"Long-term detention and mental health"
Speech given by
Dr Sev Ozdowski OAM, Human Rights Commissioner, at the 1st iMHLP International
Mental Health Development Conference: 'Developing Leadership for Mental
Health.' Rydges Hotel, Carlton, Victoria, Friday 18 October 2002
Professors Harry Minas and Byron Good - Conference Convenors and Co-directors, distinguished guests from both Australia and overseas, ladies and gentlemen, all.
I would like to acknowledge the Wurundjeri people of the Kulin nation, the traditional custodians of the land on which we stand.
Australia is one of the countries with a good record of human rights protection. We have a parliamentary democracy with free elections; we have independent courts and free media; we have a range of civil and political liberties, including a right to form Trade Unions; and our basic social and economic rights are recognised and protected.
The system of human rights protection in Australia is rather complex and depends on interaction of many different elements such as our Federal and State constitutions, legislation and common law, and more recently has been supplemented by institutions such as the Human Rights and Equal Opportunity Commission and State/Territory anti-discrimination bodies. Over the past years, the system has served the vast majority of Australians, Indigenous Australians are the most notable exception.
The Human Rights and Equal Opportunity Commission is an important element of thehuman rights protection system in Australia. It is a statutory authority which is independent of the Government of the day. It was established by the Australian Parliament in 1986 and administers laws relating to human rights and discrimination. HREOC is responsible for public education about human rights, anti-discrimination and human rights complaints, human rights compliance and policy and legislative development.
As Human Rights Commissioner, I have the responsibility to inspect and report on conditions in immigration detention centres. These visits have raised considerable concerns for me because I could see the visible changes in individuals I had met previously. I could also gauge the changes in mood in general as various factors caused many adults and their children to remain in remote centres for well over a year, remote from community contacts and cultural/religious support, and increasingly devoid of hope.
Above all, I was concerned at the many effects of detention on children and young people, and this was the reason why I initiated the National Inquiry into Children in Immigration Detention in November 2001.
Inquiries like this are partnerships. They are not possible without the involvement and support of experts, such as yourselves, community organisations, and the community itself. Submissions have been provided, evidence given in public - sometimes in camera -and a substantial number of meetings with groups and individuals has been organised with former detainees. May I say how much I appreciate the contribution made by psychiatrists to the Inquiry, in providing submissions and oral evidence and especially in helping clarify the effect of detention relative to other factors.
We have had 4 psychiatrists providing evidence, as well as paediatricians, child development experts, and psychologists specialising in torture and trauma. This evidence has come from several states. One witness in Brisbane also advised the Commission that the Royal Australian and New Zealand College of Psychiatrists had taken the initiative in having torture and trauma training for general practitioners.
All this has provided substantial information, especially on the direct experiences of detainees.
While I cannot yet talk about conclusions of the inquiry, I believe that public information from the process so far and the assessment of my numerous visits to detention centres has led me to develop some key principles.
I hope that the Inquiry will contribute to a sufficient number of Australians re-examining their attitudes to refugees and ultimately encourage all sides of politics to substantially amend the current policy settings.
I realise that every time a tragedy occurs, such as that In Bali, we have an additional hurdle to overcome: such actions are invariably linked in the public mind to people of Middle Eastern background, and the majority of recent unauthorised arrivals are from Iran, Iraq and Afghanistan.
I believe, and have already said so publicly, that our detention centres are now essentially mental health hospitals run by staff who don't have the expertise to manage those with such severe trauma. The structure of detention centres and the failure to develop a positive environment means that it has become impossible to provide any useful mental health service to detainees. They can only begin to recover when they are in the community.
I believe it is the current policies which have contributed to what I see as a major mental health problem among people who have already experienced substantial stress in their home countries.
The key features of policy may not have been designed to break individuals and families, but they have effectively done so. On my last visit to Woomera, there was almost no detainee I spoke with whom I would consider to be mentally healthy. Some families - even those where the women and some of the children were living in more conventional housing - were remote, withdrawn and finding it hard to be involved. They had made every effort to care for their children but I felt that for some it had become almost impossible.
First, there is mandatory detention. In theory, this could mean detention anywhere, but in practical terms people are detained in institutional centres, now run by people whose experience is primarily in prisons.
