The risk of self-harm in immigration detention is managed through containment, using the “Assessment Care in Detention and Teamwork” (ACDT) process for monitoring those identified to be at risk, formal and informal segregation, and restraint measures.

ACDT lacks involvement by the IRC’s healthcare team ; it is initiated and managed by guards. In some IRCs, when Medical Justice has called the healthcare team about self-harm concerns regarding a detained person, we are told to phone ‘security’. ACDT records do not form part of the detained person’s Home Office file so there is limited visibility of self-harm or suicide risk and often no associated review of whether detention should be continued.

“This is deaths of people in the care of the state and there shouldn’t be any secrecy in that”

Speaking to the Home Affairs Select Committee in 2018, former Prisons and Probation Ombudsman, Stephen Shaw said “I find it frankly odd and self-defeating that the Home Office doesn’t face the normal practice in the MoJ [Ministry of Justice] of making a statement when there is an apparently self-inflicted death in detention… The Home Office doesn’t learn enough from self-inflicted deaths in IRCs and serious acts of self-harm. …I think it should address the problem face on – what are the levels of suicide and self-harm we are facing? Is our response appropriate? This is deaths of people in the care of the state and there shouldn’t be any secrecy in that.”

Increase in self-harm rates at Brook House IRC in 2020

In the second half of 2020 the Home Office organized very frequent charter flights to remove people from the UK who had recently arrived, mostly across the Channel by dinghy. Detained people felt the likelihood of removal was ever present, serving to increase their despair. Rates of self-harm and attempted suicide were reported to be very high. The level of distress amongst detained people was unprecedented.

It was reported that there were 80 incidents requiring medical treatment amongst 100 people detained in Brook House IRC in August and September 2020. At least 26 people were removed from the UK while on ACDT[1].

The Brook House IRC Independent Monitoring Board found that, in the period from the end of July to December 2020, circumstances related to the charter programme amounted to “inhumane treatment of the whole detainee population”.

  • One man had poured boiling water on his legs to prevent himself from being removed.
  • One detainee, after a suicide attempt, was taken straight from hospital to the airport for removal.
  • Another detainee was removed from netting in the centre following a suicide attempt and then taken to the airport, and another was taken bleeding and partially clothed to the airport following a suicide attempt

The use of segregation and restrains to manage self-harm

There is a concerning use of segregation and restraints in response to self-harm in immigration detention.

Case example: Ms MD “was restrained, removed from association with other detainees and handcuffs were used to stop her harming herself. [Ms MD] self-harmed on at least eleven occasions … including occasions when she cut her forehead with the top of a sardine tin, when she again cut her forehead and the right side of her face this time with pieces of china, when she tried to strangle herself using a mobile telephone cable as a ligature and placed a pillow over her head, when she banged her head against the wall, when she cut her neck using pieces of china and occasions when she cut her stomach, neck and arm.” In response, she was subjected to force on many occasions, often by a number of male Serco officers. She was put in Isolation where she was handcuffed to stop her from self-harming.


There have been many hungerstrikes, by individuals or groups of people, in immigration detention to protest their imprisonment and the conditions they have been held in. The Guardian reported in 2019 that there had been more than 3,000 hunger strikes in UK immigration removal centres since 2015, according to Home Office figures.

A group of women on hungerstrike at Yarl’s Wood IRC were told by the Home Office that their protest could lead to their deportation being speeded up. The letter from a Home Office official told detainees refusing food or fluid “may, in fact lead to your case being accelerated and your removal from the UK taking place sooner”.

Some Medical Justice clients who have refused food and fluid have been treated as though they were doing so as a protest, but the refusal was actually as a result of mental illness, which had not been identified.

In some cases proper mental capacity assessments are not carried out.

Research undertaken by Medical Justice on 50 vulnerable detainees showed that 23% reacted to the stress of detention by refusing food and/or fluids. One client lost more than 1/3 of her body weight before receiving appropriate mental health care.