Mental Illness? What Mental Illness?
A presentation by Dr Carmen Lawrence
"We don't need elaborate research to conclude that asylum seekers are going to be damaged by these experiences. It's obvious to anyone prepared to imagine their own responses, to think about what would happen to their families if they were put under the sort of stress experienced daily in the detention centres. One man who was detained for over four years described it as 'dying every day.'"
"Australia is the only Western country that has imposed a mandatory detention system for refugees even though it is in clear breach of international law. All those who arrive undocumented are detained until they are granted refugee status or removed."
"Despite the government's policy of secrecy, we have been able to assemble a picture of life in these centres from the accounts of visitors and workers. As I have said elsewhere, it is not an exaggeration to call this a policy of "institutionalised sadism" which has at its core the deliberate, systematic degradation and torture of our fellow human beings, treatment we would normally abhor."
1 January 2007: The Gifts of Carmen Lawrence - The number of contributions from Carmen to the national debate, also but not only about Australia's treatment of refugees and asylum seekers, has kept growing, also on our website - this was the reason we constructed this page to bring all pages, all gifts from Dr Carmen Lawrence together.
Mental Illness? What Mental Illness?
Mental Health and Human Rights Conference
This paper was delivered at a one-day conference on Mental Health and Human Rights in the contemporary political context of Australia. Conference hosts were S A V E - Australia Inc., in cooperation with A Just Australia and the Edmund Rice Centre. Venue: NSW Parliament House, Macquarie Street, Sydney NSW.
The government's approach to the now well-documented increase in mental illness among those held for prolonged periods in detention is a dismissive - "So what - they brought it upon themselves." Sometimes, they simply deny that it is a problem.
John Howard, when challenged recently about the cruelty of holding children behind the razor wire, responded airily, "I believe that the action of parents who bring children into dangerous situations should be the subject of criticism rather than the government." He takes no responsibility at all for their welfare.
The former Minister, now Attorney General, and his successor, Amanda Vanstone, would have us believe that the claims about harm are exaggerated, part of a pattern of deception and manipulation designed to "exploit our decency" and obtain "outcomes" to which they are not entitled.
The Government encourages us to turn our faces away from the refugees and even to deny, as the former Minister did, that depression is a mental illness. In answering a Senate question about the incidence of mental illness in detention, the Minister actually excluded depression as a category of mental illness.
In subsequent interviews the Minister implied that the experience of detention was not particularly harmful, even though so many of those in detention are depressed, because "I'm not sure that everybody would regard depression as a mental illness." Nudge, nudge - at least not sensible people like you and me, just bothersome groups like the World Health Organisation, The Royal Australian and New Zealand College of Psychiatry and the Commonwealth Department of Health.
The plague of self-harm and suicide attempts are, in his eyes, not the companions of mental illness but rather crude attempts to engineer refugee status. He told Kerry O'Brien last year , "there were perceptions in the centres themselves that, by action of self-harm, people had achieved outcomes... And it led to a belief amongst a proportion of the Afghan population that the only way in which they were going to obtain visas was to be involved in the same sort of conduct."
He refused, as he has always done, to even contemplate the possibility that locking people away in remote areas without certainty and hope may drive them to destructive acts. He specifically refused to accept O'Brien's proposition that such acts might be construed as acts of desperation.
In a belated answer to a Question on Notice I asked last year about the frequency of attempted suicides in detention centres, the official government response reflected the same denial of reality. I was told that, "Incidents of attempted or actual self harm are recorded according to the nature of the harm involved, rather than whether or not they may be directed toward suicide."
As a result, they refused to tell me what proportion of those people in detention had attempted suicide and they had no data at all beyond the last three years during which time an extraordinary 556 incidents of self-harm were recorded.
Despite the government's policy of secrecy, we have been able to assemble a picture of life in these centres from the accounts of visitors and workers. As I have said elsewhere, it is not an exaggeration to call this a policy of "institutionalised sadism" which has at its core the deliberate, systematic degradation and torture of our fellow human beings, treatment we would normally abhor.
People are being brutalised every day in the detention centres. And many of the staff responsible for their care will never fully recover from the experience of carrying out their Government's cruel policy.
