The Journey of a Lifetime: Conceptualising Mental Health in Community-Based Asylum-Seekers Negotiating the Refugee Determination Process Debbie Hocking Bachelor of Arts Graduate Diploma of Applied Psychology Doctor of Psychology (Clinical Psychology) Submitted in partial fulfilment of the requirements of the degree of School of Social Sciences and Psychology Victoria University Melbourne, Australia March 2012 Copyright © Debbie Hocking 2012 The Journey of a Lifetime ABSTRACT There is a paucity of research on the mental health of asylum-seekers, particularly in comparison with refugee and migrant populations. Yet asylum-seekers occupy a vulnerable place in our community. After applying for a protection visa upon arrival period as they traverse the Refugee Determination Process (RDP). The RDP in in the host country, asylum-seekers frequently endure uncertainty for a protracted Australia and other Western countries can take years. Furthermore, asylum-seekers to health services, which can precipitate or perpetuate mental health problems. face psychosocial difficulties including numerous barriers to employment and access Despite this, little research has been undertaken with asylum-seekers negotiating the RDP, particularly studies employing a prospective design. The usual psychiatric classifications do not necessarily capture the extent and (Kissane, Clarke, & Street, 2001) is a construct which features hopelessness, severity of distress experienced by asylum-seekers. ‘Demoralisation syndrome’ a normal response to adversity. It is not known if demoralisation in asylum- meaninglessness, and existential distress. However, these symptoms may be seekers is distinct from major depression (MDE) and other psychiatric disorders. Demoralisation has long been considered “emotional and somatic distress” rather unavoidable stress in a range of adverse situations and is understood to result than a discrete clinical disorder. It is believed to be a consequence of unremitting, from an imbalance between personal coping and environmental stress. While demoralisation has been researched in migrant and refugee populations, this has not been extended to asylum-seekers. predictive aims. 131 adult asylum-seekers (56 at follow-up) living in the Melbourne The current study is a prospective, mixed design with both exploratory and permanent protection, while the remainder were asylum-seekers. Questionnaires community were recruited; one quarter were refugees, having been granted measured depression and anxiety (HSCL-25), psychological trauma (HTQ-R), were validated with the MINI structured interview at follow-up. It was predicted demoralisation (PERI-D) and post-migration stress (PMLDC). Self-report measures that rates of all mental health indices would increase both as a function of time and number of asylum application rejections in the RDP. The relationship between demoralisationHigh rates of psychiatric and other morbidity clinical measures were found (MDE in bothand PTSD) asylum-seekers was also explored. and refugees, although the prevalence of MDE and PTSD was significantly greater in asylum- iii The Journey of a Lifetime seekers. ‘Demoralisation syndrome’ did not adequately describe the symptom between time in the RDP and mental health symptoms did not globally emerge, profile, which was more indicative of a pan-distress syndrome. Relationships although a diagnosis of PTSD in asylum-seekers was predicted by four or more RDP rejections. Several post-migration stressors were associated with PTSD symptoms, and the type of stressors distinguished between the asylum-seeker and refugee prevention and management of mental health disorders in those seeking asylum cohorts. The findings have implications for Government policy regarding the in Australia. iv The Journey of a Lifetime stUDENT DECLARATION I, Debbie Hocking, declare that the Doctor of Psychology (Clinical Psychology) thesis entitled The Journey of a Lifetime: Conceptualising Mental Health in Community- Based Asylum-Seekers Negotiating the Refugee Determination Process is no more footnotes. This thesis contains no material that has been submitted previously, in than 40,000 words in length, exclusive of tables, figures, appendices, references and where otherwise indicated, this thesis is my own work. whole or in part, for the award of any other academic degree or diploma. Except Debbie Hocking March 2012 v The Journey of a Lifetime ACKNOWLEDGEMENTS This project was truly a team effort throughout its 4-year gestation. I therefore have many to whom I owe gratitude and thanks, and would like to acknowledge for their practical, material or spiritual support which enabled this study to birth. Thank you to my supervisor, A/Professor Gerard Kennedy, for not only allowing me the freedom to