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Lethal hopelessness: A report on mental distress among people seeking asylum who form part of the "legacy caseload"After Reza Amini’s suicide by self-immolation, his solicitor recounted how Amini evoked the Hazaragi phrase “to kill with cotton” to describe our treatment of people seeking asylum. The expression means to kill someone slowly.

A discursive paper on suicide among people seeking asylum

In 2018 the International Journal of Mental Health Nursing published a report entitled “Lethal hopelessness”. It deals with the mental deterioration of people seeking asylum who form part of Australia’s “legacy caseload”. The authors identify a gap in the research relating to the effectiveness of suicide-prevention programs for refugees.

Through their own research, the authors chronicle the systematic mental deterioration of this group. The article also provides practical suggestions for reducing suicidality among people seeking asylum.

Who are the “legacy caseload”?

The “legacy caseload” refers to people seeking asylum who arrived by boat between August 2012 and December 2013. This category includes about 30,000 individuals.

Many of these people have experienced profound psychological distress. Since 2014 there have been at least 11 suicides, 3 of which were by self-immolation. Most of these people have been living in the community on Bridging Visas, subject to changing conditions. The government can take up to 4 years to assess the protection claims of people in this group.

In Australia, people seeking asylum who arrived by boat can only apply for temporary protection. Asylum seekers in this “legacy caseload” can therefore only apply for a Temporary Protection Visa (TPV) or a Safe Haven Enterprise Visa (SHEV). When these expire after 3 and 5 years respectively, the individual will likely be granted another temporary visa. This means that this group faces at least 10 years on a temporary visa, without family reunion.

Mental deterioration and perceived burdensomeness

The report identifies suicide as a significant issue among members of Australia’s “legacy caseload”. For this group, suicide is linked to certain core factors:

  • feeling unable to continue with prolonged uncertainty;
  • flooding of traumatic experiences; and
  • overwhelming sense that one is a burden.

This ongoing trauma has serious effects on cognitive and social skills, including social confidence and autobiographical memory. Memory disruption is particularly concerning, as it can cause people to question the credibility of their experiences.

This deterioration continues for many even after their claims for protection are granted. For some, the temporary status of their protection leads to the feeling that of two possible permanent solutions – a permanent visa or death – only one is possible.

The report strongly suggests that members of the “legacy caseload” be allowed to access permanent protection visas.

Public shaming

The “legacy caseload” presents a challenge for service providers, as many of these people seeking asylum are reluctant to engage with them. All people seeking asylum are subject to the shaming of certain public officials, but the “legacy caseload” feels this shame especially acutely. Feelings of distress and uncertainty are compounded by accusations that their claims are motivated solely by a desire to stay in Australia.

Stigma, fear, and shame thus drive members of the “legacy caseload” away from service providers. When they do present, it is often difficult to get precise answers about mental health.

These barriers to service delivery illustrate the interconnection between public policy and the individual mental health of people seeking asylum.

Suggestions for managing this lethal hopelessness

The “Lethal hopelessness” report makes a number of practical suggestions aimed at improving mental health care for people seeking asylum.

The article cites previous studies which show that the asylum adjudication process causes stress and anxiety in applicants. To remedy this, the authors propose a trauma-informed response to the needs of people seeking asylum.

Under a trauma-informed response:

  • The welfare of the individual applicant will be prioritized during any interviews.
  • Mental health professionals will strive to help people seeking asylum to reframe their understanding of their positions. This will involve helping them accept that their situation is difficult but tolerable.
  • Mental health professionals will seek to diffuse the person’s focus on a single outcome or solution.
  • The link between trauma and reluctance to engage with services will be acknowledged.

The article also provides advice on collaborative safety planning for risky situations:

  • People seeking asylum need to be reminded of the reasons they have to live.
  • The key is to help troubled people to understand that their self is not the same as their emotional state.

Justice for Reza Amini

Before setting himself alight, Reza Amini prepared a suicide note. It ended with the statement:

Living shouldn’t be a crime anymore.

This statement encapsulates the treatment that people who are part of the “legacy caseload” have been subjected to. Continuously punished by changing policies and prolonged uncertainty, many in this “legacy caseload” are experiencing a mental health crisis. As this report makes clear, we need a more collaborative, trauma-informed approach to prevent future tragedies.

Author: Johan Ariff