Sidney Myer Fund and William Buckland Foundation This project was commissioned by Foundation House Research and Policy Program who would like to acknowledge their funders the Sidney Myer Fund and William Buckland Foundation

Health Pathways for Asylum Seekers on Bridging Visa E (BVE) What are Bridging Visas and how do asylum seekers on BVEs access health care in Victoria? The Australian Government releases some people from Immigration Detention Centres (IDC) or immigration detention facilities into the community on a Bridging Visa E (BVE). This presentation outlines the health journey of these asylum seekers on Bridging Visa Es who have arrived by boat to Christmas Island and then have been released into the Australian community on a BVE. They may have spent time in other detention centres prior to their release. It addresses the health access and eligibility pathways for people on Bridging Visa Es in Victoria, Australia. These people are still classified as Asylum Seekers whilst waiting to have their application for permanent protection visa’s approved. Last updated February 2013

Summary of Slides Overview and definition of BVE Income/housing and case work support Health Services on Christmas Island and other Detention facilities Health services provision and supports Resources available

Definitions Asylum Seeker Refugee An Asylum seeker is a person who has applied for a refugee protection visa They are waiting for a decision on this application A refugee is someone whose asylum claim has been successful and who has received a refugee protection visa Refugee protection visas are granted if someone is found to have “a well founded fear of persecution on the grounds of race, religion, nationality or membership of a particular social group or political opinion” An asylum seeker is a person who has applied for a refugee protection visa and is awaiting a decision by the Commonwealth Department of Immigration and Citizenship (DIAC) or the Refugee Review tribunal (RRT) on this application. In contrast a refugee is someone whose asylum claim has been successful. The claim can be made onshore in Australia or offshore (ie. when someone is living in a refugee camp or in precarious circumstances in a country of asylum). A Refugee is someone who : Owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his/her nationality, and Is unable to, or owing to such fear, is unwilling to avail himself/herself of the protection of that country (United Nations 1951 Refugee Convention) This presentation focuses on Asylum Seeker pathways when people are living in the community on a Bridging Visa E (BVE)

Australian Humanitarian Program 13,759 visas were granted in 2011-12 (Increasing to 20,000 in 2012-13 ) 2012-13 intake included: 6,004 Refugee (offshore) category visas granted (including Women at Risk visas). 7,755 Other humanitarian visas, including 714 Special Humanitarian Visa ( SHP) 7,041 Onshore Visas granted (who have applied for protection in Australia) The Humanitarian Program (takes in both on shore and off shore arrivals) in Australia. It is the total number of people who are granted visas on humanitarian grounds each year. It has recently been increased from 13,750 people in 2011-12 financial year to 20,000 in 2012-2013. Off Shore: 2 components to this program: a)Off Shore - People identified as refugees by the UNHCR in need of permanent resettlement (Visa 200) Also includes: Women at Risk (Visa 204) In Country Special Humanitarian (Visa 201) Emergency Rescue (Visa 203) b)Special Humanitarian Program (Visa 202) People in a refugee like situation who are proposed by someone in Australia (SHP). Onshore Those granted a permanent protection visa in Australia (Visa 866) having applied for asylum after arrival (by boat or air). Arrival pathways 1) Entry into Australia with a valid document by air or sea. Over stayers: tourists, students, business persons, etc. 2) Entry into Australia without a valid document. People who arrive without a valid visa are mandatorily detained for health and security checks, for people that arrive by boat this commonly happens on Christmas Island.

Boat Arrivals Irregular Maritime Arrivals (IMAs) Afghanistan, Sri Lanka, Iran and Iraq currently main countries of origin In 2011-12: 85% people that arrive by boat were men or boys on their own* 17% of people that arrive by boat were unaccompanied minors* Torture and trauma experiences are common May have had poor access to previous health care People who arrive in Australia without a valid visa are placed in mandatory detention Time in detention can affect health outcomes *DIAC Annual Report 2011-12 The country of origin for those seeking asylum in Australia changes in response to global events. Over 85% of asylum seekers arriving by boat are men and boys on their own, women and children and unaccompanied female minors (UAM) complete the numbers. It is common for people who are seeking asylum in Australia to have witnessed or personally experienced traumatic events, such as prolonged periods of deprivation, human rights abuses, the loss of loved ones or a perilous escape from their homeland. Some may have been subjected to severe physical and or psychological torture. It is common for people to have been forced to leave behind close family members who continue to live in precarious circumstances which can have an ongoing impact on mental health. Many of the people arriving by boat have experienced poor access to health care in their countries of origin and / or their first country of asylum. Their experience in detention may have an effect on both their physical and mental health.