Australia is the only Western country that has imposed a mandatory detention system for refugees even though it is in clear breach of international law . All those who arrive undocumented are detained until they are granted refugee status or removed.
The most recent figures from 25 February show that there are 929 people still being detained in Australia, with only 29 in residential housing projects. Of those detained, 70 are children, with all but 17 being held in secure detention facilities. Eighty three of the estimated 177 people in the camp on Nauru are children.
The government boasts that locking people up in remote areas for prolonged periods deters other asylum seekers from coming to our shores to seek help. Yet it is a matter of record that since 1992 when mandatory detention was introduced, the number of people arriving in Australia by boat without visas increased substantially.
The fact that no asylum seekers arrived in leaky boats over the last year (while 8000 did by air) is more likely due, not to the persecution of refugees, but to the hideous example of the drowning of over 353 souls in the SIEV X, better engagement of Australian authorities with those in Indonesia to prevent the boats leaving and changed circumstances in Iraq and Afghanistan. Refugee movement world wide has slowed.
Many asylum seekers are here precisely because they are the victims of torture and persecution, fleeing human rights abuses, often leaving family and loved ones behind. Others have lost family members to brutal regimes and are still grieving their losses. Some come from war zones where they have seen their communities bombed into oblivion.
The great majority of the people we keep behind razor wire fences have already survived torture and ill treatment, experiences predictive of later serious mental illness. There is a vast literature on the effects of trauma and we fund programs in the community for the victims of torture and trauma, understanding that it takes concerted, skilled, professional intervention to help people recover. Those who have been imprisoned and tortured in the countries from which they fled are particularly likely to be harmed by further detention, especially if they are confronted by the possibility of deportation if their applications fail.
Yet their coming here is an expression of hope; they want to rebuild their lives and give their children a better future. On arrival in Australia they are hopeful of compassionate and humane treatment. Instead, they are rebuffed, humiliated and tormented still further. Instead of providing such help we amplify the pain. On top of their traumatic experiences, they are incarcerated in remote, harsh environment.
This is particularly short-sighted when it is considered that up to 80% of detainees are eventually found to be refugees and join the Australian community. They are bound to need additional counselling and treatment as a result of the cruelty we have inflicted on them.
The mere fact of indefinite detention is bad enough, but degrading treatment is also regularly meted out. There are numerous reports of naked hostility being expressed by the staff toward the detainees. In letters to supporters, people in detention often report that they are treated with disrespect and endure petty humiliations and intrusions into their privacy.
Isolation detention and force are routinely used. People are identified by numbers, not names. As Frank Brennan reminds us, the "abuses of detention are always more aggravated when the jailers are people of another race."
Following the fires that were lit in several of the centres around Christmas 2002, strip-searching - including full body cavity searching - became routine. Many were placed in isolation and denied any communication with the people outside who attempt to support them.
Random acts of meanness are also commonplace. Last year a Baxter detainee, Ebrahim Sammaki, was sent a videotape of the ABC 7.30 report which included images of his two children from whom he had been separated for some time. Ebrahim's wife died in the Bali bombing and their two young children were still in Indonesia because the Minister refused to allow them to join their father. Ebrahim was not permitted to see the tape because the guards alleged that there was 'other material' on the tape. It was only after I sent a copy clearly identifying myself as an MP that he was allowed to see it.
The ill treatment of refugees in Australia is confirmed in a series of reports which have documented both the breaches of numerous international conventions, to which we were willing signatories, and the effects of current policies on those detained as well as those on Temporary Protection Visas - the United Nations Human Rights Commission, the Australian Ombudsman, the Human Rights and Equal Opportunity Commission and Human Rights Watch, the Joint Standing Committee on Foreign Affairs, Defence and Trade, to name but a few.
Not surprisingly, every independent inquiry into immigration detention has drawn attention to the poor mental health of detainees and the particular risks to children's well-being. Despite the campaign of denial by the government and DIMIA officials, systematic research, case studies and the accounts of people who have worked in detention centres now provide compelling and incontrovertible evidence of the destructive effects of prolonged detention.
