A last resort? - Summary Guide: Mental Health

Under the Convention on the Rights of the Child, all children living in Australia - including children held in immigration detention - have a right to the 'highest attainable standard of health'. The Convention also states that children escaping conflict, torture or trauma have a right to special help to recover 'in an environment which fosters the health, self-respect and dignity of the child.'

A child's mental health affects every part of his or her life. For instance it can stop children from enjoying healthy relationships with family and friends, it can hinder their ability to learn and it can undermine their enthusiasm to play. In other words, a child's mental health is strongly linked to his or her overall well-being.

The Inquiry received a wide range of evidence which indicated that detention has a significantly detrimental impact on the mental health of some children. While children who were detained for short periods of time may not have been greatly affected, evidence from the primary records of mental health professionals who treated children in detention showed that the longer children were held in detention, the more their mental health deteriorated.

Whilst children in detention did receive some support and help from mental health professionals, many experts told the Inquiry that the detention environment made it virtually impossible to meet the mental health needs of children and their families. This was because the source of many of the problems was the detention environment itself.

The Inquiry heard numerous examples where State mental health and child protection agencies, as well as independent experts, repeatedly recommended that children be removed from detention to protect their mental health. By April 2002 most unaccompanied children were removed from detention centres following these recommendations - but the recommendations were not implemented for children in detention with their parents.

Mental health experts, many of whom had treated children in detention, told the Inquiry that child detainees had experienced, amongst other things, clinical depression, post traumatic stress disorder, and various anxiety disorders.

Children in detention exhibited symptoms including bed wetting, sleep walking and night terrors. At the severe end of the spectrum, some children became mute, refused to eat and drink, made suicide attempts and began to self-harm, such as by cutting themselves. Some children also were not meeting their developmental milestones.

Recovery from past trauma

More than 92% of children in detention have been found to be refugees. This means that most, if not all, children in immigration detention are likely to have been affected by significant traumatic episodes before they arrived in Australia.

However, the Inquiry received evidence that the trauma children experienced before they arrived in Australia does not account for the extent of mental health problems they demonstrated in detention. In fact, the evidence was clear that immigration detention centres were not an environment where they could recover from their past persecution and trauma.

The detention environment

Children, parents, child protection authorities and psychiatrists all agreed that children are deeply affected by witnessing violence in the detention centres, such as riots, fires, suicide attempts, incidents of self-harm and hunger strikes.

An atmosphere of fear and violence can cause extreme anxiety in children, which can cause them to relive past traumas. It can also lead some children to copy the behaviour they see around them.

The atmosphere of violence was compounded by other factors associated with life in a detention centre, such as living in a closed environment and the uncertainty surrounding visa applications.

In the early stages of detention, before a primary determination is made on a visa application, detainees are generally hopeful that their application will be successful and their time in detention short. However, as weeks and months pass without any news on their visa application, or if the application has been rejected, detainees grow more depressed, anxious and fearful.

Breakdown of families

Experts agree that strong, effective parenting is crucial to the well-being and healthy development of a child. However, being in detention can severely undermine the ability of parents to care for their child.

Parents in detention spoke of their frustration at being unable to maintain normal family arrangements in detention, such as cooking their own food, providing discipline or celebrating birthdays or other special days.

Parents also said they felt guilty in bringing their children to Australia - instead of finding freedom and a new home, they were being held in 'a prison'.

The Inquiry heard that parents in detention who were previously very effective and competent became depressed in detention, which meant they were unable to play with their children, read to them, supervise them or look after their safety. In some cases, parents also found it difficult to manage their children's behaviour in the detention environment.

A parent's depression can lead to children taking on an 'adult' role - children would care for a parent or younger siblings and discuss issues with detention centre staff because they had stronger English language skills than their parents.

Child welfare experts told the Inquiry that it was very harmful for children to take on these roles. Not only is the behaviour 'developmentally inappropriate', it also means they sacrifice their own needs and try to offer a level of care to others that they are not really able to give.

Mental health problems suffered by children in detention

Children detained for lengthy periods have experienced significant mental health problems. A study by mental health professionals (the 2003 Steel report) of 20 children from a remote detention centre who had been detained for an average of 28 months found that:

All but one child received a diagnosis of major depressive disorder and half were diagnosed with Post Traumatic Stress Disorder (PTSD). The symptoms of PTSD experienced by the children were almost exclusively related to experience of trauma in detention. Children described nightmares ... and many would scream in their sleep or wake up shouting.

In April 2002, the South Australian child welfare authority made the following report on a 13 year old boy who had been detained for 455 days:

[He] is very withdrawn and lethargic. Since entering Woomera he has been suicidal and very sad. He reports nightmares nightly, seeing himself dead, or unable to move with people carrying his body. He reports waking screaming and finds trouble falling to sleep. He reports a diminished appetite. He has little memory of past events and no hope for the future. He refuses to make new friends because he believes they will be released but not him. He engages in constructive day time activities but spends hours sitting staring vacantly.

Children in detention also self-harmed - they have sewn their lips together, attempted to hang themselves, swallowed shampoo and detergents and have cut themselves. Between April and July 2002, one child detained at Woomera made four attempts to hang himself, climbed into the razor wire four times, went on hunger strike twice and slashed his arm twice. Records from April 2002 report this boy saying:

If I go back to camp I have every intention of killing myself. I'll do it again and again ... We came for support and it seems we're being tortured. It doesn't matter where you keep me - I'm going to hang myself.

Family compound at Baxter, December 2002