This
chapter of the submission examines evidence regarding the effects of detention
on the immediate and long-term mental health of children and adolescents. No
systematic research on the mental health effects of detention in Australia is
available. However there is a vast body of knowledge, based on research, which
underpins the conclusions drawn.
The
developmental needs of children and adolescents are well understood. The
psychological effects of traumatic events and environments akin to the
detention environment in Australia are also known.
This
chapter concludes that detention has an adverse immediate and long-term effect
on children and adolescents, the extent of which depends on the degree of
exposure to traumatic events preceding arrival in Australia; the length of
detention; the level of violence and self-damaging behaviours witnessed or
experienced in detention; the opportunities for play and meaningful activity;
the degree of emotional support and protection provided by parents/
care-givers; the behaviour and attitudes of detention staff, including
management; and the quality of health, mental health and educational services.
Post-detention
circumstances also vary, but the temporary nature of protection offered those
who are released, and the absolute restriction on future family reunion,
subject children and their family members to continuing uncertainty and loss.
Such circumstances can only be considered as extremely adverse for vulnerable
children and particularly so for unaccompanied minors.
With
so many causal factors operating to determine mental health, a wide range of
effects has to be expected, from extreme self-degradation and destructive
behaviours towards self and/or others, which can persist for years, to
reasonable adaptation. The weight of evidence indicates that the detention
environment will do harm because, at minimum, children have been dislocated and
have in most cases lived under oppressive regimes, making them vulnerable and
sensitive to hostile and harsh conditions in a new environment; the detention
environment is monotonous, confining, and depriving of freedom, and the
detention regime undermines the capacity of the family, where present, to
protect and support their children.
INTRODUCTION...............................................................................................................................................................................
Aim of this submission and about its authors...............................................................................................
Methodological issues....................................................................................................................................................
Content outline of mental health submission..............................................................................................
MENTAL
HEALTH NEEDS OF CHILDREN AND ADOLESCENTS.........................................................................................
Normal development........................................................................................................................................................
The effects of trauma.....................................................................................................................................................
Factors jeopardizing the mental health of children in detention
PRE-DETENTION
EXPERIENCES...................................................................................................................................................
Deleterious
ASPECTS of Detention AND their Consequences for the Mental Health of children.
THE EXPERIENCE OF CHILDREN............................................................................................................................................
THE EXPERIENCE OF FAMILIES.............................................................................................................................................
THE EXPERIENCE OF UNACCOMPANIED MINORS...........................................................................................................................
POST-DETENTION EXPERIENCES.............................................................................................................................................
The
post -detention environment and its consequences for asylum seekers and
TPV holders
Adequacy of Mental Health Services for
Children and Adolescents in Detention and Following Detention
In detention.............................................................................................................................................................................
Post-detention......................................................................................................................................................................
Post-detention services for
refugees....................................................................................................................................
Access to public mental health
services
Conclusion....................................................................................................................................................................................
This
submission to the HREOC Inquiry into children in detention examines evidence
regarding the psychological well-being of these children and adolescents, and
addresses the question of whether detention is deleterious to their mental
health.
The
submission has been prepared by the Mental Health Group of KIDS (Kids in
Detention Story). The group is made up of professionals who deal with the
mental health of children, and includes psychiatrists, psychologists, and
social workers. Many of these people work with refugees and/or victims of
trauma.
In
preparing this submission, many sources of evidence have been used. These
include former detention centre staff, people with direct experience of being
held in detention, and clinicians working with people in detention. It also
draws upon the authors’ clinical experience, as well as research and relevant
literature.
Early in the process of gathering information, it became clear to the authors that a definitive exploration of the effects of detention on children and adolescents seeking asylum in Australia was not possible. The mandatory detention of children in immigration detention centres is unique to Australia, and therefore little scientific material is available from overseas. Further, in the local context, systematic research into effects has not been carried out because of a number of difficulties in accessing primary material. Firstly, current government policy limits contact with people in detention and research has been disallowed. Secondly, refugees who have been in detention are concerned that talking about their experiences may jeopardise their claim to eventual refugee status. Thirdly, detention centre staff who are currently employed in the detention centres are concerned about losing their jobs.
Finally, even if direct access to detainees were possible, the authors have serious ethical and clinical issues to consider regarding the well-being of detainees. Interviews about personal responses to, and experiences of, detention may provoke considerable distress and expectations about assistance, which cannot be adequately addressed.