Such research has revealed high rates of posttraumatic stress disorder, depression, anxiety and panic attacks, attempted suicides and self harm. The longer people are held in detention, the worse the symptoms are likely to be, adding to the already high levels of psychopathology among those who've experienced persecution, harassment, torture and physical assaults.
Refugees allowed to resettle in the community and to get on with their lives improve significantly compared with those who are forced to confront the uncertainty of temporary protection.
Children are particularly vulnerable to the toxic effects of detention, responding to the atmosphere of despair in which they live, witnessing violent and traumatic incidents including self harm and attempted suicides, not to mention the powerlessness of their own parents.
Among children, detention produces a well documented range of psychological disturbances, including mutism, withdrawing from contact with others, bedwetting, refusals to eat and drink, as well as acts of self-harm and attempted suicide.
As one former counsellor at Woomera put it, these children see things which "none of our children here in Australia ever do." All this would in other circumstances be immediately branded child abuse and subject to the swift intervention of the State to protect the children.
It is after all the Prime Minister who said, "I see family life at the heart of a nation's existence." He should take note of the National Association for the Prevention of Child Abuse definition of child abuse: "Child abuse is anything which individuals, institutions or processes do, or fail to do, which directly of indirectly harms children or damages their prospects of a safe and healthy development into adulthood." Keeping children in detention is child abuse and no children or their families should be treated in this way.
Like many who are connected with the network of refugee advocates and supporters, I receive daily reports of suffering and degradation that make a mockery of our claim that we are a nation that respects human rights.
I also visited Port Hedland last year to see for myself the conditions in which asylum seekers were held. I thought I had at least an elementary understanding of how distressing such prolonged incarceration might be, especially to those who had already experienced persecution and torture.
But I was not prepared for what I saw when I finally set foot behind the barbed wire that contains the asylum seekers' lives. While they have valiantly tried to make the incarceration more tolerable by painting murals and flags on the outside walls, by planting gardens and decorating their airless rooms, nothing can disguise the palpable air of despair. Their lives are controlled by the dictates of others; every move in the compound is monitored and their transition from one section to another controlled by the ACM guards, to whom there are polite and deferential.
I spoke with mothers fretful and tearful about their bleak prospects but struggling to maintain a façade of optimism and cheerfulness in the presence of their children. The Iranian men I had arranged to meet all faced imminent deportation under the MOU signed by the Australian government with the regime still described as part of the "Axis of Evil". They were subdued but firm that they would not accept the government's "package" and return to Iran. I will never forget the hurt in their eyes, their despondency; strung between never ending internment here and certain punishment if there are returned to Iran.
Just last week, I received a detailed account of the treatment of one of the people caught up in the December disturbance at the Port Hedland Centre. Like many of the detainees, including a boy, this man alleges he was beaten with batons, tightly handcuffed for several hours and placed in the so-called management unit - Juliet Block - for nine days.
During that time, he received no treatment for his injured knee and was constantly insulted and ridiculed by the guards who called him an "animal" and a "criminal" and said that the detainees were "rubbish" who had no rights in Australia.
I also received reports from one of the workers in Port Hedland about the treatment of a man who was recovering from surgery following a "blood clot" on his brain, the symptoms of which appear to have been largely ignored until he collapsed. The same man had previously attempted suicide and received psychiatric treatment in Perth. During the disturbance this man was manhandled, castigated and bullied despite his recent surgery and the fact that he was trembling and hallucinating.
The results of treatment like this can be seen in the escalating incidence of severe mental illness in the Centre. Some of the people detained are showing signs of extreme depression - there have been several recent suicide attempts and instances of serious self harm. In at least three cases, it is clear that the prolonged incarceration is taking its grim and predictable toll on the detainees.
One young man, who faced deportation to the country where he had been abused and where he feared retribution, attempted suicide. He was sent to a psychiatric hospital in Perth where he again attempted suicide by hanging himself with a belt. After a short period in the hospital, he was transferred to the Perth Immigration Detention Centre, allegedly being required to walk through the Perth Airport in his Guantanamo-type chains and hand-cuffs on his way back to Port Hedland, where he was left in a small room with a mattress on the floor. He is covered in self inflicted cigarette burns the size of a dollar and has said quite openly that he will try to kill himself again.
