Deaths in Immigration and Customs Enforcement (ICE) detention: A Fiscal Year (FY) 2021-2023 update

Background

This study describes the deaths of individuals in Immigration and Customs Enforcement (ICE) detention between FY2021-2023, updating a report from FY2018-2020, which identified an increased death rate amidst the COVID-19 pandemic.

Methods

Data was extracted from death reports published online by ICE. Causes of deaths were recorded, and death rates per 100,000 admissions were calculated using population statistics reported by ICE. Reports of individuals released from ICE custody just prior to death were also identified and described.

Results

There were 12 deaths reported from FY2021-2023, compared to 38 deaths from FY2018-2020. The death rate per 100,000 admissions in ICE detention was 3.251 in FY2021, 0.939 in FY2022, and 1.457 in FY2023, compared with a pandemic-era high of 10.833 in FY2020. Suicide caused 1 of 12 (8.3%) deaths in FY2021-2023 compared with 9 of 38 (23.7%) deaths in FY2018-2020. COVID-19 was contributory in 3 of 11 (25%) medical deaths in FY2021-2023, compared with 8 of 11 (72.7%) in the COVID-era months of FY2020 (p = 0.030). Overall, 4 of 11 (36.3%) medical deaths in FY2021-2023 resulted from cardiac arrest in detention facilities, compared with 6 of 29 (20.3%) in FY2018-2020. Three deaths of hospitalized individuals released from ICE custody with grave prognoses were identified.

Conclusions

The death rate among individuals in ICE custody decreased in FY2021-2023, which may be explained in part by the release of vulnerable individuals following recent federal legal determinations (e.g., Fraihat v. ICE). Identification of medically complex individuals released from ICE custody just prior to death and not reported by ICE indicates that reported deaths underestimate total deaths associated with ICE detention. Attentive monitoring of mortality outcomes following release from ICE custody is warranted.

Mental Health Consultations in Immigration Detention: What Can We Learn From Clinical Records?

Objectives: Knowledge on mental health consultations in immigration detention and characteristics of people receiving consultations is scarce. Based on a sample of 230 adult men in immigration detention in Switzerland, we aimed to: (1) Quantify the proportion of persons receiving mental health consultations during detention; and (2) Identify socio-demographic and clinical characteristics associated with mental health consultations. Methods: Retrospective observational study with a cross-sectional design. Prevalence estimates, logistic regressions, and contingency tables were used to analyse the data. Results: A total of 30% of the sample received mental health consultations during detention. Time spent in immigration detention, mental health problems during detention, use of psychotropic medication, and self-harm were associated with mental health consultations. Although mental health consultations are provided to people with more severe mental health problems, 41% of persons with assessed mental health needs during the initial screening and 26% of those who self-harmed during detention did not receive mental health consultations. Conclusion: Mental health resources and screening procedures could be improved to ensure that mental health consultations are matched to clinical need in immigration detention settings.

Health of children in Australian immigration detention centres: An analysis of the quarterly health reports from 2014 to 2017

AIM

This study examines 3 years of child and adolescent health data from Australian onshore and offshore immigration detention centres from 2014 to 2017, quantifying the health presentation data of children and adolescents in Australian immigration detention and comparing rates between onshore and offshore detention.

METHODS

This study utilised the Quarterly Immigration Detention Health Reports over a period of 3 years. To compare onshore and offshore datasets, we calculated the rate of health events per quarter against the estimated quarterly onshore and offshore detention population of children. We ran a series of two-proportion z-tests for each matched quarter to calculate median z and P values for all quarters. These were used as an indicator as to whether the observed differences between onshore and offshore events were statistically significant.

RESULTS

The estimated number of children detained per quarter onshore ranged from 700 in 2014 (quarter 3) to 13 in 2016 (quarters 3 and 4); the estimated quarterly population of children in offshore detention ranged from 186 in 2014 (quarter 3) to 42 in 2017 (quarter 2). Children offshore had significantly higher rates of consultations with a mental health nurse (z = -1.96; P = 0.002), psychologist (z = -2.32; P = 0.01) and counsellor (z = -3.41; P < 0.001). As for reasons for presentation to general practitioners and psychiatrists, complaints related to skin (z = -1.97; P = 0.05), respiratory issues (z = -1.96; P = 0.05) and urological issues (z = -2.21; P = 0.03) were significantly higher amongst children detained offshore.

CONCLUSIONS

Compared to children in the Australian community, children detained both onshore and offshore had greater health needs. Children offshore also presented more frequently with a range of complaints and accessed health services at higher rates than children detained onshore; this adds to growing evidence about the harms of offshore detention and detention more generally.

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.

Pervasive refusal syndrome in child asylum seekers on Nauru

OBJECTIVES

Between 2013 and 2019, an estimated 200 children seeking asylum in Australia were detained on the island of Nauru. In 2018, 15 of these children developed the rare and life-threatening pervasive refusal syndrome (PRS). This paper describes the PRS case cluster, the complexities faced by clinicians managing these cases, and the lessons that can be learned from this outbreak.