Location of detention facilities This slide shows how many Immigration Detention Facilities and similar settings there are in Australia They are defined by varying levels of security. Most people arriving in Australia by boat are initially processed on Christmas Island and can be moved to other detention facilities within Australia. The health care facilities and provision of health within all detention environments are provided by the International Health and Medical Services (IHMS) Naru and Manas Island do not feature in this picture, there are people currently detained in both of those locations.

Average Time Spent in Detention Period Detained Total % of Total 7 days or less 45 0.5% 8 days - 31 days 1104 12.2% 32 days - 91 days 3576 39.5% 92 days - 182 days 2648 29.2% 183 days - 365 days 763 8.4% 366 days - 547 days 171 1.9% 548 days - 730 days 161 1.8% Greater than 730 days 591 6.5% 9059 100% Length of Time in Detention as at 31 Dec 2012 The majority of people in Immigration Detention Centre's have arrived by boat Some of the people in detention have arrived by air and may not be asylum seekers Statistics from Dec 2012 show that there were 9059 people in Immigration detention. The average period of people being held in Immigration Detention facilities has significantly decreased from 277 days (9 months) in November 2011 to 113 days (3.5 months) in May 2012. Recently many more people are being released from detention into two different programs: 1) Community Detention and 2) on Bridging Visa Es' in the community whilst awaiting their application for protection visa. This presentation focuses only on the people being released into the community from detention on BVEs. Source: DIAC, Immigration Detention Statistics Summary, 31 December 2012

Permanent protection in Australia Arriving by boat or plane – asylum pathways Non Irregular Maritime Arrivals (Non IMAs) arrive by air with a valid visa and subsequently apply for protection People who have arrived by boat (IMA) (and those that arrive by plane without a valid visa) Mandatory Detention (including Community Detention) Asylum seeker in the community; Bridging Visa A or Bridging Visa E Asylum seeker in the community; Bridging Visa E Asylum seekers who arrive by boat are mandatorily detained initially on Christmas Island, then may be moved into Community Detention, another detention centre, released on a Bridging Visa E or released with a Permanent Protection visa if found to be a refugee. Asylum seekers who arrive by air with a substantive visa are generally free to live in the community – and are issued with a Bridging Visa (typically A or E) whilst their claim is processed (or when their substantive visa expires). Those who arrive by air without documentation or do not comply due to other reasons may be detained. People who receive permanent protection through applying onshore receive Visa 866, however sometimes people have compelling reasons to stay in Australia but do not meet the full criteria for a permanent protection Refugee visa, in these circumstances other visa’s may be issued. Other visas may have different entitlement, so it is important to check on the DIAC website for details. THIS PRESENTATION FOCUSES ON THE PEOLE WHO ARE ARRIVING BY BOAT AND SEEKING ASYLUM AUSTRALIA Permanent Protection Visa 866 or granted a non humanitarian visa. Repatriation to country of origin. Permanent Protection Visa 866 or another visa. Repatriation to country of origin.

Criteria for Bridging Visa E Moving out of detention Case by case consideration Initial checks including health, security and identity are completed Behaviour and co-operation with DIAC are taken into consideration Some circumstances Unaccompanied Minors (UAM) move from Community Detention to BVE Case by case consideration of whether to grant a BVE to a boat arrival while they are awaiting their permanent protection claim. Initially priority given to people who have been in detention for long periods and to vulnerable people. People undergo initial checks including health, security and identity prior to being considered for a grant of a BVE. Other key considerations include co- operation with DIAC and behavior whilst in detention. In some circumstances people (particularly unaccompanied minors) will be moved from Community Detention (CD) to BVEs when they turn 18. Ref Australian Government Department of Immigration and Citizenship Fact Sheet 65 .-Onshore Processing Arrangements Bridging Visa E/OCt 2012

What is a Bridging Visa E(BVE)? A BVE is a Temporary Visa that is held by Asylum seekers whilst they are awaiting the result of their claim for permanent protection in Australia People on BVEs can remain lawfully within Australia Asylum seekers who arrived in Australia by boat prior to 13 August 2012 are allowed to work in Australia (work rights) and are Medicare eligible. (work  Medicare ) Asylum seekers who arrived in Australia by boat on or after 13 August 2012 have NO work rights, but are Medicare eligible. (work  Medicare ) A Bridging Visa E (BVE) can be granted to a person released from detention . The BVE will allow them to remain lawfully in Australia while their claim for permanent protection is being assessed. Some people who arrive by plane can also have a BVE. Clients who are on a BVE are eligible for different entitlements however all have access to medicare.

