Motivation and emotion/Book/2019/Asylum seeker detention and emotional well-being

Asylum seeker detention and emotional well-being:
What are the effects of detention on asylum seeker emotional well-being?

Multimedia presentation (3 min)

Overview

According to the United Nations High Commission for Refugees, there is currently the highest levels of forced population displacement, with the last decades of the 20th century resulting in an upsurge in the number of people fleeing persecution and regional wars (Silove, Austin, & Steel, 2007). Specifically, this is estimated to be around 65.3 million people and of this number 21.3 million are formally recognised as refugees by the UN (UNHRC, 2007). To be considered a refugee an individual must meet the definition outlined by the 1951 United Nations Convention on the status of refugees that stipulates'

"A refugee is an individual who has successfully completed the legal processes required to achieve permanent residency within the host country.

Figure 1. Asylum seekers are fleeing prosecution from their country of origin

Those who are awaiting refugee verification and have a well founded fear of persecution because of race, nationality, or membership in a particular social or political group in their home country are considered asylum seekers (Davidson, Murray, & Schweitzer, 2008). These individuals have often experienced traumatic events in their country of origin and then are faced with deterrence measures when they attempt to enter the country of refuge. These measures include confinement in detention centres, which has been demonstrated to have many adverse effects on their emotional wellbeing. These consequences are extensive and have the potential to have long-lasting effects.

This chapter focuses on asylum seekers and the effects that detention has on emotional wellbeing for both adults and children. Moreover, these consequences are investigated using psychological theory and research.

Focus questions: 1. What is asylum seeker detention? 2. What is emotional wellbeing? 3. What are the consequences of detention on emotional wellbeing? 4. How can specific theories of emotion help to understand these effects?

What is asylum seeker detention?

Figure 2. asylum seekers protesting on the roof of the Villawood Detention Centre

The influx of refugees has resulted in western countries utilising increasingly stringent measures to discourage people seeking asylum from entering their countries. Of those various strategies, the most controversial has been confining them in detention facilities. Many countries use this method to detain asylum seekers, however, Australia is the only one to establish a policy of mandatory indefinite detention (Silove et al., 2007). This means that all asylum seekers without valid travel documents or who arrive by boat face mandatory detention, along with those who are awaiting appeals and deportation. Moreover, since 9/11 other countries including Canada, the United States and the United Kingdom have also expanded their use of immigration detention facilities. This increase has led to much criticism, including the UNHCR expressing concerns over the lack of expertise in processing and the poor physical conditions within open-ended mandatory and arbitrary detention settings (Filges, Montgomery, & Kastrup, 2018).

The poor physical conditions of the facilities emerge as they been modelled on correctional institutions and are surrounded by palisade fencing, razor wire and more recently has been updated to include electrified perimeters. Additionally, the government outsource the management of the centres so they are contracted by a private company who apply regimented routines which is implemented by uniformed personnel and that affect all aspects of life. This has led to repeated hunger strikes, mass acts of self-mutilation and other forms of self harm, riots, damage to building and protests (Silove et al., 2007). As a result, these conditions have been shown to have deleterious effects on asylum seekers mental health and wellbeing.

Emotional well-being

Emotional well-being has recently been identified as an integral component of achieving overall general health and has been defined by the Australian Institute of Health and Welfare as;

"Emotional wellbeing refers to the way a person thinks and feels about themselves and others. It includes being able to adapt and deal with daily challenges (resilience and coping skills) while leading a fulfilling life." (Australian Institute of Health and Welfare, 2012)

However, from a psychological perspective, emotional well-being is a multifaceted construct that is complex and difficult to describe. The construct encompasses an individuals subjective interpretation of experiences which is shaped by their prior experiences and cultural, thus influences their ability to utilise psychological resources to meet a particular challenge. Moreover, each time an individual meets a psychological, physical or emotional challenge, the system of challenges and resources comes into a state of imbalance and they are forced to adapt their emotional resources to meet the specific challenge. Thus, stable emotional well-being is when the individual has adequate psychological resources to deal with challenges (Dodge, Daly, Huyton, & Sanders, 2012). This then has implications for mental health with decreases in emotional wellbeing related to increases in stress, depression, and anxiety .

