1. 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.

2. Mental Health Effects Depression Anxiety Disorders PTSD (Post-Traumatic Stress Disorder) Suicide & Self-harm: thoughts and attempts Disability

3. Vulnerability The Detention Experience

4. 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.

5. 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) 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.

6. Effects of the Detention Experience 241 former detainees (Steel et al., 2006) Detention itself increased: – PTSD – Depression – MH-related Disability Independent of other factors (e.g. pre-detention trauma). Longer detention worse mental health Detention-specific PTSD symptoms: – 74% extremely sad and hopeless thinking about detention. – 41% with nightmares of things that happened during detention. Effects persist 3 years later.

7. 10 families after 2 years of detention (Steel et al, 2004) 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.

8. Child Detainee Mental Health 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

9. 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).

10. 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 Depression, PTSD, Suicidality. Children impaired cognitive & physical development.

11. 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: 665- 683. 2008.

12. 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: MJHHicks@aol.com