Mental health consequences of detaining children who seek asylum in Australia and the implications for health professionals: A mixed methods study (2002–2019)

Author: Sarah Mares

Mares, Sarah, 2020 Mental health consequences of detaining children who seek asylum in Australia and the implications for health professionals: A mixed methods study (2002–2019), Flinders University, College of Medicine and Public Health

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It is no longer contested that indefinite mandatory detention, as implemented by Australia

for people who arrive by boat and seek asylum, has harmful consequences. There are

extremely high rates of mental illness identified in children and adults held in immigration

detention, and the practice involves multiple breaches of human rights.

I first visited detained families held in a remote Australian immigration facility in January

2002. With colleagues I documented and published what I had witnessed. This was the first

paper in the professional literature to specifically identify and document the mental health

consequences of Australia’s immigration policies for children and families. Subsequent

papers have provided further evidence of the harms caused by immigration detention of

asylum seekers and identified the implications for health professionals.

In the detention environment children cannot be protected from deprivation and repeated

exposure to trauma. This includes acts of self-harm and interpersonal violence.

Dehumanising experiences are routine, and parenting is undermined. There is a forced

communality of people from diverse backgrounds with high rates of comorbid mental

illness, particularly post-traumatic stress disorder (PTSD) and depression. Effective health

care is compromised by the pathological environment and a lack of independence and

transparency in health service provision. Prolonged detention, limited resettlement options

and continuing vilification of asylum seekers in political discourse have the combined effect

of exacerbating and maintaining mental illness in children and adults.

This thesis brings together a longitudinal body of work using mixed methodologies

undertaken between 2002 and 2019. Ten papers are included, primarily based on 24 visits

to children in 10 Australian immigration detention facilities. There were many ethical

challenges to undertaking research in conventional ways in this restricted, politicised

setting: I was granted access to detention facilities primarily as a clinician, not a researcher;

data collection required creativity and persistence; and the identity of individual children

and adults has been protected. There are consequent and acknowledged limitations in the

data which are evidence in themselves of the restrictive and politicised nature of the

research environment.

Sarah Mares 2020 4

The thesis provides a brief historical context for Australia’s reception of asylum seekers,

followed by an overview of factors influencing refugee children’s wellbeing. The included

papers are considered alongside findings from a scoping review of the relevant international

literature. Drawings by detained children are incorporated and include their voices and

experience as directly as possible. The implications of the work for clinicians and researchers

and the role of advocacy and the experience of ‘witnessing’ are discussed. Reflections on

the work have led to new insights, including a framework for understanding the impact of

immigration detention on children’s mental health, and recognition that this approach to

research could be adopted in other unstable, restricted or politicised settings.

The aim of the work has been to make an original and significant contribution to current

knowledge about the mental health consequences of detaining children who seek asylum,

and the implications of these for health professionals. It has relevance at a time when,

globally, there are unprecedented numbers of displaced people and wealthy reception

countries are adopting harmful deterrent policies, similar to those practised by Australia.

Keywords: Immigration detention, asylum seeker, refugee, children, family, mental health, professional ethics, witnessing and advocacy

Subject: Psychiatry thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Medicine and Public Health
Supervisor: Professor Malcolm Battersby