2. This project was commissioned by Foundation House Research and Policy Program who would like to acknowledge their funders the Sidney Myer Fund and William Buckland Foundation

3. Health Pathways for Asylum Seekers on Bridging Visa E (BVE) What are Bridging Visas and how do asylum seekers on BVEs access health care in Victoria? Last updated July 2013

4. Summary of Slides  Overview and definition of BVE  Income/housing and case work support  Health Services on Christmas Island and other Detention facilities  Health services provision and supports  Resources available

5. Definitions Asylum Seeker An Asylum seeker is a person who has applied for a refugee protection visa They are waiting for a decision on this application Refugee A refugee is someone whose asylum claim has been successful and who has received a refugee protection visa Refugee protection visas are granted if someone is found to have “a well founded fear of persecution on the grounds of race, religion, nationality or membership of a particular social group or political opinion”

6. Australian Humanitarian Program 20,003 humanitarian visas were granted in 2012-13 2012-13 intake included: 12,512 offshore visas were granted (including Refugee, Emergency Rescue, Global Special Humanitarian and Women at Risk visas). 7,491 onshore visas were granted (to people who have applied for protection in Australia)

7. Boat Arrivals Irregular Maritime Arrivals (IMAs)  Afghanistan, Sri Lanka, Iran and Iraq currently main countries of origin  In 2011-12:  85% people that arrive by boat were men or boys on their own*  17% of people that arrive by boat were unaccompanied minors*  Torture and trauma experiences are common  May have had poor access to previous health care  People who arrive in Australia without a valid visa are placed in mandatory detention  Time in detention can affect health outcomes *DIAC Annual Report 2011-12

8. Location of detention facilities

9. Average Time Spent in Detention Period DetainedTotal% of Total 7 days or less450.5% 8 days - 31 days110412.2% 32 days - 91 days357639.5% 92 days - 182 days264829.2% 183 days - 365 days7638.4% 366 days - 547 days1711.9% 548 days - 730 days1611.8% Greater than 730 days5916.5% Total9059100% Length of Time in Detention as at 31 Dec 2012 Source: DIAC, Immigration Detention Statistics Summary, 31 December 2012

10. Permanent protection in Australia Arriving by boat or plane – asylum pathways Non Irregular Maritime Arrivals (Non IMAs) arrive by air with a valid visa and subsequently apply for protection People who have arrived by boat (IMA) (and those that arrive by plane without a valid visa) Asylum seeker in the community; Bridging Visa E Permanent Protection Visa 866 or another visa. Asylum seeker in the community; Bridging Visa A or Bridging Visa E Permanent Protection Visa 866 or granted a non humanitarian visa. Mandatory Detention (including Community Detention) Repatriation to country of origin.

11. Criteria for Bridging Visa E Moving out of detention Case by case consideration Initial checks including health, security and identity are completed Behaviour and co-operation with DIAC are taken into consideration Some circumstances Unaccompanied Minors (UAM) move from Community Detention to BVE Bridging Visa E/OCt 2012

12. What is a Bridging Visa E(BVE)?  A BVE is a Temporary Visa that is held by Asylum seekers whilst they are awaiting the result of their claim for permanent protection in Australia  People on BVEs can remain lawfully within Australia  Asylum seekers who arrived in Australia by boat prior to 13 August 2012 are allowed to work in Australia (work rights) and are Medicare eligible. (work  Medicare  )  Asylum seekers who arrived in Australia by boat on or after 13 August 2012 have NO work rights, but are Medicare eligible. (work  Medicare  )

13. Bridging Visa E(BVE) contd  BVE holders live in the community following health, security and identity checks.  BVE holders are typically men on their own, as unaccompanied minors, women, families and more vulnerable men are placed into the Community Detention program.

