Home Office systematically ignores medical advice to keep mentally ill immigrants in detention

Exclusive: Hundreds of immigrants with mental health conditions being held in detention centres against advice of medical practitioners and in breach of Government policy

May Bulman
Social Affairs Correspondent
Saturday 25 November 2017 20:12 GMT
An analysis of cases of vulnerable detainees shows that 80 per cent have been defined by medical practitioners as being 'at risk', but all have remained in detention despite a Home Office policy designed to ensure vulnerable people are not detained
An analysis of cases of vulnerable detainees shows that 80 per cent have been defined by medical practitioners as being 'at risk', but all have remained in detention despite a Home Office policy designed to ensure vulnerable people are not detained (Reuters)

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The Home Office is systematically ignoring independent medical advice not to detain people who are mentally ill as part of their bid to crackdown on immigration, The Independent can reveal.

Hundreds of immigrants with mental health conditions are currently being held in detention centres against the advice of medical practitioners, in a breach of Government policy introduced last year to ensure vulnerable people are not detained inappropriately.

An analysis of files by charity Bail for Immigrant Detainees (BID), seen exclusively by The Independent, finds that the Adults at Risk policy, designed to ensure vulnerable people are not locked up, is leaving mentally unwell people “languishing” in removal centres.

The policy was introduced in response to a government-commissioned review into the UK’s immigration detention system last year, which found that too many vulnerable people were being placed in detention to the detriment of their mental health.

Former prisons and probation ombudsman Stephen Shaw, who conducted the review, said Rule 35 of the Detention Centre Rules – designed as a key safeguard for victims of torture or whose health would be at risk from continued detention – failed to protect vulnerable people in detention, largely due to a lack of trust in GPs to provide independent advice.

The new Adults at Risk policy sets out framework for identifying different levels of vulnerability by using a series of categories. In official guidelines, the Home Office states that it aims to “ensure that genuine cases of vulnerability are consistently identified, in order to ensure that vulnerable people are not detained inappropriately.”

“On the basis of the available evidence, the Home Office will reach a view on whether a particular individual should be regarded as being ‘at risk’ in the terms of this guidance,” it states.

But critics say that rather than reducing the number of vulnerable people held in detention, the policy instead equips the Home Office with more arguments to refuse people’s release when they are found to be vulnerable by medical practitioners.

An analysis of cases of vulnerable detainees currently represented by BID, which offers legal advice and representation to people in detention, shows that 80 per cent have been defined as being “at risk” by a medical practitioner. The diagnosed conditions and vulnerabilities were most commonly PTSD, depression and suicidal tendencies, with two thirds recorded as being torture victims.

Although this information was passed onto the Home Office, which in 90 per cent of cases accepted that the individual was vulnerable, none of the detainees have been released from detention as a result.

In one case included in the report, a woman, named only as “A”, was found to be a victim of rape who suffers from a range of mental health problems including depression, PTSD and personality disorder.

It was known to the Home Office that she was on medication for her depression, but despite this she continued to suffer from suicidal ideation, low moods and hallucinations, as well as flashbacks and bed-wetting.

A Rule 35 report stated that she suffered from trauma as a result of the rape. The clinical opinion of the Home Office’s own medical practitioner made it clear that A’s treatment could continue more effectively with specialist services that were not then available to her in detention.

But the Home Office refused to acknowledge her as an adult at risk who should not be detained. She was categorised as risk level 1 Adult at Risk despite the fact that the Home Office’s medical practitioner had confirmed that detention was not suitable and was putting her at further risk.

The woman was later granted bail having been represented by BID after being held in immigration detention for over a year.

The report states: “Despite Stephen Shaw’s recommendations and the Home Office’s response, the policy does not appear to have made any tangible improvement in the protection of vulnerable persons from harm in detention either in substance or practice.

“Indeed, we have observed a worsening of health in the cases examined through the application of the Adults at Risk policy. The stated objective of the Government’s response to the Shaw report was to reduce the number of vulnerable people detained and treat those in detention with dignity and respect.

“Instead we have seen that the onus has been placed on the vulnerable person to prove that other factors are outweighed by their vulnerability, even in circumstances where the vulnerable person’s ‘at risk’ status is evidentially supported by independent medical practitioners.”

Pierre Makhlouf, assistant director at BID, accused the Government of failing to meet the original intentions of the results of the Shaw Review, saying: “It instead equips the Home Office with more arguments to refuse people released when they are found to be vulnerable,” he said.

“It has introduced a categorisation of types of evidence, absolving the Home Office of any requirement to follow up evidence where it doesn’t meet a higher category. Instead, the lower categories are used as reason to refuse release, when in fact at the very least they should result in further enquiry.

“The intentions of the policy are being breached. The policy itself talks about reducing the number of vulnerable people detained, but the outcome of the policy is that the Home Office is able to continue to refuse peoples’ release.”

Lawyers at law firm Duncan Lewis said they have represented dozens of people who should “never have been detained” in the immigration centres, the majority of whom have been released with immediate effect following legal intervention.

Toufique Hossain, director of public law and immigration at Duncan Lewis Solicitors, said: “It has been clear since the Adults at Risk policy was introduced, supposedly as a response to the damning Shaw Report, that it is simply not fit for purpose.

“The policy has given the Home Office further justification to detain vulnerable individuals; including victims of torture, rape, trafficking and those with serious physical and mental health issues. We have represented dozens of men and women who should never have been detained, but were languishing in immigration removal centres until we intervened; after which they were generally released with immediate effect.

“We hope that this BID Report will serve as a sharp reminder to the Home Office that they are failing in their duty to safeguard vulnerable men and women from detention and that they urgently need to reconsider their approach.”

Dr Piyal Sen, from the Royal College of Psychiatrists, who specialises in the mental health of detainees, said the Home Office was too often putting the requirement of immigration detention above the immigrants’ mental wellbeing.

“While in rare cases the requirement for detention might override the mental health needs, the broad thrust of the Adults at Rick policy was set up to address serious concerns about mentally ill being detained. But this is not being applied the way it should,” he told The Independent.

“The Home Office is ignoring the evidence in a significant number of cases. Now we’ve got these guidelines set out very clearly, but they need to take more account of what the medical professionals are saying.”

Research shows that the detention of immigrants can have a highly negative impact on their wellbeing. A study by King’s College London earlier this year shows that the most prevalent screened mental disorder was depression, at 52 per cent, followed by personality disorder at 35 per cent and post-traumatic stress disorder at 21 per cent. Twenty-two per cent were at moderate to high suicidal risk.

From 2009 until the end of 2016, between 2,500 and 3,500 migrants have been in detention at any given time. On the basis that 52 per cent of immigration detainees have some mental health problems, there is therefore a total of 1,560 vulnerable people in detention at any one time – many of whom remain in there despite medical evidence that they are vulnerable.

The Royal College of psychiatrists has previously reported in a position statement that it is unsurprising that the prevalence of mental illness is high in immigration detainees, who are “likely to have experienced stressful life events that probably acted as predisposing factor to their mental illness”.

Asylum seekers and other migrants are sent to immigration removal centres when the Government wishes to establish their identities or facilitate their immigration claims. It is an administrative process, not a criminal procedure.

A Home Office spokesperson said: “Detention is an important part of our immigration system, helping to ensure that those with no right to remain in the UK are returned to their home country if they will not leave voluntarily.

“We operate on a presumption against detention, and the adults at risk policy aims to improve our approach to identifying individuals who may be particularly vulnerable to harm in detention.

“When people are detained this is for the minimum time possible, and the dignity and welfare of those in our care is of the utmost importance.”

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