Decision record relevant to ground 3(b)
62 Relevantly to ground 3(b) of the appeal, the IAA considered FPT17's "mental health" claims at DR[82]-[97].
63 At DR[82], the IAA summarised the appellant's submissions in relation to his mental health as follows (as written):
I have considered the reports about the applicant's mental health. It was submitted the applicant would face significant difficulties accessing appropriate and affordable mental health support and health services had not recovered since the war and impact of the Tsunami. It was submitted societal discrimination against people with mental health issues impacts on their ability to access assistance and subsist and are detained.
64 At DR[83], the IAA accepted that FPT17 had been diagnosed with symptoms of PTSD, anxiety and depression since 2018 and that he had received counselling from STARTTS counsellors and medication.
65 At DR[84]-[85], the IAA noted what the STARTTS reports had indicated concerning FPT17's suicide risk and the impact on FPT17 of his ongoing immigration detention. It noted that while he was considered to be at some suicide risk, he did not have suicidal ideation, and it considered that the detention trigger to some of his negative feelings would be removed if he were returned to Sri Lanka. While he had self-harmed in the past in coping with negative emotions, the IAA did not consider that that constituted persecution as it was not an act perpetrated by others or for reasons contemplated by s 5J of the Migration Act. It concluded at DR[86] as follows:
Despite societal stigma, I do not accept the applicant would not seek assistance if needed, as he has done so in Australia. I do not consider having treatment from a different counsellor if he were returned to Sri Lanka amounts to harm.
66 At DR[87]-[96], the IAA said the following in relation to access to services and treatment relating to mental health (emphasis from FPT17's submissions) (as written):
87. It was submitted there were significant doubts that the applicant could afford access to treatment that he required. Further, I do not accept the applicant will not be able to access or afford assistance, services, support and medication. I do not accept that the applicant needs private health care. The country information provided (UK Home Office report) indicated that the government provides free drugs and care to patients with mental health problems. While the report indicated that a psychiatrist considered PTSD as a western phenomenon and did not prevail very much in Sri Lanka, the applicant has reports and diagnoses he could rely on if needed upon return. Further, it was noted that 400,000 suffer serious mental illness and that depression varies from 9 to 25%. I note also Sri Lanka's progress was commended achieving significant improvement in expansion of resources and facilities and was on the right track according to WHO representative (UK border agency).
88. …
89. I note also UN Committee (2010) (from UK Home Office) indicated that services were insufficient to cope with the widespread post conflict mental disorders.
90. I have considered the information about development of mental healthcare in Sri Lanka and lessons learned. It did note that from a survey of children in the north east 92% stated they experienced severely traumatising events during the conflict and 25% of those had symptoms of PTSD. It noted that .7% of household members were receiving treatment of some kind of mental illness, most commonly for depression. It indicated that the new draft mental health care bill had not been enacted and the current ordinance promoted custodial approach. However the mental health policy says the vision is for the community care model and promotes treatment holistically and with multi-disciplinary teams and decentralisation. However, the article gave a positive view of the improvement of mental health services, noting Sri Lanka had achieved quality mental health care outcomes despite limitations in resource allocation. While there was a shortage of psychologists it indicated that there were psychiatrists practising in all districts and there were multidisciplinary mental health care teams which included nurses, counsellors, medical officers and volunteers under the guidance of psychiatrists. It indicated there was a comprehensive community care model and services available to locals at the village level. There were outreach clinics, professional development programmes for doctors, nurses, medical officers and others in the area and there many NGOs involved in mental health. It concluded that Sri Lanka had achieved quality mental health outcomes despite have considerable limitations in resource allocation and mental health services, but would need to be consistently revamped.
91. DFAT in 2019 noted despite some improvements, mental health services, overall, are considered inadequate, particularly in former conflict areas, and there remain ongoing challenges in accessing mental health care. Mental illness is not widely discussed in Sri Lankan society and carries stigma at the community level. This, in turn, deters victims from revealing and seeking treatment for mental illness. Some families seek traditional methods to "cure" mental illness, including through use of local healers. DFAT assesses that, while there has been some improvement in the availability and quality of mental health services, they remain inadequate overall, particularly in war-affected areas, where demand is greatest. DFAT further assesses that traditional attitudes toward mental illness act as a significant barrier to treatment.
