There are fears for the life of a young man on Nauru, experiencing auditory hallucinations and paranoid delusions, amid concerns of inadequate treatment, staff shortages, the closure of inpatient facilities and the cancellation of medical outreach services.
According to sources on the island and medical reports seen by Guardian Australia, the asylum seeker has a long history of mental illness and suicide attempts, and his condition is “rapidly deteriorating”. He recently threatened to self-immolate, allegedly prompting International Health and Medical Services (IHMS) to stop visiting him out of safety concerns.
Doctors for Refugees said that it had repeatedly written since June to the Department of Home Affairs about the man’s case, and advised them on 10 December that he should be brought to Australia for treatment “given the concerning duration of his reported command hallucinations and history of self-harm”.
Four days later, he was taken to the RPC1 camp by an IHMS ambulance with a security escort, for an urgent psychiatric assessment.
“He sat on the bed in the ambulance … [ and] had his hands on his ears the entirety of the journey, 40 minutes,” a psychiatrist’s report said. He had been displaying “erratic” behaviour and paranoid delusions, which “appeared fixated on the Australian government”. He believed his food was poisoned, and heard voices that told him “to get out of here, not to trust [medical staff]”.
Throughout the assessment process, the man is reported to have repeatedly tapped his foot, and said he had tried to stop but couldn’t control it. The psychiatrist said the man had “considerably de-compensated in the past six months”.
He was found to be responsive and engaging with staff, and had a low risk of harm to others but moderate to high risk of harming himself.
He had previously attempted suicide at least once, recently threatened to swallow petrol – allegedly prompting the end of IHMS visits – and refused food and fluid for more than a month this year. He had also been a close friend of Fariborz Karami, and was badly affected when the 26-year-old took his own life this year.
“This man clearly needs to be off Nauru and transferred to an appropriate inpatient psychiatric facility,” Dr Barri Phatarford, founder of Doctors for Refugees, told Guardian Australia.
“There is simply not the appropriate facility on Nauru. This is not a political opinion, it is a medical fact. Either the government is genuine about preventing death and ill-heath to the refugees or it admits that their wellbeing is a secondary consideration to its own political agenda.”
The man was meant to be sent to the managed accommodation area (MAA), now being used for inpatient care because the supported accommodation area (SAA) is closed.
However, he was kept in the “back room” of the IHMS clinic for at least one night because the MAA was full.
There are conflicting reports about whether the SAA has been closed because of staff shortages or renovations. Guardian Australia understands there have been significant concerns previously about the safety of the site as a place to accommodate people at risk of self-harm.
Fiona Owens, a former team leader for mental health on Nauru during July 2018, described the MAA as a “small metal container” surrounded by barbed wire and with security officers at gates and no nurses station or round-the-clock care.
“It has three tiny cell-like rooms with a single bed and toilet. There are no shower facilities there, no recreation rooms or eating facilities,” Owens said.
“It is a harsh and is not a therapeutic environment for somebody with mental health conditions.”
Another source , also familiar with the operations of the MAA site, said that it was under 24-hour watch by security and mental health staff could visit from IHMS, but it was not set up as a supported inpatient facility with round-the-clock mental health care.
Guardian Australia has asked IHMS if the MAA has been adapted to provide staff and facilities of the same standards as the SAA while the latter remains closed.
It has also been asked to respond to claims from multiple sources that its staff are not conducting outreach services to patients in the community for whom it is responsible.
Island sources also say that only the most serious cases are receiving medication drops from IHMS, and that family members of ill people have been advised to call for a Nauruan ambulance to go to the national hospital in cases of self-harm or other emergencies.
However, recent moves by the Nauru government to send in the police and in some cases lay charges over incidents of self-harm and attempted suicide have created a chilling effect on the refugees and asylum seekers, who are reluctant to call for ambulances or go to the hospital.
IHMS referred questions to the Department of Home Affairs, which said it did not comment on individual cases. A spokesman referred Guardian Australia to a 3 December statement which outlined the medical services available on Nauru.
“There has been no change in access to health services,” the spokesman said.
• Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78; Beyond Blue 1300 22 4636
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