Abstract
Although Australia has comparatively few individuals seeking asylum, it has had a mandatory detention policy in place since 1992. This policy has been maintained by successive governments despite the overwhelmingly negative impact mandatory detention has on mental health. For mental health professionals working in this environment, a number of moral, ethical, and human rights issues are raised. These issues are discussed here, with a focus on dual loyalty conflicts and drawing on personal experience, the bioethics and human rights literature, and recent parliamentary inquiries. For those who continue to work in this environment, future directions are also discussed.
Similar content being viewed by others
References
Amnesty International. 2012a. Nauru camp a human rights catastrophe with no end in sight. Amnesty International News, November 23. http://www.amnesty.org.au/news/comments/30533/.
Amnesty International. 2012b. Urgent reform needed for Australia’s immigration detention system. Amnesty International News, February 9. http://www.amnesty.org.au/news/comments/27826/.
Australian Broadcasting Corporation. 2012. Asylum seekers strain Darwin paramedics. ABC News, April 26. http://www.abc.net.au/news/2012-04-26/failure-to-deal-with-emergencies-at-darwin27s-immigration-cent/3973466.
Australian Human Rights Commission. 2011. Submission to the Joint Select Sommittee on Australia’s Immigration Detention Network. http://humanrights.gov.au/legal/submissions/2011/201108_immigration.html.
Australian Medical Association. 2011. Position statement: Health care of asylum seekers and refugees—2011. https://ama.com.au/position-statement/health-care-asylum-seekers-and-refugees-2011.
Australian Psychological Society. 2007. Code of ethics. Melbourne: Australian Psychological Association Ltd. http://www.psychology.org.au/Assets/Files/APS-Code-of-Ethics.pdf.
Australian Psychological Society. 2011. Submission to the Joint Committee on Australia’s Immigration Detention Network. Melbourne: Australian Psychological Association Ltd. http://www.psychology.org.au/Assets/Files/APS-Submission-to-Australias-Immigration-Detention-Network.pdf.
Bowen, C. 2012. Asylum seeker transfer to Nauru, Expert Panel recommendations, “no advantage” principle. http://www.minister.immi.gov.au/media/cb/2012/cb189879.htm. Accessed December 12, 2012.
Briskman, L., D. Zion, and B. Loff. 2010. Challenge and collusion: Health professionals and immigration detention in Australia. The International Journal of Human Rights 14(7): 1092–1106.
Coffey, G. 2006. “Locked up without guilt or sin”: The ethics of mental health service delivery in immigration detention. Psychiatry, Psychology and Law 13(1): 67–90.
Coffey, G.J., I. Kaplan, R.C. Sampson, and M.M. Tucci. 2010. The meaning and mental health consequences of long-term immigration detention for people seeking asylum. Social Science and Medicine 70(12): 2070–2079.
Commonwealth Department of Health and Ageing. 2002. National practice standards for the mental health workforce. Canberra: Commonwealth of Australia, publication approval number 3152. http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-workstds-toc.
Department of Immigration and Citizenship. 2007. Detention health framework: A policy framework for health care for people in immigration detention. Canberra: Commonwealth of Australia. http://www.immi.gov.au/managing-australias-borders/detention/services/detention-health-framework.pdf.
Department of Immigration and Citizenship. 2011. Fact sheet 60: Australia’s refugee and humanitarian program. Canberra: Commonwealth of Australia. http://www.immi.gov.au/media/fact-sheets/60refugee.htm.
Department of Immigration and Citizenship. 2012. Immigration detention statistics summary. Canberra: Commonwealth of Australia. http://www.immi.gov.au/managing-australias-borders/detention/_pdf/immigration-detention-statistics-20120930.pdf. Accessed December 12, 2012.
Detention Health Advistory Group. 2011. Submission to the Joint Select Committee on Immigration Detention. https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=1b3bf6d0-3d6f-4891-9991-2849a6c57f27.
Dudley, M. 2003. Contradictory Australian national policies on self-harm and suicide: The case of asylum seekers in mandatory detention. Australasian Psychiatry 11(suppl s1): S102–S108.