Consequences of detention on emotional well-being

The consequences of detention on the emotional well-being of asylum seekers is thoroughly researched, with a plethora of studies demonstrating that the effects are incredibly long lasting and damaging to the individual. Specifically, they have shown that those who experience detention have adverse mental health, with the effects being prolonged and extending well beyond release into the community (Silove et al., 2007) These consequences are then augmented with studies demonstrating that the longer period of detention, the greater the risk of harmful mental health outcomes.

Moreover, the detention process exacerbates the stressors suffered by a group of people who are already vulnerable to mental health difficulties as a result of their previous exposure to systematic oppression, loss, displacement, and exposure to violence (Newman, 2013; Robjantm, Hassan, & Katona, 2009). Therefore, pre-migration trauma leads to a reduction in emotional well-being that is then culminated by the post migration stress of detention leading to mental health problems. In particular, these issues include depression, anxiety, and post traumatic stress disorder. Additionally, similar issues are found in children, with the inclusion of developmental issues, as the ability to meet developmental needs of children is greatly compromised in the restricted and artificial environment of a detention centre. Thus leading to regression and attachment problems (Silove et al., 2007).

Post traumatic stress disorder

The circumstances that force an individual to seek asylum often include war and gross human rights violations, which then result in high levels of pre-migration trauma. These events have continuing psychological impacts that have been shown to have a dose-response relationship with post-displacement mental health, whereby increases in exposure to traumatic events correlate with the severity of post traumatic stress disorder (PTSD). However, this relationship has been shown to be moderated by post migration factors including the individuals living situation.

This connection has been demonstrated within many studies including Keller et al., (2003), whose research indicated that adult asylum seekers placed in detention facilities have higher levels of PTSD with severity of the symptoms directly related to time in detention. Other studies have compared those in detention with non-detained refugees from similar backgrounds including Thompson & McGorry (1998), with results exhibiting an increase in the extremity of PTSD panic for the detainees. Additionally, an important finding was that detained participants had been exposed to a greater number of trauma experiences, however pre-migration trauma did not fully account for the difference. Thus suggesting that conditions in detention facilities contribute to the mental health difficulty experienced by detainees with PTSD.

Furthermore, similar results are found within studies on children in detention. Mares & Jureidini (2004), found that within a group of children who had been detained for one to two years, all of them met the clinical criteria for PTSD. Moreover, corresponding outcomes were identified by Steel, Momartin, Bateman, Hafshejani, & Silove (2004), with some children in the study re-experiencing symptoms directly related to events in detention.

Depression

Reports have indicated that depression is the most widely observed mental health issue for asylum seekers in detention facilities (Human Rights and Equal Opportunity Commission, 1998). This has been attributed to the difficulties unique to the detention experience. Specifically, the detention experience incapacitates detainees and suppresses their capacity to utilise usual coping skills and constitutes a meaningless environment. Therefore, they are preoccupied by extreme boredom and frustration, coupled with a lack of a clear future direction, which results in a high incidence of hopelessness and despair among detainees. Furthermore, this is then combined with the potential for detention environments to reactivate and exacerbate previous trauma, whilst acting as an ongoing trauma. Ergo resulting in deterioration of mental health and increases in depressive symptoms among detainees.

This deterioration of mental health has been suggested to go through successive stages which are triggered by negative outcomes on asylum decisions leading to extended detention. Arnold, Beeks, Fluxman, Katona, & Zulueta, (2006), addressed this within their research that included 33 detainees who had each been held in facilities for a period of 9 months or more. The findings indicate that 85% of the respondents reported chronic depressive symptoms and 65% reported suicidal ideation which continued to increase the longer the participants were detained. This is reinforced by Steel et al., (2004), who utilised psychiatric assessment to assess the prevalence of psychiatric disorders both during and prior to detention. Each of the adult participants reported pre-migration trauma and traumatic experiences whilst in detention. The psychiatric assessment indicated the prevalence of psychiatric disorders had increased significantly since the participants were detained with all adult detainees diagnosed with major depressive disorder, whereas only 21% reported retrospective symptoms that would indicate diagnoses prior to confinement. Thus suggesting an overall deterioration in mental health and increase in depression in response to the detention process and to particular associated experiences.

