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The company that will manage health services, including mental health services, for detainees on Nauru is at the centre of criticisms that the mental health problems of asylum seekers detained on Christmas Island and on mainland camps have been poorly handled.

International Health and Medical Services, which is owned by the international services group International SOS, currently holds the $780 million contract for the provision of health services in the Department of Immigration’s detention centres. The company will receive an additional $22 million to provide health services on Nauru.

The provision of health services, and mental health services in particular, was considered in detail by a joint parliamentary committee early this year.

A key issue was the standard to which health services are provided by IHMS. The company is contracted to provide a specific range of services, such as health checks on arrival, three-monthly mental health checks and a primary health care service within detention centres, but undertakes to:

“… provide a level of healthcare to people in immigration detention consistent with that available to the wider Australian community, taking into account the diverse and potentially complex health needs of people in detention.”

This means there is no proactive attempt to identify mental health problems among detainees, who are expected to self-identify and seek assistance.

Criticism, particularly from the Detention Health Advisory Group, an independent group of health experts that oversees and advises on detention health care issues, has centred not on the quality of IHMS healthcare services, but on the inability of an essentially reactive health service to deal with the mental health issues, and that was not designed to address the mental health issues associated with long periods of detention. DeHAG expressed to the committee its concerns about the “psychological impact of prolonged detention difficulties in provision of health and mental health support, and services across the immigration system”.

The committee also heard from an IMHS-employed psychologist who spoke of only being allowed to provide counselling, limited to 50-minute sessions, and that three-monthly mental health checks were limited to 15 minutes and with no scheduling, no in-language advice about the checks, and with detainees simply expected to show up.

IHMS itself raised the problem of providing mental health services in remote detention facilities, telling the committee it had struggled to secure the services of a psychiatrist to visit the Curtin detention centre and had trialled psychiatric video-conferencing assessments.

Mental health problems will plainly be an even greater issue in the operation of the Nauru and Manus Island facilities, where detainees will be held as a form of exemplary punishment for several years — potentially up to five years or longer. The contractor will also have to provide services for a wider class of detainees, given families and children may be detained as well, unlike current government policy for asylum seekers. At least one Labor MP raised mental health services on Nauru at this morning’s Caucus meeting.

IHMS told Crikey that psychiatrists would be flown to Nauru on a scheduled basis: “Health services, including mental health, will be delivered onsite, by a team of health professionals based on Nauru together with scheduled visits by specialists including psychiatrists. The services will be designed and delivered in line with Australian standards, as are the services provided within the Australian immigration detention network.”

Peter Fray

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