Tag Archives: should

Critically ill ‘should not be made to die away from home’

One in three people who die in hospital could spend their final days at home if the government introduces and adequately funds a modern community-based health and social care system, a new report says.

The Institute for Public Policy Research (IPPR) says that, while most people would prefer to die at home or in a good care home, they are often unable to do so because of inadequate and underfunded local care.

The researchers analysed investment in long-term care in several European countries, and concluded that there appears to be a correlation between funding levels, modern systems and the proportion of people dying in hospitals. Citing 2017 data from the Survey of Health, Ageing and Retirement in Europe, covering 28 countries, IPPR found the proportion of people dying in hospital in England (47%) was higher than in many EU states, with people dying at home (23%) the second lowest after Sweden and the Czech Republic (22%).

An elderly woman is tucked into bed at home by a care assistant


‘Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care,’ said IPPR research fellow Jack Hunter. Photograph: Gary John Norman/Getty/Cultura RF

If funding were increased to match that in countries with the lowest rates of deaths in hospitals and the most up-to-date systems – such as the Netherlands – IPPR argues, up to a third of those who currently die in hospital could be at home or in a care setting. Data for England cited in the report also shows marked regional variations, with more people dying in hospital in poorer areas. While 49% died in hospital in the north-west and West Midlands, the proportion was 43% in the south-east.

“Taken together,” the report says, “the variation in hospital deaths between European countries and within England suggests there is significant scope for policy to reduce the proportion of people who spend their final days in hospital, and in doing so potentially develop a model for end-of-life care that is of higher quality and lower net cost to the taxpayer.”

Around 60% of those who reported poor care experienced it in a hospital, and most say they would prefer to be at home, given adequate services.

IPPR research fellow Jack Hunter said: “For too many, the end of life is an even more difficult experience than it needs to be. The fact that those in the most deprived areas are more likely to die in hospital is wholly unjust. Where you live should not affect whether you experience good-quality care at the end of your life.

“Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care. It will also be more cost-effective for the taxpayer.”

A green paper on care and support for older people is due to be published this summer. In last January’s cabinet reshuffle, Jeremy Hunt kept his health portfolio, but his responsibilities and title were expanded to include social care. This was a signal of long-promised reform, merging the health and care budgets and systems.

The report calls for more power to be devolved to local authorities and for a big cash injection. But it concludes: “It is far from clear that the government’s vision will include the size and scale of investment for care that would be commensurate with a radical shift in funding, nor whether it will also consider long-term options (including devolved fiscal measures) to ensure the long-term sustainability of local authorities.”

47%

Proportion of people in England who died in hospital .

23%

Proportion of people in England who died at home.

£487

Estimated public saving, per person, of shifting care, in final three months of life, from hospital to community.

Critically ill ‘should not be made to die away from home’

One in three people who die in hospital could spend their final days at home if the government introduces and adequately funds a modern community-based health and social care system, a new report says.

The Institute for Public Policy Research (IPPR) says that, while most people would prefer to die at home or in a good care home, they are often unable to do so because of inadequate and underfunded local care.

The researchers analysed investment in long-term care in several European countries, and concluded that there appears to be a correlation between funding levels, modern systems and the proportion of people dying in hospitals. Citing 2017 data from the Survey of Health, Ageing and Retirement in Europe, covering 28 countries, IPPR found the proportion of people dying in hospital in England (47%) was higher than in many EU states, with people dying at home (23%) the second lowest after Sweden and the Czech Republic (22%).

An elderly woman is tucked into bed at home by a care assistant


‘Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care,’ said IPPR research fellow Jack Hunter. Photograph: Gary John Norman/Getty/Cultura RF

If funding were increased to match that in countries with the lowest rates of deaths in hospitals and the most up-to-date systems – such as the Netherlands – IPPR argues, up to a third of those who currently die in hospital could be at home or in a care setting. Data for England cited in the report also shows marked regional variations, with more people dying in hospital in poorer areas. While 49% died in hospital in the north-west and West Midlands, the proportion was 43% in the south-east.

“Taken together,” the report says, “the variation in hospital deaths between European countries and within England suggests there is significant scope for policy to reduce the proportion of people who spend their final days in hospital, and in doing so potentially develop a model for end-of-life care that is of higher quality and lower net cost to the taxpayer.”

