Resources for Secure Environments

• The BMA Report: Locked up, locked out: health and human rights in immigration detention (2017) report explores the role of doctors in protecting and promoting health-related human rights of detained individuals.
• Public Health England. NHS entitlements: migrant health guide (2014, updated 2020): All prisoners and immigration detainees are exempt from charges for healthcare. This guidance explains NHS entitlements in England for overseas visitors. There is separate guidance about NHS services for overseas visitors to Scotland produced by NHS Inform
• The Detention Centre Rules 2001 is a key statutory document which applies to IRCs (but not short term holding facilities). The rules set out the purpose of detention and what people in detention should have access to, including healthcare, welfare and privileges. Rules 33-37, 40 and 42 are particularly important to doctors and other healthcare staff.
• Detention Services Orders: All healthcare personnel working in immigration removal centres should familiarise themselves with the Detention Services Orders which provide further guidance on procedures in detention. Of particular importance (although not limited to):
  • Detainees who refuse to eat or drink
  • Detention Rule 35 process
  • Management of adults at risk in immigration detention

Though not directly relevant to healthcare personnel it is important for healthcare to understand how the Home Office deal with vulnerability and how Rule 35/32 reports fit into a larger system:

• Medical appointments outside the detention estate
• Medical emergency response codes
• Medical information sharing
• Pregnant women in detention
• Release of detainees from immigration detention
• Removal from association and temporary confinement
• Self harm reduction strategy – Assessment care in detention and teamwork

Further information on Rule 35

• Home Office:  Detention services order 09/2016 Detention centre rule 35 and Short- term Holding Facility rule 32 Version 7.0 (2019)

Rule 35 of Detention Centre Rules and Rule 32 of Short-term Holding Facility Rules aim ‘to ensure that particularly vulnerable detainees are brought to the attention of those with direct responsibility for authorising, maintaining and reviewing detention’. These rules stipulate that healthcare staff must report to Home Office caseworkers responsible for managing and reviewing a person’s detention:

• the likelihood of a detainee’s health being injuriously affected by continued detention
• a suspicion that a detained person has suicidal intentions
• concern that a detained person may have been a victim of torture

This Home Office guidance provides advice about the preparation and consideration of rule 35 and rule 32 reports. Doctors must complete rule 35 reports in IRCs. In Short-term Holding Facilities both doctors and registered nurses may complete rule 32 reports.

Mental Health and immigration detention

It is important that healthcare staff working in immigration detention are aware of the potential negative impact immigration detention can have on the mental health of immigration detainees (von Werthern et al (2018) & Bosworth, M (2016)). The limitations of immigration detention as a therapeutic environment are set out in the The Royal College of Psychiatrists “Position Statement on detention of people with mental disorders in Immigration Removal Centres”,