Sarah Mares

Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia

Objective: To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia.

Psychiatric assessment of children and families in immigration detention – clinical, administrative and ethical issues

Objective: This paper reports the clinical, practical and ethical issues arising in the assessment of 10 consecutive referrals from a remote Immigration Reception and Processing Centre to a child and adolescent mental health service (CAMHS) between February and August 2002.

Seeking refuge, losing hope: parents and children in immigration detention

Objective: To record observations made by the authors on a series of visits between December 2001 and March 2002 to two of Australias immigration detention centers and to consider the mental health consequences of Australias policy of mandatory immigration detention of asylum seekers for families and children. Conclusions: Parents and children in immigration detention are often vulnerable to mental health problems before they reach Australia. Experiences in prolonged detention add to their burden of trauma, which has an impact not only on the individual adults and children, but on the family process itself. Immigration detention profoundly undermines the parental role, renders the parent impotent and leaves the child without protection or comfort in already unpredictable surroundings where basic needs for safe play and education are unmet. This potentially exposes the child to physical and emotional neglect in a degrading and hostile environment and puts children at high risk of the developmental psychopathology that follows exposure to violence and ongoing parental despair. Psychiatrists have a role in advocating for appropriate treatment of these traumatized and vulnerable parents and children.

Children and young people in immigration detention.

Purpose of review This article reviews evidence about the impact of immigration detention and other restrictive immigration policies on the mental health of children, young people and the adults who care for them. We review the implications of this for clinicians attempting to assess or work with incarcerated child and adult refugees and asylum seekers. Recent findings There are increasing numbers of adults and children seeking asylum across the globe and many nations use incarceration and other harsh and interceptive immigration practices. There is mounting evidence of the psychological harm associated with detention of already vulnerable adults and children. Australia is used as a case study. Summary Clinicians are required to consider the intersection of mental health assessment and treatment with human rights violations, and the impact of restrictive immigration policies, not only on asylum seekers and refugees but also on clinicians, clinical practice and professional ethics.

Recent advances in the theories of and interventions with attachment disorders.

Purpose of review The present review examines the available literature to consider recent advances in the theories of, and interventions with, disorders of attachment. We discuss the existing evidence to argue that the conceptualization of attachment disorders remains problematic despite their clinical significance. Recent findings Research into clinical disorders of attachment is limited, but there is some recent evidence that a standardized approach to diagnosis may improve identification. The current classificatory systems do not accommodate all clinical presentations and proposed broader approaches have greater clinical utility. A recent review of interventions for attachment disordered children confirms that ‘coercive’ interventions have no empirical support and are not biased on coherent principles of attachment theory. Summary Clinical interest in identification and treatment of attachment disorders has remained high. This is despite continuing confusion regarding terminology, phenomenology and diagnosis. The lack of agreed definition and conceptualization of these conditions is reflected in disparate approaches to intervention and limited empirical data. Interventions have little demonstrated benefit and some potential risk.

Family matters: infants toddlers and preschoolers of parents affected by mental illness

One in five young people in Australia, including infants, toddlers and preschoolers, lives in a family with a parent with a mental illness.1 Families affected by mental illness are more likely than other families to experience poverty and social isolation,2 and are more likely to have children taken into care.3 A combination of factors influences the child’s risk of psychopathology. These include psychosocial adversity, the child’s developmental status and age, genetics, family relationships, the severity and chronicity of parental psychiatric disorder, comorbidity, and the involvement of other carers in the child’s life. Not all children whose parents have mental health problems will experience difficulties themselves.4 Parental diagnosis itself does not confer risk, and many parents with severe depression, schizophrenia and other disorders are adequate caregivers.5 Rather, it is the severity and chronicity of psychopathology and the variation in parental personality, genetic characteristics, coping style and social circumstances that confer risk. Children’s characteristics, such as temperament and sex, can also influence the parent–child relationship and parenting behaviour.6 This article outlines the impact of three key mental health disorders on parenting and young offspring, and describes implications for practice.

Sadness and fear: The experiences of children and families in remote Australian immigration detention

In March 2014 we spent a week on Christmas Island as consultants to the Australian Human Rights Commission (AHRC) Inquiry into the Impact of Immigration Detention on Children. We were accompanied by three AHRC staff. We had extensive access to detained families and children and conducted semi-structured and informal interviews with 230 people as individuals or in family or other groups. We met with staff of the Department of Immigration and Border Protection (DIBP) and ‘service providers’ including Serco, the multinational corporation that runs the detention facilities, International Health and Medical Service (IHMS) and the non-governmental organisation providing activities for unaccompanied children (Maximus). DIBP staff were present at all meetings except those with detainees. We used official interpreters for the majority of interviews but occasionally used other asylum seekers, including children to translate. The AHRC provided two debriefing sessions following our return. A report, ‘The Forgotten Children: National Inquiry into Children in Immigration Detention’ was released by the AHRC to the Australian Government in November 2014, with public release in March 2015. In a separate paper, we focus on the unaccompanied children and younpeople detained in Immigration facilities on Christmas Island.

