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Mares S, Ziersch A. How immigration detention harms children: A conceptual framework to inform policy and practice. Psychol Trauma 2024:2024-74064-001. [PMID: 38635209 DOI: 10.1037/tra0001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE This paper identifies the multiple adversities and trauma experienced by children who are detained after seeking asylum. A conceptual framework identifies the specific impact of immigration detention on the psychosocial development and mental health of refugee children that can inform policy and prevent additional migration-related trauma. METHOD The paper draws on international evidence about the impact of childhood adversity, challenges faced by all displaced children, and the additional negative consequences of immigration detention. It integrates socioecological, temporal, and relational approaches to identify the pathways through which detention of forcibly displaced children causes preventable harm. The public health and human rights implications are identified. CONCEPTUAL FRAMEWORK The framework draws on Bronfenbrenner's socioecological model and has the child, their development, and experience at the center. Refugee children are exposed to cumulative adversity during displacement, flight, and resettlement. Immigration detention is associated with multiple additional adversities and human rights violations. International and national contexts and the detention environment impact on family functioning and directly on the child's well-being. CONCLUSIONS Immigration detention is a preventable and profoundly negative reception experience for already vulnerable children. It is unavoidably associated with multiple additional adverse exposures with significant health and public health consequences. The proposed framework demonstrates adversity in each socioecological sphere of the detained child's life and across time. The framework can inform migration, child protection, and public health policy. Advocacy and political action to end this practice are urgently required to prevent further harm. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Sarah Mares
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales
| | - Anna Ziersch
- Flinders Health and Medical Research Institute, Flinders University
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Ratnamohan L, Silove D, Mares S, Krishna Y, Hadzi-Pavlovic D, Steel Z. Breaching the family walls: Modelling the impact of prolonged visa insecurity on asylum-seeking children. Aust N Z J Psychiatry 2023; 57:1130-1139. [PMID: 36632824 DOI: 10.1177/00048674221148399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Children in asylum-seeking families are increasingly subject to deterrent host nation policies that undermine security in the post-migration context, however, little is known on the mental health consequences of such policy. This study examined the impact of prolonged visa insecurity on child mental health, by comparing two cohorts of refugee children entering Australia between 2010 and 2013, distinguished by visa security. METHODS The insecure visa sample comprised children from Tamil asylum-seeking families, while the secure visa sample was drawn from refugee families participating in the multi-ethnic 'Building a New Life in Australia' cohort study. Children in each sample were assessed for current mental health problems and trauma exposure. Mothers were assessed for trauma exposure, post-migration family stressors and post-traumatic stress disorder (PTSD). The effects of prolonged visa insecurity on child mental health via family-and child-level variables were modelled using multi-level path analysis. RESULTS Data comprised 361 children, aged 10-18, and 242 mothers across three levels of visa insecurity: permanent protection (n = 293), temporary protection (n = 40) and bridging visa (n = 28). Modelling showed that (1) visa insecurity was associated with poorer child mental health, (2) the association was mediated sequentially by post-migration family stressors and maternal PTSD and (3) the association was moderated by maternal PTSD. CONCLUSION Our findings suggest that when government policy persistently undermines post-migration security, the capacity of families to protect children from accrued stressors is lowered, leaving a significantly higher proportion of children developing along trajectories of risk rather than resilience.
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Affiliation(s)
- Lux Ratnamohan
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Rivendell Child, Adolescent and Family Mental Health Service, Thomas Walker Hospital, Concord West, NSW, Australia
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Yalini Krishna
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | | | - Zachary Steel
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Rivendell Child, Adolescent and Family Mental Health Service, Thomas Walker Hospital, Concord West, NSW, Australia
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Amarasena L, Samir N, Sealy L, Hu N, Rostami MR, Isaacs D, Gunasekera H, Young H, Agrawal R, Levitt D, Francis JR, Coleman J, Mares S, Larcombe P, Cherian S, Raman S, Lingam R, Zwi K. Offshore detention: cross-sectional analysis of the health of children and young people seeking asylum in Australia. Arch Dis Child 2023; 108:185-191. [PMID: 36549868 DOI: 10.1136/archdischild-2022-324442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia's immigration policy of indefinite mandatory detention on Nauru. DESIGN Cross-sectional analysis of a cohort of CYP seeking asylum. SETTING Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. PARTICIPANTS Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. MAIN MEASURES Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. RESULTS Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (p<0.05); witnessed trauma (p<0.05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p<0.05). Neurodevelopmental concerns were seen in eight children (13%). CONCLUSIONS This study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia's offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.