In
spite of these limitations, some members of the mental health group have had
extensive experience, including direct contact with many children and their
parents who are currently in, or have been in detention. In addition, several
members of the group have interviewed a number of workers employed in a variety
of capacities in the detention centres. Information has been obtained with the
informed consent of all those providing interview material.
In
order to ensure confidentiality, we have removed the names of our sources,
except in those cases where a professional informant has given explicit consent
to include potentially identifying information.
For
the reasons outlined above, we cannot draw upon systematic and comprehensive
research about the impact of Australian detention centres on the mental health
of children and adolescents. Nevertheless, it is the view of the authors that
there is sufficient knowledge about the psychological needs of children and
adolescents, and the conditions to which they are subjected, to draw strong
conclusions about the effects of detention.
The
submission begins with a brief description of the mental health needs of
children and adolescents and the fundamental conditions which are needed to lay
the foundations for normal development. The next section describes the nature
of pre-detention experiences which have an impact on children and adolescents,
and the conditions in detention which affect them and their families, in both
the short and long term. Types of experiences that are deleterious to mental
health are outlined. The influence of the post-detention environment is then
considered. This is followed by a discussion of the adequacy of mental health
services available to detainees in detention and on release.
Children
and adolescents have needs which are particular to their age and are distinct
from those of adults. The way in which needs are met at various stages of their
development lays the foundation for future development in cognitive, social and
emotional domains. Authors such as Bowlby[1]
(1980), and Erikson[2] (1950), have
shown that children’s future lives and contributions to society are profoundly
influenced by their earlier experiences. It is beyond the scope of this
submission to provide a detailed overview of a child’s development, but the aim
of the following outline is to alert the reader to the importance of the
quality of parenting/care-giving, and the broader social environment, in
influencing the course of development.
An
infant until the age of two years relies for its well-being on the nurturing of
its parents or care-givers. Physical needs are paramount, but it is also the
stage of life when trust in others and the ability for emotional regulation
develops. There is a burgeoning research literature that shows that the quality
of care-giving influences the development of brain functioning.[3]
[4]Deprivation
of emotional needs for comfort, and disruption of the attachment relationship
between caregiver and infant, are known to have long term effects.[5]
The younger the child when multiple traumas occur, the greater the negative
impact later in life.[6]
The
stage of life from 18 months to 3.5 years is the period in which autonomy
develops. Autonomy refers both to physical independence and the capacity to
explore and master the environment away from primary attachment figures, who
are normally the parents. Where the external environment is insecure, hostile,
restrictive and unpredictable, and when attachment figures are unable to
moderate the influence of an uncertain environment, children’s developing
autonomy is impaired.
Further
development of initiative and independent mastery continue over the life span,
but the period from 4 years to 12 years is recognised to be the stage when
self-esteem and the development of conscience are particularly vulnerable to
environmental influences. Punitive care-givers, or other authority figures such
as teachers and custodians, can readily establish a tendency to excessive
guilt, shame and a sense of unworthiness and unlovability. Even without
punitive caregivers, children tend to see themselves as the cause of wrong
outcomes, and they take undue blame. Continued impairment of initiative,
independence and mastery produce a sense of failure and sense of continued
dependence.
Adolescence
is normally associated with the period 12 to 18 years. However it is
conventional in the refugee literature to extend it to at least 21 years, in
recognition of the fact that reaching this stage of development is often
delayed as a result of earlier experiences. The adolescent faces many
developmental changes in all spheres of functioning. Those changes produce
challenges, which must be met for the adolescent to achieve true adult
maturity.
Changes
take place in the capacity to reason. This is the period when the adolescent
develops the ability to think abstractly, and to consider multiple
perspectives. Consequently adult
motives are scrutinised and new systems of explanation for events are
generated.
Sexual
and social development and norms of behaviour also occur in this period.
Adolescents are particularly attuned to understanding what is good and bad
about behaviour. Identity formation is a major task of adolescence and
different roles are actively explored. Adolescents are especially prone to
being influenced by peers and adults who guide which roles they “should”
undertake.
