Ahmed is a 28-year-old Lebanese man detained on Manus Island. According to observations dated August 2013, Ahmed feels “like hitting his head with a steel bar, banging his head on the wall and cutting himself”. He is “fed up with his life and cannot cope with all the problems in the [regional processing centre] and the uncertain future”, according to Ahmed’s minders.

Mazdan, a 27-year-old Iranian detainee, is “finding it difficult to remain in his accommodation” since he found his friend trying to “hang himself in the bathroom”.

And Fahran, 22, from Afghanistan, is presenting with symptoms of psychosis. He “cries every night, continues to talk constantly to himself, refuses to eat or take medication provided”.

Ahmed, Mazdan and Fahran (which are pseudonyms) are just three of the dozens of asylum seekers whose fragile mental state is outlined in documents from the Manus Island detention centre seen by The Citizen. 

The documents, which date from the beginning of 2013, include minutes of regular meetings involving centre managers, some of whom were charged with monitoring the psychological wellbeing of detainees on the remote Papua New Guinea island. They give a sense of the volatile mental state of many of the asylum seekers, the pressing demands on medical personnel at the centre and the limited ability of support workers and guards to tend properly to the psychological needs of their “clients”.

The accounts provide a window into the experience of those who are being detained in a place that remains shrouded in secrecy.

The Manus Island described in the notes is a place where self-harm and attempted suicide are frequent occurrences, where there appear to be limited options for those suffering extreme psychological distress and where the situation on the ground is a constant challenge for those charged with the responsibility of managing it.

Although many asylum seekers appear  to enter the centre already traumatised after long-distance journeys taken at great risk, the documents point to many having suffered a kind of psychological “unraveling” while in detention.

Sameer, a 20-year-old Pakistani man, says “he is getting a mental problem”; Karim, 34, from Iran, says he feels as if “his head is going crazy”, prompting workers to note concerns over his “deteriorating mental health”; 39-year-old Abdul displays symptoms of “acute stress and detention fatigue”, according to managers, after being in the centre for just “a short period”. The documents warn that while Abdul’s state is “so acute”, those charged with his care “can only do the basics”.

The wide-ranging material seen by The Citizen indicates that many workers on Manus Island are regularly confronted with difficult psychological situations.

Hamasa, a 20-year old Afghani man who recently lost his sister, is — according to the documents — expressing “frustration around interpreters not being available”. Navid, 28, “often talks about taking his life as well as pleading for his health issue to be resolved”. Mahbod, a 46-year-old Iranian man, has been diagnosed with schizophrenia, which “leaves him vulnerable to bullying and intimidation”, the managers observe.

And Samir, a 28-year-old Iranian with a history of depression and anxiety who had been on medication in Iran, seems to be having trouble accessing it in the detention facility and so must wait to see a GP. Although Samir is “fearful of hurting himself and others”, the recommended action recorded in the documents is to “explain to him the time delay in seeing doctors at IOM [the International Organisation for Migration]” and to “tell him to concentrate on remaining calm in the meantime”.

“He left his country to escape the Taliban but sometimes feels like he’s no better off here than he was in his home country.”

In addition to the minutes from the psychological monitoring meetings, a separate leaked document labeled as “Operations Meeting — Manus Island — 17 January 2013”, records “grave concerns around staff who are not trained [in] doing PSP [psychological support program] monitoring”.

It notes: “G4S guards are security guards and not trained or appropriate for the role.” And it adds that management “need to consider what type of person should be doing PSP monitoring and the training that is required to be adequate for the role”.

Former Manus Island employees with knowledge of the system say because asylum seekers couldn’t directly access mental health facilities run by International Health and Medical Services, support workers were often the first point of contact for those suffering acute psychological distress.

They say support workers, who were not always suitably qualified to deal with mental health issues, witnessed incidents of self-harm and were approached regularly by asylum seekers in need of psychological help.

One incident described by one of the former employees involved an asylum seeker who removed a fluorescent light globe, smashed it and then stabbed himself in the stomach and neck. The man then banged his head on the concrete floor to the point of becoming unconscious.

The documents are peppered with accounts of endless delays and a frustration on the part of detainees waiting to see doctors because, managers note, they “fear they may hurt themselves”.

Throughout, there are reports of asylum seekers who “feel unsafe” and are “fearful” and who are experiencing constant “negative thoughts”, “thoughts of self-harm” and “suicidal ideation”.

But even when it appears that guards or support workers believe that treatment is required, they often appear only able to “observe behaviour”, advise clients to “remain calm” or offer them various activities, such as volleyball, cricket or playing cards.

Former employees shared the view that there was a lack of options for those suffering psychological distress on Manus Island. They say asylum seekers often waited days to see a mental health professional. Some detainees were also spending long periods on a Psychological Support Program.

Above all, the documents seen by The Citizen are testament to the torment of asylum seekers for whom the future is deeply clouded. They refer, for example, to the Afghani man Fahran, who is very upset when told he could “be in here at the RPC for 3 years”. Fahran’s friends and brother have “expressed grave concern for his welfare” and are holding Fahran’s medication out of concern “he will take it all at once”.

Ibrahim, 24, from Pakistan, “feels like ending his life”. A document adds: “He left his country to escape the Taliban but sometimes feels like he’s no better off here than he was in his home country.”

And Rahim, a 17-year-old Iraqi, is noted to have experienced “emotional decline” as a result of “family separation”, which is causing him to be “upset and depressed”. Rahim is described as a “normal teenager”, who “talks about his future vocational interests, particularly medicine”.

However, the document continues with a note from the Immigration Department stating that “the reality is that there is no guarantee he will make it to Australia”.

* All names of asylum seekers have been changed 

*This article was originally published at The Citizen