Volume 195 - Issue 10
Suicide and self-harm in immigration detention
Authors: Michael J Dudley, Nicholas G Procter and Louise K Newman
Med J Aust 2011; 195 (10): 582. || doi: 10.5694/mja11.11291
Published online: 21 November 2011
Published online: 21 November 2011
In reply: We thank Goldney for his thought-provoking response. We recognise that self-harm has multiple determinants, including mental disorders, but that it also attempts to influence or communicate. Acknowledging the political context that has created and sustains this issue, we also note long traditions of politically motivated self-harm and suicide, for example, by self-immolation or hunger strike; and that political protests using these methods — lip-sewing, cutting and self-burial — have occurred in Australian immigration settings.
Our belief, based on extensive clinical engagement, is that the motivation for most self-harm and suicide in Australian immigration detention is not primarily political, but anchored in detainees’ deep despair. Many say that by killing themselves, they will end their pain and no longer be a problem to themselves, the government or their loved ones.
As clinicians, we experience a tension — we acknowledge, with Goldney, the importance of not medicalising an area where the environmental and contextual influences so overtly create and maintain distress, yet we have a duty of care to reduce the risk associated with such behaviour and distress, irrespective of their origins. A pre-eminent challenge for professionals working in such stressful environments is to remain open to these multiple influences. We remain open to what the data will tell us about political and other contributing factors.
Competing interests
Michael Dudley is a member of the Detention Health Advisory Group (DeHAG) Mental Health Sub-group and Chair of Suicide Prevention Australia. Nicholas Procter is a member of the DeHAG Mental Health Subgroup and Council for Immigration Services and Status Resolution. Louise Newman is Chair of DeHAG, providing independent advice to the Department of Immigration and Citizenship, and Convenor of the Alliance of Health Professionals for Asylum Seekers. All authors have received meeting sitting fees and Nicholas Procter has also received grant funding from the Department of Immigration and Citizenship.