CONCLUSIONS

The emergence of PRS on Nauru highlighted the risks of long-term detention of children in settings that are unable to meet their physical and psycho-social needs. The case cluster also underscored (a) the difficulties faced by doctors working in conditions where their medical and legal obligations may be in direct conflict, and (b) the role of clinicians in patient advocacy.

Self-Care in an Interprofessional Setting Providing Services to Detained Immigrants with Serious Mental Health Conditions

The authors are social workers and lawyers in an interprofessional setting providing legal and social services to detained immigrants in deportation proceedings who have serious mental health conditions. Drawing on direct experience working in the setting, as well as survey responses and feedback from other involved providers, the authors (a) identify barriers to self-care for social workers and lawyers that prevent them from effectively addressing the effects of secondary trauma; (b) propose a relationship-centered framework that, as an alternative to individualized practices of self-care, serves as a way to overcome those barriers; and (c) apply that framework to a case example from their interprofessional setting. The authors advocate for a relationship-centered, recovery-based approach to self-care to manage trauma exposure responses for social workers and lawyers in their specific interprofessional setting and for those working together in similar settings.

The mental health of asylum seekers in Australia and the role of psychiatrists

There are more displaced people around the world than ever before, and over half are children. Australia and other wealthy nations have implemented increasingly harsh policies, justified as ‘humane deterrence’, and aimed at preventing asylum seekers (persons without preestablished resettlement visas) from entering their borders and gaining protection. Australian psychiatrists and other health professionals have documented the impact of these harsh policies since their inception. Their experience in identifying and challenging the effects of these policies on the mental health of asylum seekers may prove instructive to others facing similar issues. In outlining the Australian experience, we draw selectively on personal experience, research, witness account issues, reports by human rights organisations, clinical observations and commentaries. Australia’s harsh response to asylum seekers, including indefinite mandatory detention and denial of permanent protection for those found to be refugees, starkly demonstrates the ineluctable intersection of mental health, human rights, ethics and social policy, a complexity that the profession is uniquely positioned to understand and hence reflect back to government and the wider society.

Mental health of unaccompanied asylum-seeking adolescents previously held in British detention centres

AIM

To investigate whether the mental health of unaccompanied asylum-seeking children (UASC) was negatively affected by having their ages disputed and being detained.

METHOD

Participants within this cross-sectional study were 35 UASC, aged between 13 and 17 when they were detained. Some years later, a team of child mental health professionals interviewed them to assess their current mental health and to determine, as far as possible, the impact that having their age disputed and being detained may have had on their mental health. The Structured Clinical Interview for DSM-IV (SCID-IV), Reactions of Adolescents to Traumatic Stress (RATS), Stressful Life Events (SLE) and Detention Experiences Checklist-UK version (DEC-UK) were administered.

RESULTS

The vast majority of UASC reported being negatively affected. Based on diagnostic interviews using the SCID-IV, self-report measures and contemporaneous records, the professionals reported a diagnosis of post-traumatic stress disorder (PTSD) developing in 29% ( n = 10), PTSD exacerbated in 51% ( n = 18), major depressive disorder (MDD) developing in 23% ( n = 8) and MDD exacerbated in 40% ( n = 14). A total of 3 years post-detention, 89% ( n = 31) met diagnostic criteria for psychiatric disorders and reported high PTSD symptoms.

CONCLUSION

There was a high prevalence of psychiatric disorder. The additional stress of age dispute procedures and detention was judged to have been harmful.

No jab, no record: Catch-up vaccination of children in immigration detention

International Health and Medical Services (IHMS) are contracted to provide health services, including catch-up vaccination, for individuals in immigration detention. Our audit of catch-up vaccination in asylum seeker children who spent time in held detention demonstrates inadequate and suboptimal vaccine delivery in this setting, and no evidence that IHMS recorded vaccines on the Australian Childhood Immunisation Register at the time. We also found substantial shortfalls in vaccination for these children after they were released from detention. Immunisation in this cohort falls well below Australian community standards, does not demonstrate assurance in IHMS provision of care, and has implications for similar asylum seeker cohorts nationally as well as people in held detention.