Second, such detention remains in force unless and until a visa is granted. This could be a period of years. The longest time a child has been in detention in Australia is five and a half years. It involves the Chen Shi Hai case: where the child, brother of Chen Shi Hai, was born in China and lived in Port Hedland from 1994 to 2000; the case succeeded in the High Court on the basis that, as 2nd-actually,3rd -child, Chen Shi Hai would be 'black'.
Third, little information was available about the progress of cases; and at times processing ceased for no good reason as far as the detainees were concerned. (Woomera late 2001)
Fourth, the assessment of claims often militates against those who, because of trauma and shock, do not express themselves clearly and who forget vital events and situations. Those of you who are familiar with post traumatic stress syndrome will not be surprised at this. Unfortunately, the unconvincing account that is produced of fear and flight is seen too often as evidence not of shock and confusion but of a false claim.
Fifth, the long legal process itself, after the rejection of the initial claim, demands emotional resources which dwindle rather than increase during time in detention. The sense of security that may have been felt on arrival has long since been replaced by fear, anger, and a loss of identity.
All these factors impact on individual mental health. Over time, many adults have visibly changed from participators, who may have been angry and disillusioned, but who were still able to take some action, to withdrawn, monosyllabic individuals. They have become detached from children and spouses; many have trouble expressing any emotion; they blame themselves for everything; small incidents to us have become major matters; their life has become a series of negative results.
The cumulative effect of this is a person who no longer functions normally. I felt that for many people even one more little incident would be the proverbial straw breaking the camel's back.
I believe the above situation is also true for many children. I don't know if it takes a longer or shorter time for children to become affected to the same extent; or if younger children are adversely affected more quickly than older ones; nor do I know the extent to which parental problems or pre-existing trauma or discrimination accelerate the severe mental health problems that many children clearly have. We have received evidence that, although the first three years of a child's life are crucial, older children who have previously had a more settled life will also be adversely affected in many ways by detention.
The children known as Unaccompanied Minors or UAMs, have often had to fight their own legal and other battles. One of the youngest UAMs was 8 years old, but data shows that there were two applications made in 1999 for children under 6.
Between 1999 and 2002, 372 applications for visas were made by UAMs, compared with 2007 applications by children who were part of a family.
What are the key issues facing UAMs?
The UAMs have not had the direct support of a family, although they may have had some emotional and cultural support from other detainees.
Often they have been unable to contact relatives back home.
In detention, they may have felt physically unsafe and prone to sexual assault, harassment and intimidation. It is almost impossible to prevent this in such large centres. Persecution of oneself has not necessarily made people any more tolerant of traditional enemies or persons deemed untouchables.
They may have had limited access to recreation or educational services, have become bored and unable to concentrate.
The environment and attitudes they are exposed to makes them feel like criminals. This is confusing and distressing for those who had no opportunity to come here with a valid visa.
Children with families are not necessarily much better off than UAMs. In fact, they may be subject to other pressures.
I have noticed, for example, the large number of children whose parents have lost the capacity to parent in many ways. They cannot make decisions, and the child has taken over; the parents' English is less fluent, and their child deals more with guards and others; the cultural boundaries for children have been overturned as they are called on to talk about intimate medical matters, assume responsibility for mentally ill parents, and become directly involved in hunger strikes, self harm and other action.
For many, especially males, there has been direct involvement in escapes and escape attempts. They have witnessed adults and peers taking action ranging from setting themselves on fire, cutting their throat, throwing themselves on razor wire to burying themselves in graves. At times, there has been almost continual self-harm demonstrated.
Certainly, very young children have also been affected. There has been some evidence of inability of mothers to bond with newborns because of the circumstances of birth and the stress of centre life; special services for pregnant and nursing mothers have not always been available; birth may be in a distant hospital, where staff do not speak one's language, and husbands and other children have been left in the detention centre.
There has been little, if any, child care or respite;
The actual structure of centres and the absence of safe places and playgrounds has limited the availability of a positive developmental environment. In some cases, there is no safe space to crawl, which can profoundly affect the development of children.
What of the effect also of noisy and crowded accommodation, interrupted by searches and by muster checks; being cold, or too hot; having food that in portions, texture, taste and availability takes no account of the needs of children for small, attractive and nutritious meals throughout the day.
Allow me to quote from some evidence provided to the Inquiry. The evidence quoted provides a very good illustration of points made by me earlier.
