“Putting Adults at Risk” reports that the Adults At Risk (AAR) policy was having the opposite effect to its stated aim of increasing protections for the vulnerable and called on the Home Office to review the policy. The AAR policy leads to more vulnerable people being detained for longer and does not provide the safeguards needed to avoid future Article 3 breaches.”

The report set out concerns that the policy failed to identify vulnerable people as it lacked provision for active screening and did not effectively link with Rule 35 processes. Other concerns included the increased evidential burden on individuals to prove their vulnerability, in circumstances where the most vulnerable would struggle to do so. The key concern was that evidence of harm required by the policy was hard to obtain prior to detention, and although this might be available after detention once the individual had deteriorated, the policy was not then operating to prevent harm being caused in the first place.

The research considered a sample of Rule 35 reports and found that 97% identified the individual as an adult at risk and in 95% the decision was taken to maintain detention. Only 2% of cases were assessed as at level 3 despite reports referencing significant mental health symptoms and in 14% detention was maintained despite the doctor specifying that the detainee was deteriorating. Immigration factors used to justify continued detention seemed much less than would have been required under the previous policy requiring ‘exceptional circumstances’ and there was evidence of prolonged detention of people who had been identified as vulnerable under the policy.

There were also concerns of a lack of follow up of people identified as at risk, with the policy again operating only when there was evidence that harm had occurred, and the research referencing examples where harm had resulted but had initially been missed.


Medical Justice reminded the Home Office that the concerns set out in the research had been identified when the policy was proposed and suggested a new meaningful consultation process to develop an effective policy. The conclusion remained that the best solution was to end immigration detention but in the absence of such a commitment, proposed the following recommendations:

  • Reinstating a category-based approach to identifying vulnerability where demonstrating that one belongs to a category at increased risk of harm in detention triggers protection from this risk – including an effective catch-all and effective screening for vulnerability.
  • Replace the ‘torture’ and ‘victims of sexual or gender based violence’ categories with a more inclusive category modelled on the UNCHR detention guidelines, namely ‘victims of torture or other serious, physical, psychological, sexual or gender based violence or ill-treatment’.
  • Abandon AAR evidence levels and ensure that all those identified as particularly vulnerable to harm in detention can be detained only if there are ‘very exceptional circumstances’. The policy should retain the commitment to self-declaration of vulnerability but this should trigger a duty of inquiry on the Home Office into the vulnerability.
  • Update the Rule 35 process to ensure that it can effectively identify all vulnerable groups, lower the threshold for reporting health issues and improve the reporting of suicide and self-harm risk. Such assessments must happen within 24 hours and doctors must be properly trained. The policy and its protections should be extended to all immigration detainees, including those held in prisons to whom the policy does not currently apply.
  • Ensure that there are robust independent monitoring mechanisms in place to ensure that the operation of policies achieve their stated aim and to avoid unintended consequences. To move towards a culture of transparency and openness around Home Office processes where independent oversight is welcomed, and external input recognised as a valuable opportunity to improve processes and safeguard the wellbeing of vulnerable people in immigration detention. This must include a commitment to future reviews of the impact of detention policy.