Over the past few decades, several developed Western countries have increased their strict immigration policies in order to deter those seeking asylum from entering their borders (United Nations High Commissioner for Refugees, 2000). An asylum-seeker is someone who is requesting asylum or refuge and has asked to be given formal legal refugee status (UNHCR, 1951: Article 1A(2). The number of people forcibly displaced worldwide as a result of persecution, conflict, generalised violence or human rights violations has also increased dramatically in the last 5 years and as a result, the number of people displaced and seeking asylum has created a refugee crisis (Angelica, et al. 2018). The time spent in detention centres, the uncertainty relating to their asylum application status and separation from family result in feelings of fear, anxiety and trauma in a large number of these individuals.
The time spent in the detention centres is an important post-migration stressor. The complete lack of liberty, as well as the possibility of having to return to their country of origin can cause a large amount of distress. This absolute deprivation of their autonomy and human rights, could bring back similar past trauma from their lives in the countries that they fled. The detention of these asylum-seekers, who have gone through past trauma, can further exacerbate their mental health difficulties, as it can act as a new stressor, adding to the cumulative effect of exposure to trauma, causing the ‘building block effect’(Tribe, 2002). This refers to the relationship between the amount of adverse experiences and the severity of pathology in PTSD. This phenomenon can be seen in refugees in a study conducted on West Nile African refugees testing the effect of cumulative stressors on the onset of PTSD. The results suggest that the repeated occurrence of the traumatic stress over time clearly have an additive damaging effect on the mental health of the victim, regardless of the type of traumatic stressors (Schauer, et al. 2003). During their time in the detention centre, there is also large sense of uncertainty, about the whereabouts of their family, the status of their asylum application and details of the potential deportation if rejected. Intolerance of uncertainty is defined as “the dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications and involves the tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events” (Buhr & Dugas p. 216). Evidence suggests that the intolerance of uncertainty is highly associated with generalised anxiety disorder as well as worry severity and depressive symptoms (Boswell, James F et al.2013). Hence, the duration of the time spent by asylum seekers in detention seekers can have a large impact on their mental health due to stressors such as lack of liberty and violation of their human rights, and the presence of uncertainty about their future.
It is seen that risk of mental health issues were lower in larger family units, as opposed to those refugees who were isolated from other family members were more likely to develop severe psychiatric symptoms. In the case of Australia, there are protocols that deny refugees the right to family reunion, and disallow reentry into the country if they travel overseas to visit family, making face to face contact with relatives nearly impossible (Steel, Zachary, et al, 2006). Separation anxiety refers to the excessive fear or worry about separation from home or an attachment figure( ‘Separation Anxiety’). A study on the mental health problems of separated refugee adolescents shows that refugee adolescents separated from both parents experienced the highest number of traumatic events compared to accompanied refugee adolescents. This highly influenced the development of serious mental health problems such as anxiety, depression, and post-traumatic stress (Derluyn, Ilse, et al, 2009). Thus, the separation of individuals from their family members can lead to the development of several distressing emotions, further deteriorating the mental state of the detainees.
According to Silove, Ventevogel, and Rees (2017), “interventions aimed at creating a supportive environment which facilitates the capacity of refugees to restore their lost resources will advance the overall aim of promoting resilience and mental health.” Providing asylum seekers with proper, sensitive, and culturally appropriate support from clinicians and psychiatrists could potentially improve the mental health crisis taking place in detention centres at the present. Creating policy changes, especially those regarding the isolation and exposure to trauma and abuse from authority, as well as long term separation from one’s family, can also help the detainees feel more at ease as they await to start a new chapter in their lives.
References:
Silove, D., Ventevogel, P., & Rees, S. (2017). The contemporary refugee crisis: an overview of mental health challenges. World psychiatry : official journal of the World Psychiatric Association (WPA), 16(2), 130-139.
“Separation Anxiety.” Psychology Today, Sussex Publishers, https://www.psychologytoday.com/intl/conditions/separation-anxiety.
Derluyn, Ilse, et al. “Mental Health Problems in Separated Refugee Adolescents.” Journal of Adolescent Health, vol. 44, no. 3, 2009, pp. 291–297., doi:10.1016/j.jadohealth.2008.07.016.
Yook, Keunyoung, et al. “Intolerance of Uncertainty, Worry, and Rumination in Major Depressive Disorder and Generalized Anxiety Disorder.” Journal of Anxiety Disorders, vol. 24, no. 6, 2010, pp. 623–628., doi:10.1016/j.janxdis.2010.04.003.
Dugas MJ, Schwartz A, Francis K. Intolerance of uncertainty, worry, and depression. Cognitive Therapy and Research. 2004;29:835–842.
Boswell, James F et al. “Intolerance of uncertainty: a common factor in the treatment of emotional disorders.” Journal of clinical psychology vol. 69,6 (2013): 630-45. doi:10.1002/jclp.21965
Angelica, et al. “Global Trends - Forced Displacement in 2018 - UNHCR.” UNHCR Global Trends 2018, https://www.unhcr.org/globaltrends2018/.
Tribe, Rachel. “Mental Health of Refugees and Asylum-Seekers.” Advances in Psychiatric Treatment, vol. 8, no. 4, 2002, pp. 240–247., doi:10.1192/apt.8.4.240.
Storm, T., and M. Engberg. “1095 – The Impact of Immigration Detention on the Mental Health of Torture Survivors: a Systematic Review.” European Psychiatry, vol. 28, 2013, p. 1., doi:10.1016/s0924-9338(13)76202-3.
Maggie Schauer , et al. “PTSD and the “building block” effect of psychological trauma among West Nile Africans” European Society for Traumatic Stress Studies Bulletin 10 (2003) , 2, pp. 5-6
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