'Parental mental ill health, overwhelming stress, social disadvantage, and poor education or knowledge about child rearing, can all lead to disruption in the development of secure attachment relationships, which in turn has an effect on the infant's developing brain, sometimes with irreversible consequences for the infant's capacity to think, feel and form meaningful stable relationships. These consequences can continue on through childhood and into adult life.' (Quote from the Australian Association for Infant Mental Health submission)
Detention centres have a major impact on children because of the constant exposure to a harsh environment and what were described by one psychiatrist as 'cognitively impoverished conditions.'
'It is not so much the lack of toys and the like, although that is significant, it is just that the environment is so hostile to play, so hostile to a child's ordinary life .
It is the lack of things like ordinary family rituals around food the lack of privacy that is available to children, the lack of consistency in their environment, the fact that they can't necessarily come back to.. the same game, the restrictions on children's mobility and their use of what is available in the environment and the ever present violence and threat of violence, not just the big things that are reported in the media but the things that happen day to day.' (Quote from Dr John Jureidini, Adelaide)
Regardless of the impoverished background of many children and young people in detention, and their awareness of discrimination and persecution at an early age, I believe the situation they have been placed in here has a distinct effect on them.
The institutional setting takes away choice, power and responsibility. It takes away from parents a role that helped to identify them. Dr Nicholas Procter, from the University of South Australia, told the National Inquiry of his project which looked at the experiences of different refugee groups. One group was of men from Iran and Afghanistan who had been either in Woomera or Port Hedland detention centres.
'I think the main point to make is that these people talked very much about their experiences being a dehumanising one and the dehumanising experience begins in the detention camp and never really ends.
The sort of treatment that they were talking about was sort of mocking of them as being terrorists, or their humanness was not trusted, their worthwhile sense of who they were was not trusted and many of them felt that it would take a long time for them to develop the sort of trust that they needed in order to get on with everyday life .
People talked about what the group determined as time torture. This notion of not knowing the outcome of their detention and having to tell their story over and over and over again, and will they be believed.'
(Quote from Dr Nicholas Proctor, public hearing, Adelaide, 1 July 2002)
Dr Procter also spoke specifically about those men whose families had also been in detention:
'there were issues in relation to the dreams and aspirations that parents had for their children and their feeling of letting down the child and betraying the child and that inevitably broke down relationships between the child and the parent and there were periods of frustration.'
I believe that losing this role can lead to other results:
- A reduced respect for parents;
- Anger because of the situation and the parental 'decision' that resulted in detention; anger because hoped-for benefits have not eventuated;
- For the more politically active young people, anger that their suffering seems to be irrelevant and of no concern; they didn't expect the Taliban, Saddam Hussein or others, to care. But they did believe Australians might have thought they were worthwhile.
Below Quote follows from evidence given by Ms Tina Dolgopol of Action for Children, South Australia, at HREOC Public hearing, Adelaide, 1 July 2002:
'They could not understand why having fled persecution they were being made to suffer yet again by a government that they thought was democratic because they've had so little interaction with the Australian population they don't actually know what any of us think about the situation.'
Both adults and children are coming to terms with loss of self-identity, uncertainty about the future, and loss of family. In most cases, they have not had any control over the events that forced them to leave. I think that if I knew the Taliban wanted my children, I would have left, with the children; or, if I was from the long-suffering Sabian Mandaean untouchable group, who are excluded from many jobs and tertiary education, I would consider myself discriminated against. I believe we can all empathise with their situations rather than thinking that they are completely different from us.
Also, we should not underestimate the cost to others involved in the detention process, including ACM and DIMIA staff. Some are able to remain quite detached and, from many accounts, some seem to be intolerant, insensitive, and abusive.
But others who have tried to soften the impact and effects of detention have not been able to remain detached. The Commission has heard evidence from a number of former ACM employees, including doctors, nurses, psychologists and others. They have been open about the impact on themselves: some have been diagnosed with PTSD, others have stated that they just could not return to work in an environment where they felt both that their professional standards were being compromised and that their interaction with detainees was of maintenance rather than cure.
For staff such as doctors in particular compromised care could include:
- Not being able to automatically request a service, but having to clear it - sometimes on the grounds of cost;
- Being unsure about the confidentiality of patients' medical records; and
- Having recommendations about care ignored.
It has been said that detainees with mental health problems were pre-disposed to mental ill health.
I think we need to emphasise that by definition, refugees are people whose experiences have caused them to suffer both physical and mental ill health. No war has occurred without leaving an effect on those who lived through it. The Refugees Convention exists because nations, including Australia, agreed that the world community must help the victims of war and civil conflict.