Bridging Visa E(BVE) contd BVE holders live in the community following health, security and identity checks. BVE holders are typically men on their own, as unaccompanied minors, women, families and more vulnerable men are placed into the Community Detention program.

How long are BVEs granted for? BVEs remain in effect while a person’s permanent protection case is being resolved Length of BVE may vary BVE holders are expected to abide by all visa conditions If they fail to abide they are liable for visa cancellation and risk being returned to detention The BVE will remain in effect while their cases are resolved. The length of the visa may vary, dependent on the stage of a person’s processing, but initial grants will be for a number of months. Further BVE can be granted if needed, based on the progress and status of an individual’s case and taking into account their compliance with visa conditions. There are appeals processes if someone is initially not refused a permanent protection visa. DIAC will manage departures from the community if protection claim unsuccessful. The rates of voluntary return are higher when people are in the community then when they are in detention. Bridging Visa E/OCt 2012

What happens once a person is released from detention onto a BVE?

Transitional CAS First 6 weeks of support in the community CAS stands for Community Assistance Support. Transitional CAS is provided by Red Cross or AMES in Victoria for 6 weeks. Up to 600 clients per month are entering this program in Victoria. Clients are directly referred from the Department of Immigration and Detention (DIAC) to this program Group orientation and individual case work support Income support including living allowance and rent assistance (equivalent to 89% of Centrelink payments) BVE holders are eligible for Transitional Community Assistance Support (CAS) support on release from detention for a period of 6 weeks. This is managed by Red Cross and AMES. Services include case work support in a group and individual setting, and access to tranistional accommodation (if the person doesn’t have links) . Up to 600 clients released per month to Victoria onto this program. Have Income support for 6 weeks (equivalent to 89% of centrelink payments).

Transitional CAS contd First 6 weeks of support in the community Health and welfare support PBS prescription medication eligibility After six weeks people are then assessed by DIAC, who determine ongoing support options Clients circumstances are regularly reviewed Housing support: emergency short term accommodation for clients who are unable to stay with community links - then support to access the private rental market. Emergency short term accommodation is provided to eligible clients. Clients are then supported to find private rental of their own. Other health and welfare support includes registration with Medicare, concession applications and referrals to appropriate health services (including T&T) and community services including language and employment services. Health and Welfare - CAS clients are required to contribute the first $5.80 of their PBS prescription medication. Non prescription or non PBS medication needs to be covered by the client. Case workers can apply for DIAC to cover the costs of these medications IF they are essential for health and there is no PBS alternative. Eligible for torture & trauma counselling services. Client circumstance are regularly reviewed . After six weeks the clients are reassessed by DIAC

Support following initial six weeks During the fifth week of transition DIAC assess clients’ ongoing needs post 6 weeks. Following the initial support by Transitional Community Assistance Support stream DIAC could refer to: Community Assistance Support (CAS) as an ‘ongoing’ client Asylum Seekers Assistance Scheme (ASAS) No Program – this is where clients do not meet the eligibility criteria for either CAS Ongoing or ASAS or are able to provide for themselves so receive neither CAS or ASAS After six weeks of the initial Community Assistance Support (CAS) Transitional support The clients are assessed by the Department of Immigration and Citizenship (DIAC) . Regularly reviewed once client in the community. Can be reviewed to require ongoing CAS support. If the client is assessed as requiring basic health and welfare support only, DIAC can refer the client to ASAS, The client may be reviewed as needing no program. However a client can self refer to ASAS Community Assistance Support (CAS) Transitional Support - Australian Red Cross http://www.redcross.org.au/files/20120816_CAST_FACTSHEET.pdf Community Assistance Support (CAS) Ongoing; Australian Red Cross http://www.redcross.org.au/files/20120816_CAS_FACTSHEET.pdf They could be referred to Community Assistance Support (CAS) Ongoing They may be assessed as going onto Asylum Seeker Assistance Scheme only Or They may be assessed as able to provide for themselves so will receive neither ASAS or CAS support Clients who received a negative decision at the Refugee Review Tribunal (known as ‘double negative’ ) are not eligible for support under ASAS either and will be referred to no program post the 6 week transitional period