A
comprehensive understanding of the influence of the detention environment on
children depends on an appreciation of the developmental needs of children and
adolescents outlined above. It depends also on the recognition that the social
environment has the power to produce change, for better and worse. Effects on children and adolescents
will depend on a number of factors:
§
The
age of the child or adolescent
§
The
extent to which their development has been disrupted by pre-arrival
experiences, such as exposure to violence and disruption to relationships
§
The
length of detention and the quality of that environment
§
The
extent of exposure to violence whilst in detention, both direct and indirect
§
The
extent to which their family is intact
§
The
extent to which parents retain their capacity to nurture and protect whilst in
detention
The
following description of the course of development by Garbarino and colleagues[7], who are recognised leaders in the
field of the effects of violence on children, highlights the legacy of failing
to take responsibility for the adverse effects of the environment on children.
“
In the developmental process, the child forms a picture or draws a map of the
world and his or her place in it. As children draw these maps, they move
forward on the paths they believe exist. If a child’s map of the world depicts
people and places as hostile, and the child as an insignificant speck relegated
to one small corner, we must expect troubled development of one sort or
another: a life of suspicion, low self-esteem, self-denigration, and perhaps
violence and rage. We can also expect a diminution of cognitive development and
impediments to academic achievement and in-school behaviour”
In
order to understand the impact of violence and traumatic events on a child or
adolescent’s development, the age of the child, as well as the extent of
exposure to those events, must be taken into account. The following section
describes the effects of traumatic events, highlighting age-specific effects.
There
is no simple relationship between a particular event or cause, and effect. The
impact of detention depends on previous experiences, personal and family
vulnerabilities and strengths. The children and adolescents who are detained
are already at risk by virtue of dislocation and separation from relatives and
friends. The detention environment, a close examination of which can be found
in the following section, can only exacerbate the deleterious effects of
previous experiences. The detention environment itself is a stressful one. It
is a traumatic environment, particularly when prolonged.
Pynoos,
Steinberg and Wraith in a textbook review[8] noted a wide range of frequently
encountered deleterious effects following traumatic stress in children of
various ages, both in the short and the long term. Importantly, they also note
that the longer children remain in environments where they are exposed to
violence, the greater the risks of significant effects on developmental
achievements. They emphasise that for all ages, “in violent environments, each
successive exposure may cause acute traumatic reactions from which there is
only incomplete recovery, potentially increasing the risk of significant
deviation in developmental trajectory.”
Not
only are children especially vulnerable at the time of traumatic events, but on
the whole, enduring psychosocial ill effects of trauma are much more prominent
in children than adults, ever more so in the younger groups.[9] “The
DSM-IV64 PTSD field trials found that
associated features of PTSD, such as difficulties with regulation of affect and
alterations in self-concept, were most prominent in adults who report being
traumatized before age 4 years.”65
Davidson and Smith (1990)[10]
report that individuals who experienced an initial trauma before the age of
eleven, were three times more likely than those who experienced their first
trauma as teens to develop psychiatric symptoms. Limited coping resources may
render children more vulnerable to indirect stressors than adults.
When
basic developmental needs are not met, or seriously disrupted, psychological
symptoms and disorders are likely to occur. These manifest differently at each
developmental stage: children are affected by traumatic events according to
their level of cognitive and emotional development.
Age
specific effects of traumatic events
|
Infants |
failure
to thrive, basic trust does not develop, searching for protective figure |
|
Preschool children |
difficulties
with regulation of affect, separation anxiety, re-enactment of traumatic
events |
|
School-age children |
attentional
disturbances, extreme internalising and externalising behaviours, impaired
skill acquisition, omen formation (look for omens to predict future
disasters) |
|
Adolescents |
substance
abuse, sexual acting-out, anti-social behaviour, suicidal ideation, identity
disturbance, depression, |
Intense
anxiety, fear, feelings of helplessness, and the symptoms of posttraumatic
stress disorder, can develop and persist for a long time after a traumatic
event or events. The experience of helplessness, rather than the ostensibly
horrific nature of an event, is the critical factor in determining the severity
of the trauma reaction.[11]
There are many ways in which anxiety manifests itself and they occur at all
ages:
·
Intrusive
and recurrent distressing recollections of the traumatic event, including
nightmares, flashbacks and in children, repetitive reenactments in play
·
Impairment
in the ability to think, concentrate and remember
·
Conditioned
fear response to reminders, places, things and people’s behaviour leading to
avoiding fearful situations and emotional withdrawal
·
Generalised
fear not directly related to trauma such as fear of strangers or fear of being
alone
·
Hypervigilance
or watchfulness
·
Regressed
behaviours such as bedwetting in children
·
Startle
responses to sudden changes in the environment
·
Reduced
capacity to manage frustration and tension
·
Emotional
numbing and detachment
·
Psychosomatic
complaints
The
effects of anxiety are disturbing and reinforce feelings of helplessness.
