As the situation for hundreds of asylum seekers in the Manus Island continues to deteriorate the harmful consequences of Australia’s punitive immigration detention policies are obvious. Despite the secrecy surrounding immigration detention it is only the wilfully blind who avoid this conclusion.
As a doctor with a senior position in the medical provider for immigration detention I thought in 2011 that there may have been some prospect of working from within the system to minimise harm. Over three years I found that I was mistaken. Policies became more punitive and conditions deteriorated. The government shut down independent scrutiny and sought to manipulate perceptions and deceive the public, especially about offshore facilities.
In immigration detention, the fundamental aspects of delivering care, such as trust and confidentiality between doctor and patient are compromised by deliberate government policies, and medical decisions are routinely overridden by departmental officers. This prevents practice within the prescribed standards as set out by professional and accrediting bodies including the RACGP and RANZCP and ACSQHC. Moreover, from a psychiatric perspective, immigration detention is designed to cause mental suffering which over time has the inevitable consequence of resulting in frank mental illness.
The appropriate medical response is to advocate to stop the cause of suffering rather than to continue to apply less and less effective band aid responses while propping up a damaging system and providing convenient cover for the government. Within the system no advocacy is allowed, stating medical facts or giving clinical opinions which counter department aims is considered “political” and leads to swift sanctions.
It is extremely difficult for doctors, nurses, psychologists and other health workers to acknowledge that sometimes being involved in a system does more harm than good. Proposals to boycott have been controversial but in my view, it is the government that has decided to impose conditions that do not allow normal practice to occur, and health professionals should not practice where these standards are not met.
Health staff who continue to work within this system and do not speak out support and collude with it. By accepting government imposed restrictions they breach their professional responsibilities. There are many recent and historical examples in which health professionals have been similarly seduced into collusion with harmful and abusive policies of governments.
Australia’s international reputation is tarnished by these policies and history will judge us harshly. It is well past time for health professionals to decide on which side they stand.
Dr Peter Young is a Consultant Psychiatrist with experience of 20 years working in NSW Health. He took on the role responsible for oversight of mental health services to people in Australian and offshore detention centres. He held this position for three years from 2011 to 2014. Dr Young has given evidence to the Australian Human Rights Commission enquiry into children in detention and other public enquiries regarding mental health harms caused by detention.