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Psychological impact of detention on children

HREOC's National Inquiry into Children in Immigration Detention
 Hearing with Dr Jon Jureidini

Dr Jon Jureidini, Department of Psychological Medicine, Women's and Children's Hospital.

Excerpt from Transcript of Hearing, Adelaide, Tuesday, 2 July 2002, Human Rights and Equal Opportunity Commission (HREOC).


DR OZDOWSKI: In your professional expertise what is the overall impact of detention on the mental health of children?

DR JUREIDINI: Well, I mean, on the day that I visited it was the day after the United Nations had been there and it was climatically a beautiful day, so I don't think anybody has seen Woomera in better circumstances than I saw it and nevertheless I was completely horrified by what I saw. If I were to set out to design an environment hostile to child development I don't think I could have done better than what I saw there.

MS LESNIE: Could you explain what elements brought you to that conclusion?

DR JUREIDINI: The cognitively impoverished conditions, the environment

MS LESNIE: Sorry, what does that mean?

DR JUREIDINI: Well, just there's nothing there for children to play with, to interact with, to - I mean, children's development and growth is centred around play as much as anything else as much as it is around school work or study or whatever and generally children can play in very deprived environments. They can, you know, you don't need expensive toys or - children can play with stones and, you know, simple things that are found in the environment. So it is not so much the lack of toys and the like, although that is significant, it is just that the environment is so hostile to play, so hostile to a child's ordinary life. It is not just the physical environment, the pervasiveness of the razor wire and the security measures. It is not just the de-humanising aspects. I know that the use of numbers rather than names is not supposed to be happening but during my visit only a month ago it was still very prevalent.

It is the lack of things like ordinary family rituals around food, it is the lack of availability of parents to provide the protective and nurturing environment which children need in order to play. It is the lack of privacy that is available to children, the lack of consistency in their environment, the fact that they can't necessarily come back to, you know, the same game, the restrictions on children's mobility and their use of what is available in the environment and the ever present violence and threat of violence, not just the big things that are reported in the media but the things that happen day-to day.

MS LESNIE: For example?

DR JUREIDINI: Well, you know the protests that people carry out, for understandable reasons, out of their desperation and despair. The impact of that on children is destructive on a day-to-day basis. It is not just when there's a riot or people are actually physically damaged. There is the pervasiveness of self-destructive behaviour and it is all very well to say that parents should be able to keep their children away from that. The reality based on my observations is that in that environment it would be almost impossible to deprive children of the opportunity to see that kind of behaviour. Children are drawn to exciting things and if the most exciting thing that is happening is something negative and destructive they will be drawn to that just as surely as they are drawn towards positive exciting things that are available to them in our environment.

DR OZDOWSKI: So what can be the impact on children and the development of staying in Woomera for half a year, 1 year?

DR JUREIDINI: Well, I think that, you know, the emotional impact is obvious and that is bad enough but what is even more worrying, I think, in smaller children is the cognitive impact because it is - my impression based on what staff told me at Woomera that they observe children to regress during their experience in Woomera, not just emotionally regress but cognitively regress in terms of their use of language and so on. My understanding, my prediction would be that children would actually suffer in terms of their cognitive development, their development of intellectual skills, speech and language and the like.

DR OZDOWSKI: It would be a long-term impact?

DR JUREIDINI: Yes, potentially. I mean, unless they got some kind of remedial rehabilitation it would potentially be life long impact and I think that it is a matter of urgency for us to assess just how badly damaged these children are in terms of their cognitive development, the smaller children.

DR OZDOWSKI: It is not really a question whether they are damaged, but a question of how much they are damaged?

DR JUREIDINI: I think so. I mean, we don't know but I think, just based on my limited observation, that we can be sure that they are damaged. 

A Generation of Trauma

Justice for Refugees SA, Media Release, 21 October 2003
"Children in immigration detention are denied anything remotely resembling a normal life. They are constantly exposed to an environment which is detrimental to their physical and psychological wellbeing", comments Dr Jon Jureidini, psychiatrist and spokesperson, Justice for Refugees SA. 

RANZCP AIRS DEEP CONCERN AT THE MANDATORY DETENTION OF CHILD ASYLUM SEEKERS

Royal Australian and New Zealand College of Psychiatrists, Media Release, 11 November 2003

A study of children detained in Australia as asylum seekers has found that 80% had attempted to harm themselves. It also found that all the children met the diagnostic criteria for major depression and posttraumatic stress disorder. [...]

A RANZCP spokesperson, Dr Louise Newman, said she was deeply concerned about the mental health of children detained as asylum seekers. She said the combination of pre-migration trauma, the detention environment and parental depression was �damaging� the children.

