"Long-term detention and mental health": Dr Sev Ozdowski OAM (2002)

"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.

s

Last
updated 13 November 2002