ORCID Profile
0000-0002-4514-9111
Current Organisation
Medical Council of New South Wales
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Publisher: Wiley
Date: 07-2015
DOI: 10.1111/JPC.12953
Publisher: Wiley
Date: 07-2015
DOI: 10.1111/JPC.12954
Publisher: Elsevier BV
Date: 12-2017
Publisher: SAGE Publications
Date: 08-12-2015
Abstract: To review and summarise the evidence about and consequences of Australia’s policy of mandatory indefinite detention of children and families who arrive by boat to seek asylum. This paper will summarise the accumulated scientific evidence about the health and mental health impacts of immigration detention on children and compare methodologies and discuss the political reception of the 2004 and 2014 Australian Human Rights Commission (AHRC) Inquiries into Immigration Detention of children. The conclusions of the 2004 and 2014 Inquiries into Immigration Detention of Children are consistent with Australian and international research which demonstrates that immigration detention has harmful health, mental health and developmental consequences for children and negative impacts on parenting. The evidence that prolonged immigration detention causes psychological and developmental harm to children and families and is in breach of Australia’s human rights obligations is consistent. This is now partially acknowledged by the Government. Attempts to limit public scrutiny through reduced access and potential punishment of medical witnesses arguably indicates the potency of their testimony. These harmful and unethical policies should be opposed.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2020
Publisher: BMJ
Date: 23-12-2017
Publisher: Springer Science and Business Media LLC
Date: 24-11-2017
DOI: 10.1007/S00787-017-1082-Z
Abstract: Accumulating literature demonstrates that immigration detention is harmful to children. However, there is a scarcity of scientifically rigorous and reliable data about the health of children held in detention facilities. The aim of the study was to compare a community-based population of recently arrived refugee children flown into Australia, not detained, resettled in a non-urban area, with a population of children who arrived by boat seeking asylum, detained since arrival. The parent-version of the strength and difficulties questionnaire (SDQ) of children aged 4-15 years was compared in children living in the community with those held in detention. We compared 86 children who had a parent-completed SDQ performed, 38 (44%) in the community group and 48 (56%) in the detention group. The community s le had been living in Australia for 325 days, with no time in detention. The detention s le had been living in detention for a mean of 221 days. The mean age was similar for the community and detention s le at 8.4 years (P = 0.18). In the total s le, children in the detention group had significantly higher SDQ total difficulties scores than children in the community group (P < 0.0001). There was no difference between age groups (P = 0.82). The children in the detention group had, on average, an SDQ total difficulties score that was 12 points higher than children in the community group. Four of the five SDQ subscale scores indicated greater disturbance amongst children in detention (< 0.0001) compared to children living in the community. The detention group had significantly higher scores (P < 0.001) for all except Pro-social scores as compared to Australian norms for the 4-6 and 7-15 years age group. This study presents a rare opportunity to compare the wellbeing of displaced children who were detained following arrival in Australia with those settled in the Australian community since arrival. The community children's scores approximated data from the general Australian childhood population. Children held in detention had significantly more social, emotional and behavioural difficulties than children living in the community, and at levels resembling a clinical cohort. Despite the small s le size, data restrictions and other limitations of the data, statistical significance in differences between the community and detention children is marked and arguably demonstrates the negative impact of post-arrival detention in children who are presumed to have similar levels of pre-arrival adversity. If the objective is to optimise the health and wellbeing of children seeking asylum, removal of post-arrival detention is one of the most powerful interventions available to host countries.
Publisher: Oxford University Press (OUP)
Date: 14-01-2014
DOI: 10.1093/IJE/DYT269
Publisher: Wiley
Date: 04-2013
DOI: 10.5694/MJA11.11285
Publisher: SAGE Publications
Date: 12-06-2017
Abstract: This article considers what successful working relationships between fly-in professionals and Aboriginal community workers involve. Interviews with six Aboriginal workers and the experience of the jointly delivered Let’s Start parent–child programme in remote north Australian Indigenous communities confirm the importance of developing positive relationships within a both-ways learning approach, drawing on each other’s strengths, and the significance of reflection on practice. Working cooperatively enables effective programme implementation, supports incorporation of new learning into practice, and benefits local Aboriginal community members through employment and development opportunities. This model has relevance for health and community programmes delivered in remote Aboriginal communities.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1111/J.1467-842X.2004.TB00041.X
Abstract: This paper reports the clinical, practical and ethical issues arising in the assessment of 10 consecutive referrals from a remote Immigration Reception and Processing Centre to a child and adolescent mental health service (CAMHS) between February and August 2002. The 16 adults and 20 children (age range 11 months to 17 years) were comprehensively assessed by allied health clinicians and child psychiatrists. All children were also assessed by the statutory child protection agency. There were very high levels of mood disturbance and post-traumatic symptoms in this population. All children had at least one parent with psychiatric illness. Of the 10 children aged 6-17 years, all (100%) fulfilled criteria for both post-traumatic stress disorder (PTSD) and major depression with suicidal ideation. Eight children (80%), including three pre-adolescents, had made significant attempts at self harm. Seven (70%) had symptoms of an anxiety disorder and half reported persistent severe somatic symptoms. The majority (80%) of preschool-age children were identified with developmental delay or emotional disturbance. Few clinically based recommendations were implemented. Very high levels of psychopathology were found in child and adult asylum seekers. Much was attributable to traumatic experiences in detention and, for children, the impact of indefinite detention on their caregivers. Multiple obstacles to adequate service provision are identified. Adequate clinical intervention and care was not possible. The impact on involved clinicians is discussed.