Fifteen years of detaining children who seek asylum in Australia – evidence and consequences

Objective: To review and summarise the evidence about and consequences of Australia’s policy of mandatory indefinite detention of children and families who arrive by boat to seek asylum. Methods: This paper will summarise the accumulated scientific evidence about the health and mental health impacts of immigration detention on children and compare methodologies and discuss the political reception of the 2004 and 2014 Australian Human Rights Commission (AHRC) Inquiries into Immigration Detention of children. Results: The conclusions of the 2004 and 2014 Inquiries into Immigration Detention of Children are consistent with Australian and international research which demonstrates that immigration detention has harmful health, mental health and developmental consequences for children and negative impacts on parenting. Conclusion: The evidence that prolonged immigration detention causes psychological and developmental harm to children and families and is in breach of Australia’s human rights obligations is consistent. This is now partially acknowledged by the Government. Attempts to limit public scrutiny through reduced access and potential punishment of medical witnesses arguably indicates the potency of their testimony. These harmful and unethical policies should be opposed.

Culture, context and therapeutic processes: delivering a parent-child intervention in a remote Aboriginal community:

Objective: Little is written about the process of delivering mainstream, evidence-based therapeutic interventions for Aboriginal children and families in remote communities. Patterns of interaction between parents and children and expectations about parenting and professional roles and responsibilities vary across cultural contexts. This can be a challenging experience for professionals accustomed to work in urban settings. Language is only a part of cultural difference, and the outsider in a therapeutic group in an Aboriginal community is outside not only in language but also in access to community relationships and a place within those relationships. Method: This paper uses examples from Let’s Start, a therapeutic parent-child intervention to describe the impact of distance, culture and relationships in a remote Aboriginal community, on the therapeutic framework, group processes and relationships. Results: Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Conclusions: Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Program adaptation, evaluation and staff training and support need to take these factors into account to ensure cultural accessibility without loss of therapeutic fidelity and efficacy.

Commentary: Reducing further harm to asylum-seeking children. The global human rights context

and number of relocations: a cross-sectional study. BMC Public Health 2008;8:293. 11 Tousignant M, Habimana E, Biron C, Malo C, SidoliLeBlanc E, Bendris N. The Quebec Adolescent Refugee Project: psychopathology and family variables in a sample from 35 nations. J Am Acad Child Adolesc Psychiatry 1999;38:1426–32. 12 Wiegersma PA, Stellinga-Boelen AA, Reijneveld SA. Psychosocial problems in asylum seekers’ children: the parent, child, and teacher perspective using the Strength and Difficulties Questionnaire. J Nerv Ment Dis 2011;199:85–90. 13 Jelleyman T, Spencer N. Residential mobility in childhood and health outcomes: a systematic review. J Epidemiol Community Health 2008;62:584–92. 14 Rumbold AR, Giles LC, Whitrow MJ et al. The effects of house moves during early childhood on child mental health at age 9 years. BMC Public Health 2012;12:583. 15 Vogels AGC. The Identification by Dutch Preventive Child Health Care of Children With Psychosocial Problems: Do Short Questionnaires Help? Groningen, The Netherlands: University of Groningen, 2008. 16 Weed LL. Medical records that guide and teach. N Engl J Med 1968;278:593–600. 17 Anstiss H, Ziaian T, Procter N, Warland J, Baghurst P. Help-seeking for mental health problems in young refugees: a review of the literature with implications for policy, practice, and research. Transcult Psychiatry 2009; 46:584–607. 18 Ee Ev, Kleber RJ, Mooren TTM. War trauma lingers on: associations between maternal posttraumatic stress disorder, parent-child interaction, and child development. Infant Ment Health J 2012;33:459–68. 19 McMullen JD, O’Callaghan PS, Richards JA, Eakin JG, Rafferty H. Screening for traumatic exposure and psychological distress among war-affected adolescents in postconflict northern Uganda. Soc Psychiatry Psychiatr Epidemiol 2012;47:1489–98. 20 Clayton D, Schifflers E. Models for temporal variation in cancer rates. II: Age-period-cohort models. Stat Med 1987; 6:469–81. 21 Huber M, Stanciole A, Wahlbeck K et al. Quality in and Equality of Access to Healthcare Services. Brussels: European Commission, 2008. 22 Norredam M, Mygind A, Krasnik A. Access to health care for asylum seekers in the European Union – a comparative study of country policies. Eur J Public Health 2006;16: 286–90.