REFUGEES ARE A VULNERABLE POPULATION
Refugees and asylum seekers are a vulnerable population who have often suffered conflict, torture and trauma to an unprecedented magnitude. These experiences predispose them to significantly poor mental health outcomes. A large systematic review and meta analysis of articles pooling 80,000+ refugees over 30 years highlighted a strong and undeniable association between traumatic events and negative mental health outcomes .
DETENTION AND OFFSHORE PROCESSING IS DETRIMENTAL TO MENTAL HEALTH
Evidence of this fact has been gathered from independent research institutions, inquiries from the United Nations and the Australian Human Rights Commission and first hand accounts of health professionals who have worked in detention centres [2,14,15].These studies have produced insurmountable evidence that detention centres have triggered and exacerbated mental health problems amongst this vulnerable population [2,3,5]. Prolonged and uncertain periods of detention exacerbate mental health issues by a contagion effect where by dysfunctional thinking is magnified and shared by groups of people who are frustrated, distressed and/or have mental illness
Access to mental health services at off-shore sites such as Christmas Island, Nauru and Manus Island is limited at best [14, 15]. There is mounting concern amongst health professionals working at detention facilities that the substandard health care is jeopardising the lives and well-being of the people detained there .
These conditions have results in mental health issues such as: 
- Post-traumatic Stress Disorder
- Suicidal ideation
- >85% of detainees are reported to have anxiety, depression, and post-traumatic stress disorder were commonly reported, self-harm and suicidal ideation were also very prevalent.
- Mental health illness is the most common reason for a detainee to present to the hospital .
- From 2011-2013, there were 4,313 incidents of actual, threatened or attempted serious self harm in immigration facilities in Australia .
- Suicide rates are up to 10 times higher in detention centres than in the Australian community .
In a 2004 systematic research study investigating mental health in detention, every adult was diagnosed with a major depressive episode and the majority had PTSD .Most expressed suicidal ideation with a third actually harming themselves while in detention .Prior to detention, only half reported having PTSD, a small number had co-morbid depression and no adults had self-harmed or had experienced suicidal ideation .
Furthermore, the length of time in detention is proportional to the severity of mental disturbances suffered [6,7]. A 2010 health record analysis revealed rates of disorder are low in the early periods of detention and extremely high after 18 months in detention .The mental health effects of detention may be prolonged, extending well beyond the point of release into the community .
CHILDREN IN DETENTION: THE DEVASTATING EFFECT ON MENTAL HEALTH AND DEVELOPMENT
Detention of children (or families with children) has undeniable immediate and long term effects on the mental health of the child(ren) involved . Detention threatens the childs development and mental health, causing long-term damage to social and emotional functioning. These effects are highly likely to be carried into adult life and are a consequence of the punitive policies in place . There is sufficient evidence to establish a causal relationship between these two facets [9, 10, 11, 12].
Several serious suicide attempts have been documented in young children and adolescents . The rates of adolescents participating in protest and self-harming behaviours occur at rates up to 12 times that of the general population .
TPVs DEPRIVE PEOPLE OF SECURITY, CERTAINTY AND A RIGHT TO ADEQUATE HEALTH SERVICES
This added anxiety only compounds existing mental health problems in this vulnerable population. Refugees issued with temporary protection visas have reported significantly poorer mental health outcomes when compared to those with permanent visas .Momartin et al. concluded that
- Holders of TPVs returned higher scores on three psychiatric symptom measures compared with those on permanent protection .
- TPVs were the strongest predictor of anxiety, depression and PTSD .
Next: Ethical Concerns
- Steel Z, Chey T, Silove D et al. Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta-analysis.JAMA. 2009;302(5):537-549.
- Silove D, Austin P, Steel Z. No Refuge from Terror: The Impact of Detention on the Mental Health of Trauma-affected Refugees Seeking Asylum in Australia . Transcultural Psychiatry [Internet]. 2007;44(3):359-393. Available from:SAGE Journals
- Bull M, Schindeler E, Berkman D et al. Sickness in the System of Long-term Immigration Detention. Journal of Refugee Studies. 22 Jun 2012;26(1):47-68.
- Silove D, Steel Z, Watters C. Policies of Deterrence and the Mental Health of Asylum Seekers. JAMA [Internet]. 2000;284(5):604-11. Available from: http://jama.jamanetwork.com/article.aspx?articleid=192952
- Steel Z, Momartin S , Bateman C. et al. Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia. Australian & New Zealand Journal of Public Health. 2004; 28(6): 527536.
- Steel Z. Silove D, Brooks R et al. Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry. 2006; 188, 58-64.
- Triggs G. Mental Health and Immigration Detention. The Medical Journal of Australia [Internet]. 2013;199(11):721-722. Available from: https://www.mja.com.au/journal/2013/199/11/mental-health-and-immigration-detention
- Green, J. P., & Eagar, K. (2010). The health of people in Australian immigration detention centres. Medical Journal of Australia, 192(2), 6570.
- Dudley M, Steel Z, Mares S et al. Children and young people in immigration detention. Current Opinion in Psychiatry. 2102;25(4):285 292.
- Newman L, Proctor N, Dudley M. Seeking asylum in Australia: immigration detention, human rights and mental health care. Australasian Psychiatry. 2013; 21(4): 316-320.
- Those whove come across the seas: Detention of unauthorised arrivals Report [Internet].Sydney: Human Rights and Equal Opportunity Commission; 1998. Available from: http://www.humanrights.gov.au/publications/those-whove-come-across-seas-detention-unauthorised-arrivals
- Commonwealth Ombudsman. Report of an own motion investigation into the department of immigration and multicultural affairs immigration detention centres report under section 35A of the Ombudsman Act 1976. Report, Commonweath Ombudsman. Canberra, Australia, March 2001.
- Momartin S, Steel Z, Coello M at al. A comparison of the mental health of refugees with temporary versus permanent protection visas. Medical Journal of Australia. 2006; 185 (7): 357-361.
- Australian Human Rights Commission. Immigration Detention and Offshore Processing on Christmas Island . Report. Sydney; 2009.
- International Health and Medical Services. Christmas Island Medical Officers Letter of Concerns- November 2013. The Guardian. January 2014.
- Newman, L. K., Procter, N. G., & Dudley, M. J. (2011). Suicide and self-harm in immigration detention. The Medical Journal of Australia, 195(6), 310311.