Commission Website: National Inquiry into Children in Immigration Detention
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Submission to the National
Inquiry into Children in Immigration Detention from
the Department of Health and
Ageing
ROLE OF THE DEPARTMENT AND
THE CHIEF MEDICAL OFFICER
The Department's
role in the setting of standards in relation to public and other health
issues.
Health and aged care
are shared responsibilities: all levels of government have roles in funding,
administering or providing services.
The Commonwealth
has some statutory obligations to set standards: eg, under the Quarantine
Act 1908 (see below), and the Therapeutic Goods Act 1989 (to
provide a national framework for the regulation of therapeutic goods in
Australia and ensure their quality, safety and efficacy).
In other areas, the
Commonwealth has a policy interest but responsibility for service delivery
rests with the States and Territories, or involves an industry sector
for which the Government sees self-regulation as appropriate. In these
cases, the Commonwealth (through the Department of Health and Ageing)
has a leadership role in facilitating the setting of standards: eg, the
National Standards for Mental Health Services; the Australian Standard
Vaccination Schedule; and the Standards Framework of Accreditation and
Certification for residential care.
The process by
which health undertakings negotiated with Health Services Australia are
monitored.
The term "Health
Undertaking" has a specific meaning in migration legislation and
policy, to do with post visa issue monitoring of (mainly) tuberculosis
by state health chest clinics. The process does not involve Health Services
Australia (HSA) as it is an arrangement made between the visa issuing
officer, the visa applicant, the Medical Officer of the Commonwealth (appointed
by the Minister for Immigration for immigration purposes) based in the
Health Assessment Service and the state-based chest (or other) clinic
director.
DIMIA can provide
detail on the operation of health undertakings.
What is the role
of the Department in monitoring major communicable diseases?
Under the Quarantine
Act 1908 the Commonwealth Department of Health and Ageing has responsibility
for human quarantine policy in Australia. The policy enables the identification
and surveillance of persons who have been potentially exposed to a quarantinable
disease, the provision of appropriate medical treatment if necessary,
and the application of public health measures to prevent the outbreak
of any of the quarantinable diseases in Australia.
Five human diseases
are subject to quarantine controls: plague, rabies, cholera, yellow fever
and viral haemorrhagic fever. The only vaccination requirement for entry
to Australia is for yellow fever. Any person over one year of age is required
to hold an international yellow fever vaccination certificate if, within
the six days prior to their arrival in Australia, they have stayed overnight
or longer in a declared yellow fever infected country in Africa or South
America. Any such person who does not posses a valid vaccination certificate
on arrival in Australia, is placed under a quarantine surveillance order
by an officer of the Australian Quarantine & Inspection Service. A
surveillance order allows a person to enter Australia on the basis that
they report to a health authority if they develop symptoms of yellow fever
infection within the surveillance period (up to a maximum period of six
days).
The Department is
also a member of, and provides the Secretariat for, the Communicable Diseases
Network Australia. The network:
- comprises state
and territory representatives as well as representatives from key laboratory,
academic and other institutions with expertise in the public health
management of communicable diseases;
- develops protocols,
discusses information in immediate disease threats, etc, and contributes
data on communicable diseases to the National Notifiable Diseases Surveillance
System (see further below); and
- can be convened
at short notice to handle an acute situation.
Can a copy of
the public health protocol referred to in DIMIA's submission (p.61) be
provided?
A copy of the 'Interim
Protocol for public health management at DIMA detention environments'
is attached (Appendix A). This protocol, endorsed by
the Commonwealth Chief Medical Officer, is still operational. Negotiations
on finalising guidelines are continuing with DIMIA.
IMMUNISATION
Are there national
standards of required immunisation, and are these determined by the Department?
National standards
are set out in the Australian Standard Vaccination Schedule, but there
is no legal requirement for immunisation. The Department facilitates the
development of the standards through the Australian Technical Advisory
Group on Immunisation (ATAGI). The Schedule, produced by ATAGI and endorsed
by the National Health and Medical Research Council, outlines all immunisations
recommended by the ATAGI.
