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” ever 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 not their real names) 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 PNG island.

The documents warn of the possibility of suicide and say that Abdul has “unravelled” after only one week. His minder adds that while Abdul’s state is “so acute”, those charged with his care “can only do the basics”.

They give a sense of the volatile mental state of many of the asylum seekers, of 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”.

Though incomplete, 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 (a situation further confirmed this week by an International Health and Medical Services study revealed in The Age), the references in the documents point to many having suffered a kind of psychological “unravelling” 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 of the possibility of suicide and say that Abdul has “unravelled” after only one week. His minder adds that while Abdul’s state is “so acute”, those charged with his care “can only do the basics”.

It is impossible to determine the merit of every claim recorded in the documents. A lack of transparency at the island facility, a dot in the Pacific Ocean 800 kilometres north of Port Moresby, makes judgment from afar difficult.

In such circumstances, asylum seekers “lose any certainty about their future and any control over every element of their lives”. — Zachary Steele, mental health expert

However, according to Zachary Steele, one of Australia’s leading experts in asylum seeker trauma and mental health, there is unequivocal evidence that immigration detention of the kind that is practiced on Manus Island has a damaging effect on detainees’ wellbeing.

Dr Steele says that while seeking asylum is itself undoubtedly stressful, when uncertainty is combined with the confinement of a “closed detention facility” a particular level of deterioration can follow.

In such circumstances, asylum seekers “lose any certainty about their future and any control over every element of their lives”. Pre-existing issues are magnified; new mental disorders develop.

Such conditions “breed a profound collective helplessness and we see these very terrible results,” says Dr Steele, who holds the Professorial Chair of Trauma and Mental Health at the University of NSW.

He notes that all of the relevant research undertaken globally suggested that the majority of the asylum seekers on Manus Island would now be suffering from a variety of psychiatric illnesses as a result of their confinement and their pre-existing mental state and risk factors.

“At this point, we’d be expecting almost the whole population to be experiencing various types of psychiatric disorders,” he says. 

Dr Steele has not been to Manus Island, and says he cannot comment on the level of care on the ground or its adequacy.

But he believes at such a remote centre, where “we’ve started to get really large numbers with really long periods of stay”, it would be extremely difficult providing comprehensive mental health care.

“[Then] mental illness starts to move from being a minority problem to a majority problem and perhaps at a certain point to a universal problem and it’s just very difficult,” he adds. “There are just not enough mental health professionals to meet that need.”

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”.

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 said that 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 said that 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.

Similar allegations of ill-equipped officers finding themselves out of their depth, aired on SBS TV in March, were rejected by the Salvation Army, which managed the welfare of asylum seekers until early this year. It claimed that the skills of its workforce were “at all times adequate” for discharging their duties.

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 said asylum seekers often waited days to see a mental health professional.

Also, some detainees were spending long periods on a Psychological Support Program. The notes refer to Farid, a 28-year-old Iranian man who has “demonstrated severe psychological symptoms, thoughts of self-harm and suicidal ideation throughout this time” and who has “remained on PSP for almost 3 consecutive months with the exception of one week”.

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” . . . [A]sylum seekers “feel unsafe” and are “fearful” and . . . experiencing constant “negative thoughts”, “thoughts of self-harm” and “suicidal ideation”.

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.” His assessor notes in August 2013 that in Ibrahim’s compound there is “no hot water for tea, toilet facilities, no Internet or phone access”.

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