The adults at risk policy (AAR) is the key safeguarding policy that applies in immigration detention. It is underpinned by s59 of the Immigration Act 2016 which requires the Home Office to issue guidance on whether a person is particularly vulnerable to harm if they are detained, or remain in detention, and so to determine if they should be released. The overall approach is that the Home Office decision-maker weighs evidence of vulnerability against the immigration factors in the case to decide if detention is appropriate.
AAR governs the way that the Home Office is required to consider evidence of detained people’s vulnerability, and to consider how much weight to give this in decisions about detention.
These are the key questions for the AAR policy:
Has the individual been identified as being at risk of harm in detention?
What is the level of evidence of the person’s vulnerability and so their category of risk?
How should the person’s vulnerability which would argue in favour of their release, be weighed against other factors that could justify their detention?
AAR is clear that the Home Office has to approach these questions based on the individual circumstances of a person’s situation at the time that the decision about detention is taken. There is not a limit to how many times AAR can be applied to an individual’s situation. It can be re-applied whenever a decision on detention is required, where there is evidence they are vulnerable to harm.
The AAR Policy states that an individual is an “adult at risk” if:
“they declare that they are suffering from a condition, or have experienced a traumatic event (such as trafficking, torture or sexual violence), that would be likely to render them particularly vulnerable to harm if they are placed in detention or remain in detention”
The policy provides a list of categories of “conditions or experiences” which indicate a person may be vulnerable to harm in detention and so could fall within the scope of AAR. These are:
The person is “suffering from a mental health condition or impairment (this may include more serious learning difficulties, psychiatric illness or clinical depression, depending on the nature and seriousness of the condition)”.
The person “has been a victim of torture” as defined by Rule 35(6) of the Detention Centre Rules 2001 (see ).
The person has “been a victim of sexual or gender-based violence, including female genital mutilation”.
The person has “been a victim of human trafficking or modern slavery”.
The policy stresses that this list is not exhaustive and that there may be other conditions and experiences that fall outside of this list which render people vulnerable to harm if they are in detention. It also emphasises that “the nature and severity of a condition, as well as the available evidence of a condition or traumatic event, can change over time.”
Once a detained person is assessed as falling within the terms of AAR, the next question that informs the Home Office decision-maker is the level of evidence of their risk. There are three levels of evidence and broadly the policy is a balancing exercise: the greater the level of evidence of risk, the stronger the immigration factors that are needed in order to justify detention.
The evidence levels within the policy framework are:
Level 1: a self-declaration of being an adult at risk should be afforded limited weight in most cases, including where the issues raised cannot be readily confirmed.” This does not mean that a detained person needs to know the AAR policy to explain that they fall within it, just that they need to raise to an aspect of their vulnerability or risk of harm. The wording of the policy also states that where professional evidence is not immediately available observations from Home Office officials that lead to a belief that a person is at higher risk then they can be allocated to a higher category of risk.
Level 2: “professional evidence (e.g. from a social worker, medical practitioner or NGO), or official documentary evidence, which indicates that the individual is an adult at risk.”
Level 3: “professional evidence (e.g. from a social worker, medical practitioner or NGO) stating that the individual is at risk and that a period of detention would be likely to cause harm. For example, evidence that a period of detention or continued detention will increase the severity of the symptoms or condition that have led to the individual being regarded as an adult at risk.”
When considering “professional evidence”, the Home Office can decide to obtain their own report to determine the level of risk of detention in response to a report that has been obtained externally. Whilst they are obtaining such evidence the Home Office caseworker must still consider “the needs and circumstances of the person in detention in view of the evidence submitted.” i.e. the Home Office cannot simply wait to commission their own evidence about the risk of harm, a decision needs to be taken in the meantime about whether detention is appropriate.
A second complicating factor is that the Home Office caseworker is required to take into account any credibility issues that apply to the evidence submitted and this can reduce the category of risk. This provides caseworkers with a wide level of discretion as AAR states this includes “Determinations from courts or tribunals about the credibility of a person’s account or claims, or about professional evidence, or credibility concerns arising from other sources.”
