1. Health Pathways for people living in Community Detention in Victoria
Last updated Mar 2013
Health Pathways for people living in Community Detention in Victoria

2. Sidney Myer Fund and William Buckland Foundation
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. Summary This presentation includes an overview of:
the Community Detention Program,
health services on Christmas Island and detention facilities,
health orientation and health supports for people in Community Detention,
information and contact details for International Health and Medical Services (IHMS) providers,
organisations who support people in Community Detention, and
resources and referral pathways.
CommunityDetention, Nov 2012

4. Definitions Asylum Seeker Refugee
An Asylum seeker is a person who has applied for a refugee protection visa
They are waiting for a decision on this application
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”
An asylum seeker is a person who has applied for a refugee protection visa and is awaiting a decision by the Commonwealth Department of Immigration and Citizenship (DIAC) or the Refugee Review Tribunal on this application.
In contrast a refugee is someone whose asylum claim has been successful. The claim can be made onshore in Australia or offshore (ie. when someone is living in a refugee camp or in precarious circumstances in a country of asylum).
A Refugee is someone who :
Owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion,
is outside the country of his/her nationality, and
Is unable to, or owing to such fear, is unwilling to avail himself/herself of the protection of that country
(United Nations 1951 Refugee Convention)
This presentation focuses on Asylum Seeker pathways when people are living in community detention.

5. Australian Humanitarian Program
13,759 visas were granted in (Increasing to 20,000 in )
intake included:
6,004 Refugee (offshore) category visas granted (including Women at Risk visas).
7,755 Other humanitarian visas, including
714 Special Humanitarian Visa ( SHP)
7,041 Onshore Visas granted (who have applied for protection in Australia)
The Humanitarian Program (takes in both on shore and off shore arrivals) in Australia. It is the total number of people who are granted visas on humanitarian grounds each year. It has recently been increased from 13,750 people in financial year to 20,000 in
Off Shore: 2 components to this program:
a)Off Shore - People identified as refugees by the UNHCR in need of permanent resettlement (Visa 200)
Also includes:
Women at Risk (Visa 204)
In Country Special Humanitarian (Visa 201)
Emergency Rescue (Visa 203)
b)Special Humanitarian Program (Visa 202)
People in a refugee like situation who are proposed by someone in Australia (SHP).
Onshore Those granted a permanent protection visa in Australia (Visa 866) having applied for asylum after arrival (by boat or air).
Arrival pathways
1) Entry into Australia with a valid document by air or sea.
Over stayers: tourists, students, business persons, etc.
2) Entry into Australia without a valid document.
People who arrive without a valid visa are mandatorily detained for health and security checks, for people that arrive by boat this commonly happens on Christmas Island.

6. Boat Arrivals Irregular Maritime Arrivals (IMAs)
Afghanistan, Sri Lanka, Iran and Iraq currently main countries of origin
In :
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
The country of origin for those seeking asylum in Australia changes in response to global events.
Over 85% of asylum seekers arriving by boat are men and boys on their own, women and children and unaccompanied female minors (UAM) complete the numbers.
It is common for people who are seeking asylum in Australia to have witnessed or personally experienced traumatic events, such as prolonged periods of deprivation, human rights abuses, the loss of loved ones or a perilous escape from their homeland. Some may have been subjected to severe physical and or psychological torture.
It is common for people to have been forced to leave behind close family members who continue to live in precarious circumstances which can have an ongoing impact on mental health.
Many of the people arriving by boat have experienced poor access to health care in their countries of origin and / or their first country of asylum.
Their experience in detention may have an effect on both their physical and mental health.

7. Location of detention facilities
This slide shows how many Immigration Detention Facilities and similar settings there are in Australia
They are defined by varying levels of security. Most people arriving in Australia by boat are initially processed on Christmas Island and can be moved to other detention facilities within Australia.
The health care facilities and provision of health within all detention environments are provided by International Health and Medical Services (IHMS)
Naru and Manas Island do not feature in this picture, there are people currently detained in both of those locations.

