1. Health Pathways for people living in Community Detention in Victoria Last updated July 2013

2. 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

3. Summary This presentation includes an overview of: the Community Detention Program, health services on Christmas Island and detention facilities, health orientation and health supports for people in Community Detention, information and contact details for International Health and Medical Services (IHMS) providers, organisations who support people in Community Detention, and resources and referral pathways.

4. Definitions Asylum Seeker An Asylum seeker is a person who has applied for a refugee protection visa They are waiting for a decision on this application Refugee 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”

5. Australian Humanitarian Program 20,003 humanitarian visas were granted in 2012-13 2012-13 intake included: 12,512 offshore visas were granted (including Refugee, Emergency Rescue, Global Special Humanitarian and Women at Risk visas). 7,491 onshore visas were granted ( to people who have applied for protection in Australia)

6. 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

7. Location of detention facilities

8. Average Time Spent in Detention Period DetainedTotal% of Total 7 days or less450.5% 8 days - 31 days110412.2% 32 days - 91 days357639.5% 92 days - 182 days264829.2% 183 days - 365 days7638.4% 366 days - 547 days1711.9% 548 days - 730 days1611.8% Greater than 730 days5916.5% Total9059100% Length of Time in Detention as at 31 Dec 2012 Source: DIAC, Immigration Detention Statistics Summary, 31 December 2012

9. 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) Asylum seeker in the community; Bridging Visa E Permanent Protection Visa 866 or another visa. Asylum seeker in the community; Bridging Visa A or Bridging Visa E Permanent Protection Visa 866 or granted a non humanitarian visa. Mandatory Detention (including Community Detention) Repatriation to country of origin.

10. Community Detention (CD) CD is a form of immigration detention which allows people to reside in the community without an escort Does not give a person any lawful status in Australia Does not give the same rights and entitlements as person living in the community on a visa People in CD are not allowed to work Conditions include a mandatory requirement to report regularly to the Department of Immigration and Citizenship (DIAC)

11. Community Detention (CD) contd People are released from Immigration Detention to Community Detention following health, security and identity checks that occur in immigration detention facilities. People in CD are often women and families, unaccompanied minors and men assessed as vulnerable. Clients live in broader community in rented accommodation.

12. Access to Healthcare in Victoria  The International Health and Medical Services (IHMS) is contracted by DIAC to provide health services to people in detention, including community detention  People in CD have access to health providers through IHMS  DIAC through IHMS will reimburse any Victorian Public Health services

13. 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 People may be transferred to another Immigration Detention Facility and health issues followed up as they arise.

14. Health Discharge Summary from health service at detention facility  Fitness to travel is completed  Advice given to client on ongoing /post-arrival health care needs when they leave immigration detention  Health summary provided to clients, Red Cross and AMES in large white envelope  Explanation in their own language of the importance of documents Bridging Visa E/OCt 2012

15. Housing and support services Some organisations have direct contracts with Department of Immigration and Citizenship:  Red Cross  Anglicare  Mackillop Family Services  AMES  Wesley Mission  Life Without Barriers  Hotham Mission Red Cross also sub contracts  Berry Street  Mackillop Family Services  Anglicare Victoria  AMES  Wesley Mission  Life Without Barriers  Hotham Mission

16. Housing and support services Support agencies provide;  Housing  Income support  People that arrived before 13 th of August receive 70% Centrelink benefits  People that arrived after 13 th of August receive 60% Centrelink benefits  Case management

17. Review People are released from Immigration Detention to Community Detention following health, security and identity checks that occur in immigration detention facilities. People in CD are often women and families, unaccompanied minors and men assessed as vulnerable. Legally still in detention, no visa status. Have freedom of movement. Clients live in broader community in rented accommodation. CD services are managed by Australian Red Cross, AMES and other providers. CD include housing, income support and case management.

18. Healthcare for people in CD  Not eligible for Medicare.  Health services provided by International Health and Medical Services (IHMS).  Clients should carry IHMS card to identify status.  IHMS subcontracts General Practices to provide services to this group.  Specialist services need to have approval from IHMS to provide services (the wait for this approval can be lengthy).

