Exclusive: Confidential health briefing obtained under freedom of information laws shows dramatic deterioration in mental health of people held on Nauru and Manus

Asylum seekers in offshore detention are being placed under surveillance for suicide and self-harm at a rate of two every three days, and growing more seriously mentally ill the longer they are detained, a new health briefing to the federal government shows.

Obtained under a freedom of information request by Guardian Australia, the latest report shows a dramatic deterioration in the mental health of asylum seekers held in offshore detention.

It warns that rates of mental illness are almost certainly higher than reported because people in offshore detention have given up going to see doctors, “feeling ... hopelessness and apathy ... relating to time in detention, lack of progress … and the perceived dangers of resettlement”.



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Every three months, International Health and Medical Services (IHMS), the government’s immigration health services provider, prepares the report for the government on “health trends” in immigration detention.

A new statistic, added by IHMS for the past six months, shows the number of times asylum seekers are placed on “supportive monitoring and engagement” (SME), a process of monitoring by staff after an attempt or threat to self-harm or take their own life.

At its highest level, SME is an around-the-clock suicide watch, involving one-on-one monitoring of a person at close physical proximity 24 hours a day, even as they shower, sleep or go to the toilet. Asylum seekers report this regime is highly invasive and distressing.

In the six months between July and December of 2015, SME was initiated 124 times over 184 days in offshore detention, a rate of more than two every three days. Up to 66 individual people were placed on SME, meaning most made several separate attempts to self-harm or take their own life. Nearly 40 people were placed on the highest category suicide watch, known as “high/imminent”.



But the figure of self-harm attempts is likely to be even higher. Nauru’s transition to an “open centre” meant SME could not, legally, be applied for a period, meaning those who had committed self-harm or attempted to take their own life could not be fully monitored.

The latest figures are released as the medical fraternity in Australia continues to resist government impositions of mandatory offshore detention.



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Last month doctors at Brisbane’s Lady Cilento hospital refused to discharge the Australian-born asylum seeker “baby Asha” until they were assured she would not be returned to Nauru, an environment they regarded as “unsafe”. The head of the Australian Medical Association, Dr Brian Owler, said offshore processing was “state-sanctioned child abuse” that was “pulling apart the moral fabric of the country”.

An asylum seeker on Nauru, whom Guardian Australia has chosen not to name, has attempted to take her own life numerous occasions over the past several months, and is now on 24-hour close watch.

She says she is given a cocktail of sedative drugs every day to stop her harming herself again. If she refuses to take the tablets given to her she is injected.

“I have problems mentally,” she told Guardian Australia. “I have tried for suicide many times, so I am on high watch. Someone is watching me all the time, everywhere, all the day and night. They give me lots of tablets, but they make me dizzy and feel sleepy. I say, ‘I don’t want to take,’ and they tell me, ‘If you don’t take, we will give injection.’

“I am very scary about what will happen to me. I have been here 26 months, but this place is terrible for me. I don’t have a future, I can’t think about the future.”

Over several reports, IHMS has consistently told the government that rates of anxiety, distress, and depression all increase the longer people are held in detention. Across the Australian immigration detention regime, onshore and offshore, the average time in detention is now 457 days, the highest it has ever been.

Based on the Kessler Psychological Distress Scale, known as the K10 scale, IHMS data shows 22.4% of asylum seekers rated as “severely” mentally distressed, and 19.4% moderately mentally distressed.

The rate of severe mental distress is more than six times that in the Australian community, which is 3.5% severe (8.5% moderate). But IHMS has warned the offshore detention rate is likely higher because severely distressed people are likely to refuse to take part in the K10 survey.

In its latest report, IHMS noted a correlation between length of stay in detention and mental health issues, and said the data clearly showed a “persisting trend for movement towards the severe end on the distress scale over time”.



IHMS also said accurately gauging mental health of asylum seekers was becoming increasingly difficult because of “detention fatigue”. All but one of offshore detainees have been in detention for more than 18 months, and fewer and fewer people are seeing doctors in both Nauru and Manus Island because they feel hopeless about their situation and, in some cases, are frightened about being resettled.

“On Nauru, a 32% reduction in consultations appears to be related to a reduction in transferee numbers, the establishment of a 24-hour, 7-day-per-week ‘open centre’ combined with an increase in feelings of hopelessness and apathy in some transferee cohorts,” IHMS wrote.

“On Manus Island, a 4% reduction in consultations reflects relative disengagement with health services associated with an increase in feelings of hopelessness and apathy … staff are also noting an increased level of hopelessness in this cohort relating to time in detention, lack of progress with and the perceived dangers of resettlement.”

The secretary of the immigration department, Michael Pezzullo, said on Tuesday that people in offshore immigration detention had access to mental health care that “broadly commensurates with Australian community standards”.

Many asylum seekers placed in detention had existing mental health issues from trauma suffered in their home country or on their journey to Australia, Pezzullo said.



“For this reason the department and its service providers support individuals with a range of specialist care options including mental health assessments and individualised care plans,” he said. “The department provides access to mental health nurses, counsellors, psychologists and psychiatrists to individuals transferred to Australia for medical care.



“The Nauru and Manus regional processing centres both have mental health care staff onsite, including mental health nurses, counsellors, torture and trauma counsellors, psychologists and a psychiatrist. There are also additional mental health care staff based at the Nauru Settlement clinic.”



• In Australia, the crisis support service Lifeline is on 13 11 14. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. Hotlines in other countries can be found here