Suicide and self-harm in immigration detention

On 29 July this year, Commonwealth Ombudsman Allan Asher confirmed that his office would undertake an investigation into suicide and self-harm in Australian immigration detention facilities.1 The investigation will examine rates of suicide and self-harm relative to those in the broader Australian community, and factors such as length of time in detention and the design of mental health services for detainees.

Our view is that the Ombudsman is right to undertake such an inquiry. Simply put, there is a crisis within the detention system, requiring an urgent need to identify contributory factors. More than 1100 incidents of threatened or actual self-harm across all places of detention were reported in the 2010–11 financial year.1 Fifty-four incidents of self-harm were reported during the first week of July this year alone. After a lengthy period of no suicides,2 there have been five since September 2010.3 There have been reports of many “near-miss” cases and of a culture of hopelessness and despair inside detention centres.3

Given that suicidal behaviour can be considered as a continuum of thoughts and behaviours, ranging from suicidal ideation to completed suicide,4 we think the need for such an investigation raises important questions about how much is known within immigration detention centres about:

• the determinants of detainee self-harm and suicide risk;5

• a detainee’s preparatory acts toward imminent suicidal behaviour (eg, locating ligature points and assembling the necessary apparatus);

• how detainees are managed after a serious suicide attempt;

• the type and cultural appropriateness of the support being provided to detainees;

• the possibility of possible contagion surrounding suicide and self-harm; and

• how effective existing policies and staff training are in preventing suicidal behaviour.

These considerations are important because the detention environment is known to harm both mental and physical health. Detainees express their distress in ways that are in keeping with their culture and the setting they are in. Strong evidence confirms poor health among immigration detainees, which deteriorates over time, and shows a clear association between time in detention and rates of mental illness.6 Overcrowding within immigration detention is a major concern and most likely magnifies mental ill health through factors such as tense patterns of interaction and an inability to buffer stressful events or uncomfortable physical factors such as heat. Living in limbo and uncertainty can manifest in feelings of fear, anxiety, sleep disturbance and self-harm, along with irritability and frustration. A recent systematic review of studies investigating the impact of immigration detention on the mental health of children, adolescents and adults identified high levels of mental health problems in detainees.7 Time in detention was found to be associated with severity of distress. Anxiety, depression and post-traumatic stress disorder were commonly reported, as were self-harm and suicidal ideation. There is evidence for an initial improvement in mental health shortly after release, although mental health effects may be prolonged, extending well beyond the point of release into the community.8

In the months leading up to the Commonwealth Ombudsman’s announcement, significant incidents had been unfolding, including detainees stitching their lips together, hunger strikes, violent confrontations and property damage. There are also reports of isolation cells being converted into full-time behaviour management units where detainees who are distressed or disturbed, or who try to kill themselves, are fitted with soft helmets and handcuffs to stop them cracking their heads against the floor or walls or harming themselves in other ways.9 Such claims must be examined. They raise serious issues about the commitment of the detention system to human rights.

In addition to these matters, the detention environment is also known to impact heavily on the mental and physical health of the people who work there. A national humanitarian solution is critical. Without this, the consequences will be catastrophic for all who are engaged in this system. We urge the government to act swiftly to prevent more human tragedy.