Fujio, C.C. 2011. Dual loyalties: The challenges of providing professional health care to immigration detainees. Cambridge, MA: Physicians for Human Rights. https://s3.amazonaws.com/PHR_Reports/2011_DualLoyalties_Final_3_24_2011_opt.pdf.
Green, J.P., and K. Eagar. 2010. The health of people in Australian immigration detention centres. Medical Journal of Australia 192(2): 65–70.
Grover, A. 2010. Right of everyone to the enjoyment of the highest attainable standard of physical and mental health. United Nations General Assembly, A/65/255. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N10/477/91/PDF/N1047791.pdf?OpenElement
Joint Select Committee on Australia’s Immigration Detention Network. 2012. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate_Committees?url=immigration_detention_ctte/immigration_detention/index.htm. Accessed December 4, 2012.
Jugessur, T., and I.K. Iles. 2009. Advocacy in mental health nursing: An integrative review of the literature. Journal of Psychiatric and Mental Health Nursing 16(2): 187–195.
Mares, S., and J. Jureidini. 2004. Psychiatric assessment of children and families in immigration detention—clinical, administrative and ethical issues. Australian and New Zealand Journal of Public Health 28(6): 520–526.
McNeill, P.M. 2003. Public health ethics: Asylum seekers and the case for political action. Bioethics 17(5–6): 487–503.
Mooney, G. 2002. Public health, political morality and compassion. Australian and New Zealand Journal of Public Health 26(3): 201–202.
Murthy, R.S., and R. Lakshminarayana. 2006. Mental health consequences of war: A brief review of research findings. World Psychiatry 5(1): 25–30.
Newman, L.K. 2013. Seeking asylum-trauma, mental health, and human rights: An Australian perspective. Journal of Trauma and Dissociation 14(2): 213–223.
Newman, L.K., M. Dudley, and Z. Steel. 2008. Asylum, detention, and mental health in Australia. Refugee Survey Quarterly 27(3): 110–127.
Physicians for Human Rights and School of Public Health and Primary Health Care, University of Cape Town, Health Sciences Faculty. 2002. Dual loyalty and human rights in health professional practice: Proposed guidelines and institutional mechanisms. Cape Town: Physicians for Human Rights and School of Public Health and Primary Health Care, University of Cape Town, Health Sciences Faculty. http://physiciansforhumanrights.org/library/reports/dual-loyalty-and-human-rights-2003.html.
Pont, J., H. Stover, and H. Wolff. 2012. Dual loyalty in prison health care. American Journal of Public Health 102(3): 475–480.
Robertson, D., J. Bedell, J. Lavery, and R. Upshur. 2002. What kind of evidence do we need to justify humanitarian medical aid? The Lancet 360(9329): 330–333.
Steel, Z., T. Chey, D. Silove, C. Marnane, R.A. Bryant, and M. van Ommeren. 2009. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. The Journal of the American Medical Association 302(5): 537–549.
Steel, Z., S. Momartin, D. Silove, M. Coello, J. Aroche, and K.W. Tay. 2011. Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science and Medicine 72(7): 1149–1156.
Tobin, J. 2011. The right to health in international law. Oxford: Oxford University Press.
United Nations. 1966. International covenant on economic, social and cultural rights. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx.
United Nations. 2012. Re-opening of offshore detention camps in Australia could lead to rights violations. UN News Centre, August 17. http://www.un.org/apps/news/story.asp?NewsID=42700&Cr=australia&Cr1#.UMB4Job4JfM.
United Nations High Commissioner for Refugees. 2012. Global trends 2011. Geneva: United Nations High Commissioner for Refugees. http://www.unhcr.org/4fd6f87f9.html.
Zion, D., L. Briskman, and B. Loff. 2012. Psychiatric ethics and a politics of compassion: The case of detained asylum seekers in Australia. Journal of Bioethical Inquiry 9(1): 67–75.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Essex, R. Human Rights, Dual Loyalties, and Clinical Independence. Bioethical Inquiry 11, 75–83 (2014). https://doi.org/10.1007/s11673-013-9493-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11673-013-9493-0