We can hardly then say that:
- No refugee should have any pre-existing problems; and
- We'll keep you in jail-like conditions for an indefinite period but you mustn't have any reaction to this.
It sounds like a Yes, Minister scenario: 'we only want nice refugees from nice countries, who have time to get their passports and tell us they are coming; real refugees are so untidy.'
In Australia we are currently operating three different systems which in administrative costs alone must be expensive.
First, we have the offshore application process, where refugees are selected and medically cleared and then come to Australia.
Second, we have the 'valid visa' process whereby several thousand people each year arrive on business, tourist or student visas and then apply for refugee status. These applicants are allowed to live in the community while their claims are being processed, and those who apply within 45 days of arrival do receive work and other rights. Even though this group has a success rate of only 15% we are not told that they are a danger to society and likely to abscond.
Third, we have the 'unauthorised' arrivals, who have no visa, and who mostly arrive by boat. This group is much smaller than the group with valid visas. However, even though they have a much higher success rate in their applications, they must stay in detention. In addition, it is this group which receives all the bad press, and is seen as encouraging people smuggling.
I think we would all agree that people-smuggling is an unpleasant trade. But the people smuggler's market is the group of people who could not possibly get a valid visa.
People from Afghanistan, Iraq and Iran are unlikely to qualify for a tourist visa because, apart from the difficulty of finding a nearby consulate:
- It is likely they will be seen as wanting to stay in Australia, rather than visit;
- They may have no relatives here; and
- They may lack the money that has to be paid as a guarantee that they will leave Australia.
So, far from being the rich people we've heard of who strangely chose to come by a long and rather unpleasant sea journey, the unauthorised arrivals are primarily people who weren't rich enough. Or didn't have existing contacts in Australia.
There may be some logic in this policy, but possibly only John Cleese of Fawlty Towers can find it.
It is also contradictory that the Commonwealth government supports policies which directly address the needs of families and the particular needs of people with mental illness.
I refer to the National Mental Health Strategy and the substantial funding provided for research and other projects under this; and also the Stronger Families and Communities Strategy, which - and I quote - 'has an emphasis on prevention and early intervention initiatives for families and communities.'
Why then run a detention policy totally contradictory to this when at least 70% of those who arrive in an 'unauthorised' fashion' - having failed to let us know in advance of their arrival -are accepted as refugees. It seems to me that, at its most fundamental, it is more cost effective to let people live in the community than keep them in conditions which can only increase their need for family and mental health services.
So, to conclude, it seems that our current long term detention policy has hallmarks of social engineering by Frankenstein. Its long term impact on both society and individuals is likely to be disastrous. The policy would create urban underclass, a sense of injustice, poverty and crime.
What my visits to detention centres indicate is that we should have:
An initial period of mandatory detention, enabling rudimentary health, identity/security and refugee status background checks. Refugees themselves have no problem with this.
After that, permit supervised release, especially of families, into the general community pending final determination of refugee status. This is the current Swedish model, and in 2001 Sweden received 23,520 applications for refugee status.
There are concerns by Australian policy makers that boat arrivals are people who will automatically abscond. But I do not believe families are going to abscond. Where would they go, what would they live on, how would they access medical care?
How would they ensure their children had access to the education they value so highly?
I can see every reason why we would benefit from moving to the Swedish model for our on-shore applications.
- We would reduce detention costs;
- We would demonstrate that we treated all refugee applicants in the same manner, regardless of their national origin; and
- We would be able to address mental health and other problems in a community setting, which experts consider to be the only way to proceed.
Obviously, this would require appropriate provision of services and funding. But the gains for governments, for those who are currently unauthorised arrivals, and for the wider community would be substantial.
In another report on immigration detention centres, I noted that we needed to be more aware of what had happened to refugees and take positive steps to helping them:
'Surely it would be better for us and them if our management of their mental fragility began earlier ..and was removed from the artificiality of a detention centre, allowing early commencement in the process of fruitful integration into the Australian way of life.'
To have the different outcomes outlined above depend only on the way you arrived is the mark of a policy designed by Frankenstein. In my view this can lead only to the creation of a bitter and disillusioned underclass. For society as a whole, when we condemn the poorest and most vulnerable to the worst treatment, we have lost our way and our capacity to empathise. This too will have long term effects.
sLast updated 13 November 2002