This blog has frequently drawn attention to the inhumanity of Australia’s treatment of asylum seekers fleeing the world’s trouble-spots, some which the Australian government were directly complicit in creating.
The chief psychiatrist responsible for the care of asylum seekers in detention for the past three years has accused the immigration department of deliberately inflicting harm on vulnerable people, harm that cannot be remedied by medical care. Until a month ago he was director of mental health for International Health and Medical Services (IHMS), the private contractor that provides medical care to detention centres on the Australian mainland, Christmas Island, Nauru and Manus Island. Young has been a psychiatrist for nearly 20 years, most of that time working in public health. He joined IHMS believing the detention system was problematic but confident that good could be done from the inside.
Rather than offer vulnerable refugees sanctuary Australia has instead responded with a system he says is deliberately harsh, breaks people’s health, costs a fortune, compromises the ethics of doctors and is intended to place asylum seekers under “strong coercive pressure” to abandon plans to live in Australia. “Suffering is the way that is achieved.” He goes on to explain “When you go to Manus Island and you walk down what is called the ‘walk of shame’ between the compounds and you see the men there at the fences it’s an awful experience,” he says. “You have to feel shame. You have to understand what that feeling is about in order to be able to be compassionate. By feeling the shame you stay on the right side of the line.”
Dr Peter Young told Guardian Australia IHMS figures had shown for some time that a third of adults and children in the detention system had what he called“a significant-level disorder”. If they were living in Australia, that would require the care of specialist medical health services. The figures only got worse as detainees stayed longer in detention: “After a year it approaches 50%.” Young said the immigration department had refused to accept IHMS statistics proving damage to children and adolescents held in prolonged detention. “The department reacted with alarm and asked us to withdraw the figures.”
He continue:
“We have here an environment that is inherently toxic. It has characteristics which over time reliably cause harm to people’s mental health. We have very clear evidence that that’s the case.” He believes this process is akin to torture: “If we take the definition of torture to be the deliberate harming of people in order to coerce them into a desired outcome, I think it does fulfil that definition.”
He accused the Australian immigration department of:
• Delays that endanger health in bringing patients to Australia from Manus and Nauru: “It is seen as undesirable because it undermines the idea that people are never going to Australia and also because of the concern that if people arrive onshore then they may have access to legal counsel and other assistance.”
• Leaving people in detention who are acutely suicidal: “Trying to manage them in a non-therapeutic setting like that is just inherently futile. It’s not going to work.”
• Returning patients with less severe problems to detention despite medical advice that they cannot be expected “to fully respond to treatment in an environment that was making them sick”.
• Misusing patient information. “People disclose a lot of personal information which is then recorded in notes which are then available to non-medical people for other purposes.” Young says the dual role of IHMS staff treating detainees but reporting to the department raises fundamental ethical problems for doctors in the system.
• Displaying an obsession with secrecy: “Speaking out of turn is clamped down on whenever it occurs … they continue to maintain the fantasy that they can keep everything a secret.”
• Reluctance to gather and use mental health statistics that might “result in controversy or threaten the application of the policies of deterrence”.
• Directing doctors not to put in writing that detention has led to deterioration in their patients’ mental health. IHMS doctors ignored the direction. Young said they saw evidence all around them of detainees “sick because they are there and getting sicker while they remain there”.
The secretary of the immigration department, Martin Bowles, accused the president of the Human Rights Commission, Gillian Triggs, of making “highly emotive claims” about health problems in the detention system. But Bowles did not deny a link between prolonged detention and mental illness. He called this a “well-established” issue and insisted his department was doing “everything it humanly can” to provide “appropriate medical care” to address the mental health problems of detainees.
Young says that would be impossible: “The problem is the system. You can’t mitigate the harm, because the system is designed to create a negative mental state. It’s designed to produce suffering. If you suffer, then it’s punishment. If you suffer, you’re more likely to agree to go back to where you came from. By reducing the suffering you’re reducing the functioning of the system and the system doesn’t want you to do that. Everybody knows that the harm is being caused and the system carries on. Everybody accepts that this is the policy and the policy cannot change. And everybody accepts that the only thing you can do is work within the parameters of the policy.”
The immigration department had been put on notice once again that prolonged detention harms mental health. Professor Kathy Eager of Wollongong University reached that conclusion in a study commissioned by the department itself.
