Dr Jane HuntDespite twenty years working as an inner-city GP and being particularly interested in refugee health, it was only when I started volunteering for the Helen Bamber Foundation that I really understood what a “detention centre” was and its impact on those who had been detained in one.
What do we mean by Immigration Detention and Immigration Removal Centres?
The Home Office uses detention as an administrative means to process an asylum application or to facilitate removal from the UK. However, detainees and staff both view detention as punitive. Detainees are not serving any criminal sentence and no time limit currently exists on the duration of detention meaning that detainees can remain in limbo for several years. Immigration Removal Centres (IRCs) are closed establishments and there is no automatic judicial oversight on a decision to detain.
There are currently 10 IRCs across the UK. At any time about 2,000-3,000 people are held in administrative detention in the UK – about 30,000 a year
What are the healthcare concerns of those detained in IRCs?
People seeking asylum are an inherently vulnerable population and many detainees will be amongst the most vulnerable people in our society – many have suffered torture, trafficking or other forms of ill treatment and they may have significant and chronic health problems from pre-migration, migration or post- migration difficulties.
Detention creates a reduced sense of safety and freedom from harm, an aggravated fear of imminent return, a reminder of past traumatic experiences, a separation from existing support networks as well as a disruption of any existing treatment or care.
Detention is particularly concerning for victims of trafficking as it destroys trust in the authorities leading to a reduced chance of disclosure and to an increased risk of re-trafficking post detention, as well as increased trauma by a further experience of confinement.
Good clinical care for people seeking asylum depends upon consistent, trauma-informed working and proactive health screening. Evidenced-based psychological treatments for mental health issues are paramount. Many independent reports and legal judgements have provided evidence of the inadequate healthcare provided in detention centres.
People seeking asylum and survivors of human trafficking have been consistently found to have high rates of Post-Traumatic Stress Disorder (PTSD), Complex PTSD, depression and anxiety disorders. Some people seeking asylum have mental health problems and associated behaviours that can place them at a higher risk of suicide or accidental death. These include suicidal behaviours, self-harm and substance dependence. Evidence indicates that immigration detention can be harmful to mental health, especially for people with such pre-existing mental health problems and that time spent in detention is positively associated with the severity of mental health problems.
What is done to protect vulnerable people in IRCs?
There has been significant evidence over the last decade of systemic failings in immigration detention from a wide range of sources including the courts, non-governmental organisations (NGOs), independent inspectors, parliamentary inquiries and the media.
A new ‘Adults at Risk’ guidance was introduced in 2016 which recognised that vulnerable individuals may be at increased risk of harm from detention and stated that vulnerable individuals (‘adults at risk’) should not normally be detained and can only be detained when immigration factors outweigh their indicators of risk.
An indicator of risk includes:
- a person suffering from a mental health condition or impairment,
- a victim of torture, a victim of sexual or gender-based violence,
- a victim of human trafficking or modern slavery and
- those suffering from post-traumatic stress disorder.
However, vulnerabilities (or indicators of risk) are often not identified due to inadequacies in the screening processes pre and post- detention. Added to this issue is the fact that it is not enough that an indicator of risk is present – then evidence has to be gathered to assess whether the detainee is indeed at risk of harm from detention. This puts a significant burden on the detainee to attain this level of proof which often needs a professional report from a clinician – something that can be very difficult to access in a detention setting. Even with this evidence, home office caseworkers can override medical opinion on the basis of immigration factors.
It is now very clear that the new AAR policy leads to more vulnerable people being inappropriately detained for longer periods of time due to inadequate provision for screening, the need for documentary evidence of vulnerability, and the higher threshold needed for release ie; not just an indicator of risk needed but also evidence that that risk will (or has already) led to harm.
For those who are interested in learning more about this subject:
Medical Justice is an organisation that offers essential medical help to detainees. Clinicians volunteering for Medical Justice document detainees’ psychological and physical injuries to assist in their asylum claims and challenge medical mistreatment of those held in detention. These cases provide the evidence for research, publications and campaigns for lasting improvements for detainees.
Other references:
Porter and Haslam (2005), JAMA Aug 3;294(5):602-12. ‘Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis’; and Ottisova, L., Smith, P., & Oram, S. (2018). Psychological consequences of human trafficking: Complex posttraumatic stress disorder in trafficked children. Behavioral Medicine, 44(3), 234–241.
H Grant-Peterkin at all, Inadequate Mental Healthcare in IRCs, Editorial BMJ 2014;349:g6627
Von Werthern, M., Robjant, K., Chui, Z. et al. The impact of immigration detention on mental health: a systematic review. BMC Psychiatry 18, 382 (2018).
Robjant K, Hassan R, Katona C. Mental health implications of detaining asylum seekers: systematic review. Br J Psychiatry 2009;194:306-12.