AAR specifies the following factors should be taken into account when making a decision about the detention of a person who has been identified as at risk:
Length of time in detention
AAR is explicit that time considerations is one of the most important factors in favour of detention. Where removal or deportation is “likely to be within a short timeframe, an individual considered vulnerable under this guidance is likely to be able to be detained for removal notwithstanding the other elements of this guidance.”
The policy also reminds decision-makers of the approach needed to ensure a lawful decision to detain[1]. More explanation of how the Home Office can lawfully exercise powers of detention is included in in .
Are there any public protection issues?
This is widely defined but includes people with a criminal history, those considered a security risk, and people subject to a court decision that they are to be deported for the public good.
Compliance issues
The Home Office decisionmaker makes an assessment of the individual’s risk of absconding, based on their previous compliance record.
This table illustrates the immigration factors which the evidence (depending on its level) are balanced against, to decide whether detention is justified:
[1] The summary of the legal position on the detention of people who are recognised as vulnerable according to AAR is set out in the policy as “where detention is for the purpose of removal or deportation, there must be a realistic prospect of removal within a reasonable period. Where detention is for any other statutory purpose, it must be for a period considered reasonable for that specific statutory purpose of detention. In accordance with section 12 of the Illegal Migration Act 2023, it is for the Secretary of State to determine what constitutes a “reasonable period” of detention and this period will vary according to the particular factors of a case (including whether or not the individual is considered vulnerable) and the specific statutory purpose of detention. When considering continuing detention, the period of detention to date should be factored in when determining whether a further period of detention is reasonable. In all cases, every effort should be made to ensure that the length of detention is as short as possible. Where detention is for the purpose of removal or deportation, it should be possible to estimate the likely duration of detention required to effect removal or deportation. Where removal or deportation is likely to be within a short timeframe, an individual considered vulnerable under this guidance is likely to be able to be detained for removal notwithstanding the other elements of this guidance.”
In 2015, there were several high profile reported legal cases in decisions by UK courts which ruled that detention in the UK had amounted to inhuman and degrading treatment, i.e. very serious breaches of the European Convention on Human Rights. These arose from a series of instances where people with serious mental illnesses, some requiring hospital treatment under the Mental Health Act 1983, had suffered a deterioration in their mental state because of detention. This included symptoms such as suicidal feelings, self-harming and psychosis. Common themes in these cases were inadequate healthcare facilities in immigration removal centres, deficient medical assessments and a lack of consideration of the harmful effect of detention when decisions were taken by Home Office caseworkers about whether release of the person was required.
This led the Home Office to commission Stephen Shaw, a former Prisons and Probation Ombudsman for England and Wales, to carry out a review into the policies and procedures affecting the welfare of people in immigration detention.
Prior to Stephen Shaw’s contribution, the Detention Centre Rules 2001 were the primary basis for deciding whether a person should be detained. These comprise three categories of individual:
(i) People whose “health would be injuriously affected by their detention.”
(ii) People who were experiencing “suicidal intentions.”
(iii) People who “may have been the victim of torture.”
These and other categories of people deemed to be generally unsuitable for detention were set out in a now withdrawn policy document, the ‘Enforcement Instructions Guidance’ which explained how Home Office caseworkers needed to factor such information into detention decisions. The general approach of the wording of the guidance was that people who fell within the guidance should not be detained unless there were exceptional circumstances. This meant a general presumption against detention that could only be overridden by the person’s individual immigration situation such as imminent removal or concerns that they were a risk to the public.
Stephen Shaw’s review developed an entirely different approach to understanding the risk of detention to detained people. He sought to introduce a much wider notion of ‘vulnerability’ as a concept in detention and to recognise all detained people are vulnerable:
“I believe the notion of ‘vulnerability’ is best understood as a dynamic term… vulnerability is intrinsic to the very fact of detention and an individual’s degree of vulnerability is not constant but changes as circumstances change.”
When the review was originally commissioned, Stephen Shaw was offered a broad scope to considering the position of detained people, with the discretion to expand the issues he wanted to address. He was specifically asked by the Home Office to address the policies and systems designed to:
identify vulnerability and appropriate action
provide welfare support
prevent self-harm and self‐inflicted death
manage food and fluid refusal safely without rewarding non-compliance
assess risk effectively
transmit accurate information about detainees from arrest to removal
safeguard adults and children
manage the mental and physical health of detainees.