Publisher: Elsevier BV
Date: 02-2013
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1111/J.1467-842X.2004.TB00042.X
Abstract: To document the psychiatric status of a near complete s le of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia. Structured psychiatric interviews were administered by three same-language speaking psychologists by phone to assess the lifetime and current psychiatric disorders among 10 families (14 adults and 20 children) held in immigration detention for more than two years. All adults and children met diagnostic criteria for at least one current psychiatric disorder with 26 disorders identified among 14 adults, and 52 disorders among 20 children. Retrospective comparisons indicated that adults displayed a threefold and children a tenfold increase in psychiatric disorder subsequent to detention. Exposure to trauma within detention was commonplace. All adults and the majority of children were regularly distressed by sudden and upsetting memories about detention, intrusive images of events that had occurred, and feelings of sadness and hopelessness. The majority of parents felt they were no longer able to care for, support, or control their children. Detention appears to be injurious to the mental health of asylum seekers. The level of exposure to violence and the high level of mental illness identified among detained families provides a warning to policy makers about the potentially damaging effects of prolonged detention on asylum seekers. In their attempt to manage the international asylum crisis, it is important that Western countries do not inadvertently implement policies that cause further harm.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Publisher: SAGE Publications
Date: 11-2004
Publisher: Royal College of Psychiatrists
Date: 17-07-2018
DOI: 10.1192/BJI.2018.11
Abstract: There are more displaced people around the world than ever before, and over half are children. Australia and other wealthy nations have implemented increasingly harsh policies, justified as ‘humane deterrence’, and aimed at preventing asylum seekers (persons without preestablished resettlement visas) from entering their borders and gaining protection. Australian psychiatrists and other health professionals have documented the impact of these harsh policies since their inception. Their experience in identifying and challenging the effects of these policies on the mental health of asylum seekers may prove instructive to others facing similar issues. In outlining the Australian experience, we draw selectively on personal experience, research, witness account issues, reports by human rights organisations, clinical observations and commentaries. Australia’s harsh response to asylum seekers, including indefinite mandatory detention and denial of permanent protection for those found to be refugees, starkly demonstrates the ineluctable intersection of mental health, human rights, ethics and social policy, a complexity that the profession is uniquely positioned to understand and hence reflect back to government and the wider society.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Wiley
Date: 06-2012
DOI: 10.1017/AFT.2012.17
Publisher: Wiley
Date: 12-0011
DOI: 10.1002/IMHJ.20232
Abstract: Postgraduate training in infant mental health (IMH) was offered by the New South Wales Institute of Psychiatry in Sydney, Australia for the first time in 1998. Since 2002, the program has been offered at the master's level by distance education to a multidisciplinary group of students across Australia and New Zealand. This article considers the various ways that the notion of reflective practice and reflective supervision is used in different disciplines and defines our understanding of its place in IMH training. The program content and delivery emphasize the development of reflective skills in students in a number of ways. These include a supportive relationship-based approach to training a 12-month infant observation which provides students with the opportunity to understand early development, develop observational skills about infants and families as well as their own responses to the infant and family ongoing clinical supervision and development of a reflective clinical journal and study and assessment tasks that require the student to integrate new knowledge into clinical practice.
Publisher: Wiley
Date: 26-01-2022
DOI: 10.1002/AJS4.200
Abstract: Reducing the rate of over‐representation of Aboriginal and Torres Strait Islander children in out‐of‐home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The “gap” is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non‐Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compounding intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a transformative foundation to address historical, institutional, well‐being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.
Publisher: BMJ
Date: 22-12-2022
DOI: 10.1136/ARCHDISCHILD-2022-324442
Abstract: To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia’s immigration policy of indefinite mandatory detention on Nauru. Cross-sectional analysis of a cohort of CYP seeking asylum. Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01) originated from the Eastern Mediterranean region (p .05) witnessed trauma (p .05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p .05). Neurodevelopmental concerns were seen in eight children (13%). This study highlights the almost universal physical and mental health difficulties in a s le of CYP who experienced forced migration and were subjected to Australia’s offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.