Is this really the high level of medical care that the government has boasted about? Another detainee spent an extended period on the roof of the centre, walking up and down and talking to himself, completely naked in the searing summer heat - 47 degrees in the shade. He is now seriously disturbed and has been described as "completely mad", apparently barking like a dog when visitors come. He was kept in isolation after apparently having a major mental breakdown. It is not clear what, if any, competent psychiatric treatment he is receiving.
When asked about this man the Minister's office confirmed that he had spent significant time up on the roof but that "no we don't know why he did it, it's most peculiar behaviour..." It's not "peculiar"; it's a predictable response to indefinite incarceration and hopelessness.
A third man climbed on to the roof and bled profusely after slashing his chest. His friends eventually coaxed him down from the roof and he had his cuts attended to by a nurse. This man was apparently upset and depressed by his treatment by DIMIA and recent reports of US attacks on his region of Afghanistan.
It really does seem as though Port Hedland is falling apart. The interminable detention is leading to mounting stress and tension and, inevitably, to severe mental illness. These people who sought asylum are now in an asylum - like those used in the 19th century to segregate and manage the mentally disturbed.
These men have been held in limbo for up to five years. I spoke to some of them when I visited the Centre last year. They have nowhere to turn, fearful of returning to persecution in their home countries yet desperate to get out of detention. Their sense of powerlessness means that many of them see no way out, except death. Some are beginning to snap.
The December disturbance referred to in these accounts is now the subject of an investigation by the Ombudsman and complaints have also been made to HREOC. Not that the government will necessarily take any notice of such complaints. Last week, the Human Rights and Equal Opportunity Commission reported on the treatment of a seven year old boy who was assaulted with a baton by an officer during an incident at Woomera. in 2002. Both he and his mother, amongst others, were also teargassed.
The woman and her son were found not to have been involved in any of the violence, escapes or damage to property which happened at Woomera at the time. Despite the HREOC report and an apology from the Department, Immigration Minister Amanda Vanstone said there was no evidence to substantiate the allegation.
I believe we must confront the immorality of this policy and its destructive consequences and invite Australians to exercise their empathic imagination, something which the Howard government has been at pains to prevent us doing.
The Government clearly understands that keeping a safe distance and reducing the opportunities to "humanise" asylum seekers is necessary to ensure the continuing acceptance by the Australian people of the more brutal elements of the asylum seeker policy. That's why they are housed in remote camps in Australia and thousands of kilometres from the mainland on Christmas Island and on Nauru, where visas are refused to journalists and human rights activists.
Even so, the government is aware that many Australians, otherwise supportive of their policy, choke on the practice of keeping children in such places year after year, which is why they have been quietly slipping them out of detention.
Nonetheless, it is imperative that we ask ourselves how we would feel in similar circumstances, if our freedom were taken away. To imagine how we would feel if our children were denied a proper education and the normal experiences of childhood; how distressed we would be if we couldn't call on our own doctor when we were ill; how humiliated we would be if we were forced to be strip-searched at regular intervals; how desperate we would feel if we knew we might never be allowed to bring our families to join us; how hurtful it would be to be treated as liars and cheats.
Contemplate for a moment the care you lavish on your own children, your thoughtfulness in protecting them from exposure to violence and suffering; your careful planning of their education, their access to opportunities to learn, to explore the world from a secure, loving base. How can your children safely explore a world from behind barbed wire? There's certainly a world to be explored, but one that will destroy them.
We should think about the importance we place on protecting our children and ensuring their physical safety. How can parents in detention camps, with no private place and no control over their daily lives provide such a safe environment?
We don't need elaborate research to conclude that asylum seekers are going to be damaged by these experiences. It's obvious to anyone prepared to imagine their own responses, to think about what would happen to their families if they were put under the sort of stress experienced daily in the detention centres. One man who was detained for over four years described it as "dying every day."
 SBS "Insight", May 8, 2003.
 ABC "7.30 Report", May 20, 2003.
 Human Rights and Equal Opportunity Commission, Immigration Detention Guidelines, March 2000.