In no other area has cross-cultural awareness had such significance as in Australia's policies for refugees and asylum seekers and their subsequent resettlement. There is now a cohort of psychologists working within the immigration detention system in Australia, supporting those in detention and trying to assist them in developing resilience in these extreme circumstances. The challenge has been to remain advocates for the civil and human rights of these detainees, while retaining the counselling role. Asylum seekers who have survived torture and trauma, and a hazardous journey to these shores, often find the fact of immigration detention the last straw in their battle for good mental health. There is a substantial body of research that speaks to the psychological damage that can be caused by indefinite detention, especially to young people.
This article focuses on the development of mental health and psychological support policies for those in immigration detention, and the struggle to operationalise these policies for the best outcome for the clients. It also addresses the needs of the psychologists working in that environment and the ethical challenges they confront.
Detainee Health Expert Advisory Group
Following the various Royal Commissions and Coroners' Reports regarding particular individuals' treatment and subsequent damage to their mental health (e.g., Palmer, 2005; Comrie, 2005), in 2005 the Federal Government invited various professional bodies to nominate members of the Detainee Health Expert Advisory Group (DeHAG), which was established to assist in the determination of best practice and response. I have been a member of that body, and its Mental Health Subgroup, since early 2006, and have had significant input into policy development and implementation since then. In addition, I have met many of the psychologists who have worked in the immigration detention network as contractors to the health service provider (International Health Management Services), and provided training to health and non-health personnel working in the environment.
The DeHAG is comprised of representatives of the Australian Psychological Society, Royal Australian College of General Practitioners, Royal Australian and New Zealand College of Psychiatrists, Australian Medical Association, Royal College of Nursing Australia, Federation of Associations of Survivors of Torture and Trauma, Public Health Association, Australian Dental Association, and a pediatrician from the Royal Australian College of Physicians. All members have also been, and continue to act as, advocates for those who arrive in Australia as asylum seekers. There has been significant discussion within DeHAG regarding our dual role, and the necessity to maintain our distance from the Department of Immigration when Government policy and/or Departmental actions are not consistent with best practice for the safety and health of detainees, or indeed, those working within the environment.
The Mental Health Subgroup of DeHAG has been a working group of mental health experts, who have helped the Department to develop policy documents for mental health screening, psychological support for those in distress, and identification and support for those with torture and trauma backgrounds. These policies have been formally adopted by the Department and training has been provided to Departmental staff, as well as those working for the health service provider and the detention service provider. Unfortunately, implementation – although not yet formally audited – is clearly at a low level at many centres. Detainees remain at grave risk of being misidentified as "troublemakers" or "behaviourally challenging" when their mental health is deteriorating. Detention centres ( and "other places of detention" in Government-speak) remain places in which people's normal resilience is challenged, self-efficacy is denied, hope declines, normal relationships are distorted, unhappiness and depression are the normal affect, and anxiety is rife.
The DeHAG members, who regularly make 'site visits' and report their concerns to the Department, are aware of the danger of legitimising, by their very existence as an Advisory Group, the existence of immigration detention centres that hold people for many months and often over a year. The dilemma as to whether our ongoing criticisms and statement of need for change fall on deaf ears, while meeting with us and minuting our conversations vindicates the Department, is something that is in the forefront of our meetings. Members continue to speak out to the media, to the Coroner and to politicians regarding our concerns. We search our consciences regarding ongoing involvement and, at the time of writing this, continue to believe that our presence is better than losing our voice as a unified group.
Mental health policies
The development of mental health policies for those in immigration detention, and the subsequent training of those working in the environment, was a most gratifying exercise. The collaborative and cross-discipline approach meant that the policies took into account the need for mental health promotion, ongoing support for, and the building of, resilience of those in detention, psychiatric illness identification, and hasty referral of those with backgrounds of significant trauma and torture. The policies are thus comprehensive and inclusive, although written for a lay audience.