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Affiliation(s)
- Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia .,Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Nora Samir
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia
| | - Louise Sealy
- Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Nan Hu
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia
| | - Mohammad Reza Rostami
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - David Isaacs
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,The Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,The Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Young
- Paediatrics, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rishi Agrawal
- Paediatric Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - David Levitt
- Mater Refugee Complex Care Clinic, Mater Misericordiae Health Services, Brisbane, Queensland, Australia.,Paediatrics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research - Charles Darwin University, Darwin, Northern Territory, Australia.,Paediatric Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jacinta Coleman
- Adolescent Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Penny Larcombe
- Paediatrics, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sarah Cherian
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Discipline of Paediatrics, University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia.,Community Paediatrics, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia.,Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia.,Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Chamberlain C, Gray P, Bennet D, Elliott A, Jackomos M, Krakouer J, Marriott R, O'Dea B, Andrews J, Andrews S, Atkinson C, Atkinson J, Bhathal A, Bundle G, Davies S, Herrman H, Hunter S, Jones‐Terare G, Leane C, Mares S, McConachy J, Mensah F, Mills C, Mohammed J, Hetti Mudiyanselage L, O'Donnell M, Orr E, Priest N, Roe Y, Smith K, Waldby C, Milroy H, Langton M. Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start (SAFeST Start): Urgent call to action to address crisis in infant removals. Aust J Soc Issues 2022; 57:252-273. [PMID: 35910416 PMCID: PMC9304314 DOI: 10.1002/ajs4.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/29/2021] [Accepted: 01/01/2022] [Indexed: 05/22/2023]
Abstract
Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The "gap" is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non-Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compounding intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a transformative foundation to address historical, institutional, well-being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.
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Affiliation(s)
- Catherine Chamberlain
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia
- The Lowitja InstituteCarltonVicAustralia
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdochWAAustralia
| | - Paul Gray
- SNAICC ‐ National Voice for our ChildrenCollingwoodVic.Australia
- Jumbunna Institute for Indigenous Education and ResearchUniversity of Technology SydneySydneyNSWAustralia
| | - Debra Bennet
- SNAICC ‐ National Voice for our ChildrenCollingwoodVic.Australia
- Relationships AustraliaEight Mile PlainsQLDAustralia
| | - Alison Elliott
- Bouverie CentreLa Trobe UniversityMelbourneVic.Australia
| | | | - Jacynta Krakouer
- SNAICC ‐ National Voice for our ChildrenCollingwoodVic.Australia
- Health and Social Care UnitMonash UniversityClaytonVic.Australia
| | - Rhonda Marriott
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdochWAAustralia
| | - Birri O'Dea
- Molly Wardaguga Research CentreCharles Darwin UniversityCasuarinaNTAustralia
| | - Julie Andrews
- Aboriginal StudiesLa Trobe UniversityMelbourneVic.Australia
| | - Shawana Andrews
- Melbourne Poche Centre for Indigenous HealthThe University of MelbourneMelbourneVic.Australia
- School of PsychiatryUniversity of NSWSydneyNSWAustralia
| | | | | | - Alex Bhathal
- Social Work and Social PolicyLa Trobe UniversityMelbourneVic.Australia
| | - Gina Bundle
- The Royal Women's Hospital, MelbourneParkvilleVic.Australia
| | - Shanamae Davies
- Women's and Children's Health Network South AustraliaAdelaideSAAustralia
| | - Helen Herrman
- Orygen and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | | | | | - Cathy Leane
- Women's and Children's Health Network South AustraliaAdelaideSAAustralia
| | - Sarah Mares
- School of PsychiatryUniversity of NSWSydneyNSWAustralia
| | - Jennifer McConachy
- Department of Social WorkThe University of MelbourneMelbourneVic.Australia
| | - Fiona Mensah
- Murdoch Children's Research InstituteMelbourneVic.Australia
- Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsThe University of MelbourneMelbourneVic.Australia
| | - Catherine Mills
- Monash Bioethics CentreMonash UniversityClaytonVic.Australia
| | | | | | | | - Elizabeth Orr
- School of PsychiatryUniversity of NSWSydneyNSWAustralia
| | - Naomi Priest
- Murdoch Children's Research InstituteMelbourneVic.Australia
- Centre for Social Research and MethodsAustralian National UniversityCanberraACTAustralia
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVic.Australia
| | - Yvette Roe
- Molly Wardaguga Research CentreCharles Darwin UniversityCasuarinaNTAustralia
| | - Kristen Smith
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
| | - Catherine Waldby
- Research School of Social SciencesThe Australian National UniversityCanberraACTAustralia
| | - Helen Milroy
- Perth Children's HospitalNedlandsWAAustralia
- Division of PsychiatryUniversity of Western AustraliaCrawleyWAAustralia
| | - Marcia Langton
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
