Child detainee mental trauma will last, immigration healthcare provider warns

Children in detention suffer more serious mental health crises than adults and their mental health deteriorates the longer they are detained, the government’s detention healthcare provider has warned the immigration department. It also says the detention of children will cause them long-term mental health damage that will persist long after they are released, in advice seen by Guardian Australia.

International Health and Medical Services, the company contracted to run health services in detention, has also told the government that detention health services are already inadequate, and that more cuts to mental health services will further harm people in detention.

IHMS health data, confidentially provided to the Department of Immigration and Border Protection but obtained by Guardian Australia under freedom of information laws, paints a bleak picture of deteriorating mental health in detention, particularly among children.

Depression is the most common specific chronic illness among children in detention, the IHMS data shows, and those under 18 have, by far, the highest rates of mental health presentations in detention of any age group.

“The minors are seen due to a variety of triggers, including previous trauma and torture, enuresis [bed-wetting], nightmare, family conflict and situational crises,” the IHMS reports say, highlighting violence in detention harming children’s mental health.

In offshore detention, the percentage of children’s presentations to a doctor that have resulted in a mental health diagnosis has nearly doubled over the past year. Adult diagnoses have remained static.

In the last quarter of available data – from April to June 2015 – 21.8% of children aged 5 to 17 in offshore detention who presented to a doctor were diagnosed with a mental health condition.

Infants and toddlers were also significantly affected; 15.6% of children aged up to four were taken to a doctor because they were suffering from a mental health condition in the same three months.

The rate among the adult population in offshore detention was 11.6%.

But IHMS argues that the GP diagnosis figures are likely an under-representation of the true extent of mental illness, which is almost certainly far more widespread, with people accessing counselling, psychology and psychiatry directly without a doctor’s referral.

It says the figure is particularly understated for children, who, if they are enrolled in school, are often absent for doctor’s appointments.

“There has been an overall reduction in the actual numbers of children and adolescents presenting to GPs with mental health diagnoses in this quarter,” IHMS wrote in April 2015. “Contributing factors include the overall reduction in number of children in the [offshore processing centre] due to resettlements, the centre becoming ‘open’ and the large majority of children attending schools ... reducing their availability for appointments.

“Of those remaining in detention, data from this quarter appears to indicate a marked increase in the percentage of children and adolescents presenting to GPs with mental health diagnoses, with the rise being most marked in the age 11-14 group [41.3%].”

The IHMS figures do not record the number of instances of child self-harm and suicide attempts but cases have been consistently reported in detention. The Australian Human Rights Commission report, The Forgotten Children, found, over a 15-month period, more than 300 children committed or threatened self-harm in immigration detention, 30 reported sexual assault, nearly 30 went on hunger strike, and more than 200 were victims of assaults.

IHMS has cautioned the government that people held for long periods in detention will require continuing mental health treatment after they are released.

“With a large number of transferees now in detention over 18 months, this is indicative of increased need for mental health services in this population and will need to be considered in planning for mental health services following release from detention,” the latest report says.

“While some distress resulting from time in detention may reduce following resettlement in the very short term, underlying mental health issues in the resettled population are likely to emerge relatively quickly after this ‘honeymoon’ period is over.”

Children are especially affected by the compounding mental trauma of detention and are likely to require continuing psychological treatment for harm caused by their incarceration, even after they have been released.

“This issue is particularly salient for minors, as neither a child’s neurological system nor their psychological profile is fully formed, and mental health issues experienced in early childhood, including parenting by mentally ill or distressed parents, will have long-term effects on psychological functioning and will predispose this cohort to future psychological issues.”

Growing up in detention is harmful to children and affects brain development, IHMS medical officers have consistently argued in formal communication with the Department of Immigration and Border Protection, particularly when children’s parents are under acute mental stress.

“We note the progressive length of stay of the detainees, and the emergence of stressors such as concerns about loss of resilience, identity, occupational and social functioning. There are also concerns about a small but growing infant population whose early developmental stages are occurring within a detention environment.”

The number of children in immigration detention in Australia has fallen significantly, from a peak of 1,992 in July 2013 to 104 currently. However, those children still in detention have been incarcerated for far longer periods on average.

The average time people, including children, have been in detention is currently 445 days. Nearly a quarter – 23.5% – of people have been in detention more than two years.

Seventy children remain in detention on Nauru and about 80 are on Nauru as refugees. There are no remaining asylum seeker or refugee children on Manus.

The department of Immigration and Border Protection said the level of healthcare for people in detention was broadly commensurate with Australian community standards.

“The department takes the health of all people in immigration detention seriously and provides on-site health services. Many detainees have arrived with pre-existing mental health conditions.

“To ensure that the mental health support provided is at a standard comparable to that available in the general Australian community, on-site general practitioners, mental health nurses, psychologists and psychiatrists are engaged. In addition, any person disclosing or displaying symptoms of a possible history of torture or trauma is referred to a specialist torture and trauma counselling service for further assessment, care, and counselling.”

For offshore detainees, the Australian government, through IHMS, supports the PNG and Nauruan governments to provide healthcare.

While the mental health of children is disproportionately affected by detention, the IHMS figures show that mental illnesses are consistently high and rising across all age groups.

The rate of prescription of antidepressants, sedatives, antianxiety, and antipsychotic medications to people in offshore detention has grown by more than 150% over the past year of data. Onshore, the rate of drug use for psychological conditions has grown too.

IHMS has highlighted growing concerns that cuts to mental health services, concurrent with increasing rates of detention of so-called 501s – people who have had a visa cancelled due to failing the ministerial-discretionary “character test” for alleged antisocial or illegal behaviour – will further strain resources.

“Given that the detention health service has moved closer to a primary care model with reduced mental health outreach in to compounds and reductions across all specialist mental health staff, results suggest that a primary care model is unlikely to provide an adequate level of clinical service provision, and that the model should be more closely aligned with that of an adult community mental health team.

“This may be mitigated to some degree over time if the overall time in detention reduces given that distress rates tend to be lower for those with shorter periods in detention, however, if a significant proportion of new entrants to detention come from the prison system, this will increase the needs for mental health services given the high rates of mental illness and substance abuse in that population.”