Around 60% of those who reported poor care experienced it in a hospital, and most say they would prefer to be at home, given adequate services.

IPPR research fellow Jack Hunter said: “For too many, the end of life is an even more difficult experience than it needs to be. The fact that those in the most deprived areas are more likely to die in hospital is wholly unjust. Where you live should not affect whether you experience good-quality care at the end of your life.

“Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care. It will also be more cost-effective for the taxpayer.”

A green paper on care and support for older people is due to be published this summer. In last January’s cabinet reshuffle, Jeremy Hunt kept his health portfolio, but his responsibilities and title were expanded to include social care. This was a signal of long-promised reform, merging the health and care budgets and systems.

The report calls for more power to be devolved to local authorities and for a big cash injection. But it concludes: “It is far from clear that the government’s vision will include the size and scale of investment for care that would be commensurate with a radical shift in funding, nor whether it will also consider long-term options (including devolved fiscal measures) to ensure the long-term sustainability of local authorities.”

47%

Proportion of people in England who died in hospital .

23%

Proportion of people in England who died at home.

£487

Estimated public saving, per person, of shifting care, in final three months of life, from hospital to community.

Should rape victims be able to have abortions? Republicans don’t think so | Jessica Valenti

Just 45 days: if Republicans have their way, that’s how much time a woman in Iowa will have to report being raped if she wants to obtain an abortion.

To put it in perspective, that’s one missed period – assuming a woman’s cycles are regular and that she’s even paying attention, given she was just sexually assaulted a few weeks previous. If a woman who has been raped doesn’t report the attack within that small sliver of time, the state will not allow her end the pregnancy.

Iowa’s new anti-choice bill – which bans abortion if there is a fetal heartbeat, something that happens just five or six weeks into pregnancy – has mostly been covered because the unconstitutional legislation, if passed, would be a direct threat to Roe v Wade. (That’s what the bill’s architects had in mind.)

But what has gone largely under the radar is that the bill’s supposed exceptions for rape and incest are so radically restrictive that they would make it near impossible for sexual assault assault victims to end their pregnancies. Which, of course, is the point.

Republicans know that two out of three rape victims do not report their assault to the police. They also know that incest victims – who have 140 days to report being assaulted under the bill – often don’t disclose their abuse even to family doctors because medical professionals are mandated to report the crime to authorities. (Children are often fearful to tell anyone about incest because of the reasonable fear that they’ll be placed in foster care or that their relative will get in trouble.)

Women’s hesitance to report comes with good reason – even today, police departments and health care professionals frequently mishandle cases, victim-blame, and further traumatize victims. But bills like the one in Iowa are not about protecting women or doing what’s best for them; they’re about forcing girls and women to carry pregnancies whether they want to or not.

There’s also something particularly troubling about forcing women to “prove” their abuse before the state allows them to have a medical procedure. When I first read about the bill, it reminded me of a scene from the dystopian Hulu drama, The Handmaid’s Tale, where June’s husband needs to sign a giving her “permission” to get birth control.

We’re already living in a country where women need to prove their worthiness for medical care via a male institution (the government), and multiple states have tried to pass bills that would mandate women get their husband’s permission before obtaining an abortion. Last year, a bill in Arkansas would have even forced women to notify their rapist before ending the pregnancy.

The Iowa bill’s exception rules operate from much the same place that all anti-choice legislation does: that women are not to be trusted. That we lie about rape and that we can’t make decisions about our own bodies without interference from male politicians. It’s an especially interesting position to take in a moment when women across the country are demanding that their stories of sexual abuse be believed and taken seriously.

So let’s watch the Iowa bill – and other state legislation like it – because of the threat it poses to abortion rights across the board. But let’s also take notice of the incremental ways states are trying, and often succeeding, in eroding women’s rights. It’s all horrific, and it all matters.

  • Jessica Valenti is a Guardian US columnist

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.

Suicidal refugee child should not be sent back to Nauru, psychiatrist says

A psychiatrist has said an acutely unwell child held within Australia’s offshore detention regime should not be returned to Nauru because his long-running detention there is causing his mental illness.

The 17-year-old boy, who Guardian Australia will refer to as Hamid, is currently on the island of Taiwan, where he was taken, along with his mother, for health treatment.

