A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia

• Published in: Social science & medicine (1982) 2013-12, Vol.98, p.106-115
• Main Authors: Tay, Kuowei, Frommer, Naomi, Hunter, Jill, Silove, Derrick, Pearson, Linda, San Roque, Mehera, Redman, Ronnit, Bryant, Richard A., Manicavasagar, Vijaya, Steel, Zachary
• Format: Article
• Language: English
• Subjects: Administrative decision making; Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Asylum seekers; Australia; Biological and medical sciences; Cohort Studies; Decision analysis; Decision Making; Decisions; Emigration and Immigration - legislation & jurisprudence; Evidence-based medicine; Expert Testimony; Female; Health care; Humans; Male; Medical Decision Making; Medical sciences; Mental Disorders - diagnosis; Mental Health; Mental health care; Mental Health Services; Middle Aged; Miscellaneous; New South Wales; Political asylum; Post-traumatic stress disorder; Posttraumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Refugee status determination; Refugees; Refugees - psychology; Refugees - statistics & numerical data; Research methodology; Stress Disorders, Post-Traumatic - diagnosis; Symptoms; Trauma; Values
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2013.08.029

The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context. •Asylum seekers with conflict-related psychiatric morbidity may be disadvantaged in the refugee decision-making process.•Asylum seekers with particular mental health symptoms are less likely to be granted asylum compared to those who do not.•Decision makers frequently substitute their own mental health observations in lieu of accepting expert psychological evidence.•The interdisciplinary challenges facing refugee decision makers and mental health professionals are complex.•Legal and mental health professionals need to better understand the use of psychological evidence in asylum determinations.