92. Despite the social stigma, given the applicant has sought treatment and counselling already, I am not satisfied that he would only seek traditional healers or not seek appropriate assistance or treatment, if needed. I note he received counselling in Australia and the applicant has not claimed he would not seek such assistance in Sri Lanka, if needed.
93. I have considered the articles about waiting times in private hospitals of up to 30 minutes for their appointment and out of pocket expenses for private health care. However, there is no evidence that the applicant would need hospitalisation or to attend a private hospital for an appointment. He has not in Australia and the reports do not indicate he may need such assistance in the future. Nor has he claimed that he would. Further, I note the report on out of pocket expenses indicates that utilisation of public services is more pro-poor in Sri Lanka than in any other emerging market Asian country and that government healthcare in Sri Lanka performs better in equity. In any event, I do not accept that the applicant will need private health care and I note there is free universal health care. I do not accept that he faces a real chance of not being able to access or afford services or assistance needed.
94. Further, and in any event, any difficulties accessing in the health system would not be for one of the reasons specified in s 5J and not constitute persecution. I do not accept that any lack of access would be for a s5J reason.
95. The submissions suggested lack of awareness by police saw a mentally ill Tamil cornered in deep water who drowned rather than take him for psychiatric care. However, I do not accept the applicant faces a real chance of such neglect from police or authorities as the applicant's behaviour and mental health behaviour has not exhibited such issues in the past. His symptoms are depression, low motivation, nightmares and anxiety and self-harm when distressed, not psychosis. Further, I do not accept he faces a real chance of detention for his mental illness or that he would require involuntary treatment as he has not had any such problems in the past and the reports do not indicate that he would require such treatment in the future either.
96. I have considered the information about societal stigma against people with mental health issues. While the applicant may face some societal stigma, I do not accept that such stigma would amount to serious harm. The applicant is still in contact with his family. It was clear that he has a strong relationship with his family and the reports indicated that his family are a protective factor. Further, he was educated to grade 8 in Sri Lanka and received more education in Australia. He speaks Tamil and now English fluently. While he had difficulty finding employment in Australia, he previously worked in labouring jobs and [redacted] in Sri Lanka. His condition has been managed and he will be out of detention, which has exacerbated his condition. I am not satisfied and do not accept he faces a real chance of denial of basic rights, be unable to subsist or that he faces a real chance of being detained or any other serious harm for mental health reasons.
67 At DR[97], the IAA concluded:
I do not accept that there is a real chance the applicant (even considering his mental health issues), as a young Tamil male from the North, or formerly LTTE controlled area, or being absent from Sri Lanka, or because his father may have been harassed and assaulted during the conflict means the applicant was or will be of any adverse interest to the authorities, or anyone upon return, or that he faces a real chance of serious harm now or in the reasonably foreseeable future.
68 In relation to the issue of complementary protection under s 36(2)(aa) of the Migration Act, the IAA found as follows at DR[121]-[122]:
121. I have considered the applicant's mental health. I accept he may require medication and counselling assistance. However, I do not accept that he would be unable to access that. There is universal free health care and free medication available also. While mental health services are scarce, the country information indicates there have been significant improvements in health services. I do not accept that he will be detained. Further, he has sought treatment before and his condition has been well managed and was not severe or requiring hospitalisation. I do not accept the applicant faces a real risk of significant harm. Further, I am not satisfied that any difficulties in relation to medical care access amount to severe pain or suffering, pain or suffering that is cruel or inhuman in nature or extreme humiliation, intentionally inflicted or caused.
122. In respect of the stigma that the applicant may face as a result of his mental health issues, I do not accept he could not find employment or subsist given his family in Sri Lanka his education, skills and employment history in Sri Lanka and the fact that he will no longer be in detention. I am not satisfied that any stigma he may face from society would amount to significant harm as defined.