3 | Key observations and concerns Many of the community service organisations that we spoke to reinforced this as a significant issue for the detainees they had worked with, with one observing: For many who already had poor mental health, a week of isolation from the rest of the group was especially harmful and intolerable and hence it is preferable to skip vital external medical appointments rather than be subjected to lengthy quarantine. “ABF said I need another scan at RECOMMENDATION 16: Quarantine should only be used where medically necessary, and where there has been an individual assessment of risk. The application of reasonable risk mitigation measures as an alternative should always be considered as part of the risk assessment process. the hospital, but I refuse. I will not go. I will wait. I cannot go to quarantine” one refugee at the Park Hotel said. A number also expressed frustration when noting that the staff who escorted them to external appointments had continued to work in the hotel APOD facility following their return, while they had been placed in operational quarantine. We were advised that staff accompanying detainees to external appointments were required to comply with additional risk mitigation measures, including wearing personal protective equipment and undertaking rapid antigen testing. It was acknowledged that detainees were not given the option of taking these additional risk mitigation measures as an alternative to quarantine. While the Commission accepts that operational quarantine will be necessary in some circumstances, quarantine should only be used where medically necessary and where there has been a thorough assessment of the individual risk. The routine application of operational quarantine following external appointments does not appear to have been sufficiently targeted to ensure that it was used only when necessary. 42 (c) Mental health care The Commission has consistently raised concerns about the need to improve mental health care availability in immigration detention centres, and the risk of people failing to receive timely access to appropriate mental health support when they need it most.75 While the challenges of providing mental health care in the immigration detention environment (including the significant impact of the COVID-19 pandemic) continue, it is concerning that the same issues have continued to be raised with us during these inspection visits. During interviews conducted as part of the Inspections of Australia’s immigration detention facilities 2019 Report (2019 Report), many people reported to the Commission that they had concerns about their mental health. They reported experiencing depression, anxiety, stress, difficulties sleeping, problems with concentration and/or memory and lack of motivation. During interviews, the Commission observed withdrawal, distress and fatigue.76 These same issues were again reported to the Commission, and the same observations were made by the Commission during interviews conducted as part of these inspections.