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      Health professionals confront the intentional harms of indefinite immigration detention: an Australian overview, evaluation of alternative responses and proposed strategy


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          Indefinite immigration detention causes well-documented harms to mental health, and international condemnation and resistance leave it undisrupted. Health care is non-independent from immigration control, compromising clinical ethics. Attempts to establish protected, independent clinical review and subvert the system via advocacy and political engagement have had limited success.

          The purpose of this study is to examine the following: how indefinite detention for deterrence (exemplified by Australia) injures asylum-seekers; how international legal authorities confirm Australia’s cruel, inhuman and degrading treatment; how detention compromises health-care ethics and hurts health professionals; to weigh arguments for and against boycotting immigration detention; and to discover how health professionals might address these harms, achieving significant change.


          Secondary data analyses and ethical argumentation were employed.


          Australian Governments fully understand and accept policy-based injuries. They purposefully dispense cruel, inhuman and degrading treatment and intend suffering that causes measurable harms for arriving asylum-seekers exercising their right under Australian law. Health professionals are ethically conflicted, not wanting to abandon patients yet constrained. Indefinite detention prevents them from alleviating sufferings and invites collusion, potentially strengthening harms; thwarts scientific inquiry and evidence-based interventions; and endangers their health whether they resist, leave or remain. Governments have primary responsibility for detained asylum-seekers’ health care. Health professional organisations should negotiate the minimum requirements for their members’ participation to ensure independence, and prevent conflicts of interest and inadvertent collaboration with and enabling systemic harms.


          Australia’s aggressive approach may become normalised, without its illegality being determined. Health professional colleges uniting over conditions of participation would foreground ethics and pressure governments internationally over this contagious and inexcusable policy.

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          Most cited references80

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          The meaning and mental health consequences of long-term immigration detention for people seeking asylum.

          The aim of the present research was to examine the experience of extended periods of immigration detention from the perspective of previously detained asylum seekers and to identify the consequences of these experiences for life after release. The study sample comprised seventeen adult refugees (sixteen male and one female; average age 42 years), who had been held in immigration detention funded by the Australian government for on average three years and two months. They were interviewed on average three years and eight months following their release and had been granted permanent visa status or such status was imminent. The study employed a combination of qualitative and quantitative methods to explore detention and post-detention experiences, and mental health some years after release. The qualitative component consisted of semi-structured interviews exploring psychological well-being, daily life, significant events, relationships, and ways of coping throughout these periods. This was supplemented with standardised quantitative measures of current mental health and quality of life. All participants were struggling to rebuild their lives in the years following release from immigration detention, and for the majority the difficulties experienced were pervasive. Participants suffered an ongoing sense of insecurity and injustice, difficulties with relationships, profound changes to view of self and poor mental health. Depression and demoralisation, concentration and memory disturbances, and persistent anxiety were very commonly reported. Standardised measures found high rates of depression, anxiety, PTSD and low quality of life scores. The results strongly suggest that the psychological and interpersonal difficulties participants were suffering at the time of interview were the legacy of their adverse experiences while detained. The current study assists in identifying the characteristics of prolonged immigration detention producing long-term psychological harm. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia.

            To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia. Structured psychiatric interviews were administered by three same-language speaking psychologists by phone to assess the lifetime and current psychiatric disorders among 10 families (14 adults and 20 children) held in immigration detention for more than two years. All adults and children met diagnostic criteria for at least one current psychiatric disorder with 26 disorders identified among 14 adults, and 52 disorders among 20 children. Retrospective comparisons indicated that adults displayed a threefold and children a tenfold increase in psychiatric disorder subsequent to detention. Exposure to trauma within detention was commonplace. All adults and the majority of children were regularly distressed by sudden and upsetting memories about detention, intrusive images of events that had occurred, and feelings of sadness and hopelessness. The majority of parents felt they were no longer able to care for, support, or control their children. Detention appears to be injurious to the mental health of asylum seekers. The level of exposure to violence and the high level of mental illness identified among detained families provides a warning to policy makers about the potentially damaging effects of prolonged detention on asylum seekers. In their attempt to manage the international asylum crisis, it is important that Western countries do not inadvertently implement policies that cause further harm.
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              Psychiatric assessment of children and families in immigration detention--clinical, administrative and ethical issues.

              This paper reports the clinical, practical and ethical issues arising in the assessment of 10 consecutive referrals from a remote Immigration Reception and Processing Centre to a child and adolescent mental health service (CAMHS) between February and August 2002. The 16 adults and 20 children (age range 11 months to 17 years) were comprehensively assessed by allied health clinicians and child psychiatrists. All children were also assessed by the statutory child protection agency. There were very high levels of mood disturbance and post-traumatic symptoms in this population. All children had at least one parent with psychiatric illness. Of the 10 children aged 6-17 years, all (100%) fulfilled criteria for both post-traumatic stress disorder (PTSD) and major depression with suicidal ideation. Eight children (80%), including three pre-adolescents, had made significant attempts at self harm. Seven (70%) had symptoms of an anxiety disorder and half reported persistent severe somatic symptoms. The majority (80%) of preschool-age children were identified with developmental delay or emotional disturbance. Few clinically based recommendations were implemented. Very high levels of psychopathology were found in child and adult asylum seekers. Much was attributable to traumatic experiences in detention and, for children, the impact of indefinite detention on their caregivers. Multiple obstacles to adequate service provision are identified. Adequate clinical intervention and care was not possible. The impact on involved clinicians is discussed.

                Author and article information

                International Journal of Migration, Health and Social Care
                Emerald Publishing
                17 December 2020
                18 February 2021
                : 17
                : 1
                : 35-51
                [1]School of Psychiatry, University of New South Wales , Kensington, Australia
                [2]Sydney, Australia
                [3]Department of Psychiatry, University of Melbourne , Melbourne, Australia
                [4]School of Social Sciences, University of Western Sydney , Penrith, Australia
                [5]Faculty of Medicine, University of New South Wales , Sydney, Australia
                Author notes
                Michael Dudley can be contacted at: m.dudley@unsw.edu.au
                655540 IJMHSC-08-2020-0083.pdf IJMHSC-08-2020-0083
                © Emerald Publishing Limited
                : 29 August 2020
                : 08 October 2020
                : 19 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 105, Pages: 1, Words: 8744
                Self URI (journal-page): http://www.emeraldinsight.com/journal/ijmhsc
                e-viewpoint, Viewpoint
                cat-HSC, Health & social care
                , Vulnerable groups
                , Inequalities & diverse/minority groups
                , Sociology
                , Race & ethnic studies
                , Minorities
                , Sociology
                , Race & ethnic studies
                , Multiculturalism
                , Sociology
                , Race & ethnic studies
                , Racial identity
                , Sociology
                , Work
                , economy & organizations
                , Labour movements
                Custom metadata
                Web-ready article package

                Advocacy,Immigration detention,Health professional,Asylum-seeker,Cruel inhuman or degrading treatment,Dual loyalty,Moral injury


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