19. Healthcare contd  People in CD have access to Victorian Department of Health hospital services. IHMS reimbursement funding is available for these services.  ALL services approved by IHMS are paid for by IHMS, not by the agency or the Victorian Government.  Support services will arrange first General Practice appointment.  People in CD will have completed a health check, ASK FOR THIS INFORMATION.

20. IHMS identity card  Full cost recovery model from IHMS  Sample client ID card

21. Health Telephone Support Line IHMS 24 hour telephone hotline called the Community Detention Assistance Desk (CDAD). The CDAD is staffed by IHMS admin staff as well as clinicians (nurses and doctors) Assists service providers to access client’s medical history and details. Any IHMS provider can contact the hotline regarding CD clients, with the client's consent Community Detention Assistance Desk Phone: 1800 725 518 case workers 1800 689 295 health professionals Fax: (02) 9086 9875 Email: cdad@ihms.com.au

22. Health services funding for CD Fee for service paid by IHMS Specialist services, dental and optometry requires separate approval by IHMS & DIAC through client case manager Hospital admitted and non admitted patients Ambulance Primary and Community Health General Practice Immunisation services Drugs and Alcohol Pharmaceuticals Mental Health Aged support services Aids and equipment INTERPRETER SERVICES Funded by IHMS Torture & trauma counselling funded directly by DIAC.

23. Billing arrangements with IHMS  Contact Community Detention Desk: ph 1800 689 295 or email cdad@ihms.com.au  Invoices should be submitted to IHMS on last business day of each month.  Itemised GP notes need to accompany invoices  Services partnering with IHMS will receive training on how to be a provider Vesna Courtot IHMS Health Services Coordinator Victoria Mobile: 0427 905 955 vesna.courtot@ihms.com.au

24. Health Orientation for people in Community Detention People in Community Detention have minimal health services orientation. Case worker arranges first GP appointment. REMIND client to take Health Discharge Assessment to appointment. Interpreters should be arranged by case worker funded by IHMS.

25. Coordinating Care Role of Community Detention Service Provider Submit Care Plan and amendments to DIAC Assist clients to make first GP appointment. Contact IHMS for general enquiries on client’s behalf Encourage independent access to GP appointments Community Detention Service Provider then

26. Pathways from community detention Asylum Seekers in Community Detention Asylum Seeker on Bridging Visa E (BVE) Medicare eligible No Work rights if arrived after 13 Aug 2012 * See BVE PowerPoint Protection Visa 866 Medicare eligible or alternate visas which may have different entitlements Clients returned to Immigration Detention Centre or to their country of origin Failed visa application Visa application not yet resolved however person no longer needs to be in community detention Found to meet criteria for visa

27. 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 practitioners. Specialist Hospital services. GP referral only. Foundation House counseling All details on : www.refugeehealthnetwork.org.au Community Detention/Oct 2012

28. Extra resources Victorian Refugee Health Network http://refugeehealthnetwork.org.au The Victorian Refugee Health Network Asylum Seeker fact sheet http://www.ergpa.com.au/images/_uploads/20120622_fas_asylum_see ker_final.pdf Red Cross Fact Sheet Community Detention http://www.redcross.org.au/files/Community_Detention_- _Fact_Sheet.pdf Department of Immigration and Citizenship(DIAC) fact sheet community detention http://www.immi.gov.au/media/fact-sheets/83acommunity-detention.htm

29. Extra resources contd DIAC Boat Arrivals information http://www.immi.gov.au/ima/ Queries to DIAC about community placement of people in detention communityplacements@immi.gov.au DIAC information about the process for protection assessment http://www.immi.gov.au/ima/english/

30. Glossary Asylum Seeker Assistance SchemeASAS Adult Multicultural Education ServicesAMES Bridging Visa EBVE Christmas IslandCI Community Assistance SupportCAS Commonwealth Department of Immigration and Citizenship DIAC Community Detention ServicesCDSP Community DetentionCD Irregular Maritime ArrivalsIMA Permanent Protection VisaPPV Special Humanitarian ProgramSHP

31. 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