News

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Major update to immigration detention healthcare standards

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The RACGP has updated its Standards for health services in Australian immigration detention facilities (IDF Standards) for the first time in 15 years.
 
Designed to support health professionals and the Department of Home Affairs to provide healthcare to the thousands of people in immigration detention facilities, the second edition is the first major update since 2007 and aims to better reflect the detainees’ current environment and needs.
 
‘All the general practice and related standards developed by the RACGP are designed to improve the quality of care provided by the relevant primary healthcare service to its users,’ Dr Mike Civil, Chair of the RACGP’s IDF Working Group, told newsGP.
 
‘The IDF Standards are no exception, and by using the new edition for accreditation, GPs and staff can be assured that they provide profession-led standards of safe, quality care.’
 
As of 30 April 2022, the most recent date for which statistics are available, there were 1414 people in Australian immigration detention facilities.
 
A further 568 people were living in the community after being approved for residence determination, and 10,973 people classified as ‘unauthorised maritime arrivals’ were living in the community after being granted bridging visas.
 
As most detained individuals are those who have been released from the justice system, Dr Civil said the second edition IDF Standards better reflects the needs of these patient populations, by including aspects such as cultural and linguistic diversity, post-traumatic stress and other complex physical and mental health issues.
 
IDF Working Group member Dr Gillian Singleton, a GP with a special interest in asylum seeker and refugee health, told newsGP the Standards were ‘well overdue’ for review.
 
‘A great deal has changed since 2007, both in Australian legislation – particularly the restricted settlement options for people seeking asylum who arrive by boat – and consequently within the immigration detention system,’ she said.
 
These changes necessitated a thorough review of the IDF Standards to ensure that they were up to date with the current version of the Standards for general practices, as well as the breadth of needs of the current and future populations held in detention.
 
And although many individuals and families who were previously detained in the immigration detention network now live in the community, Dr Singleton points out that many continue to live in uncertainty. Not all have access to Medicare, and some may be on temporary bridging visas with limited access to income support if they are unable to work.
 
Therefore, she said a ‘robust set of Standards’ provides assurance that the healthcare being provided to individuals in detention meets the community standard.
 
‘It is broadly recognised that the populations within immigration detention are vulnerable because of previous experiences of trauma, refugee-like experiences and/or previous incarceration in the criminal justice system, and thus trauma-informed and culturally safe care is absolutely essential,’ Dr Singleton said. 
 
‘This is a diverse group of individuals … and identifying and having some understanding of their experiences can be a rewarding and valuable role for GPs.’ 
 
Updated evidence and evolved patient and practice quality outcomes from the Standards for general practices have been incorporated into the second edition.
 
In addition to broad consultation with the healthcare profession and stakeholders, the updated IDF Standards have also undergone subsequent consultation with the Department of Home Affairs, as well as pilots across two immigration detention facilities.
 
The IDF Working Group states that throughout the review of the Standards, it remained ‘very clear’ that in collaborating with Home Affairs, the RACGP was not perceived to be condoning the use of immigration detention in Australia. 
 
‘We opted to have a pragmatic approach, given that the current legislation allows the use of restrictive detention to hold individuals who do not have a substantive visa, but felt that clarity was needed to highlight the evidence about the adverse impacts on health of immigration detention,’ Dr Singleton said.
 
Dr Civil said by using the IDF Standards to accredit its facilities, the department is ‘fulfilling its duty of care to provide the same quality healthcare to individuals who are detained in immigration detention facilities as that which is available in the Australian community’.
 
In order to ensure safe, quality care for individuals in immigration detention facilities, the RACGP states it is ‘vital’ for health services to provide initial, continuing, comprehensive and coordinated care, including:
 

• integration of biomedical, psychological, social and environmental factors
• consideration of a patient’s language, culture, beliefs and values in their understanding of health.

‘As with the fifth edition of the Standards for general practices, the IDF Standards have been written, where appropriate, with a focus on outcomes and patients, instead of prescribed processes,’ Dr Civil said.
 
‘This edition therefore gives health services greater ownership over their practices and systems, so that team members are more likely to follow them continuously to help future-proof the IDF Standards … and allow GPs and staff to use them as a template for the provision of a quality health service in any immigration detention facility. 
 
‘We hope that accreditation against the second edition of the IDF Standards will encourage health service staff at these facilities, as well as the bodies that contract the health service providers for Australian immigration detention facilities, to demonstrate the provision of safe, quality healthcare to their patients.’
 
The second edition ‘Standards for health services in Australian immigration detention facilities’, along with accompanying resource and patient feedback guides and RACGP position statement, are available on the RACGP website.
 
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asylum seekers general practice standards immigration detention refugee health

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