Abstract

BackgroundAsylum seekers are at elevated risk of self-harm, and the personal and public health costs of self-harm are high; yet the monitoring and reporting of self-harm has been limited and lacking in transparency. This study aims to evaluate the quality of self-harm incident reporting across the Australian asylum seeker population, including by processing arrangements (i.e. community-based, community detention, onshore detention, Nauru, and Manus Island).MethodsAll self-harm incidents reported across the entire Australian asylum seeker population between 1 August 2014 and 31 July 2015 were obtained via the Freedom of Information Act. We assessed the quality of self-harm incident reporting according to the World Health Organization (WHO)'s self-harm reporting guidelines.ResultsA total of 949 self-harm incident reports were assessed. Date, location (processing arrangement), and time of self-harm were routinely reported. Gender was recorded in less than two thirds (62.1%) of all incidents. Method(s) used to self-harm was reported in 81.5% of all incidents, though IDC-10 codes were not reported in any episodes. Psychological or psychiatric assessments were recorded after 4.0% of all incidents, most frequently on Manus Island (10.9%), and in Nauru (10.0%), and least frequently in community-based arrangements (1.7%) and in onshore detention (1.4%), and not at all in community detention. Ambulances were reported as attending 2.8% of all episodes. Hospital attendances were reported following 6.0% of all self-harm incidents, with attendances most commonly reported in incidents occurring in community detention (30.3%), and in community-based arrangements (19.4%). Medevac (air ambulances) were recorded as being utilised in 0.4% of all incidents (2.1% of episodes on Nauru, 1.8% on Manus Island).ConclusionsThe findings of our study indicate that the accessibility and quality of self-harm data is substandard and inconsistent with WHO self-harm reporting guidelines. Such variable reporting makes the identification of self-harm trends, the implementation of prevention strategies – including those at a policy level - and the clinical management of self-harm, extremely challenging. Improved self-harm reporting and monitoring is urgently needed for mitigating and responding to self-harm risk among asylum seekers.

Highlights

  • Asylum seekers are at elevated risk of self-harm, and the personal and public health costs of self-harm are high; yet the monitoring and reporting of self-harm has been limited and lacking in transparency

  • The findings of our study indicate that the accessibility and quality of self-harm data is substandard and inconsistent with World Health Organization (WHO) self-harm reporting guidelines

  • Whilst country of origin could not be determined from the incident reports, official immigration statistics [23, 24] highlight that the two main source countries of asylum seekers in onshore detention, community detention, as well as community-based arrangements during the study period were Iran and Sri Lanka

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Summary

Introduction

Asylum seekers are at elevated risk of self-harm, and the personal and public health costs of self-harm are high; yet the monitoring and reporting of self-harm has been limited and lacking in transparency. This study aims to evaluate the quality of self-harm incident reporting across the Australian asylum seeker population, including by processing arrangements (i.e. community-based, community detention, onshore detention, Nauru, and Manus Island). Since 1992, Australia has had a policy of mandatory immigration detention for all ‘unlawful non-citizens’, the majority of which have been asylum seekers during periods when boat arrivals have been large [2]. This policy has been extended to offshore processing, most recently reinstated in late 2012. Offshore processing includes the indefinite detention of asylum seekers on the Pacific island nation of Nauru and Manus Island, Papua New Guinea, and precludes their resettlement in Australia [3]. Australia’s policy of detaining asylum seekers, and its associated immigration policies, have attracted much national and international attention [5]

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