New data from Médecins Sans Frontières shows extremely high rates of suicidal ideation and suicide attempts on the island

The island nation of Nauru is in the grips of a mental health crisis, according to new data from Médecins Sans Frontières, revealing that its Nauruan and refugee patients showed similar levels of mental illness far worse than other MSF projects around the world.

It found stigma and a lack of understanding of mental illness was leading to poor healthcare for both cohorts, but that Nauruan patients were improving under MSF treatment while refugees and asylum seekers did not.

Rates of suicidal ideation and suicide attempts among the refugees and asylum seekers were exacerbated by family separation, violence they experienced on Nauru – including violence allegedly inflicted by authority figures – and by prior detention on Christmas Island, the report also said.

The report from the international medical non-governmental organisation, released on Monday, rated the severity of mental illness using the Global Assessment of Functioning scale, measuring the impact of symptoms on everyday life, from one to 100.

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GAF scores above 70 are considered healthy, and other MSF projects treating severe mental illness report averages of about 60. But the median GAF score for MSF’s Nauruan patients was just 35, and for the asylum seeker and refugee patients it was 40.

“MSF’s data shows that Nauru is in the grip of a mental health crisis,” the report said. “The mental health suffering on Nauru is among the most severe MSF has ever seen, including in projects providing care for victims of torture.”

The NGO was contracted by the Nauru government to deliver mental health services to Nauruans and to the asylum seeker and refugee population at the end of 2017.

But the relationship deteriorated and the government abruptly kicked the doctors off the island in October. MSF subsequently publicly criticised conditions on the island, and Nauru accused the organisation of “conspiring against” it.

According to Monday’s report, in its 11 months of operation MSF provided 285 initial mental health assessments and 1,847 follow-up sessions. It said 73% of the patients were asylum seekers or refugees, and 22% were Nauruan. The group ranged from under one year old to 74, and had an average age of 32.

The low GAF score for Nauruans was attributed to high rates of untreated psychosis, Monday’s report said. Almost half of the 60 Nauruan patients were suffering psychosis, and 20% were identified as needing psychiatric hospitalisation, something that was unavailable for them.

“A total of 17 (27%) of MSF’s Nauruan patients appeared to have been neglected in term of medical care, mainly due to a lack of available mental healthcare prior to MSF’s arrival,” it said. “Almost one-third of Nauruan patients reported having experienced traumatic events, particularly domestic violence and sexual violence.”

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More than half of MSF’s Nauruan patients recorded improvements in their mental health GAF scores with treatment, but only 11% of the refugee and asylum seeker patients improved, despite receiving the same quality of care, MSF said.

“This illustrates that living under a policy of indefinite processing creates a perpetual state of despair, making it impossible for asylum seekers and refugees to recover,” said MSF Australia’s president, Dr Stewart Condon.

Almost one-third of their asylum seeker and refugee patients had attempted suicide, 60% had suicidal thoughts, and 12 patients were diagnosed with the rare disorder resignation syndrome.

Those who were split from family members by medical evacuations to Australia were 40% more likely to be suicidal, the report added. It said refugees and asylum seekers who had been detained on Christmas Island during their attempt to get to Australia were more likely to have attempted suicide.

Almost a quarter said they experienced violence on Nauru, and the data showed they were “significantly more likely” to need psychiatric hospitalisation, MSF said, although this wasn’t always possible owing to a shortage of beds.

MSF added that “disturbingly” 11% reported violence at the hands of authorities, including immigration and Australian Border Force officials.

The most common diagnosis was moderate or severe depression – found in 62% of the patients, followed by anxiety and post-traumatic stress disorder.

The report said 75% reported experiencing traumatic events in their country of origin and/or during their journey.

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In the 11 months of MSF’s time on Nauru, the mental health of the asylum seeker and refugee cohort significantly declined, coinciding with a surge of negative responses to applications for US resettlement, it said.

“The issue of ‘indefiniteness’ – that there is no timeframe for the detention process – has a strong impact on my patients’ mental health,” said MSF psychiatrist, Dr Patricia Schmid.

“They tell me that even prisoners have a sentence – they know when they will be released, they can plan their lives. My patients don’t have that. So they fear for the future, they are completely hopeless.”

Upon their return to Australia in October MSF staff spoke out against Australia’s offshore processing regime. The organisation revealed the high rates of severe mental illness among the refugee and asylum seeker population, and called for an immediate evacuation.

There are fewer than 10 refugee and asylum seeker children left on Nauru after the Australian government faced court action, internal pressure and widespread public campaigns to bring the kids to Australia for medical care.