Worried about someone’s deteriorating mental and physical health

Visitors can provide vital support to people in detention who are struggling with mental and/or physical ill health. Detention isolates people from their usual support systems, and visitors can support people to find new ways of coping and provide support, information and encouragement that can help people take action to change their situation.

Visitors are neither responsible nor - in general - trained to screen people in detention who are at high risk or especially vulnerable. As a visitor you are most likely to come away from visits or phone calls with a generalised but persistent feeling that the person you visit is not coping well or is in particular difficulty. You might find yourself worrying about them because of what they have told you about their circumstances or their health, or because of a change in their demeanour. If you are worried that the person that you are visiting is at risk of harm, your first port of call will be to your group coordinator or with the team at AVID, to share expertise, document your concerns and discuss the best way forward. It is best to identify emerging issues early on where possible. 

Medical Justice have suggested the following practical steps that visitors may be able to take, where appropriate, to assist someone with healthcare needs that are not being met in detention.

Visiting people in immigration detention is incredibly valuable. Your support and solidarity is likely to make a huge difference to the person you are seeing. It is also emotionally intense work and will likely expose you to witnessing distress, trauma and the impact of violent policies by the UK state. It is important that you consider and discuss with your visitors group what support you have in place for yourself.

When visiting someone you may have urgent concerns about their health or wellbeing. Your first port of call should be to discuss this with your visitors’ group coordinator who can provide advice and support you to take action as appropriate. You can also contact AVID for guidance. Your visitors group will have a safeguarding policy and policy on confidentiality in place which should also be followed. Make sure you discuss your visitor groups confidentiality policy as early on as possible – and re-iterating this when appropriate - with the person you are visiting so they know you may be discussing their situation with others, with who and in what circumstances.

If you are concerned about someone’s health or medical treatment:

• Establish the facts of the medical condition, any treatment, and any prescribed medication. If the person is happy for you to do so, you may consider requesting a copy of their healthcare records from the healthcare unit at the IRC where they are being held. This can be done, with the person's consent, by writing to the healthcare unit (see Access to Medical Information).

• Encourage the person to seek the advice through the healthcare facilities at the IRC, RSTHF or prison. Remind the person that they can ask to be examined by a doctor of their own gender. If they are unsure about any advice received or feel any treatment they are receiving is not working, encourage them to make another appointment. Most IRC healthcare units operate a nurse triage system, whereby it is relatively straightforward and quick to see a nurse, but there can be longer waits to see a GP.

• If you still have concerns that the person is vulnerable or that they are not receiving adequate or appropriate treatment, consider making a referral (with their permission) either through their solicitor or direct to Medical Justice via their online referral form. Medical Justice may be able to offer them advice or a second opinion for an external medical healthcare report. If you are unsure what to do, discuss with your visitors’ group coordinator, or call Medical Justice for advice. Caseworkers at Medical Justice are happy to discuss your concerns and suggest whether a referral to Medical Justice would be appropriate. Medical Justice can support people held in IRCs, RSTHFs and in prisons.

• If the person you are visiting has previously received treatment in the community (before being detained), it may be helpful for them, or - if they prefer - for you/someone else on their behalf, to speak to their clinician in the community. This is particularly important if there has been an interruption in provision of medication.

• Few people in immigration detention raise complaints when they are abused or unfairly treated. Where there are grounds for a complaint, it can be helpful to offer support with making the complaint. This should be discussed with your visitors group coordinator and you can read more about the NHS complaints system in this section of the AVID handbook (coming soon).

Adults at Risk Policy/Rule 35/32

• It is well recognised that detention can be harmful to a person’s mental and physical health. Some people are known to be particularly at risk, including people with a history of trauma. The Home Office accept that this is the case and have a policy on identifying people who are at risk of, or currently suffering harm in detention, in order to consider their release from detention.

• Some people have evidence of their health condition, trauma history of other vulnerability that they are able to submit to the Home Office (usually via their solicitor). Not everyone has this, and someone’s condition can change during their detention. The main mechanism for identifying people who this applies to in IRCs is called ‘Rule 35’ - equivalent to Rule 32 in RSTHFs – (see Healthcare safeguarding reports: Rule 35 and Rule 32). Rule 35 of the Detention centre Rules requires the GP at the detention centre to prepare a brief medical report (a ‘Rule 35 report’ using a template form) on any person in detention who:

  • (1) may be injuriously affected by detention

  • (2) in respect of whom there are suspicions that they are suicidal

  • (3) who may be a survivor of torture.

• If you suspect one of these criteria is met, it is important to raise this. This can be done by the person requesting a Rule 35 report, discussing appropriate steps with their solicitor or by you contacting the healthcare unit with your concerns (with their consent). It may also be helpful to refer them to Medical Justice. We suggest you discuss the most appropriate action with your visitors group coordinator.

Other practical steps that you can take are:

• You can help the person you are visiting to contact family and friends who can provide an important lifeline.

• Depending on the remit of the visitor group that you are part of you may be able to provide them with phone credit to facilitate communication with others or other forms of practical necessities.

• Encourage them to tell their legal advisor about their circumstances and current state of mental or physical health, explaining to them how this might help i.e. to identify further information for their application for release. With their permission, you can help facilitate communication with their lawyer, where this is a cause of additional stress.

• Help them with Finding a legal advisor if they do not have one.

• Explain how they can get independent help (for example an independent medical report, Samaritans, listeners in prisons, local authority adult social care assessment) and provide information on how to do this.

• Contact other Useful Organisations and specialist groups for advice with the permission of the person involved.