7.3 Accessing health care services People in detention can request medical assistance through filling in a medical request form. Forms are collected daily and triaged for appointments. Based on what is written on the form, there is an initial paper-based triage, then a face-to-face triage with a nurse. The targeted response time for this is 72 hours, however, urgent cases can be seen on the day or within 24 hours. IHMS staff told us they received up to 9 medical request forms per day. All forms seen at various locations during the inspection were in English only. It is unclear what support is offered to people who are unable to communicate their needs in English or who have poor written English skills. Neither was it apparent how accurately most people in detention were able to describe their medical issues to generate an appropriate triage response. IHMS staff informed the Commission that, in addition to the medical request forms, they were also very responsive to concerns raised by security or welfare staff about people who appeared unwell but had not completed a form. Nevertheless, we were advised by IHMS that there was a 50% non‑attendance rate for face-to-face triage appointments. This suggests that the current model is not efficient or effective. Additionally, people in immigration detention cannot access mental health services and torture and trauma counselling without being triaged by a non‑mental health clinician, meaning that they have to tell their story at least twice. One of the written submissions received by the Commission stated that accessing torture and trauma counselling was particularly ‘problematic for clients who do not wish to engage with IHMS.’ One person interviewed told the Commission that he had a long history of severe depression and needed to see a psychiatrist but had to see the nurse and then the general practitioner first. As they did not make the onward referral to the psychiatrist, he was unable to access any mental health care. Another person reported that they had not been able to access psychology. He reported that he had a history of depression and had made a serious suicide attempt in the past. He said that he wanted talking treatment but instead the general practitioner offered an increase in medication, which he did not want. Requiring people in detention to see a general nurse and then a general practitioner before they can access a specialist mental health or torture and trauma service does not meet the standard offered by public community mental health services. It also requires a detained person to tell their story multiple times to access care, which is not best practice from a therapeutic perspective. RECOMMENDATION 13: The Department and IHMS should review the efficiency of the current health services referral and triage procedures within immigration detention. This review should include examining the accessibility of the procedures and whether the mental health and torture and trauma referral system aligns with community mental health service standards and best practice. Yongah Hill Immigration Detention Centre Inspection Report • 2024 • 37