Self-harm among asylum seekers in Australian immigration detention
Authors: Kyli Hedrick, Gregory Armstrong, Rohan Borschmann
Journal: The Lancet Public Health (2019)

Self-harm among asylum seekers in Australian immigration detention has attracted much attention over the past two decades. In 2012, the Australian Government reinstated offshore processing for asylum seekers—a policy previously maintained from 2001 to 2008—meaning that asylum seekers who arrived by boat were transferred to Manus Island in Papua New Guinea, or to the Pacific island nation of Nauru, for processing.1Karlsen E Phillips J Developments in Australian refugee law and policy (2012 to August 2013). Parliament of Australia, Department of Parliamentary Services.https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/3412593/upload_binary/3412593.pdf;fileType=application/pdfDate accessed: October 19, 2019Google Scholar National and international attention regarding perceived rates of self-harm among people seeking asylum in Australia has intensified since this time,2The Senate Legal and Constitutional Affairs Reference CommitteeFinal report of the inquiry into serious allegations of abuse, self-harm and neglect of asylum seekers in relation to the Nauru Regional Processing Centre, and any like allegations in relation to the Manus Regional Processing Centre.http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/NauruandManusRPCs/ReportDate accessed: October 19, 2019Google Scholar, 3von Werthern M Robjant K Chui Z et al.The impact of immigration detention on mental health: a systematic review.BMC Psychiatry. 2018; 18: 382Crossref PubMed Scopus (95) Google Scholar as have calls for self-harm prevention strategies to be implemented.2The Senate Legal and Constitutional Affairs Reference CommitteeFinal report of the inquiry into serious allegations of abuse, self-harm and neglect of asylum seekers in relation to the Nauru Regional Processing Centre, and any like allegations in relation to the Manus Regional Processing Centre.http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/NauruandManusRPCs/ReportDate accessed: October 19, 2019Google Scholar A large body of evidence, including from a 2018 systematic review,3von Werthern M Robjant K Chui Z et al.The impact of immigration detention on mental health: a systematic review.BMC Psychiatry. 2018; 18: 382Crossref PubMed Scopus (95) Google Scholar indicates that asylum seekers have a higher prevalence of depression, anxiety, and post-traumatic stress disorder than the general community. Evidence also suggests that asylum seekers have many of the risk factors associated with self-harm,3von Werthern M Robjant K Chui Z et al.The impact of immigration detention on mental health: a systematic review.BMC Psychiatry. 2018; 18: 382Crossref PubMed Scopus (95) Google Scholar such as previous traumatic experiences, mental health problems (often resulting from premigration and postmigration events, including torture and trauma), and social isolation, with detention known to exacerbate such risk.4Hawton K Linsell L Adeniji T Sariaslan A Fazel S Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide.Lancet. 2014; 383: 1147-1154Summary Full Text Full Text PDF PubMed Scopus (203) Google Scholar Additionally, mental health has been shown to deteriorate with length of detention.3von Werthern M Robjant K Chui Z et al.The impact of immigration detention on mental health: a systematic review.BMC Psychiatry. 2018; 18: 382Crossref PubMed Scopus (95) Google Scholar, 5Green JP Eagar K The health of people in Australian immigration detention centres.Med J Aust. 2010; 192: 65-70Crossref PubMed Scopus (71) Google Scholar Despite evidence of the increased risk to the mental health of asylum seekers, Australia, as well as many other high-income countries, continues to detain asylum seekers.1Karlsen E Phillips J Developments in Australian refugee law and policy (2012 to August 2013). Parliament of Australia, Department of Parliamentary Services.https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/3412593/upload_binary/3412593.pdf;fileType=application/pdfDate accessed: October 19, 2019Google Scholar However, little is known about the rates and characteristics of self-harm among asylum seekers, largely because accessible data are absent. We investigated self-harm among people seeking asylum in Australia (including those transferred to Nauru and Manus Island) over a 12-month period. Calculated episode rates of self-harm in immigration detention were more than 200 times higher than rates of hospital-treated self-harm in the general Australian population.6Hedrick K Armstrong G Coffey G Borschmann R Self-harm in the Australian asylum seeker population: a national records-based study.SSM Popul Health. 2019; 8100452Crossref PubMed Scopus (18) Google Scholar By contrast, episode rates of self-harm among community-based asylum seekers were four times higher than rates of hospital treated self-harm in the general Australian population.6Hedrick K Armstrong G Coffey G Borschmann R Self-harm in the Australian asylum seeker population: a national records-based study.SSM Popul Health. 2019; 8100452Crossref PubMed Scopus (18) Google Scholar Our analysis of the Australian Government's own self-harm data6Hedrick K Armstrong G Coffey G Borschmann R Self-harm in the Australian asylum seeker population: a national records-based study.SSM Popul Health. 2019; 8100452Crossref PubMed Scopus (18) Google Scholar provides evidence of the lowered self-harm risk for asylum seekers in community-based arrangements and community detention, compared with people in immigration detention. Our findings point clearly to the deleterious effect of immigration detention on the health of asylum seekers. The high episode rates of self-harm identified in our study6Hedrick K Armstrong G Coffey G Borschmann R Self-harm in the Australian asylum seeker population: a national records-based study.SSM Popul Health. 2019; 8100452Crossref PubMed Scopus (18) Google Scholar constitute a public health crisis and warrant urgent attention. Responses to this public health issue are poor. Independent and systematic monitoring of self-harm among people seeking asylum in Australia is needed to identify trends and to implement prevention strategies, but is not being done. In light of the episode rates of self-harm, the health of asylum seekers will remain at risk without changes to government policy regarding detention. An informed government response would include three essential aspects: only using detention as an absolute last resort for the shortest possible time; mental health services specifically tailored to meet the needs of asylum seekers; and the independent monitoring of self-harm in line with WHO self-harm reporting guidelines.7WHOPractice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm. World Health Organization, Geneva2016Google Scholar Without such a response, a reduction in the high rates of self-harm observed among asylum seekers is unlikely to occur. KH has received grants from the Australian Government Post-Graduate Research Training Program during this study; personal fees from Victorian Foundation for Survivors of Torture; and personal fees from the Department of Home Affairs, outside the submitted work. The other authors declare no competing interests. The views expressed here are those of the authors.