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Govt drops shutters on asylum seekers health

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The AMA has voiced “grave concerns” about the Abbott Government’s decision to disband a group of medical experts advising on the treatment of asylum seekers.
In a shock move, the Department of Immigration and Border Protection peremptorily abolished the Immigration Health Advisory Group (IHAG), which included representatives from the AMA as well as general practitioners, psychiatrists, psychologists and other medical professionals, late last month.

The decision has heightened concerns about the health and wellbeing of asylum seekers, particularly given doubts about the adequacy of medical services for those being held in detention on Christmas Island and Manus Island.

AMA President Dr Steve Hambleton said many people seeking asylum in Australia arrived in poor health, and the experience of indefinite detention itself added to and exacerbated health problems, particularly regarding mental health.

Dr Hambleton said providing adequate care for such people required drawing on expertise from a range of specialties – something IHAG could provide.
“The [physical] and mental health conditions that asylum seekers experience are often multiple and complex, and the Immigration Department needs to avail itself of sound health and medical advice from a number of disciplines,” the AMA President said. “IHAG had the capacity to provide this sort of advice. It is regrettable that the Department has disbanded this group.”

The AMA’s IHAG representative, paediatric psychiatrist Dr Choong-Siew Yong, said the decision, revealed in a letter from the Department sent to each Group member, was completely unexpected, and the reasons for it unclear.

In a statement released several days after the decision, the Department said IHAG had been disbanded because “[its] large membership…made it increasingly challenging to provide balanced, consistent and timely advice in a fast-moving policy and operational environment”.

But Dr Choong-Siew said this did not match with his experience.

“I think we worked particularly well as a group,” he told ABC radio 666. “We were always conscious that things change rapidly, and I think most of us were quite prepared to have a quick turnaround of advice. It was a good, high level of expertise in the group that allowed the Department to [respond] very quickly.”

He said he suspected the real reason for the change in policy was to limit the involvement of external players in the immigration detention system.

“I suspect it’s in keeping with the current policy of maintain the whole system in-house, within the Government, similar to the way in which information about boat arrivals is now done on a weekly basis at a briefing with limited information,” he said. “My guess would be that the Department, and the Government, is wanting to manage all this within its own borders, rather than have external groups involved.”

Dr Choong-Siew said that, in addition to their own expertise, the members of the group were able to draw on and co-opt others with specialist knowledge, as needed.

Dr Hambleton said the decision to disband the group and rely solely upon its outgoing Chair, former Army doctor Dr Paul Alexander, for advice, placed a massive responsibility on one person.

“This is an enormous responsibility for one person,” he said.

IHAG was established in 2006 after the Palmer and Comrie inquiries into the detention of Vivian Alvarez and Cornelia Rau identified major shortcomings in the health care provided to immigration detainees.

Dr Choong-Siew said he was “very concerned” for the health and wellbeing of asylum seekers without the expertise of a group like IHAG on hand to provide advice.
He said evidence showed that those in immigration detention faced a significant risk of developing mental health problems.

“The immigration detention environment is not like being a convicted criminal. The problem with the immigration system is that the length that you might be detained [is indefinite] and [there is] uncertainty about your outcome.

“The research is very clear that the longer you’re in detention, and the greater the uncertainty, the greater the possible psychological harm.

“Many of these [asylum seekers are] presenting with psychological and psychiatric problems, some of which are probably attributable to the actual detention and detention environment,” Dr Choong-Siew said.

Dr Hambleton reiterated the AMA’s proposal for the establishment of a “truly independent” medical panel to oversee and report on health services for asylum seekers being held in both on- and off-shore immigration detention centres.

In particular, the AMA recommended that such a panel be above the bureaucracy, and report regularly to Parliament, the Prime Minister and relevant Ministers.

Adrian Rollins

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