The divisions between the Federal Government and the Federal Opposition over Australia's immigration detention policies are getting more intense and are unlikely to go away in a hurry. While the Prime Minister has agreed to talk with his colleagues about what can be done to ensure the issue is not exacerbated through the headlines, there are deeper issues at play - issues that no amount of policy softening can fix.
The very real urgency for the safety, natural justice and genuine compassion for people who are fleeing terror, a genuine fear for personal safety and life threatening fundamentalism is not something that can be debated away. A failure to act in humanitarian ways will ultimately lead to a failure to uphold human rights and a subsequent failure of standards in mental health care for people who are in need.
Recent calls by the Federal Opposition to return to the Howard years of so called `getting tough on boat people' are ill founded. This approach was exposed as a dysfunctional in a landmark judgement by of Justice Finn in the Federal Court in 2005 (S v. Secretary of DIMIA and Commonwealth of Australia). That particular case revealed that the professional delivery of mental health services for asylum seekers into detention centres and the systems and structures that underpinned them were hopelessly compromised by the then Federal Government's failure to recognise that it had a fundamental duty of care for the mental health of people in immigration detention.
In his judgement, Justice Finn found the former Government guilty of neglect of its duty because of the inadequate level of mental health care for detainees within the Baxter Centre. Standard 3 of the National Mental Health Standards makes the point that mental health professionals will practise in an appropriate manner through actively responding to the social, cultural, linguistic, spiritual, and gender diversity of people with mental health problems and mental illness, incorporating those differences in their practice.
As is perfectly clear, many of the people who seek asylum and enter immigration detention are from culturally and linguistically diverse backgrounds.
It is only in very recent times, under a new era of mental health reforms that we now have a system in place to ensure that the people who design and deliver care for people who are detained, are regulated by some form of public scrutiny and therefore more accountable for their actions. A return to the methodologies of the past will mean that we cannot be confident that the important onus of "duty of care" is taken seriously.
We must ensure that whatever the system of dealing with the issue of people seeking asylum in Australia, there is independent, external, assessment and scrutiny of mental health care for those people.
We must be confident that the circumstances in which they are detained, at the barest minimum, does no further harm to people - many of whom have already suffered acute stress and trauma prior to arrival.
The known risk factors arising from the detention environment and the current limitations in reaching and advocating for vulnerable people must not be swallowed up in opportunistic debates over policy.
We know from bitter experience that the only sustainable methods for reducing mental suffering are advocacy-based models of intervention and prevention. In what I call `engaged advocacy', this approach must be led from within the highest levels of Government. In a mental health context it must ensure culturally competent assessment and engagement for people who need basic treatment support that meets our national standards in mental health care.
To make this possible we need a bipartisan approach to what is a significant international issue - the plight of at-risk people worldwide. It requires us all to look beyond hackneyed assumptions related to flight and settlement, mental health protection and expressions of human suffering. This means accepting that when people flee terror - no matter where it is - there will be different views and expressions of what constitutes stress, safety and security. It requires the imagination to walk in other people's shoes. Then it requires acceptance that our world view - our understandings of fear, persecution and loss, our imaginings of how we might cope - because for most of us they can only be imaginings, may not be the way other people respond.
For those in need of mental health support it means demonstrating an understanding of the role of culture and of the explanatory models of stress and suffering of other cultures. Such knowledge is integral to the development of effective strategies for support and recovery from trauma, and for mental health promotion and illness prevention.
The past and alarmingly, more recent stigmatisation of people seeking asylum, undermines humanitarian consciousness and is injurious to the mental health of people who most need our compassion. We can not underestimate the fact that people who experience re-traumatisation through stigma and marginalisation will express their distress in ways that are in keeping with their culture and experiences.
Cultural competency by Governments in how they treat it asylum seekers - from reception to settlement - will only be achieved if those providing care and services understand the concepts of terror and fear, the impact they have on human behaviour, and the interpretation and evaluation of that behaviour.
Any claim of cultural competency - broadly defined - must include policy competency. Policy development and models of care must recognise other issues often associated with dealing with individuals from different cultures, including stigma, isolation, communication and language difficulties, and sensitivity to the specific problems experienced by people of diverse cultural backgrounds. It further includes the ability to understand the emphasis many cultures place on the involvement of family in finding safe passage and an understanding of the role of family and its implications, particularly in relation to confidentiality and gaining trust.
In reality this means moving beyond the rhetoric that people seeking asylum are what some describe as `stateless, placeless functionless human waste' or so called `potential terrorists'. We need to consider the way in which the expression of safety and settlement is made, how deep mental distress is understood and presented, the way help is sought and the way care is evaluated by those who receive it.
This process has significant mental health implications. It links the mental health experiences of people seeking asylum as they are held by them, their traditional healers, and other concerned individuals and groups (defined broadly and in a culturally congruent way) with a comprehensive mental health response.
Why is this so important? Because the clinical work of any mental health professional will be useless if it does not take account the asylum seeker's understanding of mental health difficulties and what practitioners themselves see as different perceived causes of ill health, distress, optimal care and culturally appropriate support and treatment.
Just as we have found the impact of the global economic crisis has melted national boundaries, global terror has no boundaries. At a time of mental health reform across Australia, it is essential to ensure that the mental health workforce has the skills and knowledge to allow it to develop and enhance the way it provides services to people from diverse cultural backgrounds. In the past we have seen Governments fail miserably in adhering to their own National Practice Standards.
In that failure, they have been responsible for significant harm to some of the most disadvantaged and vulnerable people in our global community. A return to the policies of the past will undermine all the reform work undertaken in recent months to correct these significant flaws and injustices.
UniSA's Associate Professor Nicholas Procter is a specialist in mental health nursing. He has been researching and designing care for people within and released from Australian Immigration Detention Centres since 1999.