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Campana F, Lan R, Girard C, Rochefort J, Le Pelletier F, Leroux-Villet C, Mares S, Millot S, Zlowodzki AS, Sibaud V, Tessier MH, Vaillant L, Fricain JC, Samimi M. French guidelines for the management of oral lichen planus (excluding pharmacological therapy). Ann Dermatol Venereol 2022; 149:14-27. [PMID: 34238586 DOI: 10.1016/j.annder.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/16/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Oral lichen is a chronic inflammatory disease for which diagnostic management and follow-up are heterogeneous given the absence of specific guidelines in France. Our objective was to develop French multidisciplinary guidelines for the management of oral lichen. MATERIALS AND METHODS Working groups from the Groupe d'Etude de la Muqueuse Buccale (GEMUB) formulated a list of research questions and the corresponding recommendations according to the "formal consensus" method for developing practice guidelines. These recommendations were submitted to a group of experts and the degree of agreement for each recommendation was assessed by a scoring group. RESULTS Twenty-two research questions, divided into 3 themes (nosological classification and initial assessment, induced oral lichenoid lesions, and follow-up) resulted in 22 recommendations. Initial biopsy for histology is recommended in the absence of reticulated lesions. Biopsy for direct immunofluorescence is recommended for ulcerated, erosive, bullous types and for diffuse erythematous gingivitis. Management should include a periodontal and dental check-up, and investigation for extra-oral lesions. Hepatitis C testing is recommended only if risk factors are present. Definitions, triggering factors and the management of "induced oral lichenoid lesions" were clarified. Oral lichen must be monitored by a practitioner familiar with the disease at least once a year, using objective tools. CONCLUSION This formalised consensus of multidisciplinary experts provides clinical practice guidelines on the management and monitoring of oral lichen.
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Affiliation(s)
- F Campana
- Aix Marseille Univ, APHM, INSERM, MMG, Hôpital de la Timone, Unité de chirurgie orale, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - R Lan
- Aix Marseille Univ, APHM, CNRS, EFS, ADES, Hôpital de la Timone, Unité de chirurgie orale, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - C Girard
- Dermatologie, CHU de Montpellier, 34295 Montpellier cedex, France
| | - J Rochefort
- Odontologie, Hôpital La Pitié Salpetrière - Université Paris Diderot, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - F Le Pelletier
- Anatomie Pathologique, Hôpital La Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Leroux-Villet
- Dermatologie, Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - S Mares
- Chirurgie Maxillo-faciale, Hôpital La Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Millot
- Chirurgie Orale, CHU de Montpellier, 34295 Montpellier cedex, France
| | | | - V Sibaud
- Dermatologie, IUCT Oncopôle, 31000 Toulouse, France
| | - M-H Tessier
- Dermatologie, CHU de Nantes, 44000 Nantes, France
| | - L Vaillant
- Dermatologie, CHU de Tours, Université de Tours, 37000 Tours, France
| | - J-C Fricain
- Université de Bordeaux, INSERM U1026, service de chirurgie orale, CHU Bordeaux, 33000 Bordeaux, France
| | - M Samimi
- Dermatologie, CHU de Tours, Université de Tours, 37000 Tours, France.
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Mares S. Mental health consequences of detaining children and families who seek asylum: a scoping review. Eur Child Adolesc Psychiatry 2021; 30:1615-1639. [PMID: 32926223 DOI: 10.1007/s00787-020-01629-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
Almost 80 million people globally are forcibly displaced. A small number reach wealthy western countries and seek asylum. Over half are children. Wealthy reception countries have increasingly adopted restrictive reception practices including immigration detention. There is an expanding literature on the mental health impacts of immigration detention for adults, but less about children. This scoping review identified 22 studies of children detained by 6 countries (Australia, Canada, Hong Kong, Netherlands, the UK and the US) through searches of Medline, PsychINFO, Emcare, CINAHL and Scopus data bases for the period January 1992-May 2019. The results are presented thematically. There is quantitative data about the mental health of children and parents who are detained and qualitative evidence includes the words and drawings of detained children. The papers are predominantly small cross-sectional studies using mixed methodologies with convenience samples. Despite weaknesses in individual studies the review provides a rich and consistent picture of the experience and impact of immigration detention on children's wellbeing, parental mental health and parenting. Displaced children are exposed to peri-migration trauma and loss compounded by further adversity while held detained. There are high rates of distress, mental disorder, physical health and developmental problems in children aged from infancy to adolescence which persist after resettlement. Restrictive detention is a particularly adverse reception experience and children and parents should not be detained or separated for immigration purposes. The findings have implications for policy and practice. Clinicians and researchers have a role in advocacy for reception polices that support the wellbeing of accompanied and unaccompanied children who seek asylum.
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Affiliation(s)
- Sarah Mares
- School of Psychiatry, University of NSW, Sydney, Australia.
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7
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Abstract
OBJECTIVE This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic. CONCLUSIONS Australia's policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified.
