Refugees And Mental Health: An Australian Overview – Dr Michael Dudley, Ms Julie Macken, Dr Fran Gale

What do we do in face of this suffering?


From Luke’s Journal October 2023  |  Vol.28 No.3  |  Mental Health I

Image by Ahmed Akacha, Pexels

Australia’s treatment of refugees remains broadly outside the imagination and knowledge of most Australian citizens, despite moments of media coverage. But as Christian health/helping professionals we are highly likely to meet refugees, and we are driven by both our codes of ethics and our Christian calling to enliven our care and to take their needs seriously. As medical and/or mental health professionals, we also research, document and advocate with vulnerable populations regarding their health and its social determinants. Few groups have needed our skills as healers and advocates more than asylum-seekers caught in Australia’s detention regime.

To understand the circumstances and mental health challenges that asylum-seekers and their health professionals confront, let’s imagine taking a journey with an asylum-seeker and the health professionals they encounter. It’s a journey that is grounded in Australia’s recent refugee history, and drawn from the personal experiences of this article’s authors. 

First however, some general observations. 

Faith, justice, human rights/needs and refugees

The tradition of giving asylum is central to the main monotheistic faith traditions: Abraham, Moses, Jesus and Mohammed were all forced migrants or refugees. These and other faith traditions acknowledge a duty to respond to asylum claims that is grounded in universal human need irrespective of the faith of the claimant.2 

For Jews and Christians specifically, the affirmation that humans are made in the image of God raises duties of compassion and justice towards all. The Bible provides extensive reference to treating foreigners and strangers equally (Ex 12:49; Lev 19:34; 24:22; Deut 27:9; Mal 3:5), providing for and supporting them (Lev 23:22; 25:35; Deut 10:18-19; 24: 19-22; 26:15; Ps 146:9; Matt 25:35; Heb 13:2) and not oppressing them (Lev 19: 33; Ex 22:21, 23:9; Jer 7:5-7; Ezek 22:17; Zech 7:9-10). Jewish and Christian faith-based organisations have a strong presence aiding and advocating for refugees. Moreover, the Christian churches have a long tradition of providing sanctuary. Opening St. John’s Cathedral Brisbane to desperate asylum-seekers in 2016, the Anglican Dean of Brisbane, the Reverend Dr. Peter Catt, noted:

“Many of us are at the end of our tether as a result of what seems like the Government’s intention to send children to Nauru. So we’re reinventing, or rediscovering, or reintroducing, the ancient concept of sanctuary as a last-ditch effort to offer some sense of hope to those who must be feeling incredibly hopeless.”3 

Scholars of Islam have likewise emphasised pivotal Islamic texts and the role of foundational events such as the hijrah or migration of the first Muslim refugees for the moral and legal obligations of Islamic states, civil societies, individuals, and humanitarian and asylum policies, especially in Islamic countries.4-6 Likewise, large scale Muslim organisations and local mosques assist refugees both in Muslim countries and internationally. These comments are also true for Hinduism and Buddhism.2

“Such universal moral duties that appeal to the principle of common humanity derive from religious revelation but also from moral philosophy.”

Such universal moral duties that appeal to the principle of common humanity derive from religious revelation but also from moral philosophy. In a defence of universal values, C. S. Lewis cites evidence from cultures widely separated in time and space, showing that the principles of mercy and magnanimity are ubiquitous in cultures in all ages.7 International human rights law mirrors this universal humanitarian concern. Asylum-seeking hinges upon such standards as the Universal Declaration of Human Rights (UDHR)8, clauses in the International Covenant on Civil and Political Rights9 and International Covenant on Economic Social and Cultural Rights10; the Refugee Convention11;  the Convention against Torture12;, the Convention on the Rights of the Child13 ; and the recent Global Compact on Refugees14. Signatory states are obliged to respect, protect and fulfil human rights including those of refugees, though commentators on health rights note this also requires the identification of duty bearers and the legislation of enforceable standards.15-16

Unfortunately sometimes religions have produced human displacement and conflict, maintaining inhospitality via in- and out-group dynamics and fuelling ethnic or nationalist tensions and hostilities. A significant gulf sometimes exists between religious ideals and practice, suggesting that greater dialogue is needed within as well as between faith communities where interpretations of sacred texts lead to negative behaviours2

However international researchers of migration and religion also describe religion’s importance in creating socially responsible cultures of reception and hospitality towards migrants and refugees, and in shaping and maintaining identity among migrant populations and their reception by host nations.17 Following on the formative role of religions in early humanitarian movements, and a post-WW2 phase during which the humanitarian sector secularised, the sector has reappraised the importance and expertise of faith-based organisations, local faith communities and faith leaders in forced displacement, and re-engaged with them (for a more thorough account of this complex history, see Sulewski2) . It remains true that the major world religions unite in the call to love the Other as oneself; and that practically speaking, religious agencies complement  secular agencies in providing vital services to asylum-seekers and refugees.