Does the Department
or any agency have a role in providing or assessing data about arrivals
who have not had required immunisations in country of origin or residence?
The Department has
a role only in relation to yellow fever (as above), in conjunction with
the Australian Quarantine & Inspection Service.
What are the appropriate
levels of immunisation of adults from countries where diseases such as
polio are common?
The Australian
Immunisation Handbook (7th edition) recommends that all adults have
three doses of diphtheria, tetanus, and polio vaccines and two doses of
measles, mumps and rubella (MMR)vaccine. Some extra vaccinations (such
as those against influenza and pneumococcal disease) are recommended for
older adults and persons with particular medical conditions. The standards
relate to all people: they do not vary according to a person's place of
origin.
What is the role
of the States and Territories in immunisation services generally?
The States and Territories
are responsible for the purchase, administration and delivery of vaccines
to the public. Funds for the purchase of vaccines on the Australian Standard
Vaccination Schedule are provided by the Commonwealth.
Is there a national
database of immunisation records?
The Australian Childhood
Immunisation Register (ACIR) is a national database containing information
on the immunisation status of children living in Australia who are under
the age of seven years. Only vaccines given in Australia are recorded
on the ACIR and those given to children in detention may be included.
The ACIR is administered by the Health Insurance Commission.
COMMUNICABLE AND NOTIFIABLE
DISEASES
What is the role
of the Commonwealth, the states and territories, and/or individual medical
providers in notifications?
The States and Territories:
- are responsible
for legislation requiring the notification of certain diseases to health
authorities by medical practitioners and some others (such as pathology
laboratories and hospitals). Different diseases may be notifiable by
different mechanisms depending on the jurisdiction and/or the circumstances
(eg, Detention Centre Service Provider staff are required to make notifications
in relation to detainees); and
- analyse and act
on notifications data for their own jurisdiction, and each fortnight
forward their data for inclusion in the National Notifiable Diseases
Surveillance System.
The Commonwealth:
- maintains the
national database for the National Notifiable Diseases Surveillance
System to which covers more than 50 communicable diseases or disease
groups endorsed by the National Health and Medical Research Council;
and
- undertakes national
analysis for policy purposes, and for publication on the Internet and
in the Communicable Diseases Intelligence journal.
- (see http://www.health.gov.au/pubhlth/cdi/cdihtml.htm)
PSYCHIATRIC HEALTH
Are there national
standards in relation to the provision of psychiatric care, including
special needs of people who have experienced torture and trauma?
National Standards
for Mental Health Services were endorsed by the Australian Health Ministers
Advisory Council National Mental Health Working Group in 1996.
Standard 7 of the
National Standards addresses issues of cultural awareness and sensitivity,
and a broad recognition that treatment and support should be delivered
in a manner that is sensitive to the unique social and cultural needs
and beliefs of population groups within the community (See http://www.health.gov.au/hsdd/mentalhe/resources/index.htm).
The role of the
Commonwealth in the development and implementation of improved mental
health care for at risk groups in the community (which would include people
who have previously been in immigration detention)
The planning and
delivery of mental health and related services, and the enactment of legislation
pertaining to the treatment of people with a mental illness, are State
and Territory responsibilities.
The Commonwealth's
role is principally to provide leadership and coordination, and to support
national-level activities. However, the Commonwealth has contributed substantial
funds for activities which support the mental health and related care
for at-risk groups; eg:
- The Program of
Assistance to the Survivors of Torture and Trauma assists people who
have experienced traumatising events in their home countries, and supports
their integration into mainstream medical and mental health services
($5.84 million (indexed) over four years from1999-2003. The client group
for this program includes people granted Permanent Protection and Temporary
(Humanitarian Concern) Visas.
- Under the National
Mental Health Strategy, a national transcultural mental health program
helps to improve community knowledge and understanding about mental
health, and the quality and accessibility of mental health services
available to Australians from diverse cultural and linguistic backgrounds
(around $2.58 million funding since 1995.
