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Serious gaps in detainees’ health care

Cate Swannell
Monday, 16 December, 2013
Serious gaps in detainees’ health care

DOCTORS involved with asylum seekers in closed detention are reporting crucial gaps in detainees’ primary health care, particularly in mental health, says AMA president Dr Steve Hambleton.

Dr Hambleton, commenting on new research published in the MJA on the unmet health needs and substantial levels of psychiatric morbidity among asylum seeks in immigration detention in Darwin, said “little transparency and independent scrutiny” of detainees’ health care were major concerns with the current asylum seeker policy. (1)

“The AMA is often contacted by its members who work in detention facilities to talk about their concerns”, Dr Hambleton told MJA InSight.

“We believe, from these reports, that there are gaps in health care that need to be addressed, most particularly in relation to mental health. We also remain concerned about the situation of children, pregnant women and people with complex and chronic health problems, and have publicly voiced our concerns in relation to a number of recent high-profile cases.” (2)

The MJA research, based on a retrospective audit of Royal Darwin Hospital emergency department (ED) attendances, found that 50% of immigration detainees in Darwin attended the ED at least once in 2011.

There were 770 ED attendances by 518 individual detainees, including 112 aged under 18 years. The most common primary diagnosis was psychiatric problems (24.3%, n = 187), including 138 attendances (17.9%) for self-harm.

“The primary health care provided to them was inadequate”, the authors wrote.

In an accompanying MJA editorial, Australian Human Rights Commission president Gillian Triggs called on the Australian Government to increase the use of community detention and bridging visas to free asylum seekers from the closed detention environment. (3)

“Some improvements in the delivery of mental health services to immigration detention facilities should be acknowledged”, Ms Triggs wrote. Nonetheless, “it is often the detention environment itself that causes mental illness”.

“Accordingly, it is the removal of people from closed detention that will have the most powerful effect in mitigating mental illness."

Most asylum seekers will ultimately be granted a protection visa, she wrote. “It therefore makes much better sense, and is more humane, to adopt these strategies to ensure that they can lead healthy lives in the future when they are fully released into the community.”

Graeme McGregor, refugee spokesman for Amnesty International, told MJA InSight that although Australia’s onshore detention centres provided better health care facilities than offshore centres, Darwin’s facilities were by no means the best available.

“The quality of health care in closed detention centres onshore varies considerably from centre to centre”, he said.

Mr McGregor, who had just returned from Amnesty’s inspection of Manus Island when he spoke to MJA InSight, said the Australian Government was obliged, as a signatory of the United Nations Convention Relating to the Status of Refugees, to provide the same standard of health care to detainees as is available to the general population.

“It’s anyone’s guess as to why they are not providing that level of care”, he said.

An MJA Perspectives article said that given that suicide remained the leading cause of death among detainees in Australia, more data were needed about self-harm and attempted suicide episodes, with a view to developing culturally sensitive strategies for suicide prevention. (4)

“What we do for asylum seekers while they are in detention has the potential to prevent future loss of life. Optimal mental health promotion and suicide prevention strategies can help to prevent self-harm among detainees and help detainees reclaim their lives on release.”

Dr Hambleton told MJA InSight that a fundamental problem with the current system of detention was the lack of transparency and independent scrutiny of what happened in detention facilities, what conditions were like, the extent of health services, and whether health problems were being adequately identified and addressed.

“[We] continue to call for the establishment of an independent panel of medical experts, with the power to enter and inspect facilities and report back to the Minister and the Parliament”, Dr Hambleton said.

“Until this happens, the government needs to make the best use of the Immigration Health Advisory Group (IHAG), which can provide independent advice on health care. Our understanding is that the IHAG group is not being used to its full potential, and opportunities to improve services and conditions are being wasted.”

However, after MJA InSight spoke to Dr Hambleton news reports revealed the federal government had formally disbanded the IHAG. (5)

The Department of Immigration and Border Protection had not responded to MJA InSight’s requests for comment at the time of publication.

 

1. MJA 2013; 199: 776-778
2. SBS news; 11 Oct 2013
3. MJA 2013; 199: 721-722
4. MJA 2013; 199: 730-732
5. ABC AM program; 16 Dec 2013

Poll

What should the government do to improve the physical and mental health of asylum seekers in detention?
Minimise detention
68%
Independent medical panel
17%
No change needed
15%
Total votes: 93

Comments

I'm sure that I'm in the minority on this one, at least among medical practitioners.  However in my opinion there are significant gaps in the heallth care of many Australians which should be addressed before putting more resources into asylum seekers. Two groups which come readily to mind are indigenous Australians and  Australians in prison in Australia; we certainly don't seem to hear much about the health issues of the latter group in particular.

If we, as a generous and affluent nation, decide to allocate health resources to people overseas, there are many deserving of our assistance. I would suggest victims of natural disasters, especially in the Pacific region, and legitimate, law-abiding refugees patiently waiting in overseas camps for their applications for asylum to be processed in the correct manner.

It seems to me to be beyond doubt that most "asylum seekers" who queue-jump to Australia via illegal means are in fact economic refugees, choosing to come to Australia because of our high quality of living and generous welfare and family reunion programs. I don't see why they should be given priority for health care over the groups mentioned above, or why they should be able to bypass other countries where they would be safe from persecution and demand specifically to be resettled in Australia.

Therefore I find it very disappointing that groups such as the AMA and the RACP have allocated resources and advocacy into the health care of illegal "refugees" under these circumstances. Those in the AMA or RACP who wish to pursue this agenda should do so through the political process and those political parties which are in tune with their particular point of view on this matter.

More proof, as if it were needed, that this government's attitude towards asylum seekers is morally repugnant. Surely it's time for bodies like the AMA, RACGP etc to take a stand and call this government to account. 