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Affiliation(s)
- Sarah Mares
- School of Psychiatry, University of NSW, Annandale, NSW, Australia
| | - Kym Jenkins
- University of Melbourne, Monash University, Royal Australian New Zealand College of Psychiatrists, Melbourne, VIC, Australia; and Migrant and Refugee Health Partnership, Mental Health Australia
| | - Susan Lutton
- Association for Services to Torture and Trauma Survivors, Perth, WA, Australia
| | - Louise Newman Am
- Building Early Attachment and Resilience Research Group, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Chamberlain C, Gee G, Gartland D, Mensah FK, Mares S, Clark Y, Ralph N, Atkinson C, Hirvonen T, McLachlan H, Edwards T, Herrman H, Brown SJ, Nicholson AJM. Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: 'Its Important, but How These Discussions Are Held Is Critical'. Front Psychol 2020; 11:2014. [PMID: 33041880 PMCID: PMC7522325 DOI: 10.3389/fpsyg.2020.02014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Becoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing ‘complex trauma.’ Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents. Setting and Methods A co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored. Main Findings The majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding ‘qualities’ (e.g., caring), rather than specific ‘attributes’ (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion. Conclusion Assessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social Equity, Perth, WA, Australia
| | - Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Psychology, The University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona K Mensah
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Yvonne Clark
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Naomi Ralph
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | | | - Tanja Hirvonen
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Tahnia Edwards
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie J Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia.,SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - And Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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9
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Zwi K, Sealy L, Samir N, Hu N, Rostami R, Agrawal R, Cherian S, Coleman J, Francis J, Gunasekera H, Isaacs D, Larcombe P, Levitt D, Mares S, Mutch R, Newman L, Raman S, Young H, Norwood C, Lingam R. Asylum seeking children and adolescents in Australian immigration detention on Nauru: a longitudinal cohort study. BMJ Paediatr Open 2020; 4:e000615. [PMID: 32201744 PMCID: PMC7073805 DOI: 10.1136/bmjpo-2019-000615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Immigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention. METHODS AND ANALYSIS This is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective factors for health and well-being (eg, adverse childhood experiences). Longitudinal follow-up will capture outcomes over a 5-year period after arrival in Australia. Analysis will be undertaken to explore baseline risk and protective factors, with regression analyses to assess their impact on health and well-being outcomes. To understand how children's outcomes change over time, multilevel regression analysis will be utilised. Structural equation modelling will be conducted to explore the correlation between baseline factors, mediational factors and outcomes to assess trajectories over time. ETHICS AND DISSEMINATION This research project was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee. Subsequent site-specific approvals have been approved in 5 of the 11 governing bodies where the clinical consultations took place. In order to ensure this research is relevant and sensitive to the needs of the cohort, our research team includes an asylum seeker who has spent time in Australian immigration detention. Results will be presented at conferences and published in peer-reviewed Medline-indexed journals.
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Affiliation(s)
- Karen Zwi
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia.,Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Louise Sealy
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Nora Samir
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Nan Hu
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Reza Rostami
- School of Psychiatry, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Rishi Agrawal
- General Paediatrics, Women's and Children's Hospital Adelaide Division of Paediatric Medicine, North Adelaide, South Australia, Australia
| | - Sarah Cherian
- Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jacinta Coleman
- Adolescent Medicine, Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Josh Francis
- Paediatric Infectious Diseases, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Hasantha Gunasekera
- School of Paediatrics, The University of Sydney, Sydney, New South Wales, Australia
| | - David Isaacs
- Paediatric Infectious Diseases, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Penny Larcombe
- Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Levitt
- Department of Paediatrics, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Raewyn Mutch
- Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Louise Newman
- Child Psychiatry, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia.,Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Helen Young
- Paediatrics, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
| | - Christy Norwood
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
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Abstract
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.
