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mental health

Dec 17, 2013

Inside the immigration detention facilities in Darwin: breeding grounds for mental illness

The official version of how asylum seekers are treated in immigration detention facilities in Darwin is quite different from the reality, reports a prominent medical specialist,

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The official version of how asylum seekers are treated in immigration detention facilities in Darwin is quite different from the reality, reports a prominent medical specialist, Professor Caroline de Costa, after a recent visit.

Her first-hand observations about the toll of detention upon the mental health and wellbeing of children and mothers is in line with a study published this week in The Medical Journal of Australia.

She writes:

“It would be good if we could, right now, acknowledge the suffering of the at least 1,153 children imprisoned right now in detention facilities in and outside of Australia who are our direct responsibility… Mandatory detention is no place for children of any age and particularly not for newborn babies or their mothers.”

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Caroline de Costa writes:

I am sitting on a hot Darwin Saturday morning in a room with several families and numerous small children. Tea, cakes and tropical fruits are being offered. On my knee is a small boy. He is one today. But nobody is celebrating.

This child is turning one in a detention camp. He has been in detention since he was five months old. Across from me sits his mother, unsmiling, vacant-eyed, clearly suffering from depression.

His father is in Sydney, on a bridging visa, but his wife and son cannot join him. Instead they are kept locked up in the hot, crowded environment of the camp, at considerable expense to the taxpayers of Australia.

I am in Darwin on a private visit but using my many years of experience as a doctor practising obstetrics and women’s health. The visit has been organised by ChilOut, the group which since 2001 has supported and advocated for the rights of all asylum seekers, but particularly those of children.

There are three detention facilities in Darwin in which women and children asylum seekers are located. These are all referred to as APODs, which sounds like a new device from Apple but actually stands for Alternative Places of Detention.

We have had access to all three facilities in a daylong visit organised jointly by the Department of Immigration and Border Protection (DBIP), who have overall responsibility for the facilities, International Health and Medical Services (IHMS), a private organisation which has responsibility for the healthcare of asylum seekers, and Serco, the private multinational organisation responsible for the running and security of the facilities.

During our visit we have been shown right around all three facilities and we have met a large number of employees of all the organisations.  Individually, many these people have appeared professional and caring towards the people they mostly refer to as “detainees”, but some call “clients.” Among other things we are told that names are always used when addressing or referring to asylum seekers, never numbers.

As an obstetrician, my particular concern has been the care offered during pregnancy and labour to asylum seeker women. All pregnant women currently are brought to Darwin from Christmas Island at about 34 weeks of pregnancy. They wait until the birth in the APODs, usually without their husbands and other children who are left on Christmas Island until closer to the birth.

Following birth mother and baby are transferred back to Christmas Island at four weeks postnatally.  Antenatal and postnatal care appears to be very limited on Christmas Island and any woman or baby developing complications needs to be transferred, or retransferred, to Darwin (or Perth).

There appear to have been around 40 births to asylum seeker women in Royal Darwin Hospital (RDH) in the past few months, with up to 60 women expected to give birth there between now and the end of February. Many of these women are high risk, from the point of view of their medical or previous obstetric history, or because of factors affecting the current pregnancy.

No additional staff, either midwives or doctors, have yet been employed in RDH to help provide the often complex care these women need. Nor does it appear that much discussion with RDH staff or the NT Health Department went into the decision to send pregnant asylum seeker women to RDH for care.

There is said to be a fulltime midwife at Wickham Point APOD to provide onsite care to pregnant women but I did not meet this person. There are three IHMS  doctors sharing the overall health care of all asylum seekers but none with obstetric qualifications.

We were told that there is 24/7 access to a nursing triage service, with a doctor on call, for asylum seekers (male and female, adults and children) in all three camps.  We were also told that there are regular playgroups and ‘Mums and Bubs’ sessions held in all three camps for pregnant women and new mothers.

The reality gap

Meeting individual asylum seekers, in the visitors’ rooms of all three facilities, in the two days following our formal visit, we heard stories quite different from the official accounts.

We observed in many parts of the camps that asylum seekers including children and women are routinely listed, dealt with and addressed by the numbers given to them on arrival by boat in Australia, rather than by their names.