Asylum Seeker Assistance Scheme (ASAS) ASAS is administered by the Australian Red Cross and AMES. Support through ASAS can include: Financial support Referral for basic health, welfare support and torture and trauma counseling Case work support The Asylum Seeker Assistance Scheme (ASAS) is administered by the Australian Red Cross and AMES. Support through ASAS can include : Help with living expenses – (89% of Centrelink) Rental assistance (89% of the Centrelink ) Essential healthcare and medical expenses aligned with CAS Transitional Support. This includes contribution of $5.80 towards PBS medication Mental health and Torture and Trauma counselling. Clients who have been assessed by DIAC as NOT requiring CAS or ASAS support , can self refer to ASAS. ASAS workers would assess that client against eligibility criteria. Approval from DIAC is required before ASAS support can commence. For more information on ASAS scheme http://www.redcross.org.au/asylum-seeker-assistance-scheme.aspx Please note in general terms : ONLY CLIENTS IN THE COMMUNITY ASSISTANCE SUPPORT (CAS) ARE ALLOCATED AN INDIVIDUAL CASE WORKER . Clients who have been previously assessed as NOT requiring CAS or ASAS by DIAC can self-refer to ASAS Bridging Visa E/OCt 2012

CAS Ongoing Eligibility criteria: Support includes; On a bridging visa Serious physical or mental health issue Elderly and unable to support self Serious family issues Support includes; case work support financial assistance (89% of Centrelink) medicine material aid referral to other services including torture and trauma counselling To receive CAS Ongoing assistance. A person must be on a bridging visa and meet the following criteria: experiencing mental health issues, which serve as a barrier to visa status resolution experiencing a serious physical health issue such as a stroke or brain trauma elderly and unable to support yourself, with no other means to do so unable to support yourself due to the effects of torture or trauma experiencing family issues such as child abuse, domestic violence, serious relationship issues or child behavioural problems a minor at risk of harm or a guardian of such a minor Support provided: Case workerregular appointments with interpreter. organising healthcare appointments financial assistance to help you to pay for your basic livingexpenses and rent (equivalent to 89% of Centrelink Special Benefit) and where applicable, rent assistance (equivalent to 89% of Centrelink Rent Assistance) financial assistance to help you cover the cost of your doctors appointments, medicine and emergency health care such as ambulance, hospital and emergency dental referrals to counselling, accommodation, material aid such as clothing and furniture, Referral to education, legal services and social support.

Can people on BVEs choose where they live? BVE holders can choose where they live. DIAC approval is required to move between states in the first 6 weeks after being released from detention BVE holders are required to advise DIAC of where they live and when they change address BVE holders have no access to public housing so use private rental market In many cases BVE holders live with family or friends in overcrowded circumstances BVE holders are eligible for DHS transitional emergency accommodation People on BVEs have a freedom to choose where they live – However there are limits to the support available if they choose to move between states during their 6 week transitional period and their transitional support may be cut short if they move interstate. It is a requirement of the BVE that the person must advise DIAC of their address and any change to that address. Clients must report to DIAC on a regular basis. In many cases people will reside with or close to family and/or community ties and support networks .They are often forced to reside in overcrowded circumstances due to housing shortages and financial restrictions. Some may choose to reside close to employment opportunities . People on BVE will not be provided with public housing . The DIAC will assess when clients are in detention whether they have community links that they can reside with. If they do not, Red Cross and AMES is subcontracted to provide emergency accommodation. This could be through a local motel/backpackers, through the Australian Homestay Network (living with an Australian family) or properties leased or owned by these services. Upon completion of the transitional period, most people find their own accommodation in the private rental market.

Review Some asylum seekers are released from detention facilities on a BVE (Bridging Visa E). These people live in the community following health, security and identity checks. Typically BVE holders are men on their own. BVE holders receive 6 weeks financial support through the Transitional Community Assistance Support scheme After a six week period people are reliant on finding housing in the private rental market unless assisted by CAS/ASAS. As mentioned some people are released from Immigration Detention into the community following Health, Security and Identity check clearance completed by The Department of Immigration and Citizenship. (DIAC) Typically the people on BVEs are men on their own. Eligible BVE holders receive six weeks of support from the Red Cross and AMES under the Community Assistance Support (CAS) Transitional Support stream This group of people are not eligible for public housing options and are reliant on finding housing in the private rental market