The last two statements are the most telling:

However, after MJA InSight spoke to Dr Hambleton news reports revealed the federal government had formally disbanded the IHAG. (5)

The Department of Immigration and Border Protection had not responded to MJA InSight’s requests for comment at the time of publication.

It is horrifying that 20% of respondents to [the poll] date do not see the need for any changes to the present plainly evil and downright illegal policies of this present shameful bunch of political opportunists.

Any healthcare worker who votes this way should read the latest Amnesty report and reconsider their stance.  If 20% of such Australians are so desensitised to the the needs of vulnerable refugees, what hope for others in the general population, constantly reminded and  encouraged in ignorant xenophobia?  Even if they do not care about our fellow men and woman being treated worse than the worst criminal in our cosy prisons, perhaps they should be aware of the cost of this inhumane behaviour. Perhaps ponder for a while how $1 billion /year (and counting) might be more humanely and (*Gasp*) intelligently spent.

 

I agree 100% with Greg the physician. Why is everything in this country's news and indeed the majority of blog sites always projected through the prism of a green socialist left perspective. We have 10s of thousands of aboriginal people living in third world conditions, there are a multitude of people in our prisons who in fact represent the psychiatric patients who were left to their own devices in the wider community after the socialist left succesfully closed all the psychiatric hospital beds in the1970s in this country, there are around 30,000,000 refugees waiting patiently in camps aroud the world and also around 60,000 homeless Australians, none of whom don't seem to get gersey from this self-righteous group. Why not asked them all to sign up with the taxation department to debit their sarlaries directly so they can support their earnest endevours in a meaningful way? How many 'illegal' immigrants does Ms Hanson-Young an Ms Milne actually house  within their own homes? Perhaps they don't actually eat and live for them, they just speak for them?

I feel very shocked at the tone of these comments.  People - whether Aboriginal, non-Aboriginal, in prison or detained elsewhere as so-called 'illegal' asylum seekers - have a human right to adequate healthcare.

While dismayed by the attitude of several that Assylum seekers be ignored as "less worthy" , even on economic grounds it makes no sense to provide an inferior health care in detention centres , resulting in increased load on mainstream services , thus detracting from their core work .

Primary health care means prevention - there is a wealth of evidence that the most influential factor for mental ( and thus physical ) health outcomes is prolonged indeterminate detention . Surely this is a modifiable risk factor

"The primary health care provided to them was inadequate”, the authors wrote.

Perhaps we should also be assessing why an expensive ( privately contracted overseas owned ) health service is providing inferior primary health care

The difference, Greg the Physician and Dr David is that the current policies are actively creating health problems for the detainees. This is very different to the certainly less than adequate health services received by the Indigenous communities and other marginalised groups. In the latter cases we may be considered ineffectual; in the former we are actively doing harm. And as has been pointed out, at a huge financial expense to the community. These facts remain, no matter what your views on their mode of arrival are. www.facebook.com/doctors4refugees

Many thanks to Doctors4Refugees

As a doctor who has no direct involvement with asylum seekers/refugees, I feel utterly powerless to help these people. It has got to the stage where direct action in the form of peaceful protest is the only way to create change. 

I was a doc at Manus for a month, signed a comprehensive life long secrecy document, was really concerned at the standard ( or lack of it) at the camp, as well as the clear danger of the health center position. 

If we did what we do to there, here, there would be an outcry, and maybe a royal commission.

Human rights and costs -perhaps both issues can be resolved by transparency and independent scrutiny as Steve Hambleton suggests, combined with community placement of unaccompanied minors, pregnant women, women with children, and bridging visas , including work visas. If any adult is prepared to work in a rural area, surely it would be cheaper to give them and their family a bridging visa rather than to detain them.

Ignoring human rights abuse will surely increase costs, as documented.

I shudder at the thought of unaccompanied minors and women with newborn babies , as well as any adult under the control of "security" guards , and "health services" who are beyond any scrutiny..

Those expressing reservation about costs should ask-why is Australia paying any company huge amounts of money to abuse refugees, while adding to the costs on external health services? All such contracts should be revoked immediately, and independent scrutiny should be mandatory, both to preserve human rights, and to ensure financial accountabilty of the taxpayers dollars.

Independent scrutiny does not have to be expensive-it could include volunteers from many organisations.

Bob Carr ( labour) referred to them as economic refugees. Also present foreign minister ( liberal) did also. They have had proper briefings.

 The maid from the forest has not

These people are economic opportunists. Many have been sent home. Most should be.  Read The Australian for 15-16 june 2013  and see.They are illegal immigrants, and should be described as such. 

 Australia is being brainwashed by greens and ABC--let alone AMA, Leeder, MJA,  RACGP, RACP

 

Regardless of whether they are economic refugees or illegal immigrants, why waste tax dollars paying foreign companies who are reportedly beyond scrutiny if they are abusing them  and costing  the taxpayer more ?

I did a month there, late last year on Manus .90% are young men from Iran, sick of a corrupt Islamic government. Post revolution, 1979, women were forbidden to work, contraception discouraged, multiple wives encouraged, so there has been a population explosion from 38 to 78 million ( I have this from a detainee), no music, no dancing, homosexuals shot, and no jobs for young men. Asylum seeking in Oz is the easiest gate to,traverse, to CI. 

There were a couple of English teachers amongst the mob, with whom I spoke extensively.

There are a few Rohingas, Tamils, Yemenis, Hazara, who all seem to have genuine cases, the rest, no. 

In order to stop this flow, they had to do something nasty, and a few thousand people got hurt along the way, but the flow was unstoppable till the libs got tough. 

BUT, we should at least accord them health care of a decent standard, and not enclose them behind wire eternally. Just knowing they will never get to OZ is enough to stem the flow.

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