National Inquiry into Children in Immigration Detention
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Submission to the National Inquiry into Children in Immigration Detention from
the Mental Health Council of Australia
Postal Address: PO Box 174
DEAKIN WEST ACT 2600
Telephone: (02) 6285 3100
Facsimile: (02) 6285 2166
Email Address: admin@mhca.com.au
Contact Name: Ms Carmen Hinkley
Position/Title: Senior Policy Officer
National Inquiry into Children in Immigration Detention
Terms of Reference
The National Inquiry into Children in Immigration Detention refers to the adequacy and appropriateness of Australia’s treatment of child asylum seekers and other children who are, or have been, held in immigration detention, including:
1. The provisions made by Australia to implement its international human rights obligations regarding child asylum seekers, including unaccompanied minors.
2. The mandatory detention of child asylum seekers and other children arriving in Australia without visas, and alternatives to their detention.
3. The adequacy and effectiveness of the policies, agreements, laws, rules and practices governing children in immigration detention or child asylum seekers and refugees residing in the community after a period of detention, with particular reference to:
- the conditions under which children are detained;
- health, including mental health, development and disability;
- education;
- culture;
- guardianship issues; and
- security practices in detention.
4. The impact of detention on the well-being and healthy development of children, including their long-term development.
5. The additional measures and safeguards which may be required in detention facilities to protect the human rights and best interests of all detained children.
6. The additional measures and safeguards which may be required to protect the human rights and best interests of child asylum seekers and refugees residing in the community after a period of detention.
“Child” includes any person under the age of 18.
The Mental Health Council of Australia (MHCA) provides the following information for consideration by the Inquiry. The focus of the MHCA’s concerns is in relation to the conditions of immigration detention centres and the mental health impact such conditions have on children, rather than focussing on immigration policies.
The Mental Health Council of Australia
The Mental Health Council of Australia (MHCA) is the peak, national non-Government organisation established to represent and promote the interests of the Australian mental health sector. The MHCA constituency includes consumers, carers, special needs groups, clinical service providers, private mental health service providers, non-Government organisations, Aboriginal and Torres Strait Islander groups, and State/Territory based peak bodies [1]. The activities of the MHCA primarily consist of management and coordination of national projects, representation on national committees, and development, analysis and evaluation of policies, including drafting of policy position papers and submissions to various inquiries.
Prevalence of Mental Illness
The MHCA recognises the growing burden of mental illness in Australian society. It has been estimated that currently, over one million Australians experience a mental illness, and at any particular point in time 3-4% of Australians experience severe mental disorders which will significantly interfere with their mental well being and reduce their capacity to participate fully in community life.
The National Survey of Mental Health and Well Being (1997) conducted by the Australian Bureau of Statistics found that almost one in five Australians aged 18 years or over met a criteria for a mental disorder at some time during the 12 months prior to the survey. Alarmingly, only 38% of those surveyed with a mental disorder had accessed health services. This suggests a large unmet need for mental health services. Indeed, this indicates that 62% of people with a mental illness are either receiving no assistance, or are depending on informal sources of support usually from unpaid carers and families. In addition, children and adolescents less than 18 years make up 25% of the Australian population and in any six month period 15-20% of this group may have a mental health problem.
The most common disorders are major depression and related disorders including anxiety. The World Health Organisation has predicted that by 2020 major depression will be the second largest health problem worldwide. In 1990, of the ten leading causes of disability worldwide, five were psychiatric disorders including unipolar depression. The growing burden of mental illness in Australia has an enormous economic cost to the Australian population. More importantly, there is a direct and increasing burden to the individuals with mental health problems and those who provide care for them, often family and friends (Mental Health Promotion and Prevention National Action Plan, 1999).
Mental health is influenced by risk and protective factors that occur in the many different domains of everyday life. Risk factors increase the likelihood that a mental illness or mental health problem will develop and can increase the burden of an existing illness or problem. Protective factors give people resilience in the face of adversity and moderate the impact stress and transient symptoms have on social and emotional wellbeing, thereby reducing the likelihood of mental illness or mental health problems (Promotion, Prevention and Early Intervention for Mental Health – A Monograph 2000).
The determinants of an individual’s mental health include a range of psychosocial and environmental factors such as income, employment, poverty, education, access to community resources, physical health, and demographic factors such as gender, age and ethnicity (Promotion, Prevention and Early Intervention for Mental Health – A Monograph 2000). Effective action to promote mental health, prevent the development of mental health problems, and intervene early in mental illness is crucial.
The Promotion, Prevention and Early Intervention for Mental Health – A Monograph (2000) lists the following protective and risk factors for mental health problems:
Protective Factors: (page 15)
.
