JRS psychologist Julian Caruana.

Most migrants with mental health problems are only admitted for treatment at Mount Carmel Hospital after trying to commit suicide within detention, according to a new report published by the Jesuit Refugee Service.

Additionally, the Asylum Seekers Unit in Mount Carmel is “completely substandard”, with a total lack of activities and opportunities to socialise and at risk of overcrowding. “The environment is undignified,” JRS psychologist Julian Caruana explained.

“The ward consists of small rooms with only a bed and a toilet bowl. The flushing can only be activated from outside and migrants have to ask a passing guard to flush it for them.

“They are only allowed out of their room for around an hour a day. The conditions are so bad that many migrants being treated for mental health problems ask to be sent to detention because the conditions are better there.”

Dr Caruana was speaking yesterday at the launch of a JRS report titled ‘Care in Captivity? An analysis of the provision of care for detained asylum seekers experiencing mental health problems.’

The conditions are so bad that many migrants being treated for mental health problems ask to be sent to detention because the conditions are better there

The report focused on the 74 migrants who were under inpatient psychiatric care at some point during their detention period between December 2013 and June 2014.

The ward can only cater for 10 patients – however, at one point, there were 24 being treated. The unit sometimes also accommodated Maltese female inmates with substance abuse issues.

This number has now decreased, Dr Caruana acknowledged, but warned that since the Mare Nostrum mission was discontinued, larger influxes would be expected.

Diagnosis and treatment was based on self-reporting. However, many professionals believe that detainees made up their illness to avoid deportation.

However, he continued, out of 74 migrants, only three were deported. The prospect of deportation was not of concern to them.

Additionally, there was a high rate of relapses – which was not surprising, Dr Caruana remarked, when migrants were being released from the inpatient psychiatric care and into a custodial environment.

An overwhelming number (41.9 per cent) had attempted suicide while at the detention centre while others self-harmed or harboured a death wish.

The suicide attempt was often the principal reason behind their admission, Dr Caruana noted.

The migrants spent an average of 10 to 12 months in detention and an average of three to six weeks at the unit. Many reported symptoms of mood disturbances and auditory hallucinations.

Additionally, the vast majority (70 per cent) could not speak English and required interpretation. However, 33 per cent either had no access to interpreters or only had access to untrained interpreters such as fellow detainees.

“Using fellow detainees as interpreters rather than trained interpreters could be more dangerous than having no interpreters at all due to confidentiality issues and the high levels of stigmatisation of mental health difficulties among immigrant communities in Malta.

“Additionally, interpreting is a highly skilled job. You can risk getting a false sense of security and base your treatment on that which can be dangerous.”

The report also highlighted problems ensuring continuity of care in detention as well as lengthy procedures for release from detention on vulnerability grounds.

JRS called on the government to integrate the provision of health care services in detention centres within the primary health care system, thus ensuring proper follow up in detention and beyond.

The focus should be on gradually developing an inpatient mental health service for detained asylum seekers that is more targeted to their specific needs and concerns, such as issues of past trauma, multiple losses and anxiety and insecurity related to protection issues.

The government should also guarantee the availability of trained interpreters to allow mental healthcare professionals to work unhindered – a service which is currently offered by JRS on a short-term and through project-based funding.

Immigration policy on way

A national immigration policy is the way ahead, the new Home Affairs Minister said yesterday during his first meeting with a number of NGOs involved in the field.

Carmelo Abela said that the policy should have a holistic perspective, pulling together the responsibilities now spread across different ministries.

In a statement, the government said the NGOs expressed readiness to contribute to the drawing up of a policy, with Mr Abela saying he saw NGOs as friends not adversaries. The organisations at the meeting, which was held just a week after Mr Abela was appointed instead of Manuel Mallia, included Kopin, the Malta Emigrant Commission, Integra, Aditus, JRS, Migrants Network for Equality, the Organisation for Friendship in Diversity and SOS Malta.

The government said the NGOs were optimistic about having an open and structured dialogue with the government.