Exclusive : IHMS report reveals suicide attempts and hunger strikes common and children in offshore detention vulnerable to mental health episodes

This article is more than 5 years old

This article is more than 5 years old

Asylum seekers held offshore are continuing to self-harm, attempt suicide and go on hunger strike, and grow more depressed the longer they are held on Manus and Nauru, new data from International Health and Medical Services reveal.

Children suffer especially acutely, from bed wetting, nightmares, ongoing effects of trauma and torture in previous countries, as well as “situational crisis” from their current detention, IHMS reports.

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They are particularly at risk of violence in family conflicts.



The International Health and Medical Services quarterly health report from October-December 2014, released by the immigration department under freedom of information, shows that depression remains one of the most significant illnesses for people held offshore, and that mental health deteriorates sharply after several months in detention.



The health report is the collation of health data, including primary health, medications, vaccinations, communicable diseases, disabilities and mental health.

The report shows 57% of adults and 44% of children in offshore detention required the attention of a mental health nurse in the three-month reporting period. Asylum seekers also had appointments with counsellors, psychiatrists and psychologists in significant numbers.

Depression was the second-most commonly diagnosed chronic disease diagnosed by doctors, after oral disease.

Doctors diagnosed 22% of adults, and 17% of children with a psychological condition.

The IHMS report, delivered to the Department of Immigration and Border Protection, reports asylum seekers continue to commit acts of self-harm, attempt suicide and go on hunger strike, refusing all food and water.



“IHMS has seen some incidents of self-harm and FFR [food and fluid refusal] on Nauru during this time ... Manus has also reported a number of self-harm incidents and presentations with acute psychosis which have required movement off-site.”

An increase in pathology referrals was attributable, in part, “to self-harm incidents where soap powder and insect repellent ingestion required repeated investigation and monitoring”.

Children are especially vulnerable to mental health episodes of their own, and within their family.

An IHMS-employed child psychiatrist who visits Nauru runs support groups for children in conjunction with counsellors and psychologists. “The minors are seen due to a variety of triggers, including previous trauma and torture, enuresis, nightmares, family conflict and situational crisis,” the report says.

“Domestic violence appears to have increased and during protest activity during September/October. Children were threatened with violence by parents which required extensive support and management by the mental health team.”

Asylum seekers’ own assessment of their mental health shows a sharp deterioration the longer they are held in detention.

The Kessler Psychological Distress Scale, also known as K10, is a self-rated instrument widely used in Australia and internationally to gauge a person’s anxiety and depressive symptoms.

Twenty-three per cent of offshore asylum seekers rated moderate or severe distress on the K10 scale, nearly twice the rate in the Australian community, which reported 12% of people rating in the two highest-distress categories.

“This is a significant percentage of the total population,” IHMS said of the offshore detention K-10 figure, “and ... likely to be due to a combination of factors including the relative time in detention, morbidities in the transferee population which make them predisposed to heightened distress when faced with hopelessness, and apprehension about their future.”

But serious mental distress among those held offshore is likely to be under-reported, IHMS warned.

“It should be noted that their participation in K10 screening is voluntary and that those with higher levels of distress are probably less likely to participate in screening, meaning that this percentage is likely an underestimate.”



Asylum seekers are particularly vulnerable around significant anniversaries, the report noted.

In December 2014, four asylum seekers detained on Manus Island sewed their lips together in protest at being held on the island for more than a year

“There may be a relation between the higher incidence of depression noted in the male population and the Bravo cohort on Nauru, who in September/October reached the 24 month milestone on island. This would be consistent with previous findings.”

In addition to mental health statistics, the previously unseen data reports paint a comprehensive picture of asylum seeker health on Manus and Nauru.



The asylum seekers in offshore detention range from zero years of age to 76. On average, every asylum seeker in offshore detention makes three appointments to see a health professional every month.

“Self-reporting of pain for chronic medical conditions along with large numbers of somatisation disorder” contribute to the high number of GP consultations. Somatisation disorder happens when someone feels extreme anxiety about physical symptoms such as pain or fatigue.

There were cases of malaria and tuberculosis during the three reporting months, and an outbreak of hand, foot and mouth disease among children on Nauru which required some to be isolated.

“The two main reasons for transferees seeking medical attention in this quarter are digestive and musculoskeletal conditions,” the report says. “There is some thought that in relation to digestive complaints an element of somatisation could account for this ongoing trend. Due to the terrain in Nauru and also previous reported injuries, IHMS continues to see a high presentation of musculoskeletal conditions particularly of note this quarter a rising incidence of back and knee pain.



“There remains a common complaint about sleeping surfaces and walking on uneven rocky surfaces, which may contribute to some presentations. On Nauru, this has also been reflected in a small number of injuries to stakeholders.”

Poor dental health, resulting largely from poor dental health before entering detention, has been countered by the addition of dentists’ services on the islands. IHMS also provides optometry services.



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A spokeswoman for IHMS said there were regular, structured reviews of asylum seekers’ mental health on arrival and from six months onwards.

“However, most mental health issues are identified by self-reporting or by referrals, including where anyone notices and reports possible behaviour of concern. When mental health issues are identified, a thorough assessment is performed by mental health clinicians and a management plan instituted.

“Both IHMS and other stakeholders endeavour to be alert to mental health issues, abnormal behaviour and possible self-harm behaviour. If issues are identified, a full mental health assessment is undertaken and, if there is the potential for self-harm, the supportive monitoring and engagement (SME) program.”

IHMS has faced intense scrutiny over its healthcare of asylum seekers after a Guardian Australia investigation revealed the company consistently failed to meet targets, included incorrect data in reports, and admitted it was “inevitable” fraud would be committed as it tried to meet government standards.

IHMS staff were encouraged to “grab from the excuse bag” if care standards weren’t met.