This report identified mental illness as the most significant issue for immigration detainees. Detained people had high levels of such illnesses with safeguards designed to prevent their detention proving to be ineffective. Detention caused exacerbation of mental disorders, sometimes to a degree requiring compulsory hospital treatment. The report noted particular harm caused to people with trauma-related mental illness such as PTSD and that the current arrangements were not in keeping with modern clinical practice which required the use of the least restrictive treatment options. There were inadequacies in healthcare offered to people with a mental illness, compounded by insufficient training, unsatisfactory record systems and poor access to specialist referrals. The effect of the detention of those with an illness was also recognised as impacting on other detained people exposed to behaviour caused by such illness.

Medical Justice identified problems with a lack of diagnosis of mental disorders with clinicians based in detention having potentially split loyalties and in receipt of documents from the Home Office characterising symptoms of illness as ‘manipulative.’ Treatment options were limited and there was an over reliance on psychoactive medication. Overall, diagnosis and treatment in detention were assessed as substandard.

Rule 35 did not operate as a safeguard as the assessments were often not initiated and once completed did not obtain the individual’s release as clinical judgment was overruled by Home Office caseworkers.

Recommendations include:

  • Ending the detention of people with a mental illness of a severity that required any treatment as well as people requiring compulsory hospital admission
  • Limitation of immigration detention to a period of no longer than 6 months
  • Ending the detention of people vulnerable due to a history of torture or other abuse
  • Ensuring that detention healthcare meets NHS standards for diagnosis and treatment of mental conditions
  • All IRC and immigration enforcement staff to have mental health awareness and mental health training
  • All IRCs to have policies for identifying and dealing with challenging behaviour related to mental illness, using the same least restrictive and participation principles that govern the application of the Mental Health Act 1983
  • Segregation of detainees, as in prisons and as recommended by HMIP, should be conditional on a medical assessment of mental health, and involve regular multidisciplinary reviews, and never used as a substitute for proper treatment of mental illness, supported by detailed policy guidance and audits
  • Regular audit and multidisciplinary reviews on the use of force on mentally ill detainees undertaken by the Home Office, NHS England and IRCs
  • NHS‐equivalent mental health healthcare standards for detention that are resourced
  • Proper assessments under rule 34 including access to previous clinical records
  • Proper reports under rule 35, with proper respect for professional opinions
  • There is a professional responsibility to generate rule 35 reports when appropriate, and clinicians should not be satisfied if they are rejected

There should be protocols to ensure there is proper liaison between healthcare services in detention centres and outside healthcare services, in particular when detainees are released.