Children and Families Referred from a Remote Immigration Detention Centre

Excerpt paper by Dr Sarah Mares and Dr Jon Jureidini, National Summit on Asylum Seeker Health Care, 12 November 2003.

Read the full paper...

Risk Factors in Detention

� Exposure to violence
� Witnessing violence and self harm
� Parental mental illness
� Limited developmental and educational experiences
� Adequate parenting not possible in this context.
Depending on their age and developmental capacity, children rely on their caregivers to help them make sense of the world and regulate their own responses to it. Parental mental illness increases children�s vulnerability to emotional and behavioural disorders, and post traumatic symptoms in children are strongly linked to their parent�s wellbeing and level of traumatisation. For young children, witnessing a threat to their caregiver has been identified as the most potent variable predicting the development of post traumatic stress disorder (PTSD) in the child. In this context parents have at times been the source of their child�s trauma as a result of their self destructive or otherwise disturbed behaviour. The quality of parenting is inevitably seriously compromised in the detention context.

Results of Study

Adult Psychopathology and Family Impact 

All children had at least one parent affected by psychiatric illness. In five of the seven two parent families, both parents had psychiatric illness. In both sole parent families the mother had required several hospitalisations for psychiatric treatment. 14 of the 16 adults (87%) fulfilled criteria for major depression, 9 of 16 (56%) met criteria for PTSD and 4 had psychotic illness requiring hospitalisation. Five (31%) had made significant, often multiple attempts at deliberate self harm.

 

Children under 5 years old 

Of the 10 children 5 years and under, seven had spent at least half their lives in immigration detention. Five, (50 %) presented initially with symptoms including delays in language and social development and emotional and behavioural dys-regulation. These children were functioning below their expected cognitive potential, and manifest signs of cognitive deprivation. Their parents reported the children had disturbed sleep and feeding routines and complained that they �didn�t know how to play�, and no longer obeyed them. Three of the infants (30%) showed marked disturbance in their behaviour and interaction with their parent or carer, indicating disturbances or distortion of attachment relationships. This is highly correlated with exposure to violence and chronic parental mental illness. Over the 12 month follow up oppositional behaviour and parent- child relationship difficulties were identified in a further 3 children in this age group.

 

Children aged 6 to 17 years
 Of the 10 children aged 6 to 17 years old, all (100%) fulfilled criteria for post-traumatic stress disorder (PTSD). All were troubled by experiences since detention in Australia. One also reported troubling thoughts about events on the boat to Australia as well as experiences in the IRPC.

 

All the older children reported graphic intrusive memories and thoughts of adults self-harming. They had all witnessed attempted hangings, slashings and self-poisoning. For some this included memories and images of their parents during and after suicide and self harm attempts. Within the IRPC there were times when self-destructive behaviour had escalated to daily cuttings, hanging attempts and provocation of conflict with ACM staff by children, adolescent and adults. Several children expressed a fear of harming themselves �because everyone does it here�.

 

All of the sample (100%) reported trouble sleeping, poor concentration, little motivation for reading or study, a sense of futility and hopelessness and overwhelming boredom. All children were troubled by recurrent thoughts of death and dying. All children in this age group (100%), fulfilled criteria for major depression with suicidal ideation. Some were angry, but for others, this had given way to despair. Withdrawal and emotional numbing were prevalent. One 13 years old said, �my heart has become hard�. Nightmares were very common, and three (30%) of the older children reported frequent nocturnal enuresis since being in the IRPC.

 

All reported recurrent thoughts of self harm. Disturbingly, the three pre-adolescent children (aged 7, 10 and 11years), were amongst the 8 (80%) children who had acted on these impulses. This is very different from symptom patterns and presentation seen in community samples where deliberate self harm is rare in pre-adolescent children and higher rates of depression and suicidality occur after adolescence. Seven (70%) also had symptoms of an anxiety disorder (Panic disorder, Generalised anxiety Disorder, Separation Anxiety). Half, (50 %) reported persistent severe somatic symptoms, particularly headaches and abdominal pain.

 

All children also reported extreme boredom, perplexity or anger that they were not receiving appropriate education. They reported anxiety about falling behind in their schoolwork and shame about knowing less than age appropriate peers. Another common preoccupation was a sense of unworthiness or anger that others they had met in the IRPC had now been granted visas. One girl said �what is so bad about me, why is my life so bad, what kind of bad person am I that this has happened to me?� 

 

All 10 older children reported anxiety about their parent�s wellbeing. As mentioned above, at least one parent of each child was significantly depressed, and had expressed or acted on suicidal intent.

