Breaking their minds
Breaking their minds
In 2016, UNHCR found that 88% of those then on Manus Island were suffering from depression, anxiety and/or post-traumatic stress disorder, which were “the highest recorded rates of any surveyed population”. The reasons for their suffering are many. They include the protracted uncertainty of offshore processing, their experiences of indefinite detention on Manus Island and elsewhere, and past trauma and persecution. Another factor is their indefinite separation from their family members and loved ones. This puts significant pressure on those relationships. Some of the men who spoke to RCOA in October 2018 said that they cannot even tell their families that they are still in limbo.
the lengthy, arbitrary, and indefinite nature of immigration detention on Manus Island, together with hopelessness in the absence of durable settlement options, had corroded the resilience of the detainees, and made them vulnerable to mental illness.
Now, more than two years after UNHCR 2016 visit, the situation has reached a breaking point. Since August 2017, three people have killed themselves in Manus Island.
Hamed Shamshiripour’s body was found near East Lorengau transit centre in August 2017. Repeated concerns were raised by refugees, advocates in Australia and mental health professionals working within the centre about his deteriorating mental health and psychotic episodes for over a year. The Chief Medical Officer of the Australian Border Force (ABF) at the time, Dr John Brayley, was personally told about Mr Shamshiripour’s state in August 2016.
His case had been reported on by Guardian Australia as early as June 2016. It reported that, after having a mental breakdown, Mr Shamshiripour was allegedly assaulted by guards and police. In January 2017, it reported that he had been jailed several times after behaving aggressively following severe mental health episodes. Upon release from jail he was found “hungry and homeless” in the streets of Lorengau.In October 2018, UNHCR publicly expressed its concerns about “several instances of self-harm or attempted suicide [which] have taken place in Papua New Guinea in the past month”.
The growing mental health crisis on the island has been documented more recently by Behrouz Boochani, a Kurdish-Iranian journalist on Manus Island. He has reported on:
- an Iraqi man who, in August 2018 tried to set himself on fire, after refusing to eat and isolating himself to his room
- a man who tried to hang himself in September 2018, but was cut down by refugees getting up to have breakfast
- a young man, sent to Manus Island when he was 19, attempted to kill himself in September 2018, and
- an Iraqi man who swallowed razor blades and nail clippers and continued to self-harm after being transferred to hospital.
When people self-harm, the response by PNG authorities is haphazard. Some people are taken to police cells. Others are transferred to hospitals in Port Moresby (sometimes after a court order) or are left without support in the community.
Cutting mental health support
Despite these critical mental health needs, there are now only four people providing mental health care for the men Australia has sent to PNG (see Table 4 in the appendix). This is half the number that were there on 31 January 2018. In October 2018, there were about 70 refugees and people seeking asylum in Port Moresby, and only one mental health staff member there.
PNG’s mental health system is not used to, or equipped to deal with, the issues faced by those Australia has sent to PNG. According to UNHCR:
The type, extent and severity of mental disorders presented by the asylum-seeker and refugee population sharply contrasts with the range of disorders typically seen within the Papua New Guinea context … Papua New Guinea mental health services are structured to assess and treat low prevalence illnesses such as schizophrenia, bipolar disorder and substance related disorders. There is no current skills capacity within Papua New Guinea public mental health services to address severe-post traumatic stress disorder and current resourcing will not be able to cope with the surge of cases with major depression.
PNG’s mental health system is also severely under-resourced to deal with the issues faced by refugees and people seeking asylum. A 2015 report on psychiatric care for PNG stated that there were only seven clinical psychiatrists in the country, with five in Port Moresby. Port Moresby General Hospital has a psychiatric ward and in PIH in Port Moresby the psychiatric care is provided by a psychiatrist. The mental health services in Lorengau General Hospital are much more basic and unable to cater for the complex needs of this group.
Mental health outreach and monitoring are no longer in place. These services were in place until the closure of the RPC and withdrawal of services in 2017, and enabled counsellors and other mental health staff to actively monitor refugees and people seeking asylum for mental health concerns. Now it is mainly up to the friends of the men to recognise the signs of distress and intervene on their behalf. This is much more complicated for those who have isolated themselves and do not interact with others.
Torture and trauma counselling, provided by Overseas Services to Survivors of Torture and Trauma, which was subcontracted by IHMS and had at least two counsellors working six days a week, also ended on 8 October 2017. For many, those counsellors provided a lifeline:
My own counsellor she was great. I cannot describe her kindness and the humane way she was treating me and others … At least we had a place to go and talk. They were listening without questioning us, without judgement and without agitating us. For me, she was the only person who was treating me as a human and she was listening to me. In October last year they stopped working and they haven’t come back which is a shame. They had an important role. People who were visiting them, they got worse. They now have to use lots of tablets. We really feel their absence. When they left it was a moment of sorrow for us.
— Benham, PNG, 201872