Importantly however, the review was limited to analysis or recommendations about policies that applied to people in immigration detention, rather than the wider legal framework for the use of immigration detention powers in itself.
Steven Shaw made a number of formal recommendations in his report; for full details the 349 page report is available here: website. The report is wide-ranging and made a number of key findings and 64 recommendations. From a policy perspective one of the most significant developments was an academic literature review completed by Professor Mary Bosworth, commissioned as part of the review. This identified a clear link between detention and adverse mental health outcomes for detained people and showed that the harmful impact of detention increased with longer periods of incarceration.
A further key policy development from the Shaw Review was a recommendation that the Home Office should expand its limited category-based approach of vulnerability and recognise that such categories are not exclusive; that people who do not fall within such a framework may still be vulnerable and this should be recognised in decisions about whether to detain/continue to detain someone. Other key recommendations included the inclusion of a gatekeeping function to review the situation of individuals before they are placed in detention and a replacement to the current arrangements for assessments completed by GPs in detention (a process known as Rule 35 [further explained in Healthcare safeguarding reports: Rule 35 and Rule 32). Stephen Shaw concluded that Rule 35 assessments need to change because they did not fulfil their purpose of protecting “vulnerable people who find themselves in detention – and that the fundamental problem is a lack of trust placed in GPs to provide independent advice”.
Ultimately, Stephen Shaw’s review led to the Home Office’s publication of AAR in May 2016. The original policy included the overarching aim (now withdrawn) that it’s application would “lead to a reduction in the number of vulnerable people detained, to a reduction in the length of time for which people are detained generally, to a quicker and more efficient use of the detention estate and, as a result, to an improvement in the welfare of those detained.” It was also clear that the original purpose of the policy was to strengthen the presumption that where an individual was regarded as being at risk, they should not be detained, whilst also setting out the factors that could weigh in favour of their detention. It set up a process of three levels of evidence of the risk of harm set against immigration factors to allow for a balancing exercise of this information to be undertaken by Home Office decision-makers to take detention decisions. [This three tier balancing process remains true to the original policy. The current version of the AAR policy is described in more detail above.]
Since AAR is the key safeguarding policy that governs decisions about detention and people at risk of harm from their incarceration it has been highly contentious; as well as subject to regular external reviews and amendments by the Home Office.
The person is “suffering from post-traumatic stress disorder (which may or may not be related to one of the above experiences)”.
The person is pregnant.
The person is “suffering from a serious physical disability, suffering from other serious physical health conditions or illnesses.”
The person is aged 70 or over.
The person is transgender or intersex.
Evidence
Weight given by the Home Office decision-maker about the risk of harm when considering whether detention is appropriate
Immigration Factors
Level 1: A self-declaration of being an adult at risk
Limited weight
Where detention is for the purposes of removal, “the date of removal can be forecast with some certainty” and is “within a reasonable timescale given the logistics involved”.
Any public protection issues are identified.
Indicators of non-compliance with immigration law “which suggest that the outcome sought by detaining the individual would not be achieved without the detention of the individual.”
Level 2: Professional evidence stating that the individual is an adult at risk.
Greater weight than a self declaration/ level 1 category of risk
“Where detention is for the purposes of removal, the date of removal is fixed, or can be fixed quickly, and is within a reasonable timescale and the individual has failed to comply with reasonable voluntary return opportunities” or if the individual is being detained having been refused entry to the UK.
There are public protection concerns (e.g. previous conviction) that justify detention.
Indicators of non-compliance which suggest that the individual is highly likely not to be removable unless detained. Less compelling evidence of non-compliance should be taken into account if there are also public protection issues.
Level 3: Professional evidence that the individual is an adult at risk and that detention will likely cause them harm
Significant Weight
Detention should only occur if one of the following applies:
Removal has been set for a date in the immediate future, there are no barriers to removal, and escorts and any other appropriate arrangements are (or will be) in place to ensure the safe management of the individual’s return and the individual has not complied with voluntary or ensured return.
The individual presents a significant public protection concern, or if they have been subject to a 4 year plus custodial sentence, or there is a serious relevant national security issue or the individual presents a current public protection concern.
