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The mental health toll of policies that seek to keep people “out of sight and largely out of mind”

The harm that detention inflicts upon asylum seekers, including children, is powerfully described in three articles in the latest edition of the Medical Journal of Australia.

The articles (herehere, and here) note that suicide is the leading cause of premature death for those in the immigration detention network, and document the toll that detention takes upon mental health.

In one study, researchers estimated that 50 per cent of immigration detainees in Darwin attended the Royal Darwin Hospital emergency department in 2011, including 112 children. The most common diagnoses were psychiatric problems, including self-harm.

As the Federal Government comes under fire for scrapping  the Immigration Health Advisory Group, physician Dr Michael Gliksman – an AMA councillor and member of Doctors for Refugees – writes in today’s Crikey bulletin:

“Out of sight and largely out of mind, Australia is building a generation of damaged people — almost all of whom, statistics and history show, are entitled to be granted refugee status under our international treaty obligations. In our deserts and on isolated islands, our government is building a legacy to haunt and shame us for generations.”

Meanwhile, the Queensland Government has also angered health professionals with its plans to secure all mental health inpatient facilities in the State.

This “locked door policy” is a “retrograde and draconian” step, warns Adjunct Associate Professor Kim Ryan, Chief Executive Officer of the Australian College of Mental Health Nurses.

****

Blanket decision to lock mental health units a draconian step backwards

Kim Ryan writes:

My organisation has joined the Royal Australian and New Zealand College of Psychiatrists in condemning the recently announced Queensland Health ‘lock-up’ security measures to all adult mental health hospital inpatient facilities in Queensland, and the expansion of the use of ankle bracelets.

These security measures would see all of Queensland’s 16 mental health inpatient facilities secured, and a new ‘locked-door’ policy adopted.

I completely understand the need for safety and security, but a decision to lock all mental health units, as a knee jerk reaction to address issues of absconding, is a retrograde and draconian solution.

It seems that no consideration has been given to the rights of those who are voluntarily admitted for treatment and care.

We need to be working towards a mental health system that supports people with mental illness to live rich and meaningful lives.

The Newman government can’t cut costs and pare back services, and not expect there to be a consequence. The cost of installing locks and electronic security could be better spent providing more support and staffing to the units.

Clients abscond for many reasons. They might feel trapped and confined, bored, frightened, feel cut off from friends and relatives, or have household responsibilities they think they must fulfil. Psychiatric symptoms obviously also contribute to the decision to leave, but most clients cite additional and rational reasons for their absconding.

A 2003 study conducted by Bowers, Alexander and Gaskell trialled anti-absconding interventions in acute mental health wards.

During the trials, anti-absconding packages were implemented in five mental health wards and one hospital. These packages included: the use of a signing in and out book for clients; careful and supportive breaking of bad news to clients; post-ward incident debriefing of clients; multidisciplinary review of clients who had absconded more than once; identification of clients at high risk of absconding; targeted nursing time daily for those high absconding risk clients (for the discussion of worries/concerns about home, family and friends, followed by practical attempts to address those needs); and facilitated social contact for those at high risk of absconding.

When the anti-absconding packages were implemented, absconding rates fell overall by a statistically significant 25%. On some wards, absconding rates fell by 50%.

The researchers noted in their findings that staff locked the ward doors less during the intervention periods. Clearly, “locked door” policies are not the answer.

This was an English study and there is little Australian evidence around absconding and interventions to prevent it. The Queensland government should be investing in research to establish causes of absconding in Australia, and interventions that support clients and staff to prevent it.

My organisation is calling on Dr Michael Cleary, Queensland Health’s deputy director-general who ordered the security upgrade, to reverse this decision and establish a process of consultation with the mental health units regarding the actions being taken to address incidents of absconding.

• Adjunct Associate Professor Kim Ryan is Chief Executive Officer of the Australian College of Mental Health Nurses.

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