Long waits for refugee status lead to new mental health syndrome

Some Australian refugees develop “protracted asylum seeker syndrome”. Alex E. Proimos

There’s a common misconception within the Australian community that asylum seekers arrive by boat. In fact, most asylum seekers arrive here by aeroplane with valid travel documents and reside in the community. This invisible population has largely been ignored by the media and politicians, and is marginalised from social and health services.

It’s hard to know exactly how many asylum seekers currently live in the community because official sources are difficult to obtain. But we know from the Department of Immigration and Citizenship that 11,491 applications for asylum in Australia were lodged in 2010-11. And 6,316 of these were not from people arriving by boat.

This number doesn’t include people who arrived earlier but are still waiting for their application to be processed. Overall in the same period, 2,101 of these asylum seekers were granted protection visas, equating to a considerable number of asylum seekers still waiting for a determination of their refugee status.

Causes of mental ill health

Most asylum seekers living in the community are on bridging visas while their applications for protection are processed. Few have been in detention. Nevertheless, this group suffers significant social stressors such as poverty, unemployment, social dislocation, isolation from family and issues related to life in a new and strange community, such as language and cultural differences.

This is often on top of a history of experiencing and/or witnessing torture, persecution and severe trauma. As a consequence of all these factors, asylum seekers are extremely vulnerable to developing mental health problems.

Australia’s protracted refugee determination process is often difficult and distressing for asylum seekers. And we now have evidence to show this process contributes directly to post-traumatic stress disorder in those who have repeatedly had their claim for asylum rejected.

We’ve also found that because of the protracted refugee determination process, some asylum seekers develop a clinical syndrome which is distinct from other trauma-related mental disorders. We’ve labelled this disorder “protracted asylum seeker syndrome”.

Protracted asylum seeker syndrome

The characteristics of the syndrome share many features of current mental disorders such as major depression, post-traumatic stress disorder, generalised anxiety disorder and adjustment disorders. These include:

  • fluctuating mood,
  • poor concentration and attention,
  • irritability, and
  • recurrent intrusive thoughts about the refugee determination process and
  • overwhelming feelings of hopelessness and powerlessness.
Image from community art workshop with asylum seekers. postscriptum

Some people may also develop dissociative and psychotic symptoms.

Other symptoms found in those with protracted asylum seeker syndrome aren’t usually associated with the disorders above. These include becoming obsessed with the asylum application and not being able to think about anything else outside of this process.

Accessing help

Despite the prevalence of mental health disorders and other social issues, services for asylum seekers in the community are limited and have, until recently, been delivered only by charitable, non-governmental and religious organisations such as the Asylum Seeker Resource Centre in Melbourne, Hotham Mission and the Red Cross.

Recent changes to bridging visa regulations have expanded access to work and study rights and Medicare, but there still remain significant resource and knowledge constraints on the services available to asylum seekers. As such, many asylum seekers with significant mental health issues are either not aware or are unable to access the services they require for treatment.

There are two mechanisms by which to address these mental health issues. The first is to change current policy and legislation for processing asylum seekers’ protection claims. The process could be expedited if officials from the Department of Immigration and Citizenship and the Refugee Review Tribunal were given the power to make determinations for asylum based on physical and mental health issues. These decisions are currently restricted to the minister.

Better mental health services

The second solution is to develop specialist mental health services for asylum seekers. Assessing and managing protracted asylum seeker syndrome requires specialist mental health services to provide a combination of psychotherapy and medications.

To ensure those in need can access such assistance, we need a dedicated asylum seeker mental health service. Such a service would bring together expert mental health clinicians and interpreters, using a limited out-reach and case management model of care.

It’s only with investment in tailored services that we’ll be able to appropriately treat the asylum seekers living in the community who suffer from severe mental health disorders. I hope Australia’s state and territory health ministers are listening.