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    Psychiatric services in the Woomera detention centre according to John Ditchburn

Mental health issues for asylum seekers

If TPV holders already disoriented by trauma, sometimes years of detention and then the relentless insecurity of temporary status in Australia, find that once again they are facing mixed messages, it will be disastrous.

Trust is a fundamental requirement for mental stability - now more than ever TPV holders will need a trust guarantee, so that they can set about living useful, fruitful and hopefully happy lives in their new homeland.

Long after the eye-catching headlines fade, we will need a dedicated team of immigration officials who are clear about what applies and who can communicate that information to refugees with clarity and certainty.

Related pages

7 April 2004: Supporting TPV Holders: Partnering Mental Health and Migration Law - Nicholas Procter calls for the structure of individual mental health support to be built around the processes of seeking asylum and coping with rejections and setbacks during the processes attendant upon applications for refugee status.

1 August 2004: Nicholas Procter: Paper plates and throwaway cutlery - Working with some of the most marginalised of mental health consumers - asylum seekers released from immigration detention centres and living in rural South Australia - Nicholas Procter makes a cogent case for a return to practical strategies in this paper, subtitled "Aspects of generating trust during mental health initiatives with asylum seekers released from Immigration Detention Centres."

The Mental Health of Moving Asylum Seekers

From 'temporary' to 'permanent' Protection Visas: It's Much More Than a Quick Political Fix

Nicholas Procter
Contemporary Nurse
Volume 17 Number 3
October 2004)

Nicholas G Procter [RN PhD] works as Associate Professor at the School of Nursing and Midwifery at the Division of Health Sciences, at the University of South Australia.

"I have to get out. I want my children to live in a peaceful, safe place."
Zeinab Heart, seeking a passport
to leave the new sovereign state of Iraq
New York Times, July 16 2004

On Friday May 18, 2004, Zekria Ghulm Salem Mohammed completed suicide in Glasgow just days after he was told by the British Home Office that his claims for asylum had been rejected and he must return to Afghanistan. Electronic and print media reports surrounding the death indicate that after exhausting all legal attempts to stay in Britain, he was told that he would have to leave his flat and his £38-a-week allowance for food and other essentials was stopped. Informal non-government supports failed to arrive and he was 'too proud to beg and scavenge for food in bins'. Forbidden to work or study, starving, ashamed and broken, he felt there was no hope left. He smashed a glass panel above a door, looped a rope around it and then he hanged himself. As one of his close friends who found his body told Scottish television, 'They first killed his heart and drove him to such a condition that he took his own life' (Scotland Today, 2004).

The suicide of Zekria Ghulm Salem Mohammed is believed to be the third by an asylum seeker in Scotland during the past 12 months (Kelbie, 2004). While it remains to be seen if his death will be the subject of a coronial investigation, it has - albeit in a tragic way - highlighted the complex nature of mental health issues for refugees and asylum seekers who say they 'would rather kill themselves than go back to their countries and face imprisonment, torture or death' (Ashford, 2003).

Australia like Scotland has also been touched by suicide and attempted suicide by asylum seekers. In February 2003 Dr Habib Vahedi an Afghan physiotherapist became a national example of asylum seeker suffering when he hanged himself from live powerlines in country South Australia after receiving a letter from the Immigration Department requesting he return to Afghanistan. His suicide note blamed 'mental pressure' (Ashford, 2003).

But could it be there is now some compassion, or at the very least a change in direction?

On July 14 the Australian government announced that 9,500 temporary protection visa (TPV) holders would have the opportunity to apply for mainstream migration visas to enable them to remain in Australia permanently, without needing to leave the country to lodge their applications.

Minister for Immigration, Amanda Vanstone, announced the initiative, along with a new return-pending visa, which would allow people not in need of further protection, 18 months in which to make arrangements to return to their home country, or elsewhere.

What caught my eye in the Minister's statement were these words:

This decision in relation to the opportunity for those on TPVs to apply to stay in Australia permanently, recognises the fact that many TPV holders are making a significant contribution to the Australian community, particularly in regional areas, [and] Because of links with Australia through social or work activities, many of these people were able to apply for mainstream migration visas from offshore (Vanstone, 2004).

If it is the case that TPV holders can apply to remain in Australia permanently and there are no 'hidden extras' then it may be that compassion has finally prevailed for many refugees who are suffering depression, anxiety and have seen suicide as a very real alternative to returning to their homeland.

It is true that 'many TPV holders are making a significant contribution to the Australian community, particularly in regional areas' but that is also true for TPV holders in city areas.

That contribution can only be strengthened if there is certainty about their fate.

As a mental health professional what I am most concerned about is that there may be 'devil in the detail'.

What TPV holders and in fact most refugees and asylum seekers need is clarity.

More than anything they need to know where they stand - they need a starting point in a life that has lost its place. What the TPV system has done to date is exacerbate mental anguish in a population that is already highly traumatised by their experiences in their homeland and the whole process of flight and dislocation from their country of origin.

If there has been a real change of heart on the TPV policy, then this will indeed be a fresh start for many traumatised people. But there must be something real and genuine in the Government's efforts to make the transition from temporary to permanent status possible.