Health screen on Christmas Island Provider: International Health and Medical Services (IHMS) Screened for TB and other serious illness immediately on arrival Chest X rays Initial Health Assessment Mental Health Assessment Child Health Assessment Well women’s check Antenatal care Dental care No further medical tests unless requested by client Immediately on arrival Public Health Screen TB and other serious illness are considered Chest X-ray Within 72 hours post arrival All clients over . 12years of age at Christmas Island hospital Initial health Assessment within 72 hours Medical History Vital signs :weight ,height, blood sugar level U/A, Beta HCG (BHCG) Test ( pregnancy test) for all women > 14years Physical examination Routine blood:. > 16years: Full Blood Count , Hepatitis B , Syphilis, Liver Function Tests ,and Urea and Electrolytes Mental Health Assessment Screened and assessed at induction and Mental Health team review and assessment within one week Referred to mental health team/torture & trauma services as required Torture and trauma counseling provided by CI hospital . 3 Monthly mental health check Child Health Assessment 4-6 weeks post arrival All babies, infants and pre-primary children referred to Maternal and Child Health Nurse at CI hospital According to age on presentation, may include : growth monitoring immunisation developmental audiometry Eye testing Antenatal Care If pregnant antenatal bloods as per clinical guidelines and referral for antenatal check Dental Health If urgent direct referral to dental clinic at CI hospital Child check up and treatment commenced 1-2 months post arrival No other dental services provided People who are in an Immigration Detention receive an initial health assessment , but receive no further medical follow up unless specifically requested by the client. People may be transferred to another Immigration Detention Facility and health issues followed up as they arise.

Health Discharge Summary from health service at detention facility Health summary provided to clients, Red Cross and AMES in large white envelope Explanation in their own language of the importance of documents Fitness to travel is completed Advice given to client on ongoing /post-arrival health care needs when they leave immigration detention Clients given health advice prior to leaving Christmas Island Copy of health summary given to clients in a sealed envelope , ask client for this envelope on first consultation. Note that often the client does not have this envelope. This may be, because they have misplaced it, do not understand they need to bring it to the medical appointment, or are not confident in giving their medical information to strangers. See Slide 21 for detail of IHMS to follow up if needed. The summary should contain Presentations to health service in immigration detention centre Immunisation record X-ray and pathology results Diagnoses Treatments and current medications Bridging Visa E/OCt 2012 Refer to Asylum Seeker Fact Sheet for contact details

Transfer of health information for people with mental health issues Especially relevant for people who are on - anti–depressants, anti-anxiety meds, sleeping tablets and pain killers. Information on medical condition contained in health summary. Client should be given up to 14 days medication on departure from detention. Transfer of medical information for people with mental health issues is of particular importance. People who are on anti-depressants, anti-anxiety medication ,sleeping tablets, pain killers ,or who are currently under professional mental health care should be discharged from Immigration Detention with : Information on the client’s medical condition and medication regime in their medical summary Clients are free to pass on their health information to any health professional they choose to engage. The client should be given 14 days of medication on departure from Immigration Detention to tide them over until they have established contact with their new provider. Bridging Visa E/OCt 2012

Health Telephone Support Line IHMS 24 hour telephone hotline called the Community Detention Assistance Desk (CDAD). Queries about BVE client’s health discharge and transitional information can be directed to the CDAD desk. The CDAD is staffed by IHMS admin staff as well as clinicians (nurses and doctors)     Community Detention Assistance Desk Phone: 1800 725 518 case workers 1800 689 295 health professionals Fax: (02) 9086 9875 Email: cdad@ihms.com.au The International Health and Medical Service (IHMS) recently launched a 24 hour telephone hotline called the Community Detention Assistance Desk.(CDAD) Queries about health discharge from IHMS and transitional information only can be directed to the CDAD desk for people on BVEs. The CDAD is staffed by IHMS admin staff as well as clinicians (nurses and doctors)  Any IHMS health provider can contact the hotline regarding CD clients. CDAD phone:  1800 689 295 health providers 1800 725 518 case workers Fax: (02) 9086 9875 Email: cdad@ihms.org.au

On arrival in Victoria Basic health orientation by Red Cross and AMES on arrival in Melbourne In some areas a more extensive health triage and referral process in place by health professionals Health orientation talk by health professionals Initial triage and referral Case work support to follow up appointments provided by Red Cross and AMES DIAC subcontracts to Red Cross and AMES who provide basic health orientation to the Australian Health system in a group and individual setting on arrival in Melbourne In some areas in Melbourne a system exists where health professional provide a health triage and referral function. The case workers then assist clients to access medical appointments