Suicidal ideation

Suicidal ideation is thinking about, considering, or planning to commit suicide and is associated with depression and major life events (Klonsky, May, & Saffer, 2016). Within the population of detained asylum seekers, research has indicated that the prevalence of suicidal ideation among men and women to be approximately 41 and 26 times the national average respectively (Dudly, 2003). Qualitative studies have suggested that this is attributed to psychological factors that influence the mental health of detainees including feelings of hopelessness and a sense of injustice. Thus suggesting both the psychological effect of detention compounded with factors related to the facilities environment adversely affect cognition and mental health which leads to suicidal ideation.

Moreover, prolonged detention is a large contributor, with rates of suicidal thoughts increasing threefold within the aforementioned study conducted by Steel (2004). Specifically, prior to detention none of the detainees experienced suicidal ideation nor had any of them self harmed, yet since being detained 93% of participants reported experiencing these cognitions and 36 had attempted acts of self harm. These results are paralleled in studies focusing on children, with outcomes demonstrating that among children who were interviewed, all were diagnosed with depression and each expressed suicidal ideation with a statistically significant portion engaging in self harm.

Additional problems for children

Emotional disturbances in very young children effect not only their mental health in the form of PTSD, depression and suicidal ideation but also their development and ability to form secure attachments (Silove et al., 2007). Specifically children who are contained in facilities for long periods of time, manifest a significant regression in development over the course of being detained. In particular, nocturnal enuresis is common with children either unable to attain the milestone of dry nights or regressing back to incontinence. Additional to physical developmental issues, research has also highlighted delays in language, behaviour and social development (Robjant, 2009). These delays can be associated with a lack of access to satisfactory educational opportunities, resources, or the inability to form meaningful connections .

Moreover, parents of children are often experiencing their own mental health issues and therefore are unable to provide adequate nurturing for and management of their children (Silove et al., 2007). This reduction in both the physical and emotional availability of attachment figures, leads to the inability to form a secure attachment style, which then has implications for interpersonal relationships and emotional functioning both in the current setting and throughout the individuals life span (Prather & Golden, 2009).

Case study: JP from Africa, Detained in the UK, aged 10 (True story from Corlett, G, Van Hove, L, & Wright, 2012) JP, aged four, arrived in the UK with her mother in 2003. JP’s mother had been subjected to domestic violence by her partner many times in the presence of JP. After being subjected to immigration detention, an attempt was made to remove JP and her mother from the UK, but this was cancelled because of the extreme distress the girl was experiencing.The mother was again detained after a few months and her daughter lived with a relative. Some years after living in the UK she and her mother were subjected to a dawn raid and taken to Yarl’s Wood IRC [Immigration Reception Centre]. On route, JP reportedly witnessed her mother being hit over the head by an immigration officer. She could no longer bear her anxieties and fears. She began to regress in her functioning and in the ways fear and anxiety are expressed. She began not being able to sleep at night, and could not stop thinking about her fear of return. She could no longer hold her fears in her mind, needed to go to the toilet about five times each night, sometimes wet her bed and it was very hard for her to sleep. When she fell asleep she tended to talk in her sleep and have bad dreams and nightmares.

Quiz Suicide ideation in asylum seeker populations can be partially attributed to feelings of hopelessness and a sense of injustice. True False

Attachment theory

Recent studies on children who are detained whilst seeking asylum have proposed that the experience has implications for parent-child relationships with it often being disruptive to regular attachment behaviours (Silove et al., 2007). This research has focused on the effects of poor parental mental health and the resulting inadequate nurturing and management. In turn, this interferes with the children's ability to form secure attachments, and therefore disrupts their healthy development.