14. How long are BVEs granted for?  BVEs remain in effect while a person’s permanent protection case is being resolved  Length of BVE may vary  BVE holders are expected to abide by all visa conditions  If they fail to abide they are liable for visa cancellation and risk being returned to detention Bridging Visa E/OCt 2012

15. What happens once a person is released from detention onto a BVE?

16. Transitional CAS First 6 weeks of support in the community  CAS stands for Community Assistance Support.  Transitional CAS is provided by Red Cross or AMES in Victoria for 6 weeks.  Up to 600 clients per month are entering this program in Victoria.  Clients are directly referred from the Department of Immigration and Detention (DIAC) to this program  Group orientation and individual case work support  Income support including living allowance and rent assistance (equivalent to 89% of Centrelink payments)

17. Transitional CAS contd First 6 weeks of support in the community  Housing support: emergency short term accommodation for clients who are unable to stay with community links - then support to access the private rental market.  Health and welfare support  PBS prescription medication eligibility  After six weeks people are then assessed by DIAC, who determine ongoing support options  Clients circumstances are regularly reviewed

18. Support following initial six weeks During the fifth week of transition DIAC assess clients’ ongoing needs post 6 weeks. Following the initial support by Transitional Community Assistance Support stream DIAC could refer to: Community Assistance Support (CAS) as an ‘ongoing’ client Asylum Seekers Assistance Scheme (ASAS) No Program – this is where clients do not meet the eligibility criteria for either CAS Ongoing or ASAS or are able to provide for themselves so receive neither CAS or ASAS

19. Asylum Seeker Assistance Scheme (ASAS)  ASAS is administered by the Australian Red Cross and AMES.  Support through ASAS can include: Financial support Referral for basic health, welfare support and torture and trauma counseling Case work support Clients who have been previously assessed as NOT requiring CAS or ASAS by DIAC can self- refer to ASAS Bridging Visa E/OCt 2012

20. CAS Ongoing Eligibility criteria:  On a bridging visa  Serious physical or mental health issue  Elderly and unable to support self  Serious family issues Support includes;  case work support  financial assistance (89% of Centrelink)  medicine  material aid  referral to other services including torture and trauma counselling

21. Can people on BVEs choose where they live?  BVE holders can choose where they live.  DIAC approval is required to move between states in the first 6 weeks after being released from detention  BVE holders are required to advise DIAC of where they live and when they change address  BVE holders have no access to public housing so use private rental market  In many cases BVE holders live with family or friends in overcrowded circumstances  BVE holders are eligible for DHS transitional emergency accommodation

22. Review  Some asylum seekers are released from detention facilities on a BVE (Bridging Visa E).  These people live in the community following health, security and identity checks.  Typically BVE holders are men on their own.  BVE holders receive 6 weeks financial support through the Transitional Community Assistance Support scheme  After a six week period people are reliant on finding housing in the private rental market unless assisted by CAS/ASAS.

23. Health screen on Christmas Island Provider: International Health and Medical Services (IHMS)  Screened for TB and other serious illness immediately on arrival  Chest X rays  Initial Health Assessment  Mental Health Assessment  Child Health Assessment  Well women’s check  Antenatal care  Dental care  No further medical tests unless requested by client People may be transferred to another Immigration Detention Facility and health issues followed up as they arise.

24. Health Discharge Summary from health service at detention facility  Fitness to travel is completed  Advice given to client on ongoing /post-arrival health care needs when they leave immigration detention  Health summary provided to clients, Red Cross and AMES in large white envelope  Explanation in their own language of the importance of documents Bridging Visa E/OCt 2012

25. Transfer of health information for people with mental health issues Especially relevant for people who are on - anti– depressants, anti-anxiety meds, sleeping tablets and pain killers. Information on medical condition contained in health summary. Client should be given up to 14 days medication on departure from detention. Bridging Visa E/OCt 2012

26. Health Telephone Support Line IHMS 24 hour telephone hotline called the Community Detention Assistance Desk (CDAD). Queries about BVE client’s health discharge and transitional information can be directed to the CDAD desk. The CDAD is staffed by IHMS admin staff as well as clinicians (nurses and doctors) Community Detention Assistance Desk Phone: 1800 725 518 case workers 1800 689 295 health professionals Fax: (02) 9086 9875 Email: cdad@ihms.com.au

27. On arrival in Victoria  Basic health orientation by Red Cross and AMES on arrival in Melbourne  In some areas a more extensive health triage and referral process in place by health professionals -Health orientation talk by health professionals -Initial triage and referral -Case work support to follow up appointments provided by Red Cross and AMES