Are there Australian
standards or guidelines on the special needs of children from countries
significantly affected by warfare?
There are no specific
standards or guidelines for the special needs of children in this circumstance.
However, the National
Action Plan for Promotion, Prevention and Early Intervention for Mental
Health 2000 recognises that adverse life events such as experiencing
warfare may impact upon, and increase the risk of, children experiencing
mental health and related problems. It allows for national activities
to enhance community capacity to provide support during adverse life events,
and increase use of evidence-based prevention and early interventions
for high-risk individuals who have experienced adverse life circumstances.
FOOD AND NUTRITION
Does the Department
have a role in research, monitoring or provision of information on:
- Nutritional standards
for people who are from very disadvantaged backgrounds, and education
on the provision of appropriate nutrition and food services;
- Availability of
national/international measurements of nutritional health to determine
if particular groups or individuals need supplements etc?
- Cross-cultural
nutrition and food information;
- Special needs
of babies and pregnant women spending long periods in institutions such
as immigration detention?
No. The Department
aims to improve the nutrition and healthy eating patterns of Australians
through the development of dietary guidelines that target the general
public, rather than specific population groups such as those in institutions.
PREGNANCY, BIRTH AND POST-NATAL
CARE
Information on
cross-cultural training, and information in community languages on birth
options.
Standards for
post-natal care.
These are State and
Territory responsibilities
PRIVACY
Are there any
standards developed that ensure that appropriate privacy is guaranteed
to patients in hospitals, or is this a state matter.
This is largely a
state matter. However, under the Australian Health Care Agreements, each
State and Territory has developed a public hospital charter and these
cover commitments to treating consumers with respect, dignity, privacy
and with consideration for religion and cultural background. The charters
apply only to public hospitals within the State or Territory.
RESEARCH AND FUNDING
Has the Commonwealth
provided funding, including for research, for any of the above areas?
Health care for children
in detention is provided and paid for by DIMIA.
The Department has
no direct funding role in relation to health services for children in
detention:
- unauthorised
arrivals who are in immigration detention are not eligible for Medicare;
- the Department
has not funded research around any of the matters above in as much as
they directly relate to children in detention; and
- nor has DIMIA
provided the Department with any funding to undertake research or projects
relating to detainees.
However, the National
Health and Medical Research Council has funded one three year project
to investigate 'The impact of the refugee application process on the psychiatric
status of traumatised asylum seekers'. This project is due to be completed
later in 2002.
Further, people who
arrive illegally but are issued visas in the following categories are
eligible for Medicare under special provisions in legislation:
- Temporary Protection;
- Temporary (Humanitarian
Concern);
- Offshore Entry;
and
- Relocation Secondary
Movement.
In addition, as the
responses to the questions above show, some funds from the Department
support a range of initiatives and programs that may, indirectly, affect
detainees.
Attachment
A
Interim Protocol for public
health management at DIMA detention environments
Rationale
This interim protocol
addresses public health issues relevant to detention environments and
is not intended to cover all health management issues. It identifies the
minimum health requirements and vaccination to protect the health of detainees
and the Australian public (see footnote).
This interim protocol
will be in place while awaiting final deliberations of the Committee.
Tuberculosis (TB)
Screening for active
TB should be undertaken in all persons aged 12 years and over, and for
children under 12 who are symptomatic or are family contacts of active
cases. Screening will be by history, physical examination and chest x-ray
(PA film initially).
Chest x-rays should
be taken as soon as possible, and within two weeks of arrival at the detention
centre. Chest x-ray films must be read by a radiologist and the report
sighted by the relevant medical officer before the examination is considered
complete.
Pregnant women who
have not had a chest x-ray will be monitored by the medical staff and
have a chest x-ray performed after delivery.
Mantoux (tuberculin)
testing is indicated as a screening test for children under 12 years of
age (see Vaccination). The Mantoux test must be administered by clinical
staff specifically trained in its administration and reading. Interpretation
of the Mantoux result may require the expert advice of the relevant State
based tuberculosis service.
