop themselves repeating the behaviour witnessed in the adults.
All had trouble sleeping, reported poor concentration, little motivation for school andoverwhelming boredom. Most had lost weight. All fulfilled criteria for major depression with suicidal ideation. Several also have significant phobic or generalised anxiety symptoms. These are associated with anxiety about their parent's survival or traumatic experiences with ACM staff.
All reported anxiety about their parent's well being. All have parents who are significantlydepressed and may have attempted, certainly expressed suicidal ideation. One has seen his father psychotic and dancing naked in the camp. Another mother cut herself and wrote on the wall in her blood. All parents have been assessed or treated for depression and PTSD (several had been psychotic).
Many of the children were being required to assume roles and responsibilities of adultsbecause their parents were unable to do so because of their own ill health. An example is an 11 year old girl with several siblings under 5 who is doing most of the parenting for her siblings as mother and father are unable to do so. Another example is an 11 year old boy left to care for his 3 [year old] brother during many weeks while their mother was in Woomera hospital with psychotic depression. They were notionally in the care of their estranged father. This boy was sexually assaulted and harassed by other men in the camp during this time. There were few options available to keep him safe while his mother remained unwell.
All the parents expressed considerable guilt and despair about bringing their childreninto this traumatising and hopeless situation. Some of them express a wish to die in the belief their children may fare better without them. One believes god is calling her and her son to die ...

While each family has particular issues and difficulties, an overwhelming feature of the assessments was the clear evidence of the detrimental effects of the detention environment on the children both directly, (including inadequate developmental opportunities, exposure to violence and adult despair and removal of hope for their futures), and indirectly, as a consequence of parental mental illness. [Emphasis in original]⁽¹⁵⁴⁾

A further psychiatric study considers 10 consecutive referrals to CAMHS between February and August 2002.⁽¹⁵⁵⁾ In this study, information obtained in a series of detailed clinical interviews undertaken by a range of experienced mental health professionals during 2002, was used to develop consensus diagnoses on each individual child and adult assessed. The study included ten families, including 16 adults and 20 children aged from 11 months to 17 years, and represented approximately half of the children detained in the centre at that time. Following is a summary of the study's main findings:

Children under five-years-old (ten children):

Five (50 per cent) presented with symptoms including delays in language and social development and emotional and behavioural dys-regulation.

Three (30 per cent) showed marked disturbance in their behaviour and interaction with their parent or carer, indicating disturbances or distortion of attachment relationships.

Over time a further three children in this age group were diagnosed with severe parent-child relationship problems, particularly oppositional behaviour and separation anxiety.

Children aged six to 17 years (ten children):

All fulfilled criteria for post traumatic stress disorder.

All were troubled by experiences since detention in Australia. One also reported troubling thoughts about events on the boat to Australia as well as experiences in the detention centre.

All reported trouble sleeping, poor concentration, little motivation for reading or study, a sense of futility and hopelessness and overwhelming boredom.

All fulfilled criteria for major depression with suicidal ideation.

Three (30 per cent) reported frequent nocturnal enuresis since being in the detention centre.

All reported recurrent thoughts of self-harm. Eight (80 per cent) had acted on these impulses, including three pre-adolescent children.

Seven (70 per cent) had symptoms of an anxiety disorder.

Half (50 per cent) reported persistent severe somatic symptoms, particularly headaches and abdominal pain.

Family impact - parental mental illness:

All children had at least one parent with a major psychiatric illness. All had seen adults self harm, often their parents. In both sole parent families the parent had been hospitalised with a psychotic illness leaving children alone in the camp. During this period, four parents required psychiatric hospitalisation.

On the other hand, while ACM acknowledged that the 'assertion that detention has an impact on detainees ... simply reflects the findings of at least three decades of research,' it has also submitted that there was an 'extremely low' incidence of mental health problems regarding the 81 children in detention as at July 2003 (excluding the Woomera Residential Housing Project). ACM submitted that, having reviewed the medical records of all 81 children, only 6.2 per cent of children were suffering from depression, 1.2 per cent were suffering PTSD and 12.3 per cent were suffering developmental delay. ACM has asked the Inquiry to consider the review as 'the most accurate and compelling information available to the Inquiry'.⁽¹⁵⁶⁾

There are, however, a number of problems with the claim made by ACM as to the incidence of mental health problems and the information upon which it is based. First, ACM's statistics focus on those children for whom there has been a medical diagnosis of 'developmental delay', 'clinical depression', or 'post traumatic stress disorder'. The CRC requires a broader consideration of mental health. For example, problems like anxiety, distress, bed-wetting, suicidal ideation and self-destructive behaviour, which are noted in the studies cited earlier, are relevant to an examination of whether children have enjoyed the highest attainable standard of health and the maximum possible opportunities for development.

