Transcript Dr Madelyn Hicks, MD, MRC Psych, Institute of Psychiatry, King`s

Mental Health Effects of
Detention for Asylum Seekers
and Refugees
Dr. Madelyn Hicks, MD, MRCPsych.
Member of Physicians for Human Rights. Honorary Lecturer at
the Institute of Psychiatry, King’s College London, UK.
Mental Health Effects
• Depression
• Anxiety Disorders
• PTSD (Post-Traumatic Stress Disorder)
• Suicide & Self-harm: thoughts and
attempts
• Disability
Vulnerability
The Detention Experience
A 9-year-old’s experience of life in a detention centre.
From: ‘Seeking refuge, losing hope: parents and children in
immigration detention’, by Mares et al. Australasian Psychiatry, 10:
91-96. 2002.
Prevalence of Mental Health Problems
Survey of 33 detainees (Sultan
& O-Sullivan, 2001)
• 85% chronic depression
• 65% suicidal thoughts
• 39% paranoid delusions
• 21% psychosis
Survey of 70 detainees (PHR,
Keller et al., 2003)
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86% depression
77% anxiety
50% PTSD
26% suicidal thoughts
2 attempted suicide
Longer detention
more
symptoms.
• Improved if released, but
most still with high distress.
Effects of the Detention Experience
241 former detainees (Steel et al., 2006)
• Detention itself increased:
• Detention-specific PTSD
symptoms:
– PTSD
– Depression
– MH-related Disability
• Independent of other
factors (e.g. pre-detention
trauma).
• Longer detention
worse
mental health
– 74% extremely sad and
hopeless thinking about
detention.
– 41% with nightmares of
things that happened during
detention.
• Effects persist 3 years later.
10 families after 2 years of detention (Steel et
al, 2004)
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Adult rate of psychiatric disorder by 3 times.
Child rate of psychiatric disorder by 10 times.
Exposure to trauma in detention was common
PTSD from detention-specific trauma:
– 100% in adults
– 93% in children
• After detention, 92% of parents felt (newly)
unable to care for their children.
Child Detainee Mental Health
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•
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Loss of skills (e.g. language, enuresis)
Delayed development
Separation anxiety, disrupted conduct
Social withdrawal, loss of normal play, mutism
Poor sleep, nightmares, night terrors
Eating poorly, weight loss
Suicidal thoughts, self-harm, suicide attempts
Suicide in Detention
• Of Adults Detained >6 months (Steel et al. 2006):
– 68% saw people making suicide attempts
– 65% saw people engage in self-harm.
• Child detainees reported high distress (Steel et al. 2004):
– 100% from seeing people self-harm
– 100% from seeing people attempt suicide
• Suicide rates (Cohen, 2007):
– 211 / 100,000 in UK detained asylum seekers (2003-2005).
– Suicide rate is higher than UK mainstream prisoners (122 /
100,000) and UK national rate (9 / 100,000).
Summary Points
• Already vulnerable.
• Detention itself:
– Traumatises.
– Causes & worsens mental illness.
– Impairs later social function and social integration.
• Longer detention
worse mental health.
• Impairment often long-term, even if detention brief.
• Children & Adults
• Children
Depression, PTSD, Suicidality.
impaired cognitive & physical development.
References
Coffey GJ, Kaplan I, Sampson RC, Tucci MM. The meaning and mental health consequences of
long-term immigration detention for people seeking asylum. Social Science & Medicine 40:
2070-2079. 2010.
Cohen J. Safe in our hands?: a study of suicide and self-harm in asylum seekers. J Forensic and
Legal Medicine 15: 235-244. 2008.
Ichikawa M, Nakahara S, Wakai S. Effect of post-migration detention on mental health among
Afghan Asylum seekers in Japan. Australian and New Zealand J of Psychiatry 40: 341-346.
2006.
Keller AS et al. Mental health of detained asylum seekers. Lancet 362: 1721-1723. 2003.
Lorek A et al. The mental and physical health difficulties of children held within a British
immigration detention center: a pilot study. Child Abuse & Neglect 33: 573-585. 2009.
Mares S, Jureidini J. Psychiatric assessment of children and families in immigration detention –
clinical, administrative and ethical issues. Australian and New Zealand J of Public Health 28:
520-526. 2004.
Mares S, Newman L, Dudley M, Gale F. Seeking refuge, losing hope: parents and children in
immigration detention. Australasian Psychiatry 10: 91-96. 2002.
Newman LK, Steel Z. The child asylum seeker: psychological and developmental impact of
immigration detention. Child and Adolescent Psychiatric Clinics of North America 17: 665683. 2008.
References Continued
Physicians for Human Rights and The Bellevue/NYU Program for Survivors of Torture. From
Persecution to Prison: The Health Consequences of Detention for Asylum Seekers. Cambridge,
Massachusetts: Physicians for Human Rights. 221 pages. 2003.
Physician for Human Rights. Punishment before Justice: Indefinite Detention in the US.
Cambridge, Massachusetts: Physicians for Human Rights. 45 pages. 2011.
Physician for Human Rights. Dual Loyalties: The Challenges of Providing Professional health Care
to Immigration Detainees. Cambridge, Massachusetts: Physicians for Human Rights. 32 pages.
2011.
Robjant K, Hassan R, Katona C. Mental health implications of detaining asylum seekers: systemic
review. British J of Psychiatry 194: 306-312. 2009.
Silove D, Austin P, Steel Z. No refuge from terror: the impact of detention on the mental health of
trauma-affected refugees seeking asylum in Australia. Transcultural Psychiatry 44: 359-393.
2007.
Steel Z et al. Impact of immigration detention and temporary protection on the mental health of
refugees. British J of Psychiatry 188: 58-64. 2006.
Steel Z, Momartin S, Bateman C, Hafshejani A, Silove DM. Psychiatric status of asylum seeker
families held for a protracted period in a remote detention centre in Australia. Australian and
New Zealand J of Public Health 28: 527-536. 2004.
Sultan A, O’Sullivan K. Psychological disturbances in asylum seekers held in long term detention: a
participant-observer account. Med J Austr 175: 593-596. 2001.
Dr. M. Hicks, Presentation to UNHCR, Brussels, 16 November 2011. Email: [email protected]