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Affiliation(s)
- Derrick Silove
- Scientia Professor, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sarah Mares
- Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Sydney, Australia. Email .,PhD candidate, Flinders University, Adelaide, Australia
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Zwi K, Woodland L, Mares S, Rungan S, Palasanthiran P, Williams K, Woolfenden S, Jaffe A. Helping refugee children thrive: what we know and where to next. Arch Dis Child 2018; 103:529-532. [PMID: 29275398 DOI: 10.1136/archdischild-2017-314055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Karen Zwi
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Lisa Woodland
- District Executive Unit, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Santuri Rungan
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | | | - Susan Woolfenden
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Adam Jaffe
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Zwi K, Mares S, Nathanson D, Tay AK, Silove D. The impact of detention on the social-emotional wellbeing of children seeking asylum: a comparison with community-based children. Eur Child Adolesc Psychiatry 2018; 27:411-422. [PMID: 29177563 DOI: 10.1007/s00787-017-1082-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
Accumulating literature demonstrates that immigration detention is harmful to children. However, there is a scarcity of scientifically rigorous and reliable data about the health of children held in detention facilities. The aim of the study was to compare a community-based population of recently arrived refugee children flown into Australia, not detained, resettled in a non-urban area, with a population of children who arrived by boat seeking asylum, detained since arrival. The parent-version of the strength and difficulties questionnaire (SDQ) of children aged 4-15 years was compared in children living in the community with those held in detention. We compared 86 children who had a parent-completed SDQ performed, 38 (44%) in the community group and 48 (56%) in the detention group. The community sample had been living in Australia for 325 days, with no time in detention. The detention sample had been living in detention for a mean of 221 days. The mean age was similar for the community and detention sample at 8.4 years (P = 0.18). In the total sample, children in the detention group had significantly higher SDQ total difficulties scores than children in the community group (P < 0.0001). There was no difference between age groups (P = 0.82). The children in the detention group had, on average, an SDQ total difficulties score that was 12 points higher than children in the community group. Four of the five SDQ subscale scores indicated greater disturbance amongst children in detention (< 0.0001) compared to children living in the community. The detention group had significantly higher scores (P < 0.001) for all except Pro-social scores as compared to Australian norms for the 4-6 and 7-15 years age group. This study presents a rare opportunity to compare the wellbeing of displaced children who were detained following arrival in Australia with those settled in the Australian community since arrival. The community children's scores approximated data from the general Australian childhood population. Children held in detention had significantly more social, emotional and behavioural difficulties than children living in the community, and at levels resembling a clinical cohort. Despite the small sample size, data restrictions and other limitations of the data, statistical significance in differences between the community and detention children is marked and arguably demonstrates the negative impact of post-arrival detention in children who are presumed to have similar levels of pre-arrival adversity. If the objective is to optimise the health and wellbeing of children seeking asylum, removal of post-arrival detention is one of the most powerful interventions available to host countries.
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Affiliation(s)
- Karen Zwi
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia. .,Sydney Children's Hospitals Network, High Street, Randwick, Sydney, Australia.
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Dania Nathanson
- Sydney Children's Hospitals Network, High Street, Randwick, Sydney, Australia
| | - Alvin Kuowei Tay
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Psychiatry Research and Teaching Unit, Ingham Applied Medical Institute, Liverpool Hospital, Liverpool, Australia
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Psychiatry Research and Teaching Unit, South West Sydney Local Health District, Sydney, Australia
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Ratnamohan L, Mares S, Silove D. Ghosts, tigers and landmines in the nursery: Attachment narratives of loss in Tamil refugee children with dead or missing fathers. Clin Child Psychol Psychiatry 2018; 23:294-310. [PMID: 29260574 DOI: 10.1177/1359104517746453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To build an account of how bereaved Tamil refugee and asylum seeker children, resettled in Australia, had processed the loss of their dead or missing fathers. METHOD Phenomenological and discourse analysis was applied to attachment narratives of nine children (aged 11-17 years) and their surviving mothers in families that lost fathers in war-related circumstances. The narratives were analysed through the lens of Crittenden's Dynamic-Maturational Model of Attachment and Adaptation (DMM) and Klass' cross-cultural model of grief. RESULTS Two divergent pathways - 'burying the past' and 'reifying the past' - emerged, encompassing the children's contrasting patterns of information processing regarding loss and trauma (dismissing or preoccupying) and representation of the past (distant-buried or rich-reconstructed). Each pathway reflected a strategic compromise between the constraints and resources presented to the child by the circumstances of the loss (ambiguous or confirmed), the response of their surviving parent (stricken or stoic) and the collective narrative surrounding the loss (silenced or valorised). CONCLUSION The DMM's conceptualisation of attachment as self-protective strategies for navigating danger was helpful in explaining the contrasting adaptations of refugee children to loss and trauma. However, to understand the multivalent meanings of these adaptations, there was a need to situate child-parent attachment relationships within the wider sociocultural reconfigurations arising from contexts of political violence.
