7 | Health Services • fear of other detained people and adoption of safety behaviours to try and minimise risk of harm from others. From a service planning point of view, it should therefore be assumed that the vast majority (if not all) people detained require primary care level mental health support, and a high number would be accessing secondary mental health services if they were living in the community. This observation is also supported by evidence provided by the Department through Senate Estimates, which provides that between 1 January 2018 and 31 August 2023 there were 7,322 people in immigration detention who had engaged in mental health counselling and 597 who had received specific torture and trauma counselling.86 Previous evidence provided through Senate Estimates, however, states that between 1 January 2018 and 31 December 2022 there were 2,283 people engaged in mental health counselling and 692 who had received torture and trauma counselling.87 The reason for this discrepancy is unclear. 46 People are often very unwell and distressed before they are taken to the emergency department for their mental health concerns. There is no ability to provide involuntary or compulsory treatment at the centre. For urgent mental health assessments, the Northam Hospital only has a part time mental health nurse in their emergency department, and access to mental health telehealth the remainder of the time. The nearest inpatient mental health unit is at St John of God (SJOG) Midland Hospital, which is over an hour away. If an inpatient admission is required, there may be a further delay in the emergency department at SJOG Midland Hospital before admission to a ward. The Commission was told that, once admitted at SJOG Midland Hospital, Serco staff ‘hand over’ to the site’s security guards, but still must remain while the person is in hospital. The relationship with the SJOG mental health team was described as challenging although with some recent improvement. Figure 9: HCA external entrance