Risk Factors: (page 16)
Prenatal brain damage Having a teenage mother Bullying Physical, sexual, and emotional abuse Socioeconomic disadvantage Prematurity Having a single parent Peer rejection School transitions Social or cultural discrimination Birth injury Absence of father in childhood Poor attachment to school Divorce or family break up Isolation Low birth weight, birth complications Large family size Inadequate behaviour management Death of family member Neighbourhood violence and crime Physical and / or intellectual disability Antisocial role models (in childhood) Deviant peer group Physical illness /impairment Population density and housing conditions Poor health in infancy Family violence and disharmony School failure Unemployment, homelessness Lack of support services including transport, shopping, recreational facilities Insecure attachment in infant / child Marital discord in parents . Incarceration . Low intelligence Poor supervision and monitoring of child . Poverty / economic insecurity . Difficult temperament Low parental involvement in child’s activities . Job insecurity . Chronic illness Neglect in childhood . Unsatisfactory workplace relationships . Poor social skills Long-term parental unemployment . Workplace accident / injury . Low self-esteem Criminality in parent . Caring for someone with an illness / disability . Alienation Parental substance abuse . Living in nursing home or aged care hostel . Impulsivity Parental mental disorder . War or natural disasters . . Harsh or inconsistent discipline style . . . . Social isolation . . . . Experiencing rejection . . . . Lack of warmth and affection . . .
Multicultural Australia
Australia is a multicultural society as reflected by 20% of the Australian population represented by people from non-English speaking backgrounds (National Action Plan for Promotion, Prevention and Early Intervention for Mental Health, 2000). In many regions of Australia the proportion of the local population that is of non-English speaking background is considerably high.
The process of adjustment for new arrivals to Australia can be stressful, and the experience of migrating to a new country creates a number of unique determinants of social and emotional wellbeing. The National Action Plan for Promotion, Prevention and Early Intervention for Mental Health (2000) recognises that risk factors for mental health problems for people from non-English speaking backgrounds living in Australia are increased due to:
- low socioeconomic status or a decrease in socioeconomic status following immigration;
- inability to speak English;
- separation from family and friends;
- prejudice and discrimination in Australian society;
- lack of recognition of professional qualifications;
- isolation of others of a similar cultural background;
- grief associated with losses;
- traumatic experiences or prolonged stress before or during immigration; and
- extent of acculturation.
The final report of the Carers of People with Mental Illness Project (2000) undertaken by the MHCA and Carers Australia found that mental health services (community based and in-patient) are significantly under-utilised by communities of non-English speaking backgrounds. Such underutilisation is due to a complex range of factors including:
- high levels of stigma associated with mental illness and psychiatric treatment among non-English speaking background communities;
- lack of information about services and how to gain access to them;
- the general lack of culturally appropriate services; and
- great shortages in the availability of interpreters and of bilingual and bicultural mental health professionals in the service system.
This under-utilisation has important implications for families and particularly for carers, and suggests a significant proportion of people from non-English speaking backgrounds with mental health problems, disorders, or illnesses are receiving either no treatment or inadequate treatment.
The National Action Plan for Promotion, Prevention and Early Intervention for Mental Health (2000) identifies people of non-English speaking backgrounds who are older migrants, adolescents, refugees, and those of low socioeconomic status as being higher-risk groups for developing mental health problems. The Action Plan aims to promote mental health, and prevent and reduce mental health problems, disorders and illnesses among people from non-English speaking backgrounds through:
- acceptance and valuing of social and cultural diversity;
- reduced racism and discrimination;
- enhanced community capacity to ensure meaningful participation for people from diverse cultural and linguistic backgrounds;
- mental health literacy;
- reduced stigma associated with mental health problems and mental disorders;
- enhanced resilience and protective factors for mental health problems and mental disorders;
- reduced risk factors for mental health problems and mental disorders;
- cultural sensitivity among health care providers; and
- increased access to culturally appropriate early intervention initiatives and services.
People from culturally and linguistically diverse backgrounds require access to resources of mainstream society, whilst still being able to maintain their cultural and religious integrity. As such, systems and resources need to be easily accessible and negotiable by all members of the community, regardless of language and cultural differences. The active participation of all groups in Australian communities needs to be encouraged, with special care taken to enable people with language and cultural barriers to fully participate in community life.
Potential barriers to effective promotion, prevention and early intervention activities include language and cultural factors, culturally specific beliefs and understanding of mental health problems and causes, and stigma and attitudes relating to mental health problems held by families and communities.