Attachment theory is a perspective that focuses on relationships and how they provide a secure basis for infants and children, which has life long implications for personal development. Specifically, the theory assumes that the responsiveness, sensitivity and attunement of the maternal caregiver are essential components in the quality of attachment a child experiences to his or her attachment figure. Moreover, this bond serves as a secure base for the child, to promote personality development and affect regulation (Fitton, 2012). This occurs as the connection serves to protect the infant/child from fear and harm whilst setting the stage for the formation of a safe place from which to explore the world. Therefore, children who develop in supportive, healthy environments are more likely to develop secure attachments, compared to those who are raised in neglectful or disruptive settings who are unlikely to develop a secure attachment style. This then has implications for the child's interpersonal relationships and emotional regulation across their lifespan (Fitton, 2012).

Issues arise with attachment when children are not sufficiently cared for within their early developmental years. Specifically, when a child's safety and survival needs are not met, they fail to learn the cluster of appropriate "attachment behaviours", thus resulting in them learning atypical behaviours and emotional responses that they then utilise in their interactions with other adults. Moreover, the formation of these attachment behaviours is dependent on the child's experiences with neglected children often exhibiting an anxious/ambivalent attachment style whereas physically abused children are more likely to be characterised by avoidant attachment styles that manifest higher levels of aggression (Finzi, Ram, Har-Even, Shnit, & Weizman, 2001). In comparison, those who have developed in a secure setting, learn to trust and rely on the people caring for them. The outcome of this is a secure attachment style which is essential for self-esteem and self-confidence (Fitton, 2012).

Therefore, this knowledge can be utilised to understand the significant consequences that detention has on the emotional well-being of asylum seekers with specific reference to the impact it has on children's mental health. As parents are often plagued with mental health issues themselves, this renders them unable to provide an adequately secure base from which the child is able to develop secure attachment. This then fosters insecure attachments with caregivers and leads to limited opportunities for learning appropriate emotional responses, thereby increasing the risk of internalising problems and consequently developing psychological illness and distress.

Finally, this theory has also been applied to understand the effects of PTSD. Specifically, Van Der Kolk (1987) dictates that psychological trauma occurs when an individuals sense of safety within oneself and in relationships with others is removed in times of adversity, resulting in a lack of confidence in the order and continuity in life which initiates feelings of helplessness. In attachment terms, the PTSD reaction is a response to the possibility that protection or even ones life could be lost. This results in an increase in attachment behaviour which is reflected in excessive anxiety and an intensified effort to preserve or restore attachment. Thus PTSD can be conceived as the intensification of the response sequence to actual or threat of separation or loss from people or places that represent safety. Moreover, the anxiety is a form of separation anxiety that is so extreme that attachment behaviour is critical and demanding. This provides an explanation for PTSD in both children and in adults and how detention can exacerbate this reduction in emotional wellbeing through the potential for loss and separation.

Quiz Neglected children often display An anxious/ambivalent attachment style A secure attachment style An avoidant attachment style

Conclusion

Detention has significant, devastating, long-term effects on asylum seekers. Specifically, detaining these individuals leads to serious consequences for their emotional well-being such that it has implications for their entire life even after they have been released back into the community. These effects increase in severity the longer the individual is detained, with longer periods of detention associated with a greater risk of harmful mental health outcomes. The primary concerns for individuals in detention include PTSD, which can arise due to pre-migration stressors and be exacerbated by post-displacement factors. Moreover, depression and suicidal ideation also emerge as a consequence that impedes emotional well-being. Each of these also impact upon children detainees with their development and attachment also severely impeded. Overall, detaining individuals seeking asylum is re-traumatising and leaves those affected with emotional consequences that greatly hinder their well-being.

See also

• Asylum seekers (Wikipedia)
• Attachment theory (Wikipedia)
• Emotional well-being (Wikipedia)
• Major depressive disorder (Wikipedia)
• Posttraumatic stress disorder (Wikipedia)
• Suicidal ideation (Wikipedia)

References

Arnold, F., Beeks, M., Fluxman, J., Katona, C., & Zulueta, F. (2006). Unmet medical needs in detention BMJ Rapid Response. doi: https://doi.org/10.1136/bmj.332.7536.251

Australian Institute of Health and Welfare. (2012). Social and emotional wellbeing: development of a Children’s Headline Indicator (Vol. Cat. no. PHE 158). Canberra: AIHW.

