Refugees and asylum seekers held on Manus Island are battling some of the highest rates of depressive and anxiety disorders recorded and this is overwhelmingly the result of their detention experience, a study has found.
The disclosure is included in a submission by the United Nations refugee agency that also reveals refugees and asylum seekers continued to be held in prison-like conditions, well after Papua New Guinea's highest court ruled that the detention was unconstitutional.
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PM spruiks his refugee plan
Malcolm Turnbull has done the media rounds this morning talking up the new US resettlement deal with the same old rhetoric.
While Prime Minister Malcolm Turnbull has said women and children and family groups held on Nauru will have the highest priority for resettlement to the United States, the report highlights the urgent need to address to extreme levels of depression and post traumatic stress disorder among those in PNG.
A study by three mental health experts found rates of depressive or anxiety disorders and PTSDÂ among asylum seekers and refugees on Manus Island "amongst the highest recorded rates of any surveyed population".
"They are many-fold higher than in mainstream Australian populations and higher than that recorded in asylum-seeker populations living in the Australian community," their report says. The submission does not state whether the mental illness rates are the highest of any surveyed population in Australia, or the world.
They found it was likely that the circumstances, conditions and duration of detention had contributed significantly to the development of these disorders, citing the violence at the centre in February 2014, when Iranian Reza Barati was murdered, as being "particularly traumatic both in itself and in reactivating memories of past trauma".
The submission is to the Senate inquiry investigating allegations of abuse, self-harm and neglect of asylum seekers on Nauru and Manus Island. It is especially significant because the agency, the UNHCR, has been charged with administering the Turnbull government's agreement to send refugees from Manus and Nauru to the United States.
While Immigration Minister Peter Dutton has been vague about details, the report suggests the UNHCR will place a high priority on finding a solution for those most damaged, including those who refused to have their claims for protection assessed in PNG, and on reuniting separated families.
Although the report was written before the government announced its US resettlement plan, it repudiates the intention to hand refugees not resettled in other countries a 20-year visa to stay in Nauru. "UNHCR finds that settlement on Nauru is not an option, even on a temporary basis," it says.
Of the 181 asylum-seekers and refugees who were examined in PNG, 88 per cent were found to be suffering from a depressive or anxiety disorder and/or post-traumatic stress disorder. "A number of very severe psychiatric disorders were identified, including gross psychopathology consistent with psychosis as well as psychotic dissociation," the experts' report says.
A smaller survey of 53 asylum-seekers and refugees on Nauru found that 83 per cent suffered from post-traumatic stress disorder and/or depression.
The medical experts observed that the overwhelming majority of asylum-seekers and refugees in PNGÂ and Nauru had no pre-existing psychiatric disorder prior to their detention, even though a considerable proportion had been exposed to trauma.
The delegation visited Nauru and Manus Island a month after PNG's Supreme Court ruled that the detention of asylum seekers on Manus Island was illegal, but reported "excessive levels of security" at the centre, "creating an institutionalised and punitive environment, wholly inappropriate for asylum-seekers and refugees".
It said overcrowding in two of the compounds, Oscar and Delta, was such that detainees' dwellings were half the minimum international standard for prisons.
"The risks to public health and mental health of such overcrowding are considerable, and the possibility of abuse is increased due to the limited spaces to move persons in need of protection away from potential threats," the report said.
"The prolonged, arbitrary and indefinite nature of immigration detention in conjunction with a profound hopelessness in the context of no durable settlement options has corroded these individual's resilience and rendered them vulnerable to alarming levels of mental illness."
It also claimed mental health services on Nauru and Manus Island were inadequate.Â
The medical experts reported that a significant number of asylum-seekers and refugees reported experiences of bullying, intimidation and harassment by security staff, which had left them "frightened, withdrawn and submissive in their interactions".
This had "precipitated and/or exacerbated major depressive disorders in vulnerable individuals".
The report also mounts a powerful argument that officials statistics on self-harm and threatened self-harm on Manus Island dramatically understate the scale of the problem.
While the PNG government has said that the small number who have attempted resettlement in PNG are going well and Mr Dutton has suggested they will not be considered for resetttlement in the United States, the UNHCR submission makes it clear the resettlement has been a failure.
"As an overriding concern, refugees have informed UNHCR that they cannot settle in Papua New Guinea owing to a pervasive fear for their safety," the report says.
"Moreover, a range of measures intended to facilitate integration of refugees in the Papua New Guinean community have not worked."
Comment has been sought from Mr Dutton's office.Â