BACKGROUND FACTS
22 The Applicant arrived in Australia by a suspected illegal entry vessel on 18 August 2010. He made application for a protection visa on 24 October 2010. On 12 April 2011, a Delegate of the Minister found he was not owed Australia's protection obligations. On 2 May 2011, the Applicant requested an Independent Merits Review (IMR). The IMR was conducted and, on 15 September 2011, the Reviewer recommended the Applicant not be recognised as a person to whom Australia has protection obligations. The Applicant has applied for judicial review of the IMR in the Federal Magistrates' Court. That application is listed for hearing before Whelan FM on 28 June 2012.
23 Since his arrival in Australia, the Applicant has been detained in a number of places:
1. 18 August 2010 - 25 August 2011: North West Point Immigration Detention Centre (Christmas Island);
2. August 2011 - 2 February 2012: Maribyrnong Immigration Detention Centre (Melbourne);
3. 2 February 2012 - 24 March 2012: Christmas Island;
4. March 2012 - 17 May 2012: Maribyrnong Immigration Detention Centre (Melbourne);
5. 17 May 2012 to present: MITA.
It is common ground that each detention centre is operated by Serco, a detention service provider, and that at each detention centre health services are provided by International Health and Medical Services (IHMS), a health services provider.
24 Extracts of the Applicant's medical history whilst in detention were in evidence. Those extracts related to two distinct periods. The first period comprised typed notes of various events prepared by IHMS staff up to and including 12 March 2012 and a schedule of IHMS appointments with the Applicant from 18 August 2010.
25 It is unnecessary to set out in detail the Applicant's medical history or his mental health needs. For present purposes it is sufficient to record that the notes of the IHMS which were in evidence before the Court included the following statements:
1. 4 February 2011 - "[d]iscussed breathing and relaxation techniques … [u]nable to identify any particular trigger ... apart from ongoing environment and situation. No acute risk issues identified. …";
2. 24 July 2011 - "[o]ngoing risk of deterioration in mental state due to prolonged detention. ... Referral to net [sic] visiting psychiatrist";
3. 8 February 2012 - "Asperger like syndrome. Although there may be short term changes in behaviour, unlikely to respond to behavioural modification approach over long term. Restrictive environment likely to result in further incidents. Also likely to be vulnerable in detention environment to aggression from other clients";
4. 6 March 2012 - "underlying developmental disorder or personality disorder which schizoid personality features ... on-going [sic] incarceration is almost certainly going to lead to further problems … community management should be considered a priority to remove him from the detention centre environment which seems to be driving his ... behaviour".
As is apparent, those notes were made when the Applicant was detained at Christmas Island. The assessment on 8 February 2012 was by Dr Peter Young, the Head Psychiatrist at IHMS.
26 The second period covered the Applicant's detention in Maribyrnong and now MITA. That evidence comprised the balance of the schedule of IHMS appointments for the Applicant and three medical reports prepared at the request of, or provided to, IHMS. The first report, dated 16 May 2012, was from Dr Velakoulis, a neuropsychiatrist. The second, dated 4 June 2012, was from Dr Foot, a psychiatrist and the third, dated 18 June 2012, was from Ms Perry, an occupational therapist.
27 For present purposes, the report of Dr Foot is significant. Dr Foot saw the Applicant on 1 June 2012 at MITA. Dr Foot concluded that:
… [The Applicant] does not have any Developmental Disorder, but is a product of his culture and predicament in which that places him both within his homeland and in Australia. I believe that it is likely that many of the incidents which have occurred are a result of his inability to cope with the personal and environmental adversities with which he has been confronted in Immigration Detention. It is my opinion that [the Applicant] is likely to function more productively if given access to a less restricted but supported environment, and I think it unlikely that he would pose a risk to the community under such circumstances.
The occupational therapist assessed the Applicant on 14 June 2012 and concluded that there were no issues identified which would prevent the Applicant from living independently. Her only recommendation was that the Applicant be "provided further information in regards to government and community services available to him in Australia to assist with his integration".
28 The Applicant also produced three reports from Professor Newman, a psychiatrist, who is the Director of the Centre for Developmental Psychiatry and Psychology at Monash University. Her first two reports were dated 2 and 29 May 2012. They both related to a single assessment of the Applicant on 13 April 2012 at Maribyrnong.
29 The latest report from Professor Newman is dated 27 June 2012. In her latest report, Professor Newman states:
I have previously examined [the Applicant] and have provided reports on my assessment. I have recommended that he be released into community detention where he would be able to receive specialist psychological and support services unavailable in immigration detention.
…
(1) [The Applicant] suffers from a neurodevelopmental disorder with intellectual impairment and features of Pervasive Developmental Disorder. He exhibits features of frontal lobe dysfunction with poor frustration tolerance, impulse control problems and mood dysregulation. He has difficulty controlling his behaviour and is easily angered and distressed. He has limited understanding of his situation and problems. The environment of the immigration detention facility is one that he finds difficult to tolerate. He has impaired social interaction and suffers extreme anxiety in this crowded environment. Further, he has experienced trauma whilst in detention, including sexual assault, aggression and tormenting interactions. He is fearful and becomes agitated. He suffers ongoing post-traumatic anxiety. [The Applicant] has very limited coping capacities and easily becomes distressed and dysregulated. He cannot control his moods or anxiety symptoms and his condition is negatively impacted by ongoing detention. The mental health teams reviewing him have documented his deterioration in detention.