Promotion and prevention initiatives that are culturally appropriate are necessary to identify and address difficulties to attaining and maintaining mental health. Combating such difficulties early will assist in ensuring such difficulties do not become enduring barriers to attainment of social and emotional wellbeing for people from non-English speaking backgrounds. Indeed, an outcome of quality and effectiveness initiatives of the Second National Mental Health Plan aims for better mental health outcomes for people from culturally and linguistically diverse backgrounds.
A number of rural/remote communities have been identified as having a proportionate non-English speaking background population within the rural/remote community. The specific mental health needs and risk factors of people from non-English speaking backgrounds, as outlined above, are greatly increased with the addition of the mental health needs created by living in a rural/remote locality. In addition, non-English speaking background communities are often long established and have a large proportion of elderly people. This presents additional issues in terms of mental health service delivery for cultural and age-appropriateness.
Refugees and Immigration Detention
The United Nations define a refugee as any person who is outside their country of nationality and is unable to return due to a well founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group, or political opinion (UN Convention relating to the Status of Refugees, 1951).
Burdekin (1993) identifies that given the majority of people from non-English speaking backgrounds have come to Australia as migrants, the process of migration is a significant focus in considering prevalence, diagnosis, and treatment of mental health problems, disorders, and illnesses in different ethnic groups.
According to Burdekin (1993) Australia receives between 10,000 and 15,000 refugees each year. This finding may have increased due to recent world events. Burdekin (1993) also notes that refugees, particularly those who have experienced torture and trauma, have an increased risk of developing a mental health problem, disorder, or illness. Indeed, a significant number of refugees experience both physical and mental health problems as a result of their torture experience.
Torture and trauma have a profound, immediate and long-term impact on the physical and psychological health of those exposed to it. High percentages of torture and trauma survivors suffer from extreme levels of depression and anxiety which manifest in a diversity of forms, including sleep disorders, recurring and intrusive memories, poor self esteem, breakdown in family and personal relationships, intrusion in the identity development of children and adolescents, physical injuries which require surgery and rehabilitative treatment, and many other debilitating consequences.
Refugee children may have an increased exposure to risk factors highlighted previously due to the traumatic background in their place of origin, the migration process, and the conditions in which children are held during the migration process. Risk factors may also have a cumulative effect.
Furthermore, refugee children may have an increased risk of developing mental health problems in later life due to the combined effects of exposure to these risk factors.
A quote received by the Burdekin Inquiry (1993) highlights the risk factors refugees may be exposed to:
‘They are dispossessed, dislocated, they suffer psychological disintegration and they arrive in a country where they become disempowered. Ten to twenty percent of these people have been subject to formal torture and that’s probably an underestimate, but almost all of them have been subjected to what we call ‘organised violence’ which is a World Health Organisation term to cover a wide range of trauma to do with civil unrest, dispossession, persecution by authorities, famine, war and other forms of violence carried out in societies that are disintegrating.’ (p 725).
The Minister for Immigration and Multicultural and Indigenous Affairs (http://www.minister.immi.gov.au/detention/women_&_children.htm#children) states:
- As of 1 February 2002, the total number of women and children in mainland Australian Immigration Detention Centres is 637 (259 adult women, 224 male children, 141 female children).
- As of 1 February 2002, there were 13 unaccompanied minors in detention.
- In addition, there are 9 unaccompanied minors placed into alternative care of the South Australian Department of Human Services provided through Family and Youth Services.
- There is also one unaccompanied minor issued with a bridging visa who has been placed in foster care arrangements in the community.
The recent decrease of children in immigration detention facilities may be attributed to decreasing numbers of unauthorised air and sea arrivals to Australia; increase in persons being released from immigration detention, particularly unaccompanied minors; and minors turning 18 years of age while in detention.
Children and young people who are separated from their families, as may often be the case for refugee children who are identified as unaccompanied minors in detention, face additional risks as well as those associated with migration, to poor mental health outcomes.
Immigration processes and the conditions in which refugees are placed in when awaiting migration approval should aim to optimise mental health protective factors, and decrease risk factors associated with mental health problems, disorders, and illnesses. As previously highlighted, the life events refugees are exposed to increase their susceptibility and pre-disposition to developing mental health problems and not dealing with the life events to productive outcomes. Such effects may be heightened in children who may not have the developmental ability or support structures to cope with such events. Refugees may also be experiencing grief associated with the loss of the country, culture, and friends and family left behind.