The current AAR guidance came into force on 21st May 2024. Regrettably, the present AAR policy represents a substantial change from the original since it has been significantly watered down in the following ways:
The purpose and principles which underpin the policy no longer state the intention is a reduction in the number of vulnerable people detained and that, where detention is necessary, it will be for the shortest period possible. It instead places the policy within the context of tackling “illegal” migration and section 12 of the Illegal Migration Act (that detention is for the period the Secretary of State considers necessary for removal to take place) stating "there is no exemption from detention for any category of vulnerable person within this guidance".
In making an assessment against immigration factors, it removes the presumption that, once an individual is regarded as being at risk, they should not be detained. The updated guidance simply states that immigration and risk factors should be balanced.
It strengthens the weight of “credibility concerns” from courts, tribunals or other sources to state that this should (previously the wording was “may”) be taken into account to decide the evidence level. This takes away the ability to reconsider previous judgements due to, for example, new evidence being submitted.
It removes, from the indicators of risks, that victims of torture "with a completed Medico Legal Report from reputable providers will be regarded as meeting level 3 evidence, provided the report meets the required standards". Instead, it introduces new options for the Home Office to obtain a second professional opinion from a Home Office contracted doctor where professional external evidence has been submitted.
It states that people will “normally” (previously the wording was "will") be considered at a particular evidence level where they meet the relevant criteria making the policy more vague and more easily misused.
In a positive step it changes the use of “transexual” to the more inclusive term “transgender” in indicators of risk.
Overall, the result of these changes is likely to be that more people who are particularly vulnerable to harm in detention are detained and for longer periods.
A further reduction in the transparency of Home Office decision making and procedures continues due to the cancellation of the ICBI annual reviews of AAR. This represents a serious lack of understanding about how AAR is operating as there is no other external mechanism able to access Home Office data in this way.
AAR is presently the subject of a consultation by the Home Office published in March 2025. This is expected to be finalised by the end of the year. AVID along with our members and other partners have contributed to this consultation process.
Future Watch
Look out for the end of the Home Office consultation process to see whether there are changes to AAR and healthcare’s role in screening and reporting on vulnerability.
Look out for whether the newly appointed ICBI recommences reviews of the Adults at Risk policy.
Stephen Shaw was commissioned by the Home Office to undertake a follow-up review, which was published on 24th July 2018 and is available here: website. This was a process he informally referred to as ‘marking the Home Office’s homework’ but the stated purpose of the second review was to consider the extent to which the Home Office had adopted the recommendations included in his first report and to assess what impact this had in practice.
This second review included detailed evidence from NGOs working in detention or with detained people about the introduction of AAR which was summarised as “almost all of the interested parties making submissions to this review expressed concerns that the aims of AAR had not been realised in practice. Many argued that the previous policy … represented a stronger safeguard.”
AVID submitted evidence to Stephen Shaw which was quoted in the review. Our concerns were that the new policy had not achieved its aim of reducing the number of vulnerable people identified in detention or the length of their incarceration. In fact, the new approach placed a greater evidence burden on people detained to demonstrate their vulnerability as well as giving greater weight to immigration factors to provide justification of their detention:
“The new Adults at Risk (AAR) policy increases the burden of evidence on vulnerable people and balances vulnerability against a wide range of immigration factors. We, like other NGOs, are concerned that this leads to more vulnerable people being detained for longer... Unlike previous policy guidance, the new policy introduces the concept of ‘balancing’ or weighing up vulnerability factors to be carried out by those making the decision to detain… This is then weighted against immigration factors, such as length of detention, public protection issues and compliance issues, or a late asylum claim. It is important to note that a late asylum claim or other poor ‘immigration factor’ related to immigration history may be directly related to, or a consequence of, someone’s vulnerability, the experience of trauma, or the mental ill health they experience. There is no requirement for the decision maker to provide evidence that this detention may be injurious to health of the person being detained: the burden of proof falls disproportionately on the person being considered for detention. Imposing an additional evidential burden in this way is inconsistent with the objective to reduce the numbers of vulnerable people detained; we are worried that it is leading to more vulnerable people being detained for longer, because they cannot provide adequate ‘evidence’...” (AVID)
In his second review, Stephen Shaw recommended a more nuanced approach to assessing the level of risk contained in AAR. He also made recommendations about the wording of some categories of groups of people. He identified continued concerns about the operation of Rule 35 healthcare assessments and recommended that AAR should have greater openness and external scrutiny. This led to a formal recommendation that the Independent Chief Inspector of Borders and Immigration (ICBI) should be invited to report annually to the Home Secretary on the working of operation of the policy. The Home Office did not accept all of the recommendations but did accept the need for annual review of the policy. Overall, Stephen Shaw stated that AAR represented a “cultural change” and so needed time to reach fruition. His view then was it was a work in progress.
