Moral Injury Related to Immigration Detention on Nauru: A Qualitative Study

Abstract

Background: Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role. Objective: Our aim was to explore refugees’ and asylum seekers’ moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru.Methods: We conducted in-depth interviews with 13 refugees and asylum seekers who had an experience of immigration detention on Nauru and lived in Australia after medical transfer. We used reflexive thematic analysis to develop themes from the data.Results: The participant statement “In my country they torture your body but in Australia they kill your mind.” conveyed key themes in our analysis. We describe 1) how participants’ home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, trauma and dehumanisation after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged.Conclusion: Our findings suggest that moral injury may be one of the mechanisms by which mandatory immigration detention can cause harm. Hence, refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one’s moral frameworks. Policy makers should incorporate moral injury considerations to prevent damaging refugee mental health.

How immigration detention harms children: A conceptual framework to inform policy and practice.

“…The hierarchical authoritarian environment of closed detention and the associated lack of agency particularly when detention is prolonged or indefinite is harmful and can lead to “multiple subtle but insidious, as well as substantial, transgressions of one’s moral frameworks” (Passardi et al, 2021, p. 21). Moral injury can follow exposure to events that violate deeply held moral beliefs and frameworks about right and wrong, including violation of rights and exposure to coercive processes.…”

Dirty work: well-intentioned mental health workers cannot ameliorate harms in offshore detention

“…Working in conditions of detention gives mental health providers limited avenues of aid and advocacy and may cause moral injury to these providers. In order to maintain their position, with whatever benefits it offers to themselves and others, they must comply with the conditions of their employment 44. The system encompassed in the conditions of employment are deliberately harmful, Under Australia’s deterrence policy, ‘the clinician is being used to achieve policy objectives, rather than clinical aims’ 45…”