Mary Anne Kenny

The aim of this study was to investigate how legal professionals in Australia responded to the mental distress experienced by clients with insecure visa status in the Fast Track Assessment (FTA) process. This article reports on survey findings obtained from 38 legal professionals followed up by focus groups and interviews with 16 participants. The participants were all involved in providing legal assistance to refugees and asylum seekers with insecure visa status, the majority delivering that assistance via pro bono or community law centre settings. An inductive thematic analysis was used to analyse the data. The study uncovered a complex interplay of practical challenges, emotions, and ethical dilemmas that legal professionals encounter while assisting asylum seekers in the FTA process. The study participants’ experiences highlight that a migration law practice frequently becomes the initial setting where asylum seekers disclose mental distress. Legal professionals found themselves simultaneously witnessing human suffering and endeavouring to prevent re-traumatisation of their clients. Responding to distress was difficult to achieve as the operational setting in which they provided legal assistance and the prevailing hardline political messaging by the Australian government toward asylum seekers who arrived by boat was hostile and (re)traumatising. There is a pressing need for more trauma-informed education and training for both current and future legal professionals. Findings are discussed alongside practical suggestions for trauma-informed interviewing for legal professionals who interview asylum seekers.

Background: Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a 'fast track assessment' (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health. Aim: To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients.

Methods: Mixed methods comprising of two phases - (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data.

Results: Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling examples of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family.

Conclusions: The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status.

The COVID-19 pandemic has brought the connections between law and public health into stark relief. The pandemic has demonstrated both the essential nature of global cooperation and international regulation to promote universal rights to life and health, and the potentially harmful impacts of limitations imposed on human rights in time of emergency. It has also tested the international human rights framework, which allows for permissible limitations on human rights where required, but which remains subject to widely varying domestic implementation. In this paper, we explore the relationship between international human rights law and the COVID-19 pandemic, including a focus on the rights of vulnerable individuals and communities who have experienced disproportionate impacts from both the pandemic itself and from measures that constrain the exercise of human rights. We propose that the inquiry and monitoring mechanisms of the UN human rights bodies provide important avenues for addressing the human rights implications of COVID-19 and Government responses to the pandemic. We also review Australia’s domestic implementation of international human rights law and its relevance in the era of COVID-19, noting the piecemeal approach to human rights protection under Australian law. We conclude that this time of emergency provides an opportunity for the progressive development of international human rights law, via principles of reciprocity, social protection, human rights preparedness and comprehensive normative protection for a right to public health.

COVID-19 brings increased risk to the mental health of asylum seekers and refugees in Australia on temporary visas. Rapid government changes due to the COVID-19 pandemic are resulting in significant and sustained hardship on this already vulnerable group. This discursive paper is both an explainer and a resource for mental health nurses and health professionals with scope of practice in primary care and emergency departments responding to this population. The aim of this paper is to alert clinicians to the drivers of mental and suicide related distress and to provide recommendations as to how to therapeutically engage and support this group. Drivers include complex intersections between legal uncertainty, economic, social and mental health stress as drivers of entrapment, acute mental distress and suicidal ideation. Information about the COVID-19 related factors as drivers contributing to worsening states of distress may help guide clinicians to consider protective factors designed to mitigate the onset or worsening of mental distress, plus aid in the development of health policy and service-delivery arrangements of support and therapeutic engagement.

Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4–6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining (n = 247) to posttraining (n = 231). Improvements were maintained at follow-up (n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers’ attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

This research explored participants’ experience and perceptions of a two-day suicide prevention education programme, and any impact that it has had on them and their work with refugees and asylum seekers since. At approximately six months post-training (May to September 2018), semi-structured telephone interviews were conducted with 15 participants. The interviews were audio-recorded, transcribed, and thematically analysed. Thematic analysis of the data identified two overarching themes and five subthemes. The two overarching themes were: (1) Changes to the individual and their practice; and (2) The culture and context of the work. Participants described a range of impacts that the training had on them and their workplace, in both personal and professional domains. The study findings suggest that equipping workers with skills and knowledge in culturally tailored and evidence-based suicide prevention can lead to an increased sense of hope, optimism, confidence, and agency and reportedly enabled workers to more readily intervene when presented with clients directly or indirectly communicating suicidal ideation. Findings support existing literature regarding gatekeeper training effectiveness. However, given the unique context of asylum seeker and refugee suicide, they also extend our understanding of the impact of bespoke or tailored approaches to gatekeeper training.

Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews (n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.

The number of unaccompanied children seeking asylum has increased in recent years. Many unaccompanied children and young people arriving in countries seeking asylum lack official documents showing their identity and age. Chronological age is important as it is linked to where an individual will be initially housed and what services, supports, and legal processes they are entitled to receive. This article provides an overview of age assessment procedures used in industrialized countries. Many different methods are used; however, no currently available method has been demonstrated to have sufficient accuracy and there is a large margin of error. The consequences for young asylum seekers assessed to be 18 years or older is that they will no longer be considered as children and therefore not receive special protection in accordance with the United Nations Convention on the Rights of the Child. The article suggests a psychosocial approach that recognizes young people's transition into adulthood. Supports and serves should be provided on the basis of assessed strengths, needs, and vulnerabilities of the individual rather than on an assessed chronological age.

The mental deterioration of the so called ‘legacy caseload’ (asylum seekers who arrived in Australia by boat between August 2012–December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply; this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self-harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma-informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness.

This article examines the legal challenges asylum seekers arriving by boat to Australia experience when seeking assistance with their claims and its impact on their mental health. The authors outline the experiences of asylum seekers in the “legacy caseload” group who have been waiting up to four years to have their protection claims assessed. The complex interplay between legal assistance to support refugee claims and the way those making claims inevitably struggle to understand, engage and participate in the process is analysed. It is argued that provision of legal assistance for this group will be essential to ensuring that the refugee status determination process is fair and allows asylum seekers to understand and participate more fully in the process. Recent changes to the assessment of claims combined with a reduction in funding for legal assistance create significant hurdles and combine to compound existing stress and emotional trauma leading to detrimental outcomes on the mental health of asylum seekers.