8. Average Time Spent in Detention
Period Detained
Total
% of Total
7 days or less 45
0.5%
8 days - 31 days
1104
12.2%
32 days - 91 days
3576
39.5%
92 days days
2648
29.2%
183 days days
763
8.4%
366 days days
171
1.9%
548 days days
161
1.8%
Greater than 730 days
591
6.5%
9059
100%
Length of Time in Detention as at 31 Dec 2012
The majority of people in Immigration Detention Centre's have arrived by boat
Some of the people in detention have arrived by air and may not be asylum seekers
Statistics from Dec 2012 show that there were 9059 people in Immigration detention.
The average period of people being held in Immigration Detention facilities has significantly decreased from 277 days (9 months) in November 2011 to 113 days (3.5 months) in May 2012.
Recently many more people are being released from detention into two different programs: 1) Community Detention and 2) on Bridging Visa Es' in the community whilst awaiting their application for protection visa. This presentation focuses only on the Community Detention.
Source: DIAC, Immigration Detention Statistics Summary, 31 December 2012

9. 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)
Mandatory Detention (including Community Detention)
Asylum seeker in the community; Bridging Visa A or
Bridging Visa E
Asylum seeker in the community; Bridging Visa E
Asylum seekers who arrive by boat are mandatorily detained initially on Christmas Island, then may be moved into Community Detention, another detention centre, released on a Bridging Visa E or released with a Permanent Protection visa if found to be a refugee.
Asylum seekers who arrive by air with a substantive visa are generally free to live in the community – and are issued with a Bridging Visa (typically A or E) whilst their claim is processed (or when their substantive visa expires). Those who arrive by air without documentation or do not comply due to other reasons may be detained.
People who receive permanent protection through applying onshore receive Visa 866, however sometimes people have compelling reasons to stay in Australia but do not meet the full criteria for a permanent protection Refugee visa, in these circumstances other visa’s may be issued. Other visas may have different entitlement, so it is important to check on the DIAC website for details.
THIS PRESENTATION FOCUSES ON THE PEOLE WHO ARE ARRIVING BY BOAT AND SEEKING ASYLUM AUSTRALIA
Permanent Protection
Visa 866
or granted a non humanitarian visa.
Repatriation to country of origin.
Permanent Protection
Visa 866 or another visa.
Repatriation to country of origin.

10. Community Detention (CD)
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Community Detention (CD)
CD is a form of immigration detention which allows people to reside in the community without an escort
Does not give a person any lawful status in Australia
Does not give the same rights and entitlements as person living in the community on a visa
People in CD are not allowed to work
Conditions include a mandatory requirement to report regularly to the Department of Immigration and Citizenship (DIAC)
Community detention was introduced in June 2005 and is a form of immigration detention that enables a person to reside in the community without needing to be escorted.
Community detention does not give a person any lawful status in Australia, ie they are still in detention.
It does not give them the rights and entitlements of a person living in the community on a visa.
Community detention clients are informed of their rights and arrangements on entry into the program.
Conditions include a mandatory requirement to report regularly to the Commonwealth Department of Immigration and Citizenship(DIAC) and reside at the address specified by the minister.
CommunityDetention, Nov 2012

11. Community Detention (CD) contd
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Community Detention (CD) contd
People are released from Immigration Detention to Community Detention following health, security and identity checks that occur in immigration detention facilities.
People in CD are often women and families, unaccompanied minors and men assessed as vulnerable.
Clients live in broader community in rented accommodation.
Community detention was introduced in June 2005 and is a form of immigration detention that enables a person to reside in the community without needing to be escorted.
Community detention does not give a person any lawful status in Australia, ie they are still in detention.
It does not give them the rights and entitlements of a person living in the community on a visa.
Community detention clients are informed of their rights and arrangements on entry into the program.
Conditions include a mandatory requirement to report regularly to the Commonwealth Department of Immigration and Citizenship(DIAC) and reside at the address specified by the minister.
CommunityDetention, Nov 2012

