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