Publisher: Informa UK Limited
Date: 21-03-2017
Publisher: SAGE Publications
Date: 12-07-2013
Abstract: This article outlines an approach to assessing the quality of relationships between young foster children and their carers. These children are at high risk of disorganised attachment relationships and of developmental psychopathology given their relational experiences prior to and in care. During a semi-structured play interaction the emphasis is on identifying behaviours of clinical interest. This can be complex given the likelihood of atypical or unexpected behaviours expressed within relationships. The paper draws on literature on the clinical application of attachment theory to the assessment of relationships and on the authors’ experience of developing and delivering an assessment and intervention service for children aged 0 to 5-years-old within a mental health service for children in foster care. Clinical material is used to illustrate and develop the issues. The case for including a semi-structured observational procedure as part of a comprehensive assessment of foster children and their carers is outlined. This is argued to have more clinical utility than formal approaches to attachment classification. The benefits of including a semi-structured and relational approach to clinical assessment of foster children are outlined along with the need to be cautious in the use of attachment related terminology when formal assessments have not been undertaken.
Publisher: SAGE Publications
Date: 20-12-2017
Abstract: To build an account of how bereaved Tamil refugee and asylum seeker children, resettled in Australia, had processed the loss of their dead or missing fathers. Phenomenological and discourse analysis was applied to attachment narratives of nine children (aged 11–17 years) and their surviving mothers in families that lost fathers in war-related circumstances. The narratives were analysed through the lens of Crittenden’s Dynamic-Maturational Model of Attachment and Adaptation (DMM) and Klass’ cross-cultural model of grief. Two ergent pathways — ‘burying the past’ and ‘reifying the past’ — emerged, encompassing the children’s contrasting patterns of information processing regarding loss and trauma (dismissing or preoccupying) and representation of the past (distant-buried or rich-reconstructed). Each pathway reflected a strategic compromise between the constraints and resources presented to the child by the circumstances of the loss (ambiguous or confirmed), the response of their surviving parent (stricken or stoic) and the collective narrative surrounding the loss (silenced or valorised). The DMM’s conceptualisation of attachment as self-protective strategies for navigating danger was helpful in explaining the contrasting adaptations of refugee children to loss and trauma. However, to understand the multivalent meanings of these adaptations, there was a need to situate child–parent attachment relationships within the wider sociocultural reconfigurations arising from contexts of political violence.
Publisher: SAGE Publications
Date: 05-04-2021
DOI: 10.1177/10398562211005445
Abstract: This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic. Australia’s policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified.
Publisher: SAGE Publications
Date: 10-2005
Publisher: Springer Singapore
Date: 2021
Publisher: SAGE Publications
Date: 26-03-2012
Abstract: Objective: Little is written about the process of delivering mainstream, evidence-based therapeutic interventions for Aboriginal children and families in remote communities. Patterns of interaction between parents and children and expectations about parenting and professional roles and responsibilities vary across cultural contexts. This can be a challenging experience for professionals accustomed to work in urban settings. Language is only a part of cultural difference, and the outsider in a therapeutic group in an Aboriginal community is outside not only in language but also in access to community relationships and a place within those relationships. Method: This paper uses ex les from Let’s Start, a therapeutic parent-child intervention to describe the impact of distance, culture and relationships in a remote Aboriginal community, on the therapeutic framework, group processes and relationships. Results: Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Conclusions: Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Program adaptation, evaluation and staff training and support need to take these factors into account to ensure cultural accessibility without loss of therapeutic fidelity and efficacy.
Publisher: SAGE Publications
Date: 06-2002
DOI: 10.1046/J.1440-1665.2002.00414.X
Abstract: Objective: To record observations made by the authors on a series of visits between December 2001 and March 2002 to two of Australia's immigration detention centers and to consider the mental health consequences of Australia's policy of mandatory immigration detention of asylum seekers for families and children. Conclusions: Parents and children in immigration detention are often vulnerable to mental health problems before they reach Australia. Experiences in prolonged detention add to their burden of trauma, which has an impact not only on the in idual adults and children, but on the family process itself. Immigration detention profoundly undermines the parental role, renders the parent impotent and leaves the child without protection or comfort in already unpredictable surroundings where basic needs for safe play and education are unmet. This potentially exposes the child to physical and emotional neglect in a degrading and hostile environment and puts children at high risk of the developmental psychopathology that follows exposure to violence and ongoing parental despair. Psychiatrists have a role in advocating for appropriate treatment of these traumatized and vulnerable parents and children.
Publisher: I.B.Tauris
Date: 2013
Location: Australia
No related grants have been discovered for Sarah Mares.