12. Access to Healthcare in Victoria
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Access to Healthcare in Victoria
The International Health and Medical Services (IHMS) is contracted by DIAC to provide health services to people in detention, including community detention
People in CD have access to health providers through IHMS
DIAC through IHMS will reimburse any Victorian Public Health services
IHMS has been contracted by DIAC to arrange and provide health services to people in immigration detention, including community detention.
IHMS has a network of health providers across the state of Victoria to provide necessary health services.
People living in CD have access to this network of providers
DIAC through IHMS will reimburse Victorian funded service providers on a fee-for service basis – (see slide 16 for detail.)
CommunityDetention, Nov 2012

13. 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
Immediately on arrival Public Health Screen
TB and other serious illness are considered
Chest X-ray
Within 72 hours post arrival
All clients over . 12years of age at Christmas Island hospital
Initial health Assessment within 72 hours
Medical History
Vital signs :weight ,height, blood sugar level
U/A, Beta HCG (BHCG) Test ( pregnancy test) for all women > 14years
Physical examination
Routine blood:. > 16years: Full Blood Count , Hepatitis B , Syphilis, Liver Function Tests ,and Urea and Electrolytes
Mental Health Assessment
Screened and assessed at induction and Mental Health team review and assessment within one week
Referred to mental health team/torture & trauma services as required Torture and trauma counseling
provided by CI hospital .
3 Monthly mental health check
Child Health Assessment
4-6 weeks post arrival
All babies, infants and pre-primary children referred to Maternal and Child Health Nurse at CI hospital
According to age on presentation, may include :
growth monitoring immunisation
developmental audiometry Eye testing
Antenatal Care
If pregnant antenatal bloods as per clinical guidelines and referral for antenatal check
Dental Health
If urgent direct referral to dental clinic at CI hospital
Child check up and treatment commenced 1-2 months post arrival
No other dental services provided
People who are in an Immigration Detention receive an initial health assessment , but receive no further medical follow up unless specifically requested by the client.
People may be transferred to another Immigration Detention Facility and health issues followed up as they arise.

14. Health Discharge Summary from health service at detention facility
Health summary provided to clients, Red Cross and AMES in large white envelope
Explanation in their own language of the importance of documents
Fitness to travel is completed
Advice given to client on ongoing /post-arrival health care needs when they leave immigration detention
Clients given health advice prior to leaving Christmas Island
Copy of health summary given to clients in a sealed envelope , ask client for this envelope on first consultation.
Note that often the client does not have this envelope. This may be, because they have misplaced it, do not understand they need to bring it to the medical appointment, or are not confident in giving their medical information to strangers. See Slide 21 for detail of IHMS to follow up if needed.
The summary should contain
Presentations to health service in immigration detention centre
Immunisation record
X-ray and pathology results
Diagnoses
Treatments and current medications
Bridging Visa E/OCt 2012
Refer to Asylum Seeker Fact Sheet for contact details

15. Housing and support services
Some organisations have direct contracts with Department of Immigration and Citizenship:
Red Cross
Anglicare
Mackillop Family Services
AMES
Wesley Mission
Life Without Barriers
Hotham Mission
Red Cross also sub contracts
Berry Street
Mackillop Family Services
Anglicare Victoria
AMES
Wesley Mission
Life Without Barriers
Hotham Mission
n       Some organisations have direct contracts with Department of Immigration and Citizenship (DIAC)
l       Red Cross
l       Anglicare Victoria
l       Mackillop  Family Services
l       AMES
l       Wesley Mission
l       Life without Barriers
l       Hotham Mission
Red Cross also has sub contracts with:
Please note that this list can change as more services are enlisted to work with CD clients.
CommunityDetention, Nov 2012

16. Housing and support services
Support agencies provide;
Housing
Income support
People that arrived before 13th of August receive 70% Centrelink benefits
People that arrived after 13th of August receive 60% Centrelink benefits
Case management
CommunityDetention, Nov 2012