The Independent Chief Inspector of Borders and Immigration (ICBI) is an organisation, which is responsible for monitoring and reporting on the immigration, asylum, nationality and customs function of the Home Office. The organisation also has a democratic function as its reports are laid before Parliament. It is set up to look at systemic issues, rather than investigate individual cases. More information about the Chief Inspector’s role and work is available on the ICBI .
The ICBI has undertaken several reports specifically concerning AAR:
First report published April 2020:
Second report published October 2021
Third report published January 2023:
These reports share common themes concerning the operation of AAR. They can be broadly summarised as concerns about the lack of robustness of Home Office data concerning its use of detention powers and particularly the operation of AAR, problems of access to quality medical assessments prior to and throughout detention that would support AAR to operate effectively, and criticism of the process, reasoning and evidence behind decisions to detain vulnerable people at all stages of the detention process. A further recurrent issue was a culture of disbelief within the Home Office and that notions of vulnerability were exploited by detained people and those supporting them to undermine immigration removal processes.
Regrettably, in January 2023 Suella Braverman, at the time the Home Secretary, ended the commission of annual inspections by the ICBI to review AAR. This was subsequently addressed by David Neal the Chief Inspector of Borders and Immigration at the time in a letter published by the Guardian in September 2023: . He expressed frustration at the lack of engagement by the Home Office with his previous reports and the “defensiveness” of the organisation. He advised the then Immigration Minister Robert Jenrick that “the system – specifically the mechanism through which medical staff at immigration removal centres can bring vulnerability concerns to the attention of Home Office officials effectively – was not working” and the response was to terminate annual inspections.
The Brook House Public Inquiry was set up in the wake of footage obtained by an undercover journalist (then a G4S custody officer) between 1 April 2017 and 31 August 2017 showing violence and abuse against detained people held at Brook House IRC and disturbing treatment of overtly vulnerable people. Live evidence was heard in public in hearings held between November 2021 and April 2022 to examine both the circumstances in 2017 as well as current practice in detention. The report was published on 19 September 2023 and is available at:
The report found serious safeguarding failings at Brook House IRC and the Chair of the Inquiry – Kate Eves - found 19 incidents, in the short period of five months when the undercover footage was recorded, in which there was credible evidence of acts or omissions that were capable of amounting to mistreatment contrary to Article 3 of the ECHR[1]. Safeguarding failings included poor quality medical assessments, poor record-keeping, a lack of understanding amongst healthcare staff of their safeguarding obligations and inadequate Home Office practice when considering detention. The Chair concluded that AAR was disconnected from other safeguarding processes and that detained people experiencing suicidal feelings and self-harm were allowed to deteriorate.
“There was no recognition that a holistic view needed to be taken in relation to self-harm and suicide risk, and that the various processes should be complementary. This undoubtedly exposed vulnerable people to a risk of harm and, in some cases, caused actual harm to be suffered. I remain gravely concerned about the dysfunction in the operation of these layers of safeguards. Based on the evidence I have seen throughout this Inquiry, vulnerable people in detention are not being afforded the appropriate protections that these safeguards are designed to provide.” (Kate Eves)
In 2019 two parliamentary committees published reports that included trenchant conclusions concerning AAR.
published January 2019
“The Adults at Risk policy does not give adequate protection to individuals at risk of harm in detention either by way of policy or practice… More needs to be done to identify vulnerable detainees and treat them appropriately.”
report published March 2019
“The Adults at Risk (AAR) policy is clearly not protecting the vulnerable people that it was introduced to protect. Instead, by introducing three levels of evidence of risk which are then weighed against a broad range of immigration factors, the policy has increased the burden on vulnerable people to evidence the risk of harm that might render them particularly vulnerable if they were placed or remained in detention... We are concerned that the AAR policy is not only failing to protect vulnerable people but, by introducing a requirement for individuals to provide evidence of the level of their vulnerability risk in detention, has significantly lowered the threshold for Home Office caseworkers to maintain detention of those most at risk.”