“There is,” she wrote, “almost universal criticism of the policy of detaining asylum seekers, particularly in terms of the mental health implications.”
Her findings were backed by the department’s independent Detention Health Advisory Group (Dehag), the Australian College of Mental Health Nurses and the Australian Psychological Society. In 2011 the Royal Australian and New Zealand College of Psychiatrists declared: “Prolonged detention, particularly in isolated locations, with poor access to health and social services and uncertainty of asylum seeker claims, can have severe and detrimental effects.”
Each quarter IHMS presents the department with figures on the health of detainees. The data for July to September 2013 showed a third of those held in detention for more than a year were experiencing extremely severe depression; 42% were suffering extremely severe anxiety; and 42% were extremely stressed. The report notes these figures are consistent with internationally published research: “The pattern shows the negative mental health effects of immigration detention with a clear deterioration of mental health indices over time in detention.”
While detainees were being rapidly released, Young observed attitudes towards them improved throughout the system. They were not treated as prisoners. Their mental health was generally good: “These people are actually quite robust and psychologically healthy individuals despite all the suffering that they have been through. You just can’t overstate how things changed so rapidly when the policy changed,” Young says. Once again the system treated them as prisoners. The impact on their mental health was as predicted: fine for a few months, then increased depression, anxiety and stress. “Most people have a level of resilience which allows them to function fairly well for a few months, but after that time there is a steady deterioration … after six months the cumulative harms accelerate very rapidly.” Uncertainty does the worst damage, Young says. Then comes hopelessness. “They are constantly given a message that they are on a negative pathway, meaning their claim is not going to be accepted. This is despite what we know about the outcomes of processing in the long term, which is that greater than 80% of people are found to be genuine refugees.”
Young sees immigration detention as inherently more harmful than prison. “In prison those with mental health problems generally improve. People are more well on their release than when they entered. What we see in detention is the opposite of that. Over the course of time in detention, they get sicker.
“We don’t have families in prisons. Secondly, when people go to prison they go through a recognised independent judicial process. It’s not arbitrary. This is an arbitrary process and people see it as being unfair and that is another factor. Also, when people are in prison they have a definitive sentence so they know there is an end point. This is not like that at all. This is indefinite.”
Full story can be read here
The chief psychiatrist responsible for the care of asylum seekers in detention for the past three years has accused the immigration department of deliberately inflicting harm on vulnerable people, harm that cannot be remedied by medical care. Until a month ago he was director of mental health for International Health and Medical Services (IHMS), the private contractor that provides medical care to detention centres on the Australian mainland, Christmas Island, Nauru and Manus Island. Young has been a psychiatrist for nearly 20 years, most of that time working in public health. He joined IHMS believing the detention system was problematic but confident that good could be done from the inside.
Rather than offer vulnerable refugees sanctuary Australia has instead responded with a system he says is deliberately harsh, breaks people’s health, costs a fortune, compromises the ethics of doctors and is intended to place asylum seekers under “strong coercive pressure” to abandon plans to live in Australia. “Suffering is the way that is achieved.” He goes on to explain “When you go to Manus Island and you walk down what is called the ‘walk of shame’ between the compounds and you see the men there at the fences it’s an awful experience,” he says. “You have to feel shame. You have to understand what that feeling is about in order to be able to be compassionate. By feeling the shame you stay on the right side of the line.”
Dr Peter Young told Guardian Australia IHMS figures had shown for some time that a third of adults and children in the detention system had what he called“a significant-level disorder”. If they were living in Australia, that would require the care of specialist medical health services. The figures only got worse as detainees stayed longer in detention: “After a year it approaches 50%.” Young said the immigration department had refused to accept IHMS statistics proving damage to children and adolescents held in prolonged detention. “The department reacted with alarm and asked us to withdraw the figures.”
He continue:
“We have here an environment that is inherently toxic. It has characteristics which over time reliably cause harm to people’s mental health. We have very clear evidence that that’s the case.” He believes this process is akin to torture: “If we take the definition of torture to be the deliberate harming of people in order to coerce them into a desired outcome, I think it does fulfil that definition.”
He accused the Australian immigration department of:
• Delays that endanger health in bringing patients to Australia from Manus and Nauru: “It is seen as undesirable because it undermines the idea that people are never going to Australia and also because of the concern that if people arrive onshore then they may have access to legal counsel and other assistance.”