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Affiliation(s)
- Lux Ratnamohan
- 1 Psychiatry Research and Teaching Unit, Liverpool Hospital, Sydney, Australia.,2 Health Education and Training Institute, Sydney, Australia.,3 School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sarah Mares
- 3 School of Psychiatry, University of New South Wales, Sydney, Australia.,4 Menzies School of Health Research, Darwin, Australia
| | - Derrick Silove
- 1 Psychiatry Research and Teaching Unit, Liverpool Hospital, Sydney, Australia.,3 School of Psychiatry, University of New South Wales, Sydney, Australia
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Mares S. The Mental Health of Children and Parents Detained on Christmas Island: Secondary Analysis of an Australian Human Rights Commission Data Set. Health Hum Rights 2016; 18:219-232. [PMID: 28559688 PMCID: PMC5395006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This paper describes secondary analysis of previously unreported data collected during the 2014 Australian Human Rights Commission Inquiry into Children in Immigration Detention. The aim was to examine the mental health of asylum-seeking parents and children during prolonged immigration detention and to consider the human rights implications of the findings. The average period of detention was seven months. Data includes 166 Kessler 10 Scales (K10) and 70 Strengths and Difficulties Questionnaires (SDQ) for children aged 3-17 and parental concerns about 48 infants. Extremely high rates of mental disorder in adults and children resemble clinical populations. The K10 indicated severe co-morbid depression and anxiety in 83% of adults and 85.7% of teenagers. On the SDQ, 75.7% of children had a high probability of psychiatric disorder, with lower conduct and hyperactivity scores than clinic populations. Sixty-seven percent of parents had concerns about their infant's development. Correlations were not found between time detained or parent/child distress. Multiple human rights breaches are identified, including the right to health. This is further evidence of the profound negative consequences for adults and children of prolonged immigration detention. Methodological limitations demonstrate the practical and ethical obstacles to research with this population and the politicized implications of the findings.
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Affiliation(s)
- Sarah Mares
- Cert Child Psychiatry, MMH is Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Sydney, Australia and Honorary Fellow, Menzies School of Health Research, Darwin Australia
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15
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Abstract
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.
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Affiliation(s)
- Sarah Mares
- Child and Family Psychiatrist, Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Annandale, NSW, and; Honorary Fellow, Centre for Child Development and Education, Menzies School of Health Research, Darwin, NT, Australia
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16
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Affiliation(s)
- Karen Zwi
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Mares
- Centre for Child Development and Education, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Mares S, Zwi K. Sadness and fear: The experiences of children and families in remote Australian immigration detention. J Paediatr Child Health 2015; 51:663-9. [PMID: 26135147 DOI: 10.1111/jpc.12954] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Child Development and Education, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Karen Zwi
- Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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18
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Affiliation(s)
- Sarah Mares
- Jade House and Toddler Clinics, Karitane, Sydney, NSW
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Mares S, Torres M. Young foster children and their carers: an approach to assessing relationships. Clin Child Psychol Psychiatry 2014; 19:367-83. [PMID: 23855012 DOI: 10.1177/1359104513494871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This article outlines an approach to assessing the quality of relationships between young foster children and their carers. These children are at high risk of disorganised attachment relationships and of developmental psychopathology given their relational experiences prior to and in care. During a semi-structured play interaction the emphasis is on identifying behaviours of clinical interest. This can be complex given the likelihood of atypical or unexpected behaviours expressed within relationships. METHOD The paper draws on literature on the clinical application of attachment theory to the assessment of relationships and on the authors' experience of developing and delivering an assessment and intervention service for children aged 0 to 5-years-old within a mental health service for children in foster care. Clinical material is used to illustrate and develop the issues. CONCLUSION The case for including a semi-structured observational procedure as part of a comprehensive assessment of foster children and their carers is outlined. This is argued to have more clinical utility than formal approaches to attachment classification. The benefits of including a semi-structured and relational approach to clinical assessment of foster children are outlined along with the need to be cautious in the use of attachment related terminology when formal assessments have not been undertaken.
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Affiliation(s)
- Sarah Mares
- Centre for Child Development and Education, Menzies School of Health Research, Australia
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20
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Zwi K, Mares S. Commentary: Reducing further harm to asylum-seeking children. The global human rights context. Int J Epidemiol 2014; 43:104-6. [DOI: 10.1093/ije/dyt269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mares S, Ben Slama L, Gruffaz F, Goudot P, Bertolus C. [Potentially malignant character of oral lichen planus and lichenoid lesions]. ACTA ACUST UNITED AC 2013; 114:293-8. [PMID: 23849797 DOI: 10.1016/j.revsto.2013.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Many authors have reported the possible malignant transformation of oral lichen. The incidence of this event remains controversial. Many authors make a distinction between the "true" oral lichen planus (OLP) and lichenoid lesions (LL) according to the WHO clinical and histological classification. For these authors an increased risk of development of oral cancer could occur only on LL. Our aim was to check this hypothesis on a cohort followed for 10 years. MATERIAL AND METHODS We included patients who were referred to our team for the first time between 1995 and 1997, still followed in 2010, with a histological diagnosis of buccal lichen planus. We classified lesions as OLP or LL according to the WHO clinical and histological classification: the two clinical criteria for OLP were a reticulated aspect and bilateral and symmetric lesions. Three histological criteria were necessary for the diagnosis: dense inflammatory infiltrate in the upper lamina propria, liquefaction degeneration of basal keratinocytes, and no signs of dysplasia. The final diagnosis was OLP, when all clinical ad histological criteria were met otherwise it was LL. We studied the patient's outcome between their first consultations and May 2010. RESULTS Thirty-two patients, whose data was available, met inclusion criteria. Eight were diagnosed with OLP and 24 with LL. The mean follow-up was 164 months [154-183]. No oral cancer was observed in the OLP group. Two patients in the LL group presented with oral cancer after 45 and 143 months of follow-up. DISCUSSION Malignant transformations were observed only in the LL group. Our results correlate with those of Van Der Meij et al. published in 2006. The strict use of the WHO diagnostic criteria seems to allow identifying patients at risk of developing oral cancer (LL) and others with only a benign course of this chronic oral mucosal disease. These results need to be confirmed by prospective multicentric studies.