Second, the primary records before the Inquiry suggest a higher incidence of mental health problems than is acknowledged in the information provided by ACM. The Inquiry has identified discrepancies in evidence regarding five children about whom the Inquiry has detailed records.⁽¹⁵⁷⁾ This raises concerns about the overall reliability of the ACM review.

Third, the figures relied upon by ACM did not include children in the Woomera Residential Housing Project (RHP). The documents before the Inquiry indicate that at least three children detained there in July 2003 had been diagnosed with depression.

The Inquiry also notes that, to the extent that the information presented by ACM may be said to reflect the incidence of mental health problems for children generally over the period of the Inquiry, that information is at odds with the weight of evidence provided to the Inquiry. For example, State mental health experts and ACM medical staff report higher numbers of children suffering from these disorders, as discussed below.

Considering the weight of evidence before the Inquiry, the Inquiry has concluded, on balance, that it should not rely upon ACM's assessment of the mental health of children in making a general conclusion as to the extent of mental health problems for children in detention.

However, as stated earlier, the Inquiry has not sought to determine the exact statistical prevalence of mental health problems because, irrespective of the total numbers of children who have suffered mental health problems as a result of detention, human rights are designed to protect each and every individual. To the extent that the detention of any child prevents that child from enjoying the highest attainable standard of health or an environment that fosters their rehabilitation from past torture and trauma, there may be a breach of international law. Therefore, while the Inquiry is concerned by the studies suggesting relatively high numbers of children in detention with mental health problems, the exact figures are not important.

The evidence the Inquiry has received from mental health experts who have examined children in detention centres is set out below. That evidence suggests a strong link between detention and incidences of developmental delay, depression and PTSD.

There is also evidence suggesting that the Department understood the connection between prolonged detention and increasing mental health problems for children. For example, the May and June 2002 Department Manager reports from Woomera note that there is '[c]ontinued focus on a number of families whose reactions to long term detention demand increasingly frequent health service and psychologist attention'.⁽¹⁵⁸⁾ Each of these reports attaches a list of individuals with significant mental health needs.

Further, all incident reports are forwarded to the Department's head office and every kind of self-harm is classified as an 'incident' that should be reported by ACM to the Department. In addition, most correspondence with child welfare agencies and agencies like CAMHS was with the Department, thus the connections between the length of detention and mental health of children must have bec

Site navigation

Human Rights navigation

A last resort?

National Inquiry into Children in Immigration Detention

9. Mental Health of Children in Immigration Detention

9.1 What are children's rights regarding mental health and development in immigration detention?

9.2 What policies were in place to prevent and treat the mental health problems of children in detention?

9.2.1 Department policy on mental health and development

9.2.2 ACM policy on mental health and development

(a) Assessment on arrival by ACM

(b) External referrals

(c) Suicide prevention

(d) High Risk Assessment Team (HRAT)

(e) Voluntary starvation

9.2.3 State authority involvement in the mental health of children

9.3 What factors contribute to the mental health and development problems of children in detention?

9.3.1 Torture and trauma prior to arrival in Australia

9.3.2 Length of detention

9.3.3 Uncertainty and negative visa outcomes

9.3.4 Breakdown of the family unit

(a) The impact of detention on parenting generally

(b) The impact of the declining mental health of parents on their children

Example one

Example two

Example three

Example four

(c) The connection between detention and children taking on adult roles

9.3.5 Living in a closed environment

Family compound at Baxter, December 2002.

9.3.6 Safety

9.3.7 Treatment by detention staff

(a) Treatment with respect

(b) Calling children by number

(c) Training on how to treat children

9.3.8 Findings regarding the factors leading to mental health and development problems for children in detention

9.4 What was the nature and extent of the mental health and development problems suffered by children in detention?

Summary of Children and Families in Woomera IRPC Referred to and Assessed by Child and Adolescent Mental Health Services, January to July 2002

Children under five-years-old (ten children):

Children aged six to 17 years (ten children):

Family impact - parental mental illness: