Suicide and intentional self‐harm are issues of major importance in public health and public policy, with rates widely used as progress indicators in these areas. Accurate statistics are vital for a...

This article reviews evidence about the impact of immigration detention and other restrictive immigration policies on the mental health of children, young people and the adults who care for them. We review the implications of this for clinicians attempting to assess or work with incarcerated child and adult refugees and asylum seekers. There are increasing numbers of adults and children seeking asylum across the globe and many nations use incarceration and other harsh and interceptive immigration practices. There is mounting evidence of the psychological harm associated with detention of already vulnerable adults and children. Australia is used as a case study. Clinicians are required to consider the intersection of mental health assessment and treatment with human rights violations, and the impact of restrictive immigration policies, not only on asylum seekers and refugees but also on clinicians, clinical practice and professional ethics.

Objectives: (i) To compare suicide rates in 15–24 year old men and women; and (ii) for 15–4 year old men, to investigate differences in suicide rates between metropolitan and rural areas, and changes in method‐specific suicide rates and, in particular, firearm and hanging suicide rates in rural and metropolitan areas. Design: Retrospective analysis of Australian Bureau of Statistics (ABS) suicide data (1964–1993). Setting: All Australian States. Subjects: Young women and men aged 15–4 years who died by suicide. Results: Male youth suicide rates rose substantially over the 30 years in all Australian States, whereas female rates did not increase. Increases in suicide rates in young men in small rural towns consistently exceeded those in metropolitan areas in all Australian States. Metropolitan rates in 1964 were higher than those in small rural towns, but by 1993 the position was reversed. Medium‐sized cities were the only areas where there was no consistent interstate trend. Differences were noted in suicide base rates in different States. High car exhaust suicide rates were noted in Western Australia, and high firearm suicide rates in Tasmania and Queensland. The ratio of firearm suicide rates in small rural areas to those in metropolitan areas rose in all mainland States, but the same ratio for hanging suicide rates changed little. Conclusions: All Australian States reflect national suicide trends in relation to sex and residential area. In some States, particular suicide methods predominate. A decreasing trend in overall firearm suicide rates in young men in all States from 1984 to 1993 conceals substantial increases in firearm suicide rates in small rural areas in all mainland States over the 30‐year period. This, together with the marked rate ratio difference in firearm suicides between metropolitan and small rural areas, suggests that particular risk factors for suicide are operating in small rural areas. The fact that hanging rate ratios changed little suggests that more general factors in male youth suicide are also operating in all areas. A better understanding of similarities and differences in health risks faced by metropolitan and rural youth is required.

Objective: This paper argues that the decision by the Australian Commonwealth Government to continue its policy of indefinite mandatory detention, without review, in the face of the accumulated evidence regarding the harmful effects, amounts to state-sponsored trauma and child neglect and/or abuse. Conclusions: The Australian government's policies supporting successful suicide prevention programs stand in contrast to its policy regarding indefinite mandatory detention of onshore asylumseekers. Men's and women's rates of suicidal behaviours in Australian immigration detention centres (IDCs), while imprecise, are calculated as 41 and 26 times the national average, respectively, and male IDC rates are 1.8 times the male prison rates. Self-harm in detention reflects a convergence of (child) health, protection and human rights concerns, and is driven by the extremity of detention and the detention environment. Recommendations are made for these concerns to be immediately addressed. It is noted that in handling this unprecedented situation, the government has not sought advice from its own advisory councils.

Suicide in young adults remains an important public health issue in Australia. The attributable risks associated with broader socioeconomic factors, compared to more proximal psychiatric disorders, have not been considered previously in individual-level studies of young adults. This study compared the relative contributions of psychiatric disorder and socio-economic disadvantage associated with suicide in terms of relative and attributable risk in young adults. A population-based case–control study of young adults (18–34 years) compared cases of suicide (n = 84) with randomly selected controls (n = 250) from population catchments in New South Wales (Australia), with exposure information collected from key informant interviews (for both cases and controls). The relative and attributable risk of suicide associated with ICD-10 defined substance use, affective, and anxiety disorder was compared with educational achievement and household income, adjusting for key confounders. Prevalence of exposures from the control group was used to estimate population attributable fractions (PAF). Strong associations were evident between mental disorders and suicide for both males and females (ORs 3.1 to 18.7). The strongest association was for anxiety disorders (both males and females), followed by affective disorders and substance use disorders. Associations for socio-economic status were smaller in magnitude than for mental disorders for both males and females (ORs 1.1 to 4.8 for lower compared to high SES groups). The combined PAF% for all mental disorders (48% for males and 52% for females) was similar in magnitude to socio-economic status (46% for males and 58% for females). Socio-economic status had a similar magnitude of population attributable risk for suicide as mental disorders. Public health interventions to reduce suicide should incorporate socio-economic disadvantage in addition to mental illness as a potential target for intervention.