• Leaving people in detention who are acutely suicidal: “Trying to manage them in a non-therapeutic setting like that is just inherently futile. It’s not going to work.”
• Returning patients with less severe problems to detention despite medical advice that they cannot be expected “to fully respond to treatment in an environment that was making them sick”.
• Misusing patient information. “People disclose a lot of personal information which is then recorded in notes which are then available to non-medical people for other purposes.” Young says the dual role of IHMS staff treating detainees but reporting to the department raises fundamental ethical problems for doctors in the system.
• Displaying an obsession with secrecy: “Speaking out of turn is clamped down on whenever it occurs … they continue to maintain the fantasy that they can keep everything a secret.”
• Reluctance to gather and use mental health statistics that might “result in controversy or threaten the application of the policies of deterrence”.
• Directing doctors not to put in writing that detention has led to deterioration in their patients’ mental health. IHMS doctors ignored the direction. Young said they saw evidence all around them of detainees “sick because they are there and getting sicker while they remain there”.
The secretary of the immigration department, Martin Bowles, accused the president of the Human Rights Commission, Gillian Triggs, of making “highly emotive claims” about health problems in the detention system. But Bowles did not deny a link between prolonged detention and mental illness. He called this a “well-established” issue and insisted his department was doing “everything it humanly can” to provide “appropriate medical care” to address the mental health problems of detainees.
Young says that would be impossible: “The problem is the system. You can’t mitigate the harm, because the system is designed to create a negative mental state. It’s designed to produce suffering. If you suffer, then it’s punishment. If you suffer, you’re more likely to agree to go back to where you came from. By reducing the suffering you’re reducing the functioning of the system and the system doesn’t want you to do that. Everybody knows that the harm is being caused and the system carries on. Everybody accepts that this is the policy and the policy cannot change. And everybody accepts that the only thing you can do is work within the parameters of the policy.”
The immigration department had been put on notice once again that prolonged detention harms mental health. Professor Kathy Eager of Wollongong University reached that conclusion in a study commissioned by the department itself.
“There is,” she wrote, “almost universal criticism of the policy of detaining asylum seekers, particularly in terms of the mental health implications.”
Her findings were backed by the department’s independent Detention Health Advisory Group (Dehag), the Australian College of Mental Health Nurses and the Australian Psychological Society. In 2011 the Royal Australian and New Zealand College of Psychiatrists declared: “Prolonged detention, particularly in isolated locations, with poor access to health and social services and uncertainty of asylum seeker claims, can have severe and detrimental effects.”
Each quarter IHMS presents the department with figures on the health of detainees. The data for July to September 2013 showed a third of those held in detention for more than a year were experiencing extremely severe depression; 42% were suffering extremely severe anxiety; and 42% were extremely stressed. The report notes these figures are consistent with internationally published research: “The pattern shows the negative mental health effects of immigration detention with a clear deterioration of mental health indices over time in detention.”
While detainees were being rapidly released, Young observed attitudes towards them improved throughout the system. They were not treated as prisoners. Their mental health was generally good: “These people are actually quite robust and psychologically healthy individuals despite all the suffering that they have been through. You just can’t overstate how things changed so rapidly when the policy changed,” Young says. Once again the system treated them as prisoners. The impact on their mental health was as predicted: fine for a few months, then increased depression, anxiety and stress. “Most people have a level of resilience which allows them to function fairly well for a few months, but after that time there is a steady deterioration … after six months the cumulative harms accelerate very rapidly.” Uncertainty does the worst damage, Young says. Then comes hopelessness. “They are constantly given a message that they are on a negative pathway, meaning their claim is not going to be accepted. This is despite what we know about the outcomes of processing in the long term, which is that greater than 80% of people are found to be genuine refugees.”
Young sees immigration detention as inherently more harmful than prison. “In prison those with mental health problems generally improve. People are more well on their release than when they entered. What we see in detention is the opposite of that. Over the course of time in detention, they get sicker.
“We don’t have families in prisons. Secondly, when people go to prison they go through a recognised independent judicial process. It’s not arbitrary. This is an arbitrary process and people see it as being unfair and that is another factor. Also, when people are in prison they have a definitive sentence so they know there is an end point. This is not like that at all. This is indefinite.”
Full story can be read here
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