 

Parents frequently reported that their intention in leaving their country of origin was linked to fears for their children�s future, either because of direct risk of violence or because of persecution for religious or political reasons and limited access to education and other resources. All expressed considerable guilt and despair about bringing their children into a traumatising and hopeless situation. Some expressed a wish to die in the belief their children might fare better without them. 

 

Many of the children had assumed adult roles and responsibilities, surrendered by their parents because of their own ill health.

The cause of the problems is detention itself

Dr Jon Jureidini, The Age, 21 December 2003

 

The cause of the psychiatric problems for children in detention was the detention itself, Dr Jureidini said, and he and a colleague were submitting a paper to the Australian New Zealand Journal of Psychiatry making this point. "Whatever the pre-existing burden of what they were carrying into the detention centre, they are all suffering from psychiatric symptoms that are a direct result of their detention experience," he said. "We can be quite unequivocal about that."

But while release was a pre-requisite for mental healing, it did not promise a cure. Much of the behaviour learned inside detention was profoundly anti-social. The use of profanity by young children was widespread and violence, aggression, disruptive play, bed-wetting, almost catatonic withdrawal states and suicidal ideation were common. These symptoms could be treated but not necessarily cured by being outside.

[...] Dr Jureidini said it would be wrong for people to believe that the children in most need were already out of detention. The self-harming behaviour common in Woomera had abated but the more isolated and heavily-regulated environment of the Baxter detention centre 12 kilometres from Port Augusta where 12 children were held (another 13 were housed in guarded detention outside the main centre) was just as damaging, he said.

HREOC Submission to the High Court on behalf of Sahki children

Excerpt from HREOC submission, 28 January 2004.

 

The effect on children of detention in immigration detention centres
 20. The distinctive interests and vulnerabilities of children make them especially vulnerable to the effects of forced detention. That that is likely to be so is obvious. Of course, children are sometimes detained for criminal behaviour. But such detention follows an exercise of judicial process, directed to the circumstances of the individual. And the courts have recognised the particular interests and vulnerabilities of children in determining such sentences for children:

�There has been universal acceptance by the courts in England, Australia and elsewhere that there is an essential difference between children and adults when they come before a court exercising criminal jurisdiction. In particular it had been accepted by the courts that the reformation of the offender is always an important, if not the dominant consideration, and that any sentence should be tailored with greater emphasis on the future welfare of the offender�.

21. The Applicants here are held in immigration detention, relevantly the Baxter Immigration Detention facility (they were previously held at the Woomera Centre). The Commonwealth submits that it cannot be assumed that immigration detention is likely to have adverse impacts. As the above quotation implies, that submission is contrary to the learned experience of the law. The law has long accepted the human reality of the peculiar interests of children, as noted above. Taking account of that experience and recognition, it is plain that detention in immigration detention centres will be particularly deleterious to children, especially given the following circumstances. 

22. First, such detention is with adults. As has been stated in the criminal law context, �An adult prison is not an appropriate institution for the imprisonment of a child and a period of incarceration within one is not likely to do an adolescent person, male or female, any good�. Whilst the dangers to children may be somewhat different in an immigration context, they will still exist.

23. Secondly, the occasioning of self-harm and the occurrence of traumatising experiences within immigration detention is both notorious and documented. Thirdly, of the adults and children detained, a significant proportion may have been traumatised by their own past experiences. Connected to this, fourthly, it is inevitable that conditions and experiences in detention may themselves cause or exacerbate mental health problems. 

24. The peculiar interest of children in proper and unimpeded physical, mental, intellectual, moral, spiritual and sexual development will inevitably be harmed by compulsory detention in such circumstances. Such adverse effects have been discussed in international reports. It is thus unsurprising that the anecdotal study by Mares, Newman et al concluded: 

�Immigration detention profoundly undermines the parental role, rendering the parent impotent, unable to provide adequately for their child(ren)�s physical and emotional needs, in an environment where opportunities for safe play, development and education are inadequate or unavailable. Parental depression and despair leaves children without protection in an already terrifying and unpredictable place. Children are at high risk of emotional trauma since parents are unable to provide for them adequately or to shield them from further humiliation and acts of violence in a degrading, hostile and hopeless environment.�

25. It might be said that children may legitimately be detained in some sense in other circumstances � eg being sent to boarding school against a child�s will, or being denied permission to go out for social purposes for a time. It is quite unreal to compare such restrictions to mandatory immigration detention, which is vastly different in terms of the extent of deprivation of liberty, and of the significance of the effects of such detention. Further, such decisions do not involve an exercise of governmental power, and are not mandatory, in the sense that they are a choice freely made by the person/s in loco parentis.