Mental capacity of those in immigration detention in the UK

Asylum seekers and migrants can be detained in immigration removal centres (IRCs) or, post sentence, in prison while the Home Office makes decisions on their immigration status and/or arrangements for their removal or deportation. Currently, there is no process for identifying detainees who lack the mental capacity to participate in decision making relating to their immigration situation. Mental illness and distress are common among detainees. There are often cultural and language barriers; there is no consistent system of advocates, and many detainees are without legal representation. Mental capacity is decision specific. Clinicians in IRCs have a duty to consider detainees' capacity for health-care decisions, but are not expected to carry out any assessment in the broader context of immigration decision making, and there is no set procedure for notifying immigration decision makers with any concerns about a detainee's capacity. The Home Office focusses on safeguarding vulnerable people in detention, but not on whether such detention should happen or whether individuals identified as especially vulnerable have the necessary capacity for immigration-related decisions. In the community, asylum seekers and migrants can be supported in their engagement with immigration officials by family and friends and other advocates of their choice. This is not the case for immigration detainees. The current arrangements carry a significant risk of unfair decisions being made on the most vulnerable detainees without their capacitous participation. Recommendations for changes are made, including the need for a high threshold to be applied to justify any detention of people who lack immigration-related decision-making capacity.

Fifteen years of detaining children who seek asylum in Australia - evidence and consequences

OBJECTIVE

To review and summarise the evidence about and consequences of Australia's policy of mandatory indefinite detention of children and families who arrive by boat to seek asylum.

METHODS

This paper will summarise the accumulated scientific evidence about the health and mental health impacts of immigration detention on children and compare methodologies and discuss the political reception of the 2004 and 2014 Australian Human Rights Commission (AHRC) Inquiries into Immigration Detention of children.

RESULTS

The conclusions of the 2004 and 2014 Inquiries into Immigration Detention of Children are consistent with Australian and international research which demonstrates that immigration detention has harmful health, mental health and developmental consequences for children and negative impacts on parenting.

CONCLUSION

The evidence that prolonged immigration detention causes psychological and developmental harm to children and families and is in breach of Australia's human rights obligations is consistent. This is now partially acknowledged by the Government. Attempts to limit public scrutiny through reduced access and potential punishment of medical witnesses arguably indicates the potency of their testimony. These harmful and unethical policies should be opposed.

Helping professionals and Border Force secrecy: effective asylum-seeker healthcare requires independence from callous policies

OBJECTIVE

To examine the Australian Border Force Act (BFA) and its context, its implications for asylum-seeker healthcare and professionals, and contemporary and historical parallels.

CONCLUSIONS

Prolonged immigration detention and policies aiming to deter irregular migration cause maritime asylum-seekers undeniable, well-publicised harms and (notwithstanding claims about preventing drownings) show reckless indifference and calculated cruelty. Service personnel may be harmed. Such policies misuse helping professionals to underwrite state abuses and promote public numbing and indifference, resembling other state abuses in the 'war on terror' and (with qualification) historical counterparts, e.g. Nazi Germany. Human service practitioners and organisations recently denounced the BFA that forbids disclosure about these matters.Continuing asylum-seeker healthcare balances the likelihood of effective care and monitoring with lending credibility to abuses. Boycotting it might sacrifice scrutiny and care, fail to compel professionals and affect temporary overseas workers. Entirely transferring healthcare from immigration to Federal and/or State health departments, with resources augmented to adequate standard, would strengthen clinical independence and quality, minimise healthcare's being securitised and politicised, and uphold ethical codes. Such measures will not resolve detention's problems, but coupled with independent auditing, would expose and moderate detention's worst effects, promoting changes in national conversation and policy-making.

Quality of life among immigrants in Swedish immigration detention centres: a cross-sectional questionnaire study

BACKGROUND

Detention of immigrants negatively affects their health and well-being. Quality of life (QOL) is a broad concept incorporating the self-evaluation of one's own health and well-being that can provide an understanding of the health and well-being of immigrant detainees. The aim of this study was to estimate QOL among immigrant detainees in Sweden and to assess its relationship with the services provided in detention centres and with the duration of detention.

DESIGN

All immigrants in all five existing Swedish detention centres (N=193) were invited to participate in the study (n=127). In this cross-sectional study, QOL was measured using the WHOQOL-BREF questionnaire, which was administered by the first author. The questionnaire contained four additional questions measuring participants' satisfaction with the services provided in detention. Associations between QOL domain scores and service satisfaction scores were assessed using regression analysis. The Spearman's rank correlation coefficient was calculated to measure the degree of association between the duration of detention and QOL scores.

RESULTS

The mean QOL domain scores (out of 100) were 47.0, 57.5, 41.9, and 60.5 for the environmental, physical, psychological, and social domains, respectively. The level of support detainees received from detention staff was significantly positively associated with detainees' physical (βadjusted 3.93, confidence interval [CI] 0.06-7.80) and psychological (βadjusted 5.72, CI 1.77-9.66) domain scores. There was also significant positive association between detainees' satisfaction with the care they received from detention staff and the domain scores. The general health score in the WHOQOL-BREF was significantly associated with the detainees' ability to understand the Swedish or English languages. Although not statistically significant, a longer duration of detention was negatively correlated with QOL scores.

CONCLUSION

Immigrant detainees report low QOL. Services provided at the centres, especially the support received from detention staff, is positively associated with their QOL. A review of detention guidelines addressing language barriers, staff training, and duration of detention is highly recommended.