Suicidality in detention – ‘constant supervision’ is not the answer; release is

The serious suicide attempt on Tuesday of a man detained under the ‘one-in one-out’ policy – as covered by the Guardian – can come as no surprise to the Home Office because there have been so many warnings. There is a risk of increasing suicidality amongst others in immigration detention and we call for their immediate release.

The Eritrean man who attempted to take his own life was to be removed from the UK yesterday – his removal was cancelled and he was placed under ‘constant supervision’.

Vulnerable people, including those at risk of suicide, need appropriate clinical support, and we know that healthcare in immigration removal centres (IRCs) is inadequate. The Royal College of Psychiatrists say that IRCs are likely to precipitate a significant deterioration of mental health in most cases, greatly increasing suffering and the risk of suicide.

‘Constant supervision’ is not always helpful – as explained by Dr Mma Yeebo, a Medical Justice clinical psychologist ;

“Our clinicians frequently encounter the prolonged use of constant one-to-one observations for individuals at high risk of self-harm or suicide, which is referred to as ‘constant supervision’ in the context of immigration detention.  NICE guidance is clear that this should be a short-term intervention delivered by appropriately trained clinical staff who can use their observations therapeutically to inform ongoing assessment and treatment planning. In immigration detention, however, these observations are often carried out by custodial staff without the necessary clinical training. Seeing highly distressed individuals monitored in this way, without meaningful therapeutic engagement, raises serious concerns about the systemic normalisation of practices that would likely not be considered acceptable in other care environments.”

Lisa Incledon, our Head of Casework describes how ‘constant supervision’ can make detained peoples’ mental state worse;

“We see clients who are suicidal, and suffering from conditions such as post traumatic stress disorder, schizophrenia and psychosis – many find ‘constant supervision’ intrusive and distressing, as well as sometimes exacerbating paranoia and fear of guards who are imprisoning them. At the same time, crucial safeguarding reports that should be completed by healthcare staff for people suspected of having suicidal intentions are often simply not done”.

Alarmingly high levels of suicidality amongst those detained for the one-in one-out policy – our independent clinicians have assessed torture and trafficking survivors detained under this policy and found alarmingly high levels of self-harm and suicidality.

• Medical Justice has received at least 68 referrals for people detained for the ‘one-in one-out’ scheme. Of 20 assessed by its independent clinicians, all 20 had clinical evidence of a history of torture, ill-treatment and/or trafficking, and all 20 had serious mental health conditions.
• 12 out of the 20 people had suicidal thoughts yet only 5 were identified as being at risk of self-harm and/or suicide by IRC healthcare staff. Only one had a Rule 35 (2) safeguarding report, as they should, from the IRC doctor to flag suspected suicidal intentions to the Home Office who should review if detention is to be continued.
• The number of people released by the Home Office in response to safeguarding reports is so low that it risks rendering the whole process of clinical safeguards meaningless.

The severe harm caused by immigration detention is not accidental – for over 20 years Medical Justice has provided evidence to the government that clinical safeguards in detention are completely dysfunctional and that the lives of people in its care in detention are at risk. The severe harm known to be caused by immigration detention cannot be described as accidental. Immigration detention is optional – suicide attempts and deaths in immigration detention are avoidable.

The Home Office’s contempt for human life – the Home Office has issued plans to effectively decimate clinical safeguards in IRCs, which along with its planned expansion of immigration detention, risks making already vulnerable people even more so.  The ‘one-in one-out’ pilot was to conclude next month, followed by an evaluation which may have provided some level of scrutiny.  This has been side-stepped by the government which told the Guardian that the pilot has been extended until October, providing no reasons.

Notes

The Medical Justice report “Politics over people? How the UK’s “one in one out” knowingly harms and forcibly removes torture and trafficking survivors to France” is the first comprehensive analysis of the backgrounds, experiences and mistreatment of 33 clients detained in immigration removal centres (IRCs) under the ‘one-in one-out’ UK-France Treaty.

• These clients include men, women and age-disputed young people whose nationalities include Eritrean, Iranian, Palestinian and Sudanese. Many have not been able to access adequate and timely legal advice.
• Of 20 clients assessed by our independent clinicians, only three had a report by the IRC GP which is used to identify those who are likely to be injuriously affected by detention. All 20 should have had one. Those who did not included people whose health had already deteriorated in detention, one of whom had been hospitalised.
• Based on expert medical evidence, the report details the harm and distress caused and compounded by detention, as well as by the accelerated process of forced removal and the anticipation of removal. Many clients described having experienced severe violence and highly traumatic events in France – including witnessing the violent death of another person at the hands of traffickers, and being threatened by traffickers that they would be killed if they returned to France.
• Some clients had suicidal thoughts when thinking about being returned to France and expressed intent to die by suicide if they were to be removed.

 Dangerous detention conditions

• In 2024, HM Inspector of Prisons (HMIP) found conditions at Harmondsworth IRC were the ‘worst inspectors have seen’, that detained people were at “imminent risk of harm”, that 48% of detained people surveyed said they had felt suicidal, and noted that a ligature point used in 3 suicide attempts had not been removed. Harmondsworth Immigration Removal Centre: drugs, despair and decrepit conditions – HM Inspectorate of Prisons
• In December 2025, HMIP reported that at Dungavel IRC only three detained people had Rule 35-2 safeguarding reports noting their suicidality, even though 36 had been placed on constant supervision . Concerns for one man were so high that he was put on constant supervision for 4 days and was twice placed in anti-ligature clothing, yet no Rule 35-2 report was submitted. Dungavel House IRC – HM Inspectorate of Prisons
• Frank Ospina died by suicide in immigration detention in 2023 – no Rule 35-2 report was submitted. Asked at the inquest into his death why no Rule 35-2 report had been generated, the Practice Plus Group (PPG) head of healthcare at Colnbrook said: “It was not done. Healthcare missed that …  I can confidently say that if we had done the Rule 35 on the 22nd or 23rd [of March], then we wouldn’t have had that outcome.”

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