Corlett, D., G, M., Van Hove, J., L, B., & Wright, K. (2012). Captured Chilldhood. Melbourne: International Detention Coalition.

Davidson, G. R., Murray, K. E., & Schweitzer, R. (2008). Review of refugee mental health and wellbeing; Australian perspectives Australian Psychologist, 43(3), 160-174. doi:10.1080/00050060802163041

Dodge, R., Daly, A., Huyton, J., & Sanders, L. (2012). The challenge of defining wellbeing. International Journal of Wellbeing, 2(3), 222-235. doi:10.5502/ijw.v2i3.4

Dudly, M. (2003). Contradictory Australian national policies on self harm and suicide; The case of asylum seekers in mandatory detention Australian Psychiatry, 11.

Filges, T., Montgomery, E., & Kastrup, M. (2018). The impact of detention on the health of asylum seekers; a systematic review Research on social work practise, 28(4), 399-414. doi:10.1177/1049731516630384

Finzi, R., Ram, A., Har-Even, D., Shnit, D., & Weizman, A. (2001). Attachment Styles and Aggression in Physically Abused and Neglected Children. Journal of Youth and Adolescence, 20(6), 769–786.

Fitton, V. A. (2012). Attachment Theory: History, Research, and Practice. Psychoanalytic Social Work, 19(1), 121-143. doi:10.1080/15228878.2012.666491

Human Rights and Equal Opportunity Commission. (1998). Those who’ve come across the seas; The report of the commision’s inquiry into the detention of unauthorised arrivals. Retrieved from Canberra:

Keller, A., Rosenfeld, B., Trinh- Shvrin, C., Meserve, C., Sachs, E., & Leviss, J. (2003). Mental health of detained asylum seekers Lancet, 362, 1721-1723.

Klonsky, D. E., May, A. M., & Saffer, B. Y. (2016). Suicide, Suicide Attempts, and Suicidal Ideation. Annual Review of Clinical Psychology, 12, 307-330. doi:10.1146/annurev-clinpsy-021815-093204

Mares, S., & Jureidini, J. (2004). Psychiatric assessment of children and families in immigration detention clinical, administrative and ethical issues Aust N Z J Public Health, 28(520-6).

Newman, L. (2013). Seeking Asylum—Trauma, Mental Health, and Human Rights: An Australian Perspective. Journal of Trauma & Dissociation, 14(2), 213-223. doi:10.1080/15299732.2013.724342

Prather, W., & Golden, J. (2009). A behavioral perspective of childhood trauma and attachment issues: Toward alternative treatment approaches for children with a history of abuse. International Journal Of Behavioral Consultation And Therapy, 5, 56-74. https://doi.org/10.1037/h0100872

Robjantm, K., Hassan, R., & Katona, C. (2009). Mental health implications of detaining asylum seekers; systematic review The British journal of Psychiatry, 194, 306-312. doi:10.1192/bjp.bp.108.053223

Silove, D., Austin, P., & Steel, Z. (2007). No refuge from terror; the impact of detention on the mental health of trauma-affected refugees seeking asylum in Australia. Transcultural Psychiatry, 44(3), 359-393. doi:10.1177/1363461507081637

Steel, Z., Momartin, S., Bateman, C., Hafshejani, A., & Silove, D. (2004). Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia Aust N Z J Public Health, 28, 527-536.

Thompson, M., & McGorry, P. (1998). Marribyrnong Detention Centre Tamil Survey In D. Silove & Z. Steel (Eds.), Mental Health and Wellbeing of On Shore Asylum Seekers in Australia (pp. 13-18). Univeristy of New South Wales Psychiatry Research and Teaching Unit

UNHRC. (2007). United Nation Refugee Agency Figures at a glance Retrieved from http://www.unher.org/figures-at-a-glance.html.

van der Kolk, B.A. (1987).Psychological trauma. Washington, D.C.: American Psychiatric Press.

External links

• Captured childhood (2012)