(2) [The Applicant]'s condition requires specialist disability services unavailable in detention. Disability services include psychological support programs for individuals with developmental disorders, rehabilitation programs and support in developing independent living skills. Specialist psychiatric services for individuals with intellectual disability and neurodevelopmental disorders provide review of comorbid mental health problems and assess need for medication. [The Applicant] is not able to receive this treatment in MITA and is at risk of deterioration if his detention without treatment continues. I recommend his release into community detention and housing with appropriate level of support and residential care and service coordination. This should be organised in consultation with State Disability Services.
(3) The mental health services currently available within the immigration detention system and at the MITA are general support services provided by mental health nurses and psychologists with visiting psychiatric services. These services are for the support of detainees with mental disorders, such as depression and anxiety. The staff are not specialised in neurodevelopmental disorders and I note that the head of Psychiatric Services for IHMS has advised the release of [the Applicant] into the community to allow him to assess [sic] specialist services. Whilst I am informed that [the Applicant] has settled since moving to the MITA and he informed me during a telephone discussion around two weeks ago that he was well, I attribute this to the staff at MITA being positive in their interaction with him relative to his reported difficulties with SERCO officers at MIDC. [the Applicant], as a consequence of his neurodevelopmental disorder, remains unable to regulate his behaviours and emotions and is likely to be easily frustrated and impulsive. I have been provided with a copy of the SERCO Behaviour Management Plan being used with [the Applicant]. As I have previously stated, the use of such plans is contraindicated with a patient such as [the Applicant] who cannot fully comprehend the plan and, as when placed in restrictive detention on Christmas Island, he is likely to deteriorate with a strict regime of restrictions and isolation. It is, in my view, very concerning that the plan is in operation and this is in opposition to all psychiatric opinions provided on [the Applicant]. Specialist disability services would not implement such a plan and would provide an appropriate reward system and avoid isolations as a method of managing difficult behaviour.
(4) I note the affidavit of Ms.J.Mackin concluding that [the Applicant] is best accommodated at the Sydney residential housing facility. My view is that this accommodation cannot provide him with the specialist rehabilitation and treatment approach he needs and this option does not address his condition.
(Emphasis added.)
30 In general terms, Professor Newman's opinion is that:
1. the Applicant suffers from a neurodevelopmental disorder with intellectual impairment and features of Pervasive Developmental Disorder where the second condition is exacerbated by his intellectual impairment; and
2. the Applicant is not able to receive the necessary specialist psychiatric services for an individual with an intellectual disability and a neurodevelopmental disorder at MITA and is at risk of deterioration if his detention without treatment continues.
31 Mr Scassera, an employee of the Department of Immigration and Citizenship and the Centre Manager of MITA, affirmed an affidavit in which he summarised the form of the Applicant's detention in the following terms:
The Applicant currently lives in a single room in MITA. He is located in a single room. His living area contains a bathroom and laundry, a lounge and kitchenette. The Applicant has his own swipe card to enter his room. He also has exclusive use of the north courtyard. All meals are prepared in the communal kitchen and dinning [sic] area. The Applicant prepares his own breakfast in his kitchenette or in the communal kitchen. As the Applicant met all the requirements of his most recent Behaviour Management Plan, he was given full unrestricted access to the MITA. Only the Applicant and appropriate staff have access to the annexed room areas. Since his arrival at MITA, the Applicant is much calmer and more settled. He has positive interactions with other detainees and has been involved in very few incidents. This is a significant change to his earlier interactions.
32 As to the available treatment, Mr Scassera's affidavit states that the following health care arrangements are in place at MITA:
4.1. Health care services are overseen by a Regional Health Services Manager (RHSM) who is a qualified Registered Nurse with appropriate experience in managing the provision of health services in an immigration detention facility.
4.2. The RHSM, who is based at the Maribyrnong Immigration Detention Centre (MIDC), works with the IHMS Clinical Governance Team.
4.3. The current IHMS staffing model at the MITA provides for 1.0 full time equivalent (FTE) Clinical Team Leader, 2.3 FTE Registered Nurses, 0.16 FTE General Practitioner, 1.0 FTE Mental Health Team Leader, 1.0 FTE Mental Health Nurse, 1.0 FTE Counsellor, 1.0 FTE Psychologist, 1.0 FTE Immunisation Co-ordinator and 1.0 Clinic Administrator. A visiting Psychiatrist is also available once per week.
4.4. Health care services are provided between the hours of 9.00 am to 5.00 pm on weekdays.
4.5. Where IHMS considers that additional clinic services are required they can seek approval from the Department Centre Manager for additional clinic hours.
4.6. A separate telephone advisory service is available to assist with clinical issues or advice outside of clinic hours. Calls to this service are placed by Serco Officers. If urgent Serco will transport the client or call an ambulance that will take the client to closest accident and emergency centre (hospital).
33 Mr Scassera's affidavit does not address the statement by Professor Newman that the Applicant cannot receive the necessary medical services at MITA. The Respondents did not seek to file further material to address Professor Newman's third report. The Respondents were content for the application to be determined on the material before the Court.