28. Access to health services for BVE holders Medicare eligible regardless of protection visa process Access to Victorian Department of Health funded public health services All BVE holders informed of their eligibility Specialist health care - some clients eligible under ASAS and CAS program for further assistance Clients recommended to carry their interim Medicare cards with them at all times Pharmaceuticals – reimbursement to rate of Health Care Card holders (if they are receiving ASAS and CAS)

29. Health Services which BVE holders can access  Hospitals  Ambulance  Primary and Community Health  General Practice  Immunisation services  Drug and Alcohol  Pharmaceuticals  Mental Health  Torture and trauma counselling services  Aged Support services  Aids and equipment  Sexual health services

30. Other services DentalFree access to public Dental services. Asylum seekers who are BVE holders recognised as a priority population as documented by DH policy. Do not require a healthcare card OptometryFree access to public optometry services. The Australian College of Optometry (ACO). Cost for glasses? Recently ACO will provide free testing to people WITHOUT Medicare card. Allied Health Allied Health services based in community health, CH Fee policy applies. Fees can be waivered according to client’s financial circumstances. Have priority access

31. Bridging Visa E Overview of access and rights Work rightsNO – those who arrived after 13 Aug 2012 YES – those who arrived prior to 13 Aug 2012 Medicare eligibilityYES Provision of Pharmaceuticals YES – ASAS and CAS will reimburse to health care card level. NO – if not receiving ASAS or CAS Torture and Trauma Counselling YES HousingInitial transitional housing for 6 weeks and then assistance to find private rental. FinancialNo Centrelink. If eligible for CAS or ASAS income support equivalent to 89% of Centrelink payment.

32. Other Health Supports Refugee Health Nurses in Community Health Services can provide support for assessment and referral. Refugee Health Fellows can provide clinical advice and training for health services. Specialist Hospital services. GP referral only. Foundation House torture and trauma counseling All details on: www.refugeehealthnetwork.org.au

33. Health pathway for people on Bridging Visa E Health checks on arrival at Christmas Island Primary health services in detention on request from client Health summaries provided by IHMS to clients, Red Cross or AMES Health assessment & care by GP & Refugee Health Nurse in community Medicare eligible Follow up as required Primary health Specialist health Mental health Torture and Trauma counselling Sexual health Vision Oral health Detention CentreIn the community

34. Extra resources Asylum Explained; Asylum Centre Resource Centre http://www.asylumexplained.asrc.org.au/?page_id=916 Victorian Refugee Health Network http://www.refugeehealtnetwork.org.au Asylum Seeker fact sheet; Victorian Refugee Health Network website http://www.ergpa.com.au/images/_uploads/20120622_fas_asy lum_seeker_final.pdf Asylum Seeker Assistance Scheme (ASAS); Australian Red Cross http://www.redcross.org.au/asylum-seeker-assistance- scheme.aspx Community Assistance Support (CAS); Australian Red Cross http://www.redcross.org.au/files/20120816_CAS_FACTSHEE T.pdf

35. Extra resources contd Community Assistance Support;(CAS) Transitional Support; Australian Red Cross http://www.redcross.org.au/files/20120816_CAST_FACTSH EET.pdf Asylum Seeker Dental access policy ;Department of Health http://www.health.vic.gov.au/dentistry/downloads/eligibility_p riority_access_policy.pdf Refugee Oral Health Fact sheet ; Victorian Refugee Health Network website http//www.refugeehealthnetwotk.org.au DIAC; Boat Arrivals information http://www.immi.gov.au/ima/ Promoting Refugee Health Guide, Victorian Refugee Health Network website http://www.refugeehealthnetwork.org.au

36. Glossary Asylum Seeker Assistance SchemeASAS Adult Multicultural Education ServicesAMES Bridging Visa EBVE Christmas IslandCI Community Assistance SupportCAS Commonwealth Department of Immigration and Citizenship DIAC Community Detention ServicesCDSP Community DetentionCD Irregular Maritime ArrivalsIMA Permanent Protection VisaPPV Special Humanitarian ProgramSHP

37. All care has been taken to ensure that the information in this presentation is correct (as at Feb 2013). If any errors are identified or you have other queries please contact info@refugeehealthnetwork.org.au