Access to health services for BVE holders Medicare eligible regardless of protection visa process Access to Victorian Department of Health funded public health services All BVE holders informed of their eligibility Specialist health care - some clients eligible under ASAS and CAS program for further assistance Clients recommended to carry their interim Medicare cards with them at all times Pharmaceuticals – reimbursement to rate of Health Care Card holders (if they are receiving ASAS and CAS) All people on BVEs are eligible for Medicare They have access to Victorian Department of Health funded public health services as per Medicare eligibility . As of April the 17th, 2012 all people who have been granted a BVE have been informed of their eligibility to access Medicare . This information is also contained in their BVE letter. In some instances where the person is waiting for a Medicare number Red Cross or AMES may be able to provide a ‘supplier letter’ to cover the cost of medical services. For specialist health care some clients may be eligible for assistance in meeting additional costs through department funded programs such as ASAS and CAS. If clients need Specialist health care a CAS case worker can apply to DIAC to cover the cost associated with this – including scans, x-rays, blood tests etc It is recommended that people on BVEs carry a letter from the Department of Immigration with them or the identity document plus their interim Medicare card when attending health services. Pharmaceuticals reimbursement from CAS or ASAS program to the rate of health care card holders.

Health Services which BVE holders can access Hospitals Ambulance Primary and Community Health General Practice Immunisation services Drug and Alcohol Pharmaceuticals Mental Health Torture and trauma counselling services Aged Support services Aids and equipment Sexual health services Clients on Bridging Visa Es are MEDICARE eligible All BVE holders are Medicare eligible regardless of the protection process they are engaged in . They can access all the services listed including torture and trauma counseling services, Access Asylum Seeker Fact Sheet for more in depth community support arrangements. http://www.ergpa.com.au/images/_uploads/20120622_fas_asylum_seeker_final.pdf

Other services Dental Free access to public Dental services . Asylum seekers who are BVE holders recognised as a priority population as documented by DH policy. Do not require a healthcare card Optometry Free access to public optometry services. The Australian College of Optometry (ACO). Cost for glasses? Recently ACO will provide free testing to people WITHOUT Medicare card. Allied Health Allied Health services based in community health, CH Fee policy applies. Fees can be waivered according to client’s financial circumstances. Have priority access Public dental services should be provided free to asylum seekers with a BVE . As per The Victorian Department of Health Dental policy . Asylum seekers who have priority access to dental care must be offered the next available appointment for general care and must not be placed on the general care wait list. Where the person has denture care needs, they would be offered the next available appointment for denture care or placed on the priority denture waiting list, Note next available appointment may be a waits of weeks http://www.health.vic.gov.au/dentistry/downloads/eligibility_priority_access_policy.pdf Free access to public optometry services should be provided to Asylum seekers with a BVE by The Australian College of Optometry (ACO). Note next available appointment may be a matter of weeks Recently ACO has agreed to provide free testing to people WITHOUT Medicare card. BVE holders will need to pay a minimal amount required by ACO for glasses. On occasion a CAS case worker can apply to the DIAC to cover this cost during the transitional period or in CAS Ongoing – this will be determined on a case by case basis Public Audiology testing is provided by services often located in community health centres where a fees policy applies.

Bridging Visa E Overview of access and rights Work rights NO – those who arrived after 13 Aug 2012 YES – those who arrived prior to 13 Aug 2012 Medicare eligibility YES Provision of Pharmaceuticals YES – ASAS and CAS will reimburse to health care card level. NO – if not receiving ASAS or CAS Torture and Trauma Counselling Housing Initial transitional housing for 6 weeks and then assistance to find private rental. Financial No Centrelink. If eligible for CAS or ASAS income support equivalent to 89% of Centrelink payment. People on BVEs have work rights. The clients are eligible for Medicare. They are eligible for a reduced cost of prescribed PBS pharmaceuticals ($5.80 per script). The Red Cross and AMES make arrangements with Pharmacies for clients to access these reduced rate medications. The people on BVEs have initial housing support for 6 weeks, after 6 weeks they can apply to DIAC for assistance for further support through the CAS and ASAS schemes. No centrelink support, however are eligible for financial support from DIAC that is the equivalent of 89% of Centrelink payments for the initial 6 weeks (by way of example: 89% of Newstart allowance for a single person is $438 per fortnight; or $219 a week). Are then reassessed and can be eligible for CAS and ASAS support