It will be important that this process include strong consultation with TPV holders in a psychological atmosphere that is not adversarial. It is vital that in the massive job of coordinating this transition, communication and trust underpin the application process. Trust must be earned and delivered upon.

Reflecting on the past five or six years, it is difficult to overestimate the benefits of the work being done by volunteer and non-government organisations to support asylum seekers. Organisations and community groups such as the Circles of Friends and Rural Australians for Refugees, and many other individual ordinary Australians have developed close and trusting relationships with asylum seekers - relationships which have been nothing short of lifesaving.

The people who are part of these organisations have earned the trust of asylum seekers (Procter, 2004a). They have also delivered on their trust. In particular, non-government and community health organisations have performed a key role in providing support services for those asylum seekers with mental health problems and mental illness, in advocating for services to be more sympathetic and responsive, and in providing important trust networks to overcome specific access challenges due to cultural, linguistic and geographical barriers.

The Government is in the box seat to support and encourage these established trust networks. It can do so by calling upon immigration officials to formally draw upon the proximity, skill and trust developed by community people - many of them who are volunteers - to help formulate a clear process for TPV holders to move from temporary to permanent status.

Mental health literature for traumatised people the world over emphasises coordination of services, safe and predictable environments and the stability of client-provider relationships over time (Burnett and Peel, 2001; Jones and Gill, 1998). Unlike a legal or political bureaucracy where relationships can be impersonal, in cases where individuals have suffered trauma and dislocation personal trusting relationships become hugely significant to successful settlement in the community. The importance of this relationship/trust-based approach must be valued in what to date, has been a dehumanising legal process (Procter, 2004b).

We must also acknowledge that even if there is a policy 'change of heart', the impact of TPV status has left us with many depressed and suicidal asylum seekers. Again with extensive consultation with TPV holders, we can only rebuild lives and build resilience and functional capacity by developing an integrated community health response which includes appropriate specialist mental health support, and strong links between community, non-government organisations and volunteer groups. Resilience building will cost time and money.

It will require:

  • The implementation of evidence-based interventions such as psychosocial (broadly defined) supports and medication to reduce symptoms;

  • Support and encouragement from specialist mental health services and general practitioners to initiate and participate in education and guidance of children with regard to providing a safe, predictable and, as much as possible, supportive school, community environment building friendship and support networks;

  • An effort to reduce, or remove the need for drug therapy - particularly in children;

  • And for those who continue to require drug therapy, support and encouragement for specialist mental health services and general practitioners to initiate and participate in education and guidance with regard to their drug therapy (as appropriate), in order to promote a sense of culturally appropriate partnership towards adherence and the achievement of therapeutic outcomes;

  • Support and encouragement for specialist mental health services, primary care services and general health services to respond to reductions in risk and protective factors and to early warning signs and symptoms;

  • Strong collaboration between government, non-health services and volunteer groups who provide a strong support and friendship networks to asylum seekers.

More than this it requires, the Government telling asylum seekers what this announcement actually means and how they can activate whatever benefits are possible.

There needs to be clarification - urgently - on what is being offered here, how it can be actioned, and by whom.

This is about developing trust through appropriate and timely information transfer, with careful consideration being given to privacy principals.

Long after the eye-catching headlines fade, we will need a dedicated team of immigration officials who are clear about what applies and who can communicate that information to refugees with clarity and certainty.

If TPV holders already disoriented by trauma, sometimes years of detention and then the relentless insecurity of temporary status in Australia, find that once again they are facing mixed messages, it will be disastrous.

Trust is a fundamental requirement for mental stability - now more than ever TPV holders will need a trust guarantee, so that they can set about living useful, fruitful and hopefully happy lives in their new homeland.

References

Ashford K. (2003) "Seeking trust in asylum". The Adelaide Review, November, pp. 2-3.

Burnett, A. and Peel, M. (2001) "Health needs of asylum seekers and refugees". British Medical Journal, 322: 544-7.

Jones D. and Gill P.S. (1998) "Refugees and primary care: tackling the inequalities." British Medical Journal, 317: 1444

Kelbie P. (2004) "The life and death of an asylum seeker". The Independent, May 29 pp. 1-2.

Procter, N.G. (2004a) "Paper plates and throwaway cutlery: Aspects of generating trust during mental health initiatives with asylum seekers released from Australian immigration detention centres". Available from URL: http://www.safecom.org.au/procter1.htm Synergy, 4:8-9.

Procter, N.G. (2004b) "Support for Temporary Protection Visa holders: Partnering individual mental health support and migration law consultation", Psychiatry, Psychology and Law, 11: 110-112. Available from URL: http://www.safecom.org.au/procter.htm

Scotland Today. 2004. "Human tragedy of asylum seeker death". Available from URL: http://scotlandtoday.scottishtv.colo.ednet.co.uk/content/. Accessed July 17 2004.

Vanstone, A. (2004) Visa opportunities for TPV holders in Regional Australia. Media Release VPS101.04, Wednesday 14 July available from http://www.vanstone.com.au/default.asp?Menu=VPS101.04. Accessed July 14 2004.

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