Author: Imogen

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

Trigger warning : this article mentions a suicide attempt and levels of suicidality in detention.

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.”

If you have been impacted by this content, please know you are not alone, Samaritans are there – day or night, 365 days a year. You can call them for free on 116 123, email them at jo@samaritans.org, or visit samaritans.org to find your nearest branch.

Medical Justice is taking on the London Legal Walk 2026

On Tuesday 9 June, alongside 19,000 legal professionals, the Medical Justice team will be walking 10km across London to raise funds to support our work.

We support clients to access competent lawyers, harnessing the strength of the medical evidence we generate. Clinical evidence, casework and medico-legal reports are at the heart of what we do. We are the only charity in the UK that sends independent volunteer clinicians to visit people held in Immigration Removal Centres, document the physical and psychological scars of torture and trafficking, and assess serious medical conditions. The evidence produced also forms the basis of our research into systemic failures in healthcare provision, the harm caused by these shortcomings, and our advocacy on the dangerous impact of immigration detention on the health of our clients.

We are hoping to raise as much as possible to continue our vital work. These funds are needed now more than ever, as we are operating in a particularly challenging funding environment. At the same time, the cost of delivering our services is rising and increasingly hostile policies affecting our clients continue to be announced.

Your support could make a real difference:

£10 could fund a phone line for a month, helping our casework team maintain vital contact with people in detention

£80 could cover the cost of training to a new volunteer clinician

£100 could cover the travel costs for a volunteer clinician to visit someone in detention and carry out a medical assessment  

£120 could cover the cost of an interpreter during a medical assessment

You can sponsor us here 

Other ways to support the team:

Raise funds through your firm!

If you work with a legal firm taking part in the London Legal Walk, please ask whether your firm would consider allocating a percentage of what you raise to Medical Justice. For more information please contact Ariel at info@medicaljustice.org.uk

Share our fundraising page

If you are not in position to sponsor the team, please consider sharing our London Legal Walk fundraising page with your contacts, friends and family.

Policy for people who lack mental capacity disclosed in Medical Justice legal challenge

Medical Justice initiated a Judicial Review challenging the Home Office’s continuing failure to make provisions to enable people in immigration detention who lack mental capacity to participate in their immigration case or to challenge their detention or conditions of detention.

Though we were refused permission for the Judicial Review in September 2025, responding to our litigation the Home Office revealed a new policy which is likely to benefit detained people who lack mental capacity and be helpful to those supporting them.

The new policy provides that where there is medical evidence that a detained person lacks mental capacity (which Medical Justice might be able to provide) and they are not legally represented, the Home Office will not serve an immigration decision which carries a right of appeal or avenue to respond with submissions on them. This ends the situation whereby a detained person who lacks capacity does not understand or is unable to engage in an important and often negative decision against them – for example, the refusal of an asylum claim which, if unchallenged, could lead to deportation.

The Home Office also said it is “in the course of designing” a “new scheme” intended to provide meaningful assistance for detained people who lack mental capacity. Medical Justice will be following up to ensure this actually happens.

Background

In 2014 ‘VC’ was detained in an immigration removal centre (IRC). He had bipolar disorder and psychosis and had previously been admitted to psychiatric units multiple times. He remained in detention for close to 11 months during which time his mental health deteriorated. His healthcare records describe him as being confused, having delusions, persecutory thoughts, hypomania, elation, seeing visual hallucinations of angels, and presenting with ‘strange and challenging’ behaviour. He was described as having ‘lost contact with reality’ and not having insight into his illness. He was held in segregation in the IRC several times. Eventually he was sectioned and transferred to hospital.

VC was unable to arrange legal representation for himself and unable to challenge his own detention, the conditions in which he was held, or his repeated segregation. He was eventually encountered by an NGO that supports detained people who referred him to a solicitor. The Official Solicitor was appointed as ‘litigation friend’ because VC lacked capacity to represent himself.

In 2018 the Court of Appeal found that the Home Office’s failure to put in place assistance (such as independent advocacy) to enable VC to challenge his detention and conditions of detention was unlawful and discriminatory and a breach of the duty to make reasonable adjustments under the Equality Act 2010.

Seventeen months later, in July 2019, in the case of ASK and MDA the Court of Appeal made similar findings of discrimination in two further cases of mentally unwell detained men (ASK was another client of Medical Justice).

Following this a Detention Services Order (DSO) on ‘Mental Vulnerability’ has been developed, providing guidance to identify people who may lack mental capacity or who have a disability arising from their mental illness. The DSO instructs all staff to refer such concerns to healthcare and for the Home Office to be notified. Also, staff should assist individuals to understand information provided to them and legal documents served on them ‘through personal engagement’ and should signpost them to legal advice.

However, crucially, there is no provision for independent advocacy or some equivalent effective provision, as had been suggested in VC and ASK and MDA. If somebody is not able to understand or engage with a legal document served on them despite ‘personal engagement’ by an IRC officer and is not able to attend a legal advice surgery and successfully secure legal representation, then they remain at high risk of remaining detained for long periods, despite the known deleterious effect of detention on mental health. They may not be able to pursue any potential asylum or human rights claims and could be removed from the UK without their circumstances being examined.