Refugees, mental health and border policies 

In the world’s largest refugee crisis since World War II, UNHCR recently registered 108 million forcibly internally displaced people (IDPs), including twenty-nine million refugees and five million asylum-seekers.18 This number has almost tripled in the ten years between 2013-2022. Only 114,300 refugees were resettled and six million IDPs returned.

The Refugee Convention, which Australia has signed, defines a refugee as “outside their country of origin and having a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion”.11 Additionally, under Australian law asylum-seekers outside this definition facing removal that risks torture or their lives can claim Complementary Protection. Exceptions to asylum require grave proofs.19 Critically, climate change is expected to greatly increase both internally displaced communities and externally displaced people. 

Image by Ahmed Akacha, Pexels

Nevertheless, though international covenants proclaim human rights as universal, nations pre-eminently identify human rights with their citizens. Unlike other Western democracies, Australia lacks a human rights act and framework. Predictably therefore, Australia is not proactive regarding human rights.20

Due to their need to travel in undocumented and unscheduled ways, asylum-seekers are marginal, enjoying little prospect of acceptance.21-22 Post-9/11, the so-called “War on Terror” has featured arbitrary detention and torture, and exacerbated racism and animosity towards refugees.23-24  Western countries, aiming to deter and force repatriation, detain asylum-seekers in below-subsistence conditions: harsh outlying places or islands where barbed wire and armed guards patrol borders.22 They are not considered rights-bearers. If refused asylum, they can endure forced labour and exploitation.25

 “Asylum-seekers’ mental health problems exceed that of non-displaced community groups and they are weighted towards post-migration adversity, as growing evidence from reception countries shows.”

Asylum-seekers’ mental health problems exceed that of non-displaced community groups and they are weighted towards post-migration adversity, as growing evidence from reception countries shows. Imposed privation – including prolonged detention, insecure residency, burdensome determination procedures and restricted access to services, work and study – aggravates trauma, Post-Traumatic Stress Disorder (PTSD) and depression.24 These problems lengthen with detention, markedly increasing after 12 months.26 

Unfortunately, such knowledge has not impacted official policy. Australia continues to detain irregular maritime arrivals (IMAs) vastly longer than elsewhere (more than 800 days in early 2023).27 Since 1992-3, Australia has unremittingly championed global harsh border policies. Its bipartisan centrepiece for IMAs is indefinite mandatory detention. Assorted measures bolster this: temporary protection visas (1999-2008, 2013-2022), boat interceptions and turnbacks, excising offshore islands from the migration zone, and offshore detention (2001-2008, 2012-present). In February 2020, the International Criminal Court found: 

“These conditions of detention appear to have constituted cruel, inhuman, or degrading treatment (CIDT), and the gravity of the alleged conduct thus appears to have been such that it was in violation of fundamental rules of international law…”28

Supplementary measures include fast-track processing, denial of independent reviews, official stigmatisation, and indiscriminate deportation. These rigours are not reserved for detained asylum-seekers: Sister Aileen Crowe searingly documents how they also affect those arriving by plane with valid entry visas who then claim asylum.29 

“This cruel treatment is no accident: indefinite immigration detention that callously isolates and forcibly separates families is deliberate and determined.”

This cruel treatment is no accident: indefinite immigration detention that callously isolates and forcibly separates families is deliberate and determined. The Australian Government shows it understands and allows detention’s risks and harms, justifying its abusive treatment of those who come seeking protection as allegedly stopping boats, deterring, and forcing repatriation. It has been compared to “‘a hanging in the public square’ designed to intimidate and deter future asylum-seekers”.30 Eminent clinical authorities argue that it constitutes torture. In protest at this violence, Aboriginal social justice activists have asserted unceded Aboriginal sovereignty and conducted their own Passport Ceremonies for refugees.31 Although successive governments defy the UN and attempt to absolve their responsibility by outsourcing, the mental harms are not just the policy’s foreseen unavoidable consequence but its purpose.32 

Finally, whatever the merits of Australia’s historical record on refugee resettlement, Australian politicians’ sporadic defence that Australia’s refugee programs are among the world’s most generous are refuted if the measure of generosity adds refugee recognition to resettlement.18,33 

Case Study and Commentary 

The following case closely reflects the clinical caseload of the first author, and the work of all three authors and their clinical and non-clinical colleagues who are involved in this area. All names used in the case are pseudonyms, excepting refugees Reza Barati and Hamid Kehazaei and former Australian Prime Minister (PM) Kevin Rudd. 