As such, conditions in immigration detention centres should take into consideration the following points:
- foster family connection and the maintenance of family units;
- education should be provided for children and should include teaching the English language for children and adults;
- adequate health services should be provided including physical health examinations and access to counselling services;
- interpreters should be made available;
- refugees should be able to maintain their cultural identity and values;
- the physical conditions of detention centres should prevent ‘institutionalism’;
- families should be housed together;
- mental health promotion programs should be established within detention centres to support refugees throughout their period of detention;
- mental health screening of risk factors should be conducted upon refugee arrival to Australia;
- mental health promotion programs should be based on a whole-of-family approach, with the inclusion of separate programs for unaccompanied children;
- mental health programs should be designed and monitored by experience mental health professionals;
- detention centre staff should undergo awareness and training in promoting the mental health of detainees;
- arrangements should be made to ensure early identification of children identified as having high risk for the development of mental health problems, disorders, or illnesses;
- best practice guidelines for protecting and promoting the mental health of children and adults in detention should be developed as a priority; and
- a range of activities people can participate in should be made available.
Of particular importance is promoting refugees to have a sense of pride in their cultural origin. The ability to accept and include an ethnic identity within an individual’s sense of self is vital, particularly for young people (Promotion, Prevention, and Early Intervention for Mental Health – A Monograph, 2000).
As highlighted in the Promotion, Prevention, and Early Intervention for Mental Health – A Monograph, (2000), the re-establishment of safety, autonomy, and control is essential for traumatised refugees and care must be taken to not reflect further trauma on such groups.
The MHCA has provided the above information with a focus on highlighting optimal conditions for mental health, and identifying conditions which increase risk factors for the development of mental health problems, disorders, and illnesses. The MHCA submission notes the conditions of immigration detention centres and the mental health impact such conditions have on children, rather than forming a view on immigration policies.
ATTACHMENT A
MHCA MEMBER ORGANISATIONS
Association of Relatives and Friends of the Mentally Ill (ARAFMI)
Australasian Society for Psychiatric Research
Australian & New Zealand College of Mental Health Nurses
Australian Association of Occupational Therapists
Australian Association of Social Workers
Australian Board of Certified Counsellors
Australian Infant, Child, Adolescent and Family Mental Health Association (AICAFMHA)
Australian Medical Association (AMA)
Australian Mental Health Consumer Network
Australian Psychological Society (APS)
Australian Rotary Health Research Fund
Australian Transcultural Mental Health Network
Carers Australia
Catholic Health Australia
GROW
Institute of Australasian Psychiatrists
Lifeline Australia
Mental Health Coordinating Council
Mental Health Foundation of Australia
Mental Illness Education Australia
National Aboriginal Community Controlled Health Organisation (NACCHO)
National Rural Health Alliance
Network of Australian Community Advisory Groups (NOAC)
Ramsay Health Care
Royal Australian & New Zealand College of Psychiatrists
Royal Australian College of General Practitioners
Royal Flying Doctors Service of Australia
SANE Australia
Schizophrenia Fellowship Council of Australia
The Queensland Alliance of Mental Illness and Psychiatric Disability Groups
VICSERV
Western Australian Association for Mental Health
HREOC National Inquiry into Children in Immigration Detention 10
REFERENCES
Australian Bureau of Statistics (1997). The National Survey of Mental Health and Well Being.
Australian Health Ministers, Mental Health Promotion and Prevention National Action Plan, Mental Health Branch, Commonwealth Department of Health and Family Services, 1999.
Australian Health Ministers, Mental Health Statement of Rights and Responsibilities, Mental Health Branch, Commonwealth Department of Human Services and Health, March 1991.
Australian Health Ministers, National Mental Health Policy, Mental Health Branch, Commonwealth Department of Health and Family Services, April 1992.
Australian Health Ministers, National Standards for Mental Health Services, Mental Health Branch, Commonwealth Department of Health and Aged Care, December 1996.
Australian Health Ministers, Second National Mental Health Plan, Mental Health Branch, Commonwealth Department of Health and Family Services, July 1998.
Australian Medical Workforce Advisory Committee, The Specialist Psychiatry Workforce in Australia, 1999.
Commonwealth Department of Health and Aged Care 2000, National Action Plan for Promotion, Prevention and Early Intervention, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, Canberra.
Commonwealth Department of Health and Aged Care 2000, Promotion, Prevention and Early Intervention for Mental Health – A Monograph, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, Canberra.
Mental Health Council of Australia (2000), Enhancing Relationships between Health Professionals and Consumers and Carers Final Report, Canberra, ACT. Commonwealth Department of Health and Aged Care.
Mental Health Council of Australia (2001) Promoting the mental health of all Australians – A 2001 Federal Election Submission.
Monash, D. (August 2001) Access to Rural Mental Health Services, National SPGPPS Forum, 3 August 2001, Canberra.
Raphael, B. (2000). A population health model for the provision o f Mental health care. National Mental Health Strategy. Commonwealth of Australia.
1. Member organisations of the MHCA are listed at Attachment A.
Last Updated 9 January 2003.