Home Office discloses policy following our litigation

Medical Justice applied for permission to challenge by way of Judicial Review the continuing failure by the Home Office to make provision for independent advocacy or other assistance for those in immigration detention who lack mental capacity. Although we were refused permission in September 2025 following an oral hearing (the judgment is here), in evidence in response to our litigation the Home Office stated that a “new scheme” is in “development and under active and ongoing consideration” and it is “considering the viability of a system of independent advocacy or equivalent arrangements”.

The Home Office also disclosed new ‘interim guidance‘ for its caseworkers which the Home Office stated was circulated to its teams in December 2024. The guidance states:

“Where the concern regarding mental capacity is considered well-founded and continues, but a decision is taken that detention is to be maintained, it is extremely important that the responsible case-working team can confirm that the person has legal representation. This will provide a legal avenue for immigration decisions to be appropriately challenged, notwithstanding the concerns that we may hold regarding the person’s mental capacity.

Where a person for whom we have a well-founded concern regarding mental capacity is not legally represented, and that concern is supported by medical evidence directly related to the capacity issue (HC MHT treatment etc), the service and enforcement of immigration decisions which carry a right of appeal or avenue to respond with submissions, should not normally be progressed, until legal representation is obtained. Whilst this general rule should normally be applied, each case must be considered according to its circumstances.” (emphasis added).

We have since seen instances where people who had strong indications that they lacked mental capacity to make decisions relating to their immigration case and were not able to challenge immigration decisions themselves, and who were not legally represented, were nevertheless served decisions, including refusals with a right of appeal and refusals that could have been responded to with submissions or challenged by judicial review. Some got close to being removed from the UK. Medical Justice is spreading the word about the “new interim guidance” to help ensure all detained people who lack mental capacity are protected in this situation.

This guidance may be an important tool to ensure deadlines are extended and people are not removed in the meantime.

Medical Justice is the only charity that sends independent clinicians into IRCs to document detained people’s mental and physical health, including mental capacity. Where appropriate, Medical Justice’s medico-legal assessments for detained people include assessments of their capacity to make decisions relating to their immigration cases or instruct legal representatives. If you have concerns about the capacity of a detained person, you can refer them to Medical Justice or contact our casework team to discuss.

The Home Office’s next steps

The judgment in the Medical Justice case records evidence provided by Frances Hardy, Deputy Director of Detention Services for the Home Office that:

“The Home Office is currently researching options to recruit ‘mental capacity officers’ from the current body of operational staff, who will receive specialised training, have oversight of cases of concern and the responsibility to liaise with the healthcare provider, making a referral for independent mental capacity advocates (IMCA) support where appropriate. This is the current intention of the Home Office, subject to the outcome of further policy development work in the coming months.”

It was further said that the viability of providing independent advocacy services was being considered.

So far no updated version of the Mental Vulnerability DSO has been published and there has been no further indication given to stakeholders (including Medical Justice) that the design of a system for the provision of appropriate support (including advocacy services) has progressed further or when such provision may start. Medical Justice is continuing our efforts to press the Home Office for this and highlight the ongoing need. In the meantime detention is being expanded.

Barriers to disclosure for trafficking survivors detained under UK-France deal

This week a judicial review brought by trafficking survivors detained under the ‘one-in one-out’ UK-France scheme is being heard. The survivors are challenging the blocking of modern slavery appeals and the case touches on barriers to disclosure faced by trafficking survivors which have been documented by the Detention Taskforce, a consortium of expert organisations chaired by Medical Justice.

Government ministers insist that “late” or “last-minute” modern slavery claims are being used to frustrate deportation attempts. This narrative, which is being used to justify changes to modern slavery laws, fails to acknowledge the significant barriers that stand in the way of survivors disclosing their trafficking history at the earliest opportunity while held in immigration detention. Treating “late” disclosures as less credible shows a lack of understanding of the impact of trauma on people who have been trafficked.

In its March 2026 briefing “Barriers to Disclosure: A survivor of trafficking’s journey through the immigration process”, the Detention Taskforce charts the barriers to disclosure that survivors recently detained for removal to France at every stage in their journey face through the immigration process – from their arrival in the UK by small boat and often bewildering screening interview to their arrival and induction at an immigration removal centre. Drawing on Taskforce members’ experience, including Medical Justice’s recent research, the briefing identifies challenges with healthcare screening and clinical safeguards as well as access to legal advice, which are all exacerbated by the nature of the UK-France immigration decision process that is accelerated by design.

The briefing also highlights our serious concerns about the September 2025 change to the Modern Slavery Statutory Guidance which removes some people’s right to have a negative decision reconsidered, including those detained for removal under the UK-France deal. This policy change, which has been implemented inconsistently so far with some people receiving a reconsideration and others being refused it, is being challenged in the High Court this week by six trafficking survivors who were detained under the UK-France deal and whose reconsideration requests were refused. As barrister Sam Grodzinski KC told the court: “Victim identification is a process that takes time; it can’t be done speedily, not if it is to be done properly.”

Read the full briefing here

The Detention Taskforce on survivors of trafficking in immigration detention works to build a better system for survivors of trafficking in immigration detention, and ensure no victim of trafficking is further harmed by detention. Chaired by Medical Justice, the Taskforce is comprised of 18 expert organisations working with, or for, victims or survivors of trafficking.