17. Review
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People are released from Immigration Detention to Community Detention following health, security and identity checks that occur in immigration detention facilities.
People in CD are often women and families, unaccompanied minors and men assessed as vulnerable.
Legally still in detention, no visa status.
Have freedom of movement.
Clients live in broader community in rented accommodation.
CD services are managed by Australian Red Cross, AMES and other providers.
CD include housing, income support and case management.
People are released from IDC into CD following Health,Security and Identity check clearance completed by The Department of Immigration and Citizenship. (DIAC)
People most often released into CD are women and families, unaccompanied minors (People under 18years of age) and vulnerable men on their own .
Legally they are still considered as Asylum Seekers with no visa status, whilst they are awaiting their protection visa application.
People in CD have freedom of movement without being accompanied by an immigration officer.
The clients live in the broader community supported by Red Cross and other support agencies.
Houses are rented by the support agencies . Often accommodation is overcrowded and shared amongst families. This is particularly relevant when considering household contacts for diseases such as Hep B and TB.
People in community detention who arrived pre-August 13th, 2012 are provided with 70% of Centrelink benefits from the support agency. Clients who arrived post 13th August 2012 receive only 60% of Centrelink payments. The rental payment of the houses and case management .
CommunityDetention, Nov 2012

18. Healthcare for people in CD
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Healthcare for people in CD
Not eligible for Medicare.
Health services provided by International Health and Medical Services (IHMS).
Clients should carry IHMS card to identify status.
IHMS subcontracts General Practices to provide services to this group.
Specialist services need to have approval from IHMS to provide services (the wait for this approval can be lengthy).
The clients are Not eligible for Medicare: IHMS is contracted by The Department of Immigration and Citizenship (DIAC) to facilitate and pay for a specified range of health services.
Clients in this group should carry an IHMS card to identify themselves. The IHMS card means they do not need to pay for the GP services and other health services.
IHMS will pay for health services provided by a network of health providers via a subcontracting arrangement.
CommunityDetention, Nov 2012

19. Healthcare contd
People in CD have access to Victorian Department of Health hospital services. IHMS reimbursement funding is available for these services.
ALL services approved by IHMS are paid for by IHMS, not by the agency or the Victorian Government.
Support services will arrange first General Practice appointment.
People in CD will have completed a health check, ASK FOR THIS INFORMATION.
People in CD have access to Victorian Department of Health hospital services. IHMS funding available for these services.
Red Cross and support agencies facilitate initial health appointments
The detention and medical health summaries should be available either from the IHMS provider or from the clients. The health summary from detention is typically in a large white envelope with translated information for clients outlining the importance of the documentation.
CommunityDetention, Nov 2012

20. IHMS identity card Full cost recovery model from IHMS
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IHMS identity card
Full cost recovery model from IHMS
Sample client ID card
CD clients do not have entitlement to Medicare or Centrelink.
However a full cost recovery for health services can be accessed through IHMS – this typically requires approval prior to provision of service.
Verification of the persons status should occur through IHMS identity card as shown.
Sometimes people who are in CD do not have or are not carrying their card sometimes it is possible to use other documentation eg a letter of introduction from DIAC. .
The health services need to have a contracted agreement with IHMS to recover health costs. ( see slide 16).
CommunityDetention, Nov 2012

21. Health Telephone Support Line
IHMS 24 hour telephone hotline called the Community Detention Assistance Desk (CDAD).
The CDAD is staffed by IHMS admin staff as well as clinicians (nurses and doctors)
Assists service providers to access client’s medical history and details.  
Any IHMS provider can contact the hotline regarding CD clients, with the client's consent
Community Detention Assistance Desk
Phone:
case workers
health professionals
Fax: (02)
The International Health and Medical Service (IHMS) recently launched a 24 hour telephone hotline called the Community Detention Assistance Desk.(CDAD)
The CDAD is staffed by IHMS admin staff as well as clinicians (nurses and doctors)
 Any IHMS health provider can contact the hotline regarding CD clients.
CDAD phone:   health providers
case workers
Fax: (02)