Other Health Supports Refugee Health Nurses in Community Health Services can provide support for assessment and referral. Refugee Health Fellows can provide clinical advice and training for health services. Specialist Hospital services. GP referral only. Foundation House torture and trauma counseling All details on: www.refugeehealthnetwork.org.au The Refugee Health Nurses The Refugee Health Nurses play a crucial role in working directly with refugee communities, supporting timely access to health assessment, optimal care co-ordination and advising other health practitioners on refugee health matters. They are now located in 16 community health services in in areas of significant refugee settlement in metropolitan and rural Victoria.  Referral contact details available on www.refugeehealthnetwork.org,au Refugee Health Fellows A pediatrician and Gp are currently the Refugee Fellows based in Victoria . They provide education and support to GPs and specialists who see refugees in their practice. With a focus on outer metropolitan and rural and regional Victoria, the program assists practitioners to respond to the health needs of their refugee patients. Referral contact details are available on www.refugeehealthnetwork.org.au Specialist Refugee & Immigrant Health Clinics GP Referral Only  There are specialist refugee clinics available in the cute and primary care sector . Refugee clients are seen in a timely and appropriate setting in these clinics with access to interpreters . Referral contact details available on www.refugeehealthnetwork.org.au Foundation House Specialist torture and trauma services that provide t and t counseling. Training for health services and asylum seeker support agencies Research and health sector development support and programs. Info www.refugeeehelathnetwork.org.au www.foundationhouse.org.au Victorian Department of Health web site for further info http://www.health.vic.gov.au/pch/refugee/nurse_program.htm

Health pathway for people on Bridging Visa E Detention Centre In the community Health checks on arrival at Christmas Island Primary health services in detention on request from client Health summaries provided by IHMS to clients, Red Cross or AMES Health assessment & care by GP & Refugee Health Nurse in community Medicare eligible Follow up as required Primary health Specialist health Mental health Torture and Trauma counselling Sexual health Vision Oral health

Extra resources Asylum Explained; Asylum Centre Resource Centre http://www.asylumexplained.asrc.org.au/?page_id=916 Victorian Refugee Health Network http://www.refugeehealtnetwork.org.au Asylum Seeker fact sheet; Victorian Refugee Health Network website http://www.ergpa.com.au/images/_uploads/20120622_fas_asylum_seeker_final.pdf Asylum Seeker Assistance Scheme (ASAS); Australian Red Cross http://www.redcross.org.au/asylum-seeker-assistance-scheme.aspx Community Assistance Support (CAS); Australian Red Cross http://www.redcross.org.au/files/20120816_CAS_FACTSHEET.pdf More in depth handouts are recommended to accompany this slide presentation. These can be accessed on the above websites. The Community Detention Pathways are described in the second presentation of this series. For any queries re this resource please contact: Lindy Marlow marlowl@foundationhouse.org.au

Extra resources contd Community Assistance Support;(CAS) Transitional Support; Australian Red Cross http://www.redcross.org.au/files/20120816_CAST_FACTSHEET.pdf Asylum Seeker Dental access policy ;Department of Health http://www.health.vic.gov.au/dentistry/downloads/eligibility_priority_access_policy.pdf Refugee Oral Health Fact sheet ; Victorian Refugee Health Network website http//www.refugeehealthnetwotk.org.au DIAC; Boat Arrivals information http://www.immi.gov.au/ima/ Promoting Refugee Health Guide , Victorian Refugee Health Network website http://www.refugeehealthnetwork.org.au More in depth handouts are recommended to accompany this slide presentation. These can be accessed on the above websites. The Community Detention Pathways are described in the second presentation of this series. For any queries re this resource please contact: Lindy Marlow marlowl@foundationhouse.org.au

Glossary Asylum Seeker Assistance Scheme ASAS Adult Multicultural Education Services AMES Bridging Visa E BVE Christmas Island CI Community Assistance Support CAS Commonwealth Department of Immigration and Citizenship DIAC Community Detention Services CDSP Community Detention CD Irregular Maritime Arrivals IMA Permanent Protection Visa PPV Special Humanitarian Program SHP

All care has been taken to ensure that the information in this presentation is correct (as at Feb 2013). If any errors are identified or you have other queries please contact info@refugeehealthnetwork.org.au