The mental health of refugees and asylum seekers on Manus Island

Moral injury related to immigration detention on Nauru: a qualitative study

BACKGROUND

Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role.

OBJECTIVE

Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru.

METHODS

In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data.

RESULTS

Major themes included 1) how participants' home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged. The participant statement 'In my country they torture your body but in Australia they kill your mind.' conveyed these three key themes in our analysis.

CONCLUSION

Our findings suggest that moral injury may be one of the processes by which mandatory immigration detention can cause harm. Although refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one's moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health.

Solidarity now? Other stories about researchers, otherness, and polyphony in research

We are three researchers within the field of mental health. For the past 3 years, we have collaborated with colleagues in Greece on evaluating the pilot project Refugee Outreach Mental Health Team. Part of our role has been to evaluate how refugees and asylum seekers experience the treatment and support offered by the team. The findings from the evaluation have been presented in a published research report and we have thereby “completed our task.” However, following the completion of the formal obligations, we have continued to dwell on the less outspoken dialogues and inner voices. Not only those of the participants, but also the ones of the researchers that are present before, during and after research interviews. Inspired by relational autoethnography, we share some “other stories” about how the research processes touched us deeply and how it has left traces in our minds and bodies long after the project completion. We reflect on how relational processes of polyphonic meaning-making can be used to develop deeper insights and knowledge as well as a call for action. We suggest that the sharing of other stories can provide new knowledge and new understandings of how knowledge can be developed. Our hope is also that it may serve troubling or evocative purposes, and encourage the development of dialogues by invoking inner and outer voices. Perhaps, it may even call for solidarity in others and ourselves.

Understanding the pathology of psychiatric disorders in refugees

Displacement of people from their homes, families and countries is a current global crisis, with over 70 million people forcibly on the move. A substantial proportion of these people will end up in regions with a different language and culture, where they are registered as refugees or asylum seekers. Due to the underlying reasons for displacement (including conflicts, persecution or violation of human rights), displaced people are severely stress-exposed, which continues into their post-migration life and increases risk for developing psychiatric disorders such as post-traumatic stress disorder and other anxiety disorders and mood disorders. While landmark studies have illustrated the increased prevalence of psychopathology in asylum seeker and refugee populations following pre-/post-displacement stress, few studies add to our understanding of the basic biological mechanisms underpinning risk to psychiatric disorders in these populations. Additionally, the mechanisms underlying resilience despite significant adversity remain unclear. Understanding the molecular mechanisms underpinning the development of psychiatric disorders in refugees can propel treatments (both drug and non-drug) that are capable of influencing biology at the molecular level, and the design of interventions. In the following review, we summarise the status quo of research investigating the pathophysiology of psychiatric disorders in refugees, and propose new ways to address gaps in knowledge with multidisciplinary research.