Asylum seekers and healthcare

In reply: The Hon. Philip Ruddock, the Minister for Immigration and Multicultural and Indigenous Affairs, believes that the article by Sultan and O'Sullivan1 makes "several claims that are factually wrong and would not have withstood even cursory examination".

When assessing whether contributions are suitable for publication in the Journal, the editors of the MJA submit them to peer review, which has been defined as "independent assessment of the scientific merit of research by experts having knowledge of the research area equal to that of the performers of the work".2

The article referred to by the Minister posed a dilemma. Those with "equal knowledge of the research area" — representatives of the Department of Immigration and Multicultural Affairs or the Department's provider of security services (Australasian Correctional Management) — would have a patent conflict of interest. The Journal did, however, seek advice as to the accuracy of the article from a person with knowledge of the situation at Villawood, who did not advise as to "errors of fact and distortions", as alleged by the Minister.

The discrepancy between the truth according to the Minister and according to Sultan and O'Sullivan may reflect differing interpretations and perceptions of information conveyed by intermediaries.

Graves implies that detained asylum seekers' mental health and access to healthcare is a medicopolitical issue and that the forum for this debate should be the Australian Medical Association. So it should be! But the MJA has complete editorial independence from the AMA, and we believe that the mental health of asylum seekers transcends medicopolitics and goes to the very core of the ideals of medicine.

Finally, it was very clear from the title of the article, and its authorship, that it represented the perspectives of a detained doctor (one of Graves' concerns) and a former visiting psychologist. However, we believe that our readership is sophisticated enough to interpret the content of such articles. We also believe, contrary to Ruddock and Graves, that the standing of the Journal remains solid, as does its policy of "providing a forum for . . . commentary and informed debate on standards of clinical practice, ethics, social, legal and other issues related to health care in Australia".3

To our knowledge, the information conveyed by Sultan and O'Sullivan's article is the best available data on the mental health of detained asylum seekers in Australia. We look forward to a more rigorous and independent assessment, hopefully initiated by the Minister. The opportunity is his.