This is highly disrespectful and part of a culture that appears dedicated to de-humanising these people. As one pregnant woman said to us: “You can call me illegal, but don’t call my baby illegal!”

Pregnancy care once a woman reaches RDH is excellent, as would be expected. However, none of the women we spoke to had been seen by a midwife in the detention facilities, nor were they aware of the existence of such a person. Playgroups and Mums and Bubs likewise were unknown to them.

All had experience of presenting to the clinic with health concerns for themselves or their children and not being seen at all. Postnatal care and assistance with breastfeeding were minimal at best.

I spoke to two women who had recently lost their babies in Darwin; both stated that prior to their babies’ deaths they had presented to the clinic with complaints (decreased fetal movements, baby stopping breathing) that would be taken seriously in a general medical context anywhere else in Australia. Both had been turned away from the clinic over several days.

While I have no way of corroborating their stories, and it is impossible to say that the stillbirth and the early infant death which later resulted might have been prevented by earlier intervention, their stories are sufficiently consistent and alarming to warrant immediate efforts to improve current care arrangements for asylum seeker women.

There is an urgent need for improved antenatal care on Christmas Island, and for more designated midwives and doctors with obstetric qualifications to be employed in Darwin.

Earlier this year I was asked to provide some information to the International Health Advisory Group regarding the basic needs for the provision of antenatal care on Christmas Island. Protocols were drawn up consistent with the kind of care provided within the Australian community; with the abandonment of the IHAG group earlier this week, I would be concerned that these recommendations may not be implemented.

Following the IHAG sacking there was a government statement to the effect that the group’s contribution had not been useful. I would disagree – the health of mothers and babies is absolutely integral to all other healthcare, in all populations.

It also makes good sense, from the financial point of view as well as that of asylum seekers’ mental health, that families are kept together before and after birth. We saw plenty of accommodation suitable for families in all three Darwin APODs, and DIBP and Serco staff agreed that the Darwin APODs at present are far from full.

The purpose of good antenatal and pregnancy care is to produce babies and mothers who are as healthy as possible. And as happy.

Whether or not these babies ultimately become Australian citizens or residents, Australia has responsibility for them right now.

One Darwin doctor who works closely with asylum seekers said to me that “there are the mental health problems that people have before they arrive (in detention). Then there are the problems they develop as a result of being in detention, and these are much greater.”

One of these problems is postnatal depression, and my impression is that PND is rife among women in Darwin who have recently given birth. This was certainly the case on Nauru, where I was involved in providing care for asylum seeker women in 2003 in the Top Side Camp on the island.

My experience at that time of Nauru, and my extensive experience of practising medicine in Papua-New Guinea, mean that I can unequivocally state that neither Manus nor Nauru are suitable places for the detention of very young babies and their families.

These environments are hot, crowded and lacking in the most basic facilities (eg adequate bathing facilities for babies). The ease with which infections of many kinds can spread in such environments is potentially lethal for young children; in addition there are the risks of tropical diseases such as malaria.

However, the greatest and most pervasive risk is to the mental health of children and their families. The fact of ongoing uncertain detention is bad enough; adding to it with an extremely isolated hot and crowded environment with few diversions within the detention facility and none outside is demonstrably contributing to very high levels of psychiatric presentations among asylum seekers, well documented by many of my colleagues in recent weeks.

My own observations of recent mothers I met in Darwin is of a high level of postnatal depression that is continuing on well past the postnatal period; the mother of the child mentioned above is but one example.

In recent years we have seen the acknowledgment of the Stolen Generations, the inquiries and the Apology. We have seen the acknowledgment of the suffering of children institutionalised and abused, the inquiries and the apologies.

It would be good if we could, right now, acknowledge the suffering of the at least 1,153 children imprisoned right now in detention facilities in and outside of Australia who are our direct responsibility. And solve this problem right now, rather than needing further inquiries and apologies down the track.

Mandatory detention is no place for children of any age and particularly not for newborn babies or their mothers.

• Caroline de Costa is Professor of Obstetrics and Gynaecology and Director of the Clinical School at James Cook University School of Medicine, Cairns Campus in North Queensland.

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Melissa Sweet —

Melissa Sweet

Health journalist and Croakey co-ordinator

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