pursue a research topic that I would be passionate about, but for providing encouragement when my confidence flagged, containment when my Thankanxiety you peaked, to my SPSS co-supervisor support and A/Professor for getting Suresh me over Sundram, the line whenwithout it counted.whom this project would not have been conceived. You have been both task master and throughout this journey. supportive mentor. I have learned a great deal from your experience and guidance Thank you to CEO, Kon Karapanagiotidis, for permitting this study to take place at the ASRC – the first of its kind. Thank you also to the ASRC reception staff, and all the Inprogrammes particular, fromthank which you to I therequired ASRC someCasework kind teamof support – especially – I think Casework it was all of you! Coordinator, Sherrine, for championing the cause. Thanks also to Chanelle, Jamine and the caseworkers who assisted with the daunting task of recruiting participants over three long years. Who would have thought we would reach 131! I would also and Red Cross ASAS and CAS programmes. like to extend thanks to the caseworkers at Hotham Mission Asylum Seeker Project Thank you to my ASRC ‘home’, the counselling and psychiatry programme. In support. Thank you to the counsellors, psychiatrists and counselling co-ordinators particular thank you to AOC and Sheenagh for their extracurricular emotional Olivia, Pam and Sam. Your ceaseless support of me, enthusiasm and belief in the past and present: Anne, Cynthia, Elise, Emma, Flo, Jillian, Julie, Kay, Liz, Mary, Matt, can know. project and its purpose kept me afloat through many a difficult time – more than you I am grateful for the funding support through the wonderful Kat Monson at EastWeb. Thank you to Nordia Foundation, Minter Ellison Lawyers and Myer Foundation for the funds. their financial support, and the Mental Health Research Institute for administering vi The Journey of a Lifetime Thank you to Ida Kaplan of the Victorian Foundation for Survivors of Torture, who Ansupplied immense translated thank you versions to Gobsey, of questionnaires Belinda, Mono, when Felicia, DIAC the would MITC not girls return and mymy calls. other dear friends for their tireless listening ears. Thank you to my parents for their support and being open to challenging their stance on what is a shamefully politicised issue. Most of all, thank you to the courageous participants, at least 10 of whom were while we could not guarantee this research would change Government policy, our subsequently repatriated: I pray for your safety. All participants were promised that, aim was to ensure that policy-makers could not plead ignorance. It is my hope that future refugee policy be grounded in science and fact rather than mythology and fear. Finally, I would also like to acknowledge the inspiring legacy of the socially conscious researchers who have gone before me. vii This page has been left intentionally blank … Come, my friends, … for my purpose‘Tis not holds too tolate sail to beyondseek a newer the sunset, world. and the baths Of all the western stars, until I die. We…Tho’ are not much now is that taken, strength much abides;which in and old tho’ days Moved earth and heaven; that which we are, we are – Made Oneweak equal by time temper and offate, heroic but strong hearts, in will To strive, to seek, to find, and not to yield. Ulysses – ALFRED LORD TENNYSON The Journey of a Lifetime TABLE OF CONTENTS ABSTRACT ����������������������������������������������������������������������������������� iii ������������������������������������������������������������������������������� v DECLARATION ��������������������������������������������������������������������� vi ACKNOWLEDGMENTS ����������������������������������������������������������������������� tabLE OF contents ���������������������������������������������������������������������������� x LIST OF TAbLES ���������������������������������������������������������������������������xiv LIST OF FIGURES ��������������������������������������������������������������������� xv LIST OF APPENDICES ��������������������������������������������������������������� xvi LIST OF AbbREVIATIONS xvii Chapter1.1 Asylum-seekers 1: Literature �������������������������������������������������������������������������� Review 1 ������������������������������������������ 1 1.1.21.1.1 Asylum-seekersForced migration vs. in Refugees: a global context the socio-legal milieu of the West ���������� 3 1.1.3 The mental health game . ������������������������������������������������������� 6 1.2 Refugee Determination Process (RDP) ������������������������������������������������ 8 1.2.1 The Australian refugee determination process (RDP) ���������������������� 8 1.2.2 Bridging visas and welfare provision