Many in the public health and indeed the broader health community have expressed concern at the governments plan to send asylum seekers to Papua New Guinea and Nauru. Health concerns include implications for mental health, maternal health and infectious diseases such as malaria.  Melissa Sweet’s previous article on the issue provides an overview of these concerns from a range of experts.

The health community has, rightly, been vocal in raising its concerns for this disenfranchised group. So what are the plans and expectations of the federal government regarding health care for asylum seekers?

Services are to be provided by International Health and Medical Services  (IHMS). This parliamentary background paper by Rebecca de Boer provides an overview of the framework for health care provision, the IHMS contract provisions and specific provisions such as performance measures.

For this observer there is little in this document to allay concerns regarding how the Government can ensure that it is meeting its duty of care. Two key paragraphs stand out:

“Information about the timely conduct of mental health screening is an important measure of access to services, but there is no additional information about the type of treatment received or any assessment of its effectiveness. Similarly, health care is to be based on ‘best available evidence’, but there is no clinical auditing tool in the performance measures or standards to determine this. Furthermore, clinical referrals for more specialist care must be within ‘clinically appropriate timeframes’, yet the contract is silent on how this is determined and by whom this will be assessed. This raises questions about the extent to which DIAC (and the Government more broadly) can make an assessment about the adequacy and appropriateness of the health care provided by IHMS under this contract.”

and this from the conclusion:

“As noted by the Joint Select Committee on Australia’s Immigration Detention Network (JSCAIDN), the length of time spent in an ‘information vacuum’ in detention is the primary problem and contributor to stress. The JSCAIDN also highlighted that remoteness affects the quality of psychiatric care received by asylum seekers.Mares and Jureidini have also documented the challenges of providing mental health services to asylum seekers in immigration detention, as the nature of the detention environment means that ‘recommendations aimed at improving detainees’ psychological and social circumstances cannot be implemented’.The challenge for DIAC and IHMS will be how best to fulfil their duty of care in this difficult environment”.

This paper provides much context for the debate, and is a must read for all those raising their voices on this vexed issue. Read the full paper (including references) here.