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Affiliation(s)
- S Mares
- Service de stomatologie et chirurgie maxillo-faciale, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; UPMC université Paris 06, 75005 Paris, France
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Abstract
OBJECTIVE Little is written about the process of delivering mainstream, evidence-based therapeutic interventions for Aboriginal children and families in remote communities. Patterns of interaction between parents and children and expectations about parenting and professional roles and responsibilities vary across cultural contexts. This can be a challenging experience for professionals accustomed to work in urban settings. Language is only a part of cultural difference, and the outsider in a therapeutic group in an Aboriginal community is outside not only in language but also in access to community relationships and a place within those relationships. METHOD This paper uses examples from Let's Start, a therapeutic parent-child intervention to describe the impact of distance, culture and relationships in a remote Aboriginal community, on the therapeutic framework, group processes and relationships. RESULTS Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. CONCLUSIONS Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Program adaptation, evaluation and staff training and support need to take these factors into account to ensure cultural accessibility without loss of therapeutic fidelity and efficacy.
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Affiliation(s)
- Sarah Mares
- Redbank House, Western Sydney LAHN and Menzies School of Health Research, Darwin, NT, Australia.
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Warren B, Mares S. Developing reflective skills in infant mental health postgraduate students: The Australian experience. Infant Ment Health J 2009; 30:621-633. [DOI: 10.1002/imhj.20232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE This paper reports the clinical, practical and ethical issues arising in the assessment of 10 consecutive referrals from a remote Immigration Reception and Processing Centre to a child and adolescent mental health service (CAMHS) between February and August 2002. METHOD The 16 adults and 20 children (age range 11 months to 17 years) were comprehensively assessed by allied health clinicians and child psychiatrists. All children were also assessed by the statutory child protection agency. RESULTS There were very high levels of mood disturbance and post-traumatic symptoms in this population. All children had at least one parent with psychiatric illness. Of the 10 children aged 6-17 years, all (100%) fulfilled criteria for both post-traumatic stress disorder (PTSD) and major depression with suicidal ideation. Eight children (80%), including three pre-adolescents, had made significant attempts at self harm. Seven (70%) had symptoms of an anxiety disorder and half reported persistent severe somatic symptoms. The majority (80%) of preschool-age children were identified with developmental delay or emotional disturbance. Few clinically based recommendations were implemented. CONCLUSIONS Very high levels of psychopathology were found in child and adult asylum seekers. Much was attributable to traumatic experiences in detention and, for children, the impact of indefinite detention on their caregivers. IMPLICATIONS Multiple obstacles to adequate service provision are identified. Adequate clinical intervention and care was not possible. The impact on involved clinicians is discussed.
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Abstract
PURPOSE OF REVIEW The present review examines the available literature to consider recent advances in the theories of, and interventions with, disorders of attachment. We discuss the existing evidence to argue that the conceptualization of attachment disorders remains problematic despite their clinical significance. RECENT FINDINGS Research into clinical disorders of attachment is limited, but there is some recent evidence that a standardized approach to diagnosis may improve identification. The current classificatory systems do not accommodate all clinical presentations and proposed broader approaches have greater clinical utility. A recent review of interventions for attachment disordered children confirms that 'coercive' interventions have no empirical support and are not biased on coherent principles of attachment theory. SUMMARY Clinical interest in identification and treatment of attachment disorders has remained high. This is despite continuing confusion regarding terminology, phenomenology and diagnosis. The lack of agreed definition and conceptualization of these conditions is reflected in disparate approaches to intervention and limited empirical data. Interventions have little demonstrated benefit and some potential risk.
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Affiliation(s)
- Louise Newman
- New South Wales Institute of Psychiatry, Sydney, New South Wales, Australia.