I was part of a team that won the tender to administer training on these policies, and a comprehensive three-day package was developed. Unfortunately, the ideal – that everyone working in the detention environment who had client contact should have proper training in the understanding and administration of these policies – was far from fulfilled. In many cases, those with administrative rather than client-contact roles were sent to training. Those with least understanding of issues of mental health, but who had the potential to have the most impact on client day-to-day functioning, were often given truncated courses in the policies, leaving them lacking in understanding of core concepts, or without the capacity to use the policies to the clients' advantage.
Psychologists in detention centres
Psychologists are contracted by the health service provider to be part of the mental health team within a detention centre. All contracts are short term, with most placements being of only six weeks duration. There is thus no guarantee of ongoing employment, and a sense of lack of safety is not uncommon. Moving from centre to centre is difficult for those psychologists who would prefer to build ongoing relationships. A further complication is that teams are led by mental health nurses, who often do not value the unique skills a psychologist can offer. Until recently, in fact, psychologists were directed to get supervision from their team leader, a nurse, and it is only through very strong intervention that psychologists have been able to – indeed, now must – have supervision that meets their registration requirements.
As noted, working conditions can be very difficult in many centres. A model of doing individual therapy for those who seek it is not necessarily the best approach for all client groups. Early intervention, prevention and promotion of good mental health is advocated in the policies, but young psychologists brought in on contract often have to fight for the opportunity to respond to client groups flexibly. Despite the policies regarding mental health promotion, psychologists often get caught up in a system that continues old dysfunctional responses to clients overtaken by despair.
There is a concern that those working within this environment are also eventually overwhelmed by despair, and various methods of disengagement from clients are used. In remote areas, especially where alcohol is cheap and there are not many leisure alternatives, staff can be easily relaxed in a way in which their own mental health needs are compromised. Those who work in these extreme circumstances need to remain aware of their own behaviours, monitor their own needs, and ensure that they protect their own mental health. Adequate supervision should address systemic issues faced by psychologists working in such environments.
Many psychologists have struggled with their own responses to immigration detention. Although it is very difficult to work within a system if you believe it is wrong, it is often those psychologists who can be found in groups of advocates for asylum seekers, protesting for their rights, who are doing significant work within the environment. Others provide pro bono counselling or offer support in the way of psychological reports.
Psychological reports
One of the most difficult arenas in which psychologists are involved within the asylum seeker framework is in the preparation and provision of psychological reports. Some believe that the Minister for Immigration – who has the power under the Immigration Act to make a decision to allow someone to stay on our shores whatever the Departmental finding regarding their refugee status – is influenced by psychological reports. As a result, well-meaning psychologists have hastened to write reports that are, in fact, often letters of pleading. These reports often fall short of useful, as they add no information on which the Minister can rely.
Psychological reports proffered as evidence should be as rigorous in their presentation as any other forensic evaluation. They must be based on evidence, not opinion, and add to the existing knowledge about the client. The evidence of the psychologist's cross-cultural skill, assessment skill and understanding of the effects of torture and trauma should all be stated in the presentation of reports. Psychologists must consider whether a report they proffer is a document of advocacy or has objective psychological standing (or both). Without an honest evaluation of one's own motives in writing, there is a risk that the reports become useless, as each is filled with emotion.
Conclusion
Places of immigration detention used by the Australian Government are camps behind wire. Despite an array of services provided, including medical clinics, English lessons and other activities, they are far from a home away from home. There is absolute evidence that extended detention – and especially detention for an undefined period of time – will inevitably lead to a deterioration in mental health. A very high percentage of those in immigration detention become depressed and anxious, and psychotropic medication is heavily used.
Psychologists who have worked in these places have often felt isolated by their profession, judged by their peers and left to make difficult choices alone. It is important that those psychologists who do provide these services have proper training in working in the cross-cultural arena, and receive ongoing supervision which addresses both their client work and their own responses to the despair and anger of those to whom they provide services.
Psychologists working in detention centres and other psychologists with an interest in this area are encouraged to contact the author at [email protected]