Guardian Australia has reported on the treatment of his mother, Fatemeh, who was flown from Nauru after a delay of 18 months, for a heart operation. She has been treated on Taiwan.

Hamid, who had been held on Nauru since he was 11, was suffering from acute and worsening depression on the island. Since being taken to Taiwan with his mother he has had a number of meetings with a psychiatrist at the Taiwan Adventist hospital.

The psychiatrist has said he should not be sent back to Nauru.

“The depressive symptoms were not improved, moreover, he had persistent suicide ideation and some organised plans,” the latest psychiatrist’s report says. “I have already prescribed antidepressant for him and told his mother, who is also a patient with major depression, to accompany him.

“After discussing with the patient, his mother and their case manager, I think the environment in Nauru is [not only] not helpful with his depression, but even the trigger of his depression.”

Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.


Hamid’s mother Fatemeh was moved to Taiwan for heart surgery.

The doctor’s finding – that the fact of being held on Nauru indefinitely is contributing to, and even causing, Hamid’s mental distress – has caused significant consternation within the Australian Border Force and Department of Home Affairs.

Taiwan was chosen by Australia as a suitable third country to which people held on Nauru could be sent for medical treatment largely because it was outside the protections of the refugee convention and the reach of Australia’s courts, while still providing high-level care.

Most asylum seekers and refugees brought to Australia for health treatment win court injunctions preventing their return to offshore processing centres in Nauru or Papua New Guinea.

But the mental health of children still held on Nauru – most have been there five years – has reached “crisis levels”, sources on the island say. Lawyers have been forced to take individual cases to court in order to have children moved.

Three preteenaged children, suffering acute mental illnesses and having made repeated suicide attempts, have been urgently brought to Australia but only after court action was launched in Australia to have them moved. In two of the three cases, the Australian government opposed the children’s transfer in court. The government lost both, and acquiesced to the third transfer.

Nauru sources say there is growing criticality of child mental health issues, with some influenced by the condition and actions of others. “It’s an epidemic: the risk is so serious,” a source from the island told Guardian Australia.

About 142 refugee and asylum seeker children are held on the island.

Psychological reports, prepared over months, and for different children, have argued that the fact of incarceration on Nauru – many children still live in tents inside the “open” regional processing centre and do not attend school – is causing severe depression that cannot be effectively treated on the island.

A mouldy tent in the Nauru regional processing centre, where refugees live.


A mouldy tent in the Nauru regional processing centre, where many refugees, including children, live.

The Australian government’s health contractor IHMS has conceded in court there is no child psychiatrist permanently based on Nauru, and that the standard of care is inadequate.

Child psychiatrist reports provided to Guardian Australia have charted the decline of Hamid’s mental health on Nauru. The reports say he was initially achieving well at school but began to deteriorate after several years in detention and has declined precipitously in recent months. He has, reports say, a “profound sense of hopelessness” and “a high level of suicidal ideation”.

Over the course of his time on Nauru, Hamid has received mental health treatment of poor quality, with reports copied from earlier information, and recommendations for specialist treatment not followed up.

Several psychiatrists have warned Hamid’s condition would deteriorate without intervention.

“I would predict that [he] would continue to deteriorate in terms of his mental state and function. It is highly likely that he will become more acutely suicidal.

“He is a young man who is extremely hopeless and despairing – these aspects highly increase his risk [of] harm to himself and should not be underestimated. Even if [he] does not end his life then it is likely that he will endure many of these symptoms for a long time if he does not receive the appropriate treatment.”

Fatemeh fled Iran in 2013 following a violent family breakdown that forced her to abandon her job and possessions, and leave the country with her son.

Hamid was then aged 11.

The uncertainty over their futures has cruelled her and her son’s mental health, Fatemeh told Guardian Australia. “I have been officially accepted as a refugee, but still live in a tent. If I was a imprisoned as a criminal in a third-world country, that government would provide me with basic facilities.

“My son says to me, ‘let’s attempt suicide together’. He believes the only way to freedom is in death. I have sympathy for all the mothers and their children who live in Nauru. We are preyed upon and our lives are subjected to cruelty.”

Hamid and his mother were flown to Taiwan on 9 March. Fatemeh has received treatment for her heart condition. It is unclear whether and when they will be returning to Nauru.

Guardian Australia has approached the Department of Home Affairs for comment on the family’s case but has not received a response.