Children and adolescents try to cope in various ways, some of which are
adaptive in the short-term but maladaptive in the long term. Some children and
adolescents predominantly react with withdrawal and passivity, manifesting as
lack of spontaneity, constriction of play/social activities, and inability to learn.
Others predominantly react with aggression, disruptive behaviour and
restlessness to deal with frustration and stress.
The
connection with others and the world is usually dramatically altered as a
result of trauma. Grief is common with manifestations in numbing, pining or
yearning for a missing or dead relative/friend. Anxiety is associated with
grief, as are emptiness, apathy, despair and anger. Attachment behaviour in
relationships is altered leading to increased dependency, clinging behaviour or
fierce self-sufficiency, guardedness and withdrawal. The quality of
relationships is also affected, renewed loss is feared impairing the
development of new relationships. Depression can develop in children and
adolescents with symptoms of pessimism, loss of interest, sleep disturbance,
appetite disturbance, poor concentration, self-degradation, hopelessness and
suicidal thoughts and plans.
Guilt
and shame are common consequences for children and adolescents exposed to
traumatic events. They imagine that they should have been able to do something
to avert violence or other traumatic events, even when nothing could have been
done. Such thoughts can become a preoccupation. One of the most profound
effects of guilt is that it can inhibit the experience of pleasure of any kind.
This can lead in some cases to complete withdrawal, exacerbated by the need to
hide due to shame. Self-blame is extremely common, and self-destructive
behaviour can occur as an effort to expiate guilt through self-punishment.
Shame can also lead to aggression towards others that can disguise feelings of
aggression towards oneself. Defiance is also a typical defence against shame.
Other
effects are less visible, trauma affecting at an existential level perceptions
of the self and the adult world. Notions of good and bad, trust in others and
the future can be irrevocably changed, affecting fundamental values about the
self and life itself. Children and adolescents are particularly susceptible to
having their moral development truncated as a result of their exposure to
violence.
Adolescents
commonly become depressed in reaction to loss and bewilderment about the cruel
behaviour of adults. They may withdraw into passive hopelessness, or take
impetuous action fuelled by a sense of invulnerability, a feature which is
typical of their age. They may use self-destructive and antisocial acts and
behaviours as a way to distract themselves from anxiety and a loss of faith in
the world. Other responses include anorexia, self-mutilation, belligerence, ascetic
withdrawal, or the adoption of a premature adult role. The adolescent’s process
of identity formation is greatly affected and fails to develop.
Compared
to adults, adolescents are at increased risk of PTSD[12] and other
adult type disorders. In addition, trauma at this developmental stage may
affect adolescents’ abilities to integrate past, present, and future
expectations into a lasting sense of identity. This
may develop into identity confusion, aggression, deliberate risk taking, and an
inability to form stable relationships.[13]
The
context in which children and adolescents reach the shores of a country and
seek asylum must be understood in order to comprehend the potential cumulative
impact of a detention environment on them.
Most people in the remote detention centres come from Afghanistan and Iraq. Most, until the time of writing, were indeed granted refugee status66 . It is reasonable to deduce that most children and adults in those detention centres seeking asylum have been exposed to traumatic events, albeit to varying degrees.
Such events would include internal displacement and attendant hardship, civil war, sudden disappearance of family members, death of family members, knowledge of executions and torture, damage and destruction to homes, witnessing of atrocities and murders, and separation from and loss of loved ones. Some children and adolescents would have been directly targeted for persecution and experienced direct physical and psychological injuries.
Countries such as Afghanistan and Iraq are known to have had, or still have, regimes that impose political oppression with harsh punishments such as torture and death. These punishments are used as methods of control through terror. Repressive regimes cultivate a climate of fear to suppress opposition, and both children and adolescents would have lived under such conditions for varying lengths of time.
Case
1
An English Language Centre teacher recounted the experiences of a young
adolescent student whose father had been imprisoned and tortured overseas. The student was also detained in order to
influence the father’s confession. The teacher recounts that the child was also
tortured. Subsequently, the student described to the teacher that detention in
Australia had been difficult but he was unable to speak in more detail.
