Harming children's mental health

The Australian Human Rights Commission (HRC) said that the overarching finding of its report, titled "The Forgotten Children: National Inquiry into Children in Immigration Detention 2014," was that "prolonged, mandatory detention of asylum seeker children causes them significant mental and physical illness and developmental delays, in breach of Australia's international obligations."

Released on Wednesday, February 11, the paper examines the impact that prolonged immigration detention has on the mental and physical health of children, stating that 34 percent of children detained in Australia and Christmas Island have a mental health disorder of such severity that they require psychiatric support.

The inquiry also found that the children have been exposed to unacceptable levels of assault, including sexual assault and violence in detention. Some 330 children are currently in indefinite detention.

Canberra has been facing growing international scrutiny over its tough asylum policy. The conservative government has been turning back boats carrying potential refugees or detaining all asylum seekers who arrive by boat, holding them in offshore processing camps - a measure designed to serve as a deterrent.

Those found to be refugees will not be permanently resettled in Australia. In the meantime, Australian PM Tony Abbott slammed the report, saying the HRC should be ashamed of itself for conducting "a blatantly partisan politicized exercise."

Dr Karen Zwi represented the Royal Australasian College of Physicians as a pediatric expert advisor to the HRC inquiry. In a DW interview, Zwi talks about her experiences during visits to Christmas Island and her findings on the impact detention is having on children.

DW: How many children did you examine and where?

Dr. Karen Zwi: I visited the Christmas Island detention facility as part of a team of medical experts. Christmas Island is a remote island five hours flight north-west of Australia and with a very extreme tropical climate. We spoke to 225 children and families, and around 40 unaccompanied children. I also went to several detention centers in Darwin where we interviewed several more children and families.

What symptoms of mental illness did they show?

Older children and teenagers tend to develop symptoms that are consistent with depression, anxiety and post-traumatic stress disorders. They can become withdrawn, unable to learn or concentrate, and filled with despair and a sense of hopelessness to the extent that they self-harm and attempt suicide.

Younger children who are frightened or frustrated can develop developmental delay and behaviors such as tantrums, nightmares, bedwetting, head-banging and poor concentration. This was evident in many of the children we saw. We also saw children playing out their distress in games about detention guards and sinking boats.

Children were given paper and pencils whilst waiting to speak to us. We saw countless drawings depicting their sense of imprisonment: crying faces behind wire; caged birds, figures without hands. The overarching finding of the report also stated that the detention centers led to developmental delays in the children as well.

Are there mental health services or treatments available to these children in the detention centers?

There are mental health services available, but these are largely inadequate considering the volume of mental health concerns amongst people in detention. Also, the provision of mental health services doesn't actually address the primary harm, which is detention itself.

It is impossible to mitigate the impact of detention, and mental health services are simply a band-aid solution until children can get out of an intrinsically harmful environment. The most effective therapy for these children would be to live in a welcoming community with structured routines that make them feel safe, such as school, sport and other activities.

What is the age range of the children in these centers and what sort of developmental delays are they presenting?

There are children of all ages in detention centers, from in utero to newborn babies to adolescents. No-one is exempt from the policy of mandatory detention if you arrive in Australia by boat.

The types of developmental delays varied depending on age. We saw a lot of distressed children, many suffering from developmental delay, delayed speech and regression such as bedwetting.

Many parents also told me stories of their children crying themselves to sleep at night, and concerns that they felt that their children were deteriorating intellectually and emotionally.

At the time I visited, there was very limited access to education and recreational activities on Christmas Island. While this was rectified a few months after my visit, this will have an ongoing impact on development, especially that of older children.

The children I spoke to wanted to go to school, to learn, and were frustrated that the opportunity to do so was not available.

Multiple reports of abuse, sexual assaults and self-harm involving children "indicate the danger of the detention environment" - based on your observations, how prevalent are these assaults in the camps?

We know that the detention environment is inherently unsafe for children. I don't have any direct observations of this kind of abuse taking place, but the report details horrific instances of children being sexually assaulted by staff or by other detainees in full view of security officers.

It quotes statistics supplied by the Department of Immigration and Border Protection showing that in a little over one year, from January 2013 to March 2014, there were 233 assaults involving children and 33 cases of sexual assault, the majority involving children. Such statistics are usually an underestimate of the real incidence and in this case don't represent the other types of child protection issues present in detention centers.

Parental distress may reduce capacity to care for their children and provide direct supervision, and increases their risk for physical and sexual abuse and neglect. The environment is also inherently unsafe from an emotional perspective as parents are often depressed and traumatized by their past experiences compounded by being held in indefinite, long term detention. This can be called psychological abuse.

What specifically in the camps contributed to the development of mental illness in the detained children?

Children are very sensitive to the health and well-being of their care-givers. The average time that people have been in detention is now over 440 days. Asylum seekers have already fled persecution and the indefinite nature of how long they will be detained and where they will be sent (as no-one arriving by boat is resettled in Australia) can be very difficult to endure.

Many parents are depressed, anxious, highly stressed, self-harming or suicidal, and the child is going to feel that impact directly. There is good evidence showing that depressed parents talk less to their children and are unable to provide a buffer to a traumatizing environment. Thus the children develop language delays, anxiety and other behaviors illustrating their distress.

The detention environment itself is frightening - it is a prison-like environment. There are many security guards, no freedom of movement and people are surrounded by metal and wire fences. People are referred to by ID number instead of their names; there are institutional meal times, no private family or cooking time, and a loss of family functioning or autonomy which is also degrading to parents and children alike.

Dr Karen Zwi Karen Zwi is a Conjoint Associate Professor with the School of Women's & Children's Health at the University of South Wales (UNSW), Australia. Dr Zwi is also a Fellow of the Royal Australasian College of Physicians (RACP).