22. Health services funding for CD Fee for service paid by IHMS
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Hospital admitted and non admitted patients
Ambulance
Primary and Community Health
General Practice
Immunisation services
Drugs and Alcohol
Pharmaceuticals
Mental Health
Aged support services
Aids and equipment
INTERPRETER SERVICES
Funded by IHMS
Specialist services, dental and optometry requires separate approval by IHMS & DIAC through client case manager
IHMS has contracted agreements and provides funding for community detention clients to visit GP practices and Community Health Centre's in Victoria.
IHMS should PROVIDE funding to health organization's who provide services to people in CD, as listed in slide.
While the Victorian Government has a directive to provide free public health services to Asylum Seekers. (See guide to Asylum Seekers access to health and community services in Victoria). Health services that provide services to people who are in Community Detention have access to funding from IHMS.
Specialist services, dental and optometry require approval from IHMS prior to consultation.
HEALTH ORGANISATIONS ARE REMINDED THAT ALL PEOPLE IN COMMUNITY DETENTION ARE FUNDED FOR HEALTH CARE BY THE IHMS.
YOUR HEALTH SERVICE IS ENCOURAGED TO REQUEST FUNDING REIMBURSEMENT FOR SERVICES
Torture & trauma counselling funded directly by DIAC.
CommunityDetention, Nov 2012

23. Billing arrangements with IHMS
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Contact Community Detention Desk: ph or
Invoices should be submitted to IHMS on last business day of each month.
Itemised GP notes need to accompany invoices
Services partnering with IHMS will receive training on how to be a provider
Josie MacCormack
IHMS Health Services Coordinator Victoria
Mobile:
Contact Community Detention Desk to organise billing arrangements with IHMS.
Itemised summary GP notes need to accompany invoices.
IHMS will train organisations on how to be a provider agency
(Do not need to present all invoice details below this is part of IHMS training for partner engagement)
Invoices must be in the form of a valid tax invoice and include the following information
The patient ID number listed on the IHMS Patient ID card.
Date of invoice.
Reference to revised MoU for the provision of health services for people in immigration detention under negotiation between DIAC and Victoria.
Details of the health services provider.
Description of services provided.
Name and date of birth of the CD client.
Timeframe in which the services were provided.
Itemized expenditure for the services provided.
If reimbursement for a direct expense is required ( for example accommodation or interpreting services ) a copy of the tax invoice paid by the Victorian state funded service provider , and
Account details for payment by electronic fund transfer (EFT) including
Invoice date
Account name
Bank details
ABN
BSB number
Account number
GST amount
CommunityDetention, Nov 2012

24. Health Orientation for people in Community Detention
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Health Orientation for people in Community Detention
People in Community Detention have minimal health services orientation.
Case worker arranges first GP appointment.
REMIND client to take Health Discharge Assessment to appointment.
Interpreters should be arranged by case worker funded by IHMS.
The Australian Red Cross, AMES,Hotham Mission,Life Without Barriers and other local service providers are contracted through DIAC to provide case work to people in CD.
Minimal health services orientation provided to clients on arrival into community detention.
Case management services should arrange the first GP appointment and provide support to attend the appointment and other health services.
The client should be reminded by case workers to take the health discharge assessment provided by IHMS services on Christmas Island with them to the GP appointment.
INTERPRETERS SHOULD BE ARRANGED THROUGH TRANSLATING AND INTERPRETING SERVICES (TIS ) BY THE CASE WORKER. FUNDING REIMBURSMENT FOR INTERPRETERS PROVIDED BY IHMS .
Access TIS website for further information
Access Asylum Seeker Fact Sheet for more in depth community support arrangements.
CommunityDetention, Nov 2012

25. Coordinating Care Role of Community Detention Service Provider
Assist clients to make first GP appointment.
Encourage independent access to GP appointments
then
Submit Care Plan and amendments to DIAC
Community Detention Service Provider
Contact IHMS for general enquiries on client’s behalf
Role of the Community Detention Service Provider
The CDSP will assist clients to make GP appointments.
They are available to contact IHMSto make general enquiries.
They will attend medical appointments with the client until they are capable of doing so on their own
They will submit care plans and any amendments to DIAC.
CommunityDetention, Nov 2012

