Another individual stated: ‘I have no energy in my body, there is too much thinking. I am in a room alone all the time with no plan for the day, no activities to do. I don’t see anyone or have conversations with anyone and constantly am thinking about life and what sort of life I am having, over eight years in detention and my loss of freedom. Always I think about these sad, negative things’. RECOMMENDATION 12: People held in hotel APODs should have regular access to the equivalent range of programs and activities as people held in other immigration detention facilities. The lack of access to meaningful programs and activities in hotel APODs has a range of detrimental effects. These include contributing to the deterioration in the mental health of detainees, and fuelling boredom, frustration and apathy. These impacts are worsened by the length of time that some people are being detained in hotel APODs.66 The inability to access recognised programs of study and vocational training while in detention also makes it harder for individuals to subsequently integrate into the community if they are released from detention into the community. The Commission has previously recommended that the Department of Home Affairs should revise its programs and activities policy to give people in immigration detention access to recognised programs of study and vocational training.67 The Department has previously stated that it disagrees with this recommendation. For the reasons outlined above, we would reiterate this recommendation and, in particular, highlight the longer-term benefits to the Australian community of ensuring that people released from detention have strong prospects of successfully integrating into the community. RECOMMENDATION 13: The Department should revise its programs and activities policy to give people in immigration detention (including hotel APODs) access to recognised programs of study and vocational training. 3.4 Health care Repeated studies have highlighted the damaging impact that lengthy periods of detention have on an individual’s physical and mental health, with the severity of these impacts increasing the longer the period of detention.68 When assessing the health care services available in hotel APODs it is also important to recognise the background context, with many of the people detained for the longest periods in the Brisbane and Melbourne APODs being part of the Medevac cohort. This is a cohort who were transferred to Australia from offshore processing centres specifically to allow them to receive assessment and treatment for known medical conditions. Individuals The Use of Hotels as Alternative Places of Detention (APODs) • 2023 • 37