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Dirty work: well-intentioned mental health workers cannot ameliorate harms in offshore detention
  1. Janine Penfield Winters1,
  2. Fiona Owens1,
  3. Elisif Winters2
  1. 1University of Otago, Dunedin, New Zealand
  2. 2Non-Academic Staff, University of Otago, Dunedin, Otago, New Zealand
  1. Correspondence to Dr Janine Penfield Winters, University of Otago, Dunedin 9054, New Zealand; janine.winters{at}


Professional providers of mental health services are motivated to help people, including, or especially, vulnerable people. We analyse the ethical implications of mental health providers accepting employment at detention centres that operate out of the normal regulatory structure of the modern state. Specifically, we examine tensions and moral harms experienced by providers at the Australian immigration detention centre on the island of Nauru. Australia has adopted indefinite offshore detention for asylum-seekers arriving by boat as part of a deterrence strategy that relies on making detainment conditions harsh. This has known deleterious mental health effects. As a token to fiduciary care obligations, Australia employs mental health professionals to work on Nauru. These providers are often motivated to make a positive difference for detainees’ lives. We examine the overall impact of the providers’ work with detainees and the implications of their presence. The strongest evidence supports that the small mitigation of harms offered by these providers does not outweigh the harms of supporting a system designed to perpetuate human suffering. For mental health professionals considering working in offshore detention, we offer specific topics to scrutinise and weigh prior to employment. Because optimising detainee’s mental health is beyond the capacity of individual providers, we call for the organisations standardising and supporting mental health professionals to oppose employment of their associates in offshore detention. Lessons from this case study are generalisable to other jurisdictions to help inform organisations that licence and support mental health providers and individual providers considering work in similar settings.

  • human Rights
  • prisoners
  • ethics- medical
  • health personnel
  • mental health

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Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors JPW initiated and managed the collaborative project, idea formation during conceptualisation, wrote table, writer from second draft onward, made editorial decisions, wrote final text, corresponding author. FO drafted and revised work. Initiated project idea, wrote an academic case analysis that this current work is based on, revised work. EW drafted and revised work. Compiled succinct first draft of paper, added material and references from international ethics.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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