Regardless of screening
results, any person with symptoms suggestive of TB, or who develops symptoms
of TB after initial screening, should be investigated promptly and/or
referred to the relevant State based tuberculosis service.
The detention centre
service provider, contracted medical staff and the HSA should develop
strong links with the State based tuberculosis service to ensure staff
remain up to date on TB issues and to expedite diagnosis and management
of detainees with TB.
HEPATITIS B
HBsAg blood testing
on all pregnant women and/or where there are clinical indications of hepatitis.
HIV antibody testing
HIV testing should
be carried out when there are clinical and/or epidemiological indications
of disease or infection. Pre- and post-test counselling is required for
all persons undergoing HIV testing and/or for the legal guardian in the
case of a symptomatic child.
Confirmed HIV positive
persons should be referred to the State AIDS/STD service for management
and contact tracing upon discharge from detention.
Malaria
Malaria screening
by thick and thin film should be performed on persons who have come from,
or transited through, a malaria endemic country and who present with a
febrile illness, report fever in the previous week and/or are pregnant.
Other infectious
diseases
Routine screening
for other infectious diseases, including gastrointestinal parasites and
typhoid, should not be undertaken unless clinically indicated. Health
care providers should maintain a high level of suspicion of communicable
diseases and investigate accordingly.
Vaccination
The following minimum
schedule is recommended for all children aged 0-15 years unable to provide
a documented history of prior vaccination.
MMR
Two doses of MMR
spaced one month apart should be administered to all children aged 12
months to 15 years who are unable to provide documentation of vaccination.
MMR should not be given to an immunocompromised child. To protect the
health of Australians and to minimise the possibility of an outbreak in
the detention centre, MMR should be administered as soon as possible after
arrival in Australia, preferably within the first week.
Polio vaccine
Three doses of oral
polio vaccine (OPV) spaced 2 months apart should be administered to all
children aged 2 months to 15 years who are unable to provide documentation
of vaccination. Inactivated polio vaccine (IPV) should be substituted
for OPV if the person or a member of their family is immunocompromised.
BCG
All neonates born
in Australia, and tuberculin negative children up to 5 years of age, should
receive BCG except for those previously vaccinated or for TB contacts
for whom preventive treatment is being considered. BCG should not be given
to an immunocompromised child.
Notification of
State Health Authorities
In the event of a
Notifiable Disease or disease cluster
Where a notifiable
disease is diagnosed in a detainee, the case must be notified to the relevant
State Health Authority in accordance with normal disease notification
protocols. HSA, the detention service provider and contracted medical
staff should be familiar with local notification requirements, including
the procedure for urgent notifications. Maintaining close liaison at all
times with the State Health Authority should be encouraged.
Any unusual increase
in the occurrence of a disease (cluster), even for diseases not usually
notified, must be reported to the relevant State Health Authority as a
matter of urgency and all health staff must cooperate with the disease
control measures required by that Authority. Outbreaks likely to occur
in camps and institutions include measles, hepatitis A, influenza, meningitis,
acute gastrointestinal disease and skin infestations such as scabies.
In the event of discharge
from detention
On discharge, detainees
should be referred to the relevant State Health Authority for follow up
of infectious diseases such as TB, and in order to facilitate access to
public health and clinical services, including completion of vaccination
schedules as above. Pregnant women who were not x-rayed should be referred
to the relevant State Health Authority.
Medical records
To facilitate subsequent
health care arrangements, a copy of the medical discharge summary and
vaccination record should be kept at the detention centre and copies given
to each person (or their legal guardian) on discharge.
Occupational Health
and Safety
As a minimum, all
detention centre staff should be fully vaccinated in accordance with the
Australian Standard Vaccination Schedule. Staff in specific occupational
groups may require additional vaccinations as recommended in the current
edition of the Australian Vaccination Handbook.
This protocol has the endorsement of the Commonwealth Chief Medical Officer
although it will be further developed in consultation with State and Territory
Health Authorities, DIMA, the detention service provider and HSA.
Last
Updated 10 October 2002.