26. Pathways from community detention
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Asylum Seekers in Community Detention
Visa application not yet resolved however person no longer needs to be in community detention
Failed visa application
Found to meet criteria for visa
Clients returned to Immigration Detention Centre or to their country of origin
Asylum Seeker on
Bridging Visa E (BVE)
Medicare eligible
No Work rights if arrived after 13 Aug 2012
* See BVE PowerPoint
Protection Visa 866
Medicare eligible
or alternate visas which may have different entitlements
When people are released from community detention they can be released on a variety of visas, the most common are:
Bridging Visa E (BVE)
Permanent Protection Visa 866
Some people in community detention fail in their application for a visa and can either be returned back to Immigration detention Centre's or returned to their country of origin.(to date this is a very small number )
Bridging Visa E : PLEASE NOTE A MORE COMPREHENSIVE BREAKDOWN OF ELIGILBLITY AND COMMUNITY SUPPORT PROVIDED IS AVAILABLE IN SECOND PRESENTATION CONCERNING BRIDGING VISAS .
Also a breakdown of Asylum seeker information and eligibility available on the Asylum Seeker Fact sheet
CommunityDetention, Nov 2012

27. 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 practitioners.
Specialist Hospital services. GP referral only.
Foundation House counseling
All details on :
The Refugee Health Nurses
The Refugee Health Nurses play a crucial role in working directly with refugee communities,supporting timely access to health assessment, optimal care co-ordination and advising other health practitioners on refugee health matters. They are now located in 16 community health services in in areas of significant refugee settlement in metropolitan and rural Victoria. 
Referral contact details available on Refugee Health Fellows
A pediatrician and GP are currently the Refugee Fellows based in Victoria. They provide education and support to GPs and specialists who see refugees in their practice. With a focus on outer metropolitan ,rural and regional Victoria,the program assists practitioners to respond to the health needs of their refugee patients. They are available by telephone for consultation
Referral contact details are available on Specialist Refugee & Immigrant Health Clinics GP Referral Only 
There are specialist refugee clinics available in the acute and primary care sector. Refugee clients are seen in a timely and appropriate setting in these clinics with access to interpreters .
Referral contact details available on
Foundation House
Specialist torture and trauma service that provides T and T counseling. Training for health services and asylum seeker support agencies. Research and health sector development support and programs.
Victorian Department of Health web site for further info
Community Detention/Oct 2012
CommunityDetention, Nov 2012

28. Extra resources http://refugeehealthnetwork.org.au
18/01/2019
Victorian Refugee Health Network
The Victorian Refugee Health Network Asylum Seeker fact sheet
Red Cross Fact Sheet Community Detention
Department of Immigration and Citizenship(DIAC) fact sheet community detention
More in depth handouts are recommended to accompany this slide presentation
These can be accessed on the above websites.
The Bridging Visa E Health Pathways are described in the second presentation of this series.
For any queries re this resource please contact Lindy Marlow
CommunityDetention, Nov 2012

29. Extra resources contd DIAC Boat Arrivals information
18/01/2019
DIAC Boat Arrivals information
Queries to DIAC about community placement of people in detention
DIAC information about the process for protection assessment
More in depth handouts are recommended to accompany this slide presentation
These can be accessed on the above websites.
The Bridging Visa E Health Pathways are described in the second presentation of this series.
For any queries re this resource please contact Lindy Marlow
CommunityDetention, Nov 2012

30. Glossary Asylum Seeker Assistance Scheme ASAS
Adult Multicultural Education Services
AMES
Bridging Visa E
BVE
Christmas Island CI
Community Assistance Support
CAS
Commonwealth Department of Immigration and Citizenship
DIAC
Community Detention Services
CDSP
Community Detention CD
Irregular Maritime Arrivals
IMA
Permanent Protection Visa
PPV
Special Humanitarian Program
SHP

31. 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