Access to basic needs of food and shelter has also been precarious for refugees and their children. As well, many children and adolescents arriving in Australia by boat have been exposed to perilous journeys.
Case
2
One worker described the palpability of grief in the family she visited
as part of her counselling work. They had lost many of their extended family in
a boat that had sunk before reaching Australia. They also heard in detail about how a parent had tried to save
his children but failed and watched them drown.
The countries of origin of people in city based detention centres such as Villawood in Sydney, and Maribyrnong in Melbourne, are far more diverse, and the rates of approval for refugee status far less than that for the remote centres. (insert figure form legal group)
It is therefore very difficult to know to what extent traumatic events have characterised their pre-arrival experiences. Nevertheless, for the young, the dislocation and inevitable separation from family, friends and homeland are indisputable facts. The extent to which dislocation and separation are traumatic events would depend on the degree to which those disrupted connections represent disruptions to core attachment relationships. This would also be influenced by the number of family members with whom they arrive.
It is important to recognise that some children may have been well protected from violence and other threatening events in their country of origin by their families. For those children, incarceration in a detention centre could well be their first experience of restricted freedom and hardship.
Relevant
research has shown that a range of pre-migration experiences has been
implicated in the psychological well-being of refugees. Pre-migration variables
that have been found to correlate with later psychological disorder in adults
include combat exposure, incarceration, death of or separation from family
members, danger during flight from country, poor physical health status and
rural background.[14] Some of
these studies included older adolescents in their samples. The pre-migration
experiences of younger children have received less attention,[15] but the predictors of psychological
disorder in adults are likely to affect the well-being of children insofar as
their parents are disabled by those experiences (the generational transmission
of trauma is discussed below).
There
is no reason to believe that the level of pre-migration risk factors is less
amongst detained asylum seekers than in the refugee populations these results
have been derived from. In fact there is some evidence to the contrary. One
study, a survey of Tamil asylum seekers in the Maribyrnong Detention Centre[16] found that the detainees had
experienced over twice the level of exposure to war related trauma compared to
Tamil asylum seekers living in the community.
If
the vulnerabilities of detainees are at least as great as refugee compatriots
in the community, their initial 'settlement' experience, that of detention, is
arguably considerably more unfavourable than the settlement environment of
off-shore refugees.
The
psychological effects of detention cannot be understood without considering the
child who is detained, the child's family, the specific features of the
detention environment, and the duration of detention. While definitive research
is yet to be conducted, clinical experience indicates that detained children
are likely to suffer adverse psychological effects when one or more risk
factors are present.
A
child who has suffered pre-migration trauma, who has been exposed to traumatic
events within detention, whose attachment to parents is insecure or disrupted,
or who is detained for a protracted period, is at great risk of psychological
harm. While pre-existing vulnerability increases the risk of harm, there is
however little doubt that detention, especially when protracted, can cause
psychological disturbance in both children and adults who were not especially
vulnerable prior to detention. This section explores how detention undermines a
child's psychological health.
Australia's
detention centres vary physically, both according to their internal design and
their surrounding environment; however detainees and detention staff describe
both urban and rural centres as austere and prison-like.[17] While the appearance of the detention
centres may provoke a range of reactions in the general population, there is
little doubt that detained asylum seekers experience the detention centres as
prisons. "What have I done to be kept in prison" is a common plea of
the detained asylum seeker; it is a question parents put to health workers and
children put to their parents.
Despite
their differences, all centres create a monotonous environment. In terms of
sensory experience, the environment provides children with a limited range of
stimulation. Particularly for young children, the environment is institutional
and homogeneous from visual, aural and tactile perspectives. It is both bland
and harsh: visual uniformity is combined with the discordant sounds of
institutional life - the public address system, televisions on at all hours,
raised voices reverberating against hard surfaces. 17 Such a physical environment does not foster children's
capacity for sustained attention and self-directed play, nor their ability to
creatively engage with novel stimuli.
Case
3
An ethno-specific pre-school worker volunteered that children have not
learnt how to play. She has found that normally playgroups and childcare help
children to learn how to play, they improve their behaviour, and they also
learn how to communicate with other children. She says of the detention centres
that the children just play with rocks.
Case
4
A former health worker at a detention centre said "The Centre was a very barren place. There was little joy there, few areas for infants to play safely and not much grass. There weren’t many toys. Kids played with sticks