VISITS BY THE JOINT COMMISSION Against this backdrop it is possible that a suicide attempt will not go unnoticed and that minors may also be confronted with such a sight. If this group of people were in effect to be isolated from others, this would no doubt give rise to negative comments from those who are critical of the airport procedure and possibly also from the National Agency. In addition, this would exceed the resources (i.e. rooms) available in the airport reception centre. The case which the church refugee support group raises, and which it again and again brings up in every conceivable context, concerns the daughter of an Armenian family who was looking through a window when she saw an asylum seeker purportedly attempting to commit suicide. The Armenian family was in the facility between 16 September and 15 November 2012. Their relatively long stay was due to the fact that the father had to be admitted to a psychiatric hospital. The concerns regarding the assumed danger to the wellbeing of the underage girl referred to on account of her not being kept separate from adults may, possibly, have to be clarified in another context, since in the Ministry’s opinion the context referred to here is too far-fetched and inappropriate. The explanations given by the National Agency give the overall impression that the airport facility is not suitable for minors (even those who are travelling with their families). This is what the church refugee support group has again and again claimed. Unfortunately, the group has not yet been able to propose a pragmatic solution which meets legal requirements. Regardless of specific incidents, the Joint Commission feels there are still fundamental concerns about whether, given the conditions in the Reception Centre, accommodating unaccompanied minors and families with underage children together with adults is in the children’s best interests. Due to the especially stressful situation which those accommodated in the Reception Centre are generally under, it seems reasonable to assume that there is an increased risk that minors may witness acts which, in their case specifically, can lead to trauma or exacerbate existing traumatisation. The Joint Commission drew attention to the new EU Reception Directive. Article 11 (3) of that Directive specifies that detained unaccompanied minors must be accommodated separately from adults, Article 11 (4) that detained families be provided 69 with separate accommodation. The Joint Commission thus recommended examining how the requirement that minors be protected can be better complied with in the Reception Centre. The Joint Commission welcomes the fact that each time a person is booked in they are examined by a doctor as soon as possible. However, special attention should be paid during these examinations to noticing signs of traumatisation and suicidal tendencies. The examining doctor should have been specially trained in diagnosing trauma and other mental illnesses, or he or she should call in a specially trained psychologist. It must be ensured that traumatisation is accurately diagnosed. Response: According to the Ministry, the Reception Centre’s registered contract doctor is extremely conscientious when it comes to the initial examinations and subsequently providing medical care to the refugees. Where he suspects that a refugee has mental health issues he consults a registered contract psychologist or a registered contract psychiatrist employed by the Reception Centre or he refers the refugee to a psychiatric unit in a hospital. These decisions are taken on the basis of conspicuous features in a refugee’s medical history and how refugees present themselves upon examination (e.g. dejectedness, symptoms of depression). He himself says that he has not undergone any specialist training in identifying traumatisation, but that psychiatry was a part of his medical degree. Further, he has more than 30 years’ experience in medical practice. The Ministry regards the Joint Commission’s call for it be reliably ensured that traumatisation is identified to be entirely unrealistic. By employing a freelance psychologist or psychiatrist the Ministry guarantees that the best possible medical care is available during the airport procedure. It is not possible to make the same demands of the Reception Centre as are made of a diagnostic or treatment facility. It should also be borne in mind that identifying traumatisation is extremely time-consuming, even for those few specialist facilities which provide the service, and may even be impossible in the time available. Findings suggest that refugees are usually focussing on the asylum procedure at this time and as a result post-traumatic stress disorders (PTSDs) do not become apparent until much, sometimes months, later. Nevertheless, in the context of implementing the EU Reception Directive, which was amended in 2013, the Ministry and the other Länder set up a special working group to look into the question of the early recognition of PTSDs. The Reception Centre is now planning to carry out a pilot study in cooperation with the Clinic for Psychiatry and Psychotherapy at Gießen and Marburg University Hospital to identify traumatised refugees as part of a screening process without diagnostics. The Joint Commission thereupon underscored its recommendation that one particular focus during the initial examination should be on identifying traumatisation and other mental disorders. The examining doctor should have been specially trained in this matter or should bring in a specially trained psychologist 70 or psychiatrist. It must be ensured that indications pointing to traumatisation or mental illness are reliably diagnosed. 69 70 Directive 2013/33/EU of 26 June 2013 68 cf. German Medical Council (2011), Resolution, p. 125