There have been various reports from organisations and NGOs working with people in immigration detention and with direct experience of the operation of AAR, adding to the extensive evidence of the flaws with this policy.
, a research project completed by Women for Refugee Women published in 2017, one year after the introduction of AAR identified the flaws in the policy that were subsequently confirmed by the ICBI and the Brook House Public Inquiry. In their research Women for Refugee Women interviewed 26 survivors of sexual and gender-based violence and found these individuals were subject to detention despite their history of trauma, experience of mental illness and the fact that their mental state had deteriorated in detention. The data in the report also included information that the women they interviewed had been detained for significant periods of time, with difficulty in accessing the medical evidence needed for AAR to take effect. Even where such evidence was available, this did not result in their release from detention.
Bail for Immigration Detainees (BID) completed an of AAR published in 2018. This involved an analysis of 30 of their casework files which included an indicator of vulnerability that should have triggered application of AAR. The data showed a failure to collect information on indicators of risk before detention, with subsequent processes undertaken after the individual had been detained also failing to collate evidence of vulnerability. These two issues meant that AAR was not effective. There was also evidence that Home Office decision making did not take account of changes in risk over time and instead prioritised immigration factors to justify detention.
undertaken by the University of London, School of African and Oriental Studies and published in the journal Migration Studies in 2020: ‘What Are We Afraid Of? Exploring Risk and Immigration Detention” (Lindley) also addressed AAR. This analysed both Home Office published data, wider research articles and interviews with 20 lawyers and NGO staff familiar with the safeguarding processes from working with people in immigration detention. This again found Home Office decisionmakers prioritising immigration issues to justify detention with detained people struggling to access evidence of their vulnerability: “Immigration officers doggedly insist on reasonable removability, the core rationale for detention, often in the face of substantial legal and logistical obstacles. Concerns arise in relation to low standards of evidence used to support claims about immigration control risks. This contrasts with a demanding approach to evidence of individual vulnerability to harm in detention, and a system still poorly equipped to assess this effectively.”
Medical Justice have published numerous reports on the failures of the Adults at Risk policy. One such report in 2022: concluded that whilst AAR purported “to offer more protection to vulnerable people, it instead set up a complex new system which permitted greater scope for Home Office caseworkers to justify the continued the detention of those at risk.” The report analysed 45 examples of people with independent medico-legal reports completed by clinicians working with the charity to assess the effect of detention on people detained between July and December 2021. The research identified ineffective healthcare assessments and other inadequate safeguarding processes which undermined access to the evidence needed to ensure AAR could properly operate.
Stephen Shaw undertook a role as Chair of an Advisory Panel to the Home Office established in 2019. His first was completed in March 2022, but published by the department some years later in January 2025. The Panel’s role was internally focussed: to provide an overall steer on the research direction, to shape future evaluation priorities, provide guidance and advice on evaluation issues and provide a first opportunity for the Home Office to share and scrutinise emerging internal findings. The published report acknowledges some significant methodological limitations in terms of its inability to scrutinise the quality of the Home Office’s internal data but made some broadly positive findings about the operation of AAR. The only external element of the report comprised university research access to administer a questionnaire addressing issues of quality of life in detention.
A summary of the external researchers’ conclusions is available here: . This indicated “…detainees exhibited high levels of vulnerability and distress… Notwithstanding the Adults at Risk policy, detainees report experiences of victimisation including torture, domestic violence, rape, trafficking and other traumatic events…… the duration of a person’s detention significantly affects their well-being, with scores showing levels of distress increase the longer people are in detention, raising questions about case management and how detention could be limited in duration.”
[1] Article 3 of the European Convention on Human Rights applies where a state has subjected individuals to torture, inhumane or degrading treatment and is a key means of protecting human dignity. Any suggestion of a breach represents one of the most serious findings against a state.