Refugees and Mental Health: Gauging the Impact of Detention

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    By Eda Yasemin Akin

    Australia is recognised as a multicultural country; a home for people of different ethnicities from around the globe.

    For nearly two centuries, the majority of settlers and immigrants came from the British Isles. Australia currently recognises the right of asylum and is a signatory to the Convention relating to the Status of Refugees (CRSR), which is a United Nations multilateral treaty that defines a ‘refugee’. It also sets out the rights of individuals who are granted asylum and the responsibilities of countries that grant asylum. According to the United Nations 1951 Convention on the status of refugees, a refugee is: a person who is outside his/her country of nationality or habitual residence; has a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group or political opinion; and is unable or unwilling to avail himself/herself of the protection of that country, or return there, for fear of persecution.

    Statistics from the United Nations High Commissioner for Refugees (UNHCR) show that in 2013 alone, there was a combined number of 357,100 registered asylum claims. In the top ten receiving countries, Australia was positioned as the eighth largest recipient of new asylum seekers in 2013, with 24,300 claims made an, an increase of 54 per cent in comparison to 2012.

    Australia has one of the strictest asylum seeker and refugee policies in the world allowing for continued long-term mandatory detention. It is the only country to detain asylum seekers in jail-like conditions for months and sometimes more than a year at a time while necessary background and security checks are being completed. The Commonwealth Government has been condemned internationally, particularly for holding people on offshore islands such as Christmas Island and Nauru. Whilst the situation in New Zealand is more humane, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) has ongoing concerns about the mental health of asylum seekers and refugees in both countries. Asylum seekers are often without status and have little access to necessary supports and services. The situation remains critical and the provision of appropriate mental health services for asylum seekers is pertinent to their quality of life and mental health wellbeing. It is vital that more humane, efficient procedures are implemented with regard to the treatment and detention of asylum seeker and refugees.

    The detention of asylum seekers is, with no doubt, highly likely to have a negative impact on their mental health. A comprehensive inquiry undertaken by the Human Rights and Equal Opportunity Commission (HREOC) in 1998 found that mental distress in varying degrees was a common manifestation in detained asylum seekers. Factors regarded as increasing the risk of mental distress included prior experiences of torture or other forms of persecution in the country of origin and the stresses created by the length and conditions of detention. Of particular concern is the stress caused by an uncertain future; refugees and asylum seekers held in detention are unable to make future plans and can feel stressed and powerless. This population suffers from high rates of post-traumatic stress disorder (PTSD), depression and anxiety. Even once a claim is processed it can still be weeks or months before the individual is released into the community and when they are they still have no access to government financial assistance. Persons experiencing the psychological effects of trauma may report feelings of fear, sadness, guilt and anger. Psychological sequelae include depression, anxiety and substance abuse. Trauma related syndromes include significant distress or impaired functioning that often involves intrusive thoughts and emotions about the traumatic events, avoidance, emotional numbing and/or hyper-arousal. There have been several studies that show that there are consistent and strong links made between pre-migration trauma and mental health in resettlement.

    Research into the relation between pre-immigration trauma and post-migration mental health suggests a dose-response association where the severity of PTSD symptoms increases as refugees’ exposure to traumatic experiences increase. There are different sorts of traumatic experiences, such as human rights violations, threats to life, traumatic loss, dispossession and eviction. These experiences have been found to have differential impacts on mental health. Momartin and his associates conducted a study on a group of refugees. They found that threat to life was a significant predictor of PTSD status while threat to life coupled with traumatic loss contributed to symptom severity and disability associated with PTSD (Momartin, Silove, Manicavasagar, & Steel, 2003). Long-term detainees are particularly affected in the long run, while more transparency and faster processing of asylum seekers and refugees to reduce the negative impact on their mental wellbeing would be ideal. Unaccompanied minors and families with children are particularly vulnerable and should not be kept in detention.

    Impact of Detention 2Refugees residing in the community whilst their applications are processed are not immune from negative mental health impacts as prolonged asylum seeker status can have an effect on wellbeing. Insecurity of tenure and living with the fear of forced removal from Australia has been found to have significantly affected and dangerously compromised the wellbeing of refugees. While residing in the community, refugee access to adequate supports, services, and avenues for social inclusion are essential and should be available immediately. Discrimination and stigmatisation are major factors that lead to adversity for asylum seekers and refugees living in the community. All migrants from cultural backgrounds where isolation is accentuated due to an absence of compatriots are at greater risk of mental and emotional problems. For asylum seekers and refugees who face an uncertain future as well as social and professional isolation, this risk is particularly heightened. Appropriate treatment requires an understanding of an individual’s cultural background and experiences. For example, the meaning one gives to violence and trauma can vary depending on culture.

    It appears that the resettlement period is a powerful healer for refugees, as the prevalence of mental health problems drops significantly over the course or resettlement. This however, does not eliminate the heightened feeling of post-migration trauma as sufferers still remain at high risk throughout the course of resettlement. A population based study of a group of Vietnamese refugees in New South Wales, showed that individuals who were exposed to higher levels of trauma remained at great risk of mental illness after 10 years, in comparison to Vietnamese with no history of trauma exposure (Steel et. al., 2002).

    Nevertheless, there are difficulties that appear during resettlement and post-migration stressors are evident in recent research. These are factors that can be addressed and changed via individual and community interventions in the resettlement environs. Refugees may experience loss during the resettlement period, which then affect the mental health outcomes where as individuals who have had higher levels of education in their home country or who had a decrease in their socioeconomic status in resettlement are seen to have worse outcomes. Similarly, those who report a loss of significant social roles and loss of important life projects report lower levels of daily activity; they are either unemployed, facing financial difficulty and/or report as being socially isolated— all are at risk of worse outcomes in resettlement. Of course, post-migration difficulties may also be a result of the individual’s compatibility of the Australian culture and nature of the resettlement program.

    An adjustment to geographical and cultural relocation requires substantial attention and energy from refugees in the beginning stages of resettlement. In a very short amount of time, individuals find themselves confronted by a new language, cultural values, worldviews, food, traditions, paperwork and systems of business and currency. In the recent changes in the countries of origin for refugees entering Australia’s humanitarian program, the ‘cultural gap’ between Australian society and refugees has grown solidly. That is, refugees now entering Australia tend to be more disparate in cultural norms and lifestyle when compared to earlier waves of refugees.

    Adapting to the Australian culture, refugees learn to live with a sudden loss of identity and subsequent demands to reconstruct themselves within the new context. Individuals, family members and cultural groups vary in the rate and degree to which the new identity changes to become more similar to norms that apply within mainstream Australian culture. This may cause tension and conflict within families, communities and service providers. Families also have to reconstruct themselves, just like individuals, taking on new social roles and responsibilities. As children and adolescents advance much more rapidly with their English skills than adults, they then become the English broker for the family. Parental roles change and cultural differences in family structure and discipline may be at odds with Australian norms. Due to their experience of forced migration and differences in behaviour, some refugee families may be at disk of domestic violence—culturally appropriate interventions are a necessity in these situations.

    Refugees frequently struggle to overcome the psychological impacts of personal safety threats and of social and cultural dislocation. Furthermore, they face additional social, linguistic, educational and vocational challenges throughout their attempts to seek asylum and following resettlement. In order to assist refugees in effectively responding to these traumas and stresses, psychologists require adequate therapeutic interventions that respond holistically to the unique experiences of individuals and families. First and foremost, we should assist refugees in developing a sense of stability, safety and trust, as well as to regain a sense of control over their lives.

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