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Abstract
Borehole dilution techniques use repeated fluid column profiling after establishment of an initial uniform condition to monitor the rate at which ambient ground water moves into a borehole. Application of the dilution technique in a monitoring well makes it possible to estimate the horizontal Darcy flow velocity of ground water in the aquifer surrounding the borehole. Previous investigators have demonstrated the technique using either relatively concentrated saline solutions or deionized water to produce a fluid column with properties distinctly different from those of local ground water. We present a new dilution technique using the food color Brilliant Blue FCF (Euro code E-133) to mark the fluid column and using a specially constructed photometric sensor to characterize the dilution of this dye over time. The effective application of this technique is documented by two practical examples.
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Affiliation(s)
- M Pitrak
- Department of Applied Geophysics, Charles University, Albertov 6, CZ-128 43 Prague 2, Czech Republic.
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Rodilla E, Costa JA, Mares S, Miralles A, González C, Sánchez C, Pascual JM. Importancia de los componentes del síndrome metabólico en los valores de proteína C reactiva. Rev Clin Esp 2006; 206:363-8. [PMID: 16863620 DOI: 10.1157/13090502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is considered a marker of subclinical atherosclerosis. The aim of the study was to assess whether the metabolic syndrome (MS) and parameters involved in its diagnosis might influence serum CRP values. PATIENTS AND METHOD Cross-sectional study in outpatients of a HTA and Vascular Risk clinic. MS was diagnosed according to National Cholesterol Educational Program ATP-III guidelines, and hs-CRP was analyzed by nephelometry. RESULTS A total of 1,969 patients (47% male) were evaluated and distributed into four groups: 1) 1,220 non-diabetics without MS; 2) 384 non-diabetics with MS; 3) 153 diabetics without MS, and 4) 212 diabetics with MS. Patients with MS had higher CRP in both non-diabetic 3.0 (1.7-4.4) mg/l vs. 1.7 (0.9-3.4) mg/l; p=0.001 (MW), and diabetic patients: 2.8 (1.5-4.6) mg/l vs. 2.2 (0.9-4.3) mg/l; p=0.01 (MW). Diabetic patients without MS had CRP values not different to non-diabetic without MS. CRP values increased in relation to the number of parameters included in the MS from 1.7 (2.2) mg/l, in patients without any parameters, to 4.2 (2.8) mg/l in patients who fulfilled five parameters (p=0.001) (KW). In multiple regression analysis abdominal obesity (p=0.001), TG (p=0.001) and glucose (p=0.02) were associated with CRP levels after correcting for other factors. Abdominal obesity (OR: 1.9; 95% CI: 1.5-2.4; p=0.001) and TG (OR: 1.4; 95% CI: 1.1 -1.7; p=0.003), but not glucose were independent factors related to the presence of high levels of CRP (>3 mg/l) in a logistic regression analysis. CONCLUSIONS Diabetic and non-diabetic patients with MS have high CRP levels. Of the five components of MS, the most closely related to CRP is abdominal obesity.
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Affiliation(s)
- E Rodilla
- Unidad de Hipertensión Arterial y Riesgo Vascular, Servicio de Medicina Interna, Hospital de Sagunto, Agencia Valenciana de Salud, Puerto de Sagunto, Valencia, Spain
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Affiliation(s)
| | | | - S Mares
- University of Arizona1177 E 4th StTucsonAZ85721
| | - R Vazquez
- University of Arizona1177 E 4th StTucsonAZ85721
| | - D E Goll
- University of Arizona1177 E 4th StTucsonAZ85721
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Steel Z, Momartin S, Bateman C, Hafshejani A, Silove DM, Everson N, Roy K, Dudley M, Newman L, Blick B, Mares S. Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia. Aust N Z J Public Health 2005; 28:527-36. [PMID: 15707201 DOI: 10.1111/j.1467-842x.2004.tb00042.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia. METHOD Structured psychiatric interviews were administered by three same-language speaking psychologists by phone to assess the lifetime and current psychiatric disorders among 10 families (14 adults and 20 children) held in immigration detention for more than two years. RESULTS All adults and children met diagnostic criteria for at least one current psychiatric disorder with 26 disorders identified among 14 adults, and 52 disorders among 20 children. Retrospective comparisons indicated that adults displayed a threefold and children a tenfold increase in psychiatric disorder subsequent to detention. Exposure to trauma within detention was commonplace. All adults and the majority of children were regularly distressed by sudden and upsetting memories about detention, intrusive images of events that had occurred, and feelings of sadness and hopelessness. The majority of parents felt they were no longer able to care for, support, or control their children. CONCLUSIONS Detention appears to be injurious to the mental health of asylum seekers. IMPLICATIONS The level of exposure to violence and the high level of mental illness identified among detained families provides a warning to policy makers about the potentially damaging effects of prolonged detention on asylum seekers. In their attempt to manage the international asylum crisis, it is important that Western countries do not inadvertently implement policies that cause further harm.
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Affiliation(s)
- Zachary Steel
- Centre for Population Mental Health Research, School of Psychiatry, University of New South Wales.
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