Serve, subvert or emancipate?: Promoting mental health in immigration detention
Pauline J McLoughlin
Discipline of Public Health, University of Adelaide, Adelaide SA
PP: 145 - 154
Abstract
In recent years, Immigration Detention Centres (IDC) have become sites of increasing concern in Australia, due to their notoriously negative impact on the mental health of detained asylum seekers. In this paper, I question whether it is possible and beneficial to promote mental health in what might be thought of as an inherently 'unhealthy' setting.
Drawing upon health promotion theory and a Foucauldian approach to power, I critique the effectiveness of two major forms of health promoting work carried out in the immigration detention setting: internally-organised services and externally-organised support and advocacy. Given the problematic nature of the detention setting, I argue that the 'effectiveness' of these efforts is bound up in their capacity for subverting or positively reforming the IDC system itself as a barrier to mental health.
Keywords
mental health promotion, mental health, asylum seekers, immigration detention, Foucault, multicultural mental health
Article Text
Since their legislative creation in 1992, Immigration Detention Centres (IDC) have been at the nucleus of hard-line asylum seeker policy in Australia. Links between the structures, practices and social constructions shaping Australian detention centres and the deteriorating emotional wellbeing of the long-term detained have been raised through important research and critiques (see for example, Silove & Steel, 1998), as well as the prominent advocacy work of lawyers, psychiatrists and other medical professionals, and journalists and social researchers.
Especially striking are the number of inquiries and studies which have shown that detained asylum seekers bear a markedly higher burden of emotional distress and anxiety, clinical depression, post-traumatic stress disorder, suicidal thoughts and self-harm than their compatriots living in the Australian community (Silove & Steel, 1998). The Maribyrnong Detention Centre Tamil Survey conducted by Thompson, McGorry, Silove and Steel (Silove & Steel, 1998) for example, found that the average level of suicidal thoughts and wishes reported by detained asylum seekers was twice the score of asylum seekers living in the community, and as much as 54 percent greater than the average reported by refugees.
Three Inquiries by the Human Rights and Equal Opportunities Commission (HREOC, 1998, 2001, 2004) have also observed first-hand the emergence of mental illness and profound emotional deterioration among asylum seekers enduring more than several months of detention. The recent Inquiry into children in detention (HREOC, 2004) further focused attention on the role of prolonged incarceration within IDCs in the emergence of developmental problems, depression and trauma among children and young people.
In the face of this evidence and the progressive work of refugee advocates, recent Federal Government reforms have ushered in the tentative release of children and many long-term detained, as well as a fledgling community-based detention system (or 'Residential Housing Project) for women and young people (DIMA, 2006). Despite these reforms however, the strict mandatory detention ethos of asylum seeker policy remains firmly in place. With plans to replace mainland detention centres with offshore 'processing' on Pacific Island nations (Topsfield, 2006), and the rising political influence of Australia's mandatory detention system on the immigration policies of the United States, United Kingdom and Europe, it is crucial that the human cost of mandatory detention remains a focus of concern.
Yet, while the harms of immigration detention have become a centre of increasing attention, little critical thought has been given to the promotion of mental health within detention centres. This is not surprising. Beyond the obstacles of access faced by any groups setting out to promote the welfare of detained asylum seekers, a more fundamental and contentious issue remains: Is it possible, or even beneficial, to promote mental health in what might be thought of as an inherently 'unhealthy' setting? Given the present reality facing detained asylum seekers, it is crucial that we engage in this difficult debate.
In this paper, I question the effectiveness of attempts at 'promoting' the mental health of detained asylum seekers, when situated within the context of the IDC. Considering the problematic nature of detention centres, I argue that the effectiveness of mental health promotion efforts is closely bound to how well they might seek to address this setting as a profoundly negative barrier to emotional wellbeing.
I begin with a general introduction to the notion of 'health promotion' and the unhealthy nature of the detention setting, examining IDC conditions from the perspective of Foucault's notions of power, discourse, control and surveillance. These concepts inform our understanding of the barriers presented by immigration detention. Drawing upon this framework, I examine how the major approaches to mental health promotion within detention centres either serve the damaging detention milieu, seek to positively subvert aspects of it, or emancipate asylum seekers from this context altogether.
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