  • Bureaucracies risking or inviting collusion in abuse or neglect
  • Human rights violations making treatment and research impossible
  • Growing distress and anxiety over these moral dilemmas.32 

Myths regarding asylum-seekers

Health professionals should recognise and challenge false narratives emanating from some politicians and sections of the media concerning refugees and asylum-seekers, that shape popular discourse. They include the idea that IMAs are ‘illegals’, ‘terrorists’ and security threats, ‘cashed up’,  ‘queue-jumpers’ taking Australian jobs, a ‘tsunami’, ‘invasion’, ‘undeserving’ welfare recipients and unwanted ethnicities: and that Australia is losing control of its borders. Mentally ill, traumatised  asylum-seekers are disparaged as manipulative extremists.32 It is asserted without evidence that detention (offshore or onshore) deters asylum-seekers or people-smugglers.53 What is clear is the negative effects of racism on people’s mental health.54

March 2019

Meanwhile in Australia some newly-elected politicians campaign to bypass non-medical bureaucracy and airlift the severely ill for medical help. Their Medevac bill passes parliament. Volunteer doctors work with legal firms working on refugee matters to coordinate these Medevac assessments.

  1. Safety/Security
  2. Bonds/Networks
  3.  Justice
  4. Roles and Identities
  5. Existential Meaning.56

  1. Not comment
  2. Acknowledge its value as a personally significant form of religious coping that promotes mental and physical health irrespective of faith tradition65 
  3. Explore further how this works for and sustains Farhad. 

For all of us

At the time of writing, this policy is thirty-one years old. We have all known, to a greater or lesser extent, just how destructive the immigration regime is for those caught up in it. At some point we will need to ask, or be asked: what did I do in face of this suffering? Our answers will be quiet, private reflections. But as Christians and health professionals we will eventually have to live with our answers.

Footnote regarding terminology. We use the terms ‘refugee’ and ‘asylum-seeker’ to refer to both certified refugees and asylum seekers, even though the latter enjoy considerably fewer rights and experience considerably more status insecurities. 

Dr Michael Dudley 
Dr Michael Dudley is a Senior Staff Specialist in Psychiatry, Adolescent Service, Prince of Wales Hospital, and Conjoint Senior Lecturer in Psychiatry, UNSW. Former Chair, Suicide Prevention Australia. Longstanding clinical and research engagements with suicide prevention, human rights and refugees.

Ms Julie Macken 
Ms Julie Macken is a Research and Project Officer, Justice and Peace Office, Catholic Archdiocese of Sydney. Former senior writer, Australian Financial Review; Co-founder, Australian Women in Support of Women on Nauru. PhD candidate, Western Sydney University, regarding the question of Australia’s treatment of refugees.

Dr Fran Gale 
Dr Fran Gale is a Senior Lecturer in Social Work, School of Social Sciences, University of Western Sydney. Principal editor of Spirited Practices: spirituality and helping professions. (eds Gale F, Bolzan N, McRae-McMahon D), Allen and Unwin, 2022 (2007).


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  1. Australian Institute of Family Studies61
  2. Transcultural Mental Health Line – 1800 648 911  
  3. Embrace Multicultural Mental Health 
  4. Run by Mental Health Australia, it provides a national focus on mental health and suicide prevention for people from culturally and linguistically diverse (CALD) backgrounds 
  5. Mental Health Community Living Supports for Refugees
    Community-based program in seven Local Health Districts (LHDs) supporting community living and participation for refugees and asylum seekers with mental health issues 
  6. Multicultural Disability Advocacy Association
    The NSW peak body for CALD people with disability, their families and carers.
  7. NSW Refugee Health Service
    The NSW Refugee Health Service (RHS) aims to protect and promote the health of refugees and people of refugee-like backgrounds via free weekly General Practice clinics and a Refugee Health Nurse Program
  8. NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) provides treatment and rehabilitation to survivors of torture and trauma. 
  9. Refugee Council of Australia – Services in NSW
    A searchable database of organisations providing services for refugees.
  10. Settlement Services International
    Community-based, not-for-profit organisation providing services in relation to refugee settlement, migrant support, asylum-seeker assistance, housing, multicultural foster care, disability support, employment services and youth support in NSW
  11. Australian Institute of Family Studies, 2022 (AIFS)

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