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Policy and practice

An Overview

Initial detention decision by the Home Office gatekeeper before a person is detained under immigration powers.

Either the person is already identified as an adult at risk and information about their level of risk is provided to the gatekeeper
Or the gatekeeper makes a decision about the whether the person falls within the adults at risk policy based on the information held on the Home Office file.

The gatekeeper then decides whether the person should be detained applying the

People detained in a SHTF or and IRC have an initial review by a nurse within 2 hours of arrival.

Rule 30/ Rule 34 assessment

Rule 35/32 Reports

Summary of the Home Office’s approach to people’s vulnerability in detention

The Home Office’s general policy on identifying vulnerability is to move away from a category-based approach. So technically any information that could be an issue of vulnerability will be considered. But the categories below are particularly relevant to visiting people in detention as they have particular policies that apply to them.

People with mental illness either on arrival or who develop one whilst in detention. People whose mental health deteriorates in detention.

R35/32(1) report is required where a person’s health is likely to be injuriously affected by continued detention or the conditions of detention.

This triggers a review of detention by applying the Adults at Risk policy.

People with a history of trauma that means they are recognised as victims of torture or trafficking/ modern slavery.

R35/32(3) report is required where there is concern the detained person may have been the victim of torture.

This triggers a review of detention by applying the Adults at Risk policy.

First responder organisations have a duty to refer to the National Referral Mechanism. If a person receives a reasonable grounds decision from the Immigration Enforcement Competent Authority this triggers a review of their detention on the basis that they will be considered at least at level 2 under AAR.

It is worth remembering that people can also be in a situation where more than one category that applies to them.

Ad hoc safeguarding policies that monitor vulnerable people in detention and so identify their vulnerabilities but do not specifically trigger a review of whether the person should be held in detention

Adults at Risk Policy (AAR)

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.

1. Does the individual fall within the AAR policy because they have been identified at risk of harm in detention?

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.”

2. What is the level of evidence of the person’s vulnerability and so their category of risk?

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.”

3. 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 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:

Key Documents

AAR has been in force since 26 May 2016 with various amendments since then. A full discussion of the background to the policy and its changes is included in the next section.

The most up to date wording of the policy is published on the government and it is worth checking for changes.

The AAR policy is underpinned by the DSO setting out how it should operate: Management of adults at risk in immigration detention, also available on the government .

[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.”

Background to the Adults at Risk Policy

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

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: . 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 ). 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.

Ongoing Criticisms and Developments

Review of the implementation of AAR by Stephen Shaw in 2018

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.

Annual reports on AAR by the Chief Inspector of Borders and Immigration

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.

Brook House Public Inquiry

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)

Parliamentary oversight of AAR

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.”

Research on AAR

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.

Evaluation report completed by Stephen Shaw published in 2025

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.

Present position of the AAR and oversight

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.

Potential changes to AAR

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.

Healthcare screening, assessment and monitoring

Healthcare screening and assessment runs throughout policy and process documents for immigration detention. This is because medical appointments gathering clinical information for detained people have a dual purpose. Firstly, to ensure people can access medical care whilst detained. But secondly as such information is central to Home Office’s decisions about the risk of harm caused by the detention environment and so considering if that person should be detained at all.

Since healthcare assessments and communication between clinicians and the Home Office is key to understanding safeguarding in detention it would be useful to read this section with the information on the Home Office’s Adults at Risk Policy (AAR).

Healthcare professionals in detention also have a role in monitoring people identified as at risk. This includes situations involving risk of self-harm or suicide, segregation and food or fluid refusal. The policies relating to these areas are set out in the individual sections of the handbook addressing these issues.

Overview of the key structure of assessment and monitoring

The most important processes to understand that apply to all people in immigration detention centres are set out below. Please note that they do not apply to people held in prisons under immigration powers.

Screening single medical appointments for people on arrival

Rule 30 STHF Rules/ Rule 34 Detention Centre Rules 2001 sets out the process for offering a healthcare appointment by a clinician within 24 hours of arrival into each place of immigration detention.
Rule 32 STHF Rules/ Rule 35 Detention Centre Rules 2001 sets out the process that requires medical safeguarding reports to be completed by a clinician and sent to the Home Office to trigger a review of the person’s detention.

People recognised as an adult at risk under AAR

As set out in the Detention Service Order (DSO) on Management of Adults at Risk (December 2024), all people identified as having vulnerabilities that “may impact on the safety and wellbeing” of that individual should have a vulnerable adult care plan (VACP) completed to document this and any “reasonable adjustments” made in response to their situation if they are held in an IRC.

This sets out the process for making a care plan and subsequent decisions such as the level of monitoring the person will be subject to and any closure of the plan. The policy includes requirements for healthcare staff to be involved in key aspects of the care planning process. It is worth noting that a copy of the care plan should be offered to the detained person. In addition, where a care plan is opened limited information about the person’s situation is shared with the Home Office via an internal form called IS91RA Part C. This is a process for information sharing with the Home Office but does not require any review of whether the individual should be detained.

Healthcare screening and assessments as an aspect of triggering a review of detention

Overview

Both IRCs and STHFs have a broadly similar approach whereby an initial medical appointment should be offered shortly after arrival at that detention site. This appointment should offer the possibility that the clinician will raise safeguarding concerns in a Rule 32/35 report which can trigger a review of detention by the Home Office. The basis under which healthcare staff should draft these reports is the same regardless of whether the detention site is an IRC or a STHF.

The main legal and policy framework for the role of healthcare in identifying safeguarding information is set out in the (DCR 2001) which apply to IRCs and the (STHF Rules 2018) that concern STHFs. These two documents are underpinned by dated March 2019 (the guidance) which gives further detail about how the two sets of Rules should be applied.

Rule 34 DCR 2001 (i.e. the process that applies to IRCs) states:

“Medical examination upon admission and thereafter

34.

(1) Every detained person shall be given a physical and mental examination by the medical practitioner (or another registered medical practitioner in accordance with rules 33(7) or (10)) within 24 hours of his admission to the detention centre.

(2) Nothing in paragraph (1) shall allow an examination to be given in any case where the detained person does not consent to it.

(3) If a detained person does not consent to an examination under paragraph (1), he shall be entitled to the examination at any subsequent time upon request.”

This means detained people at an IRC must be offered an appointment with a GP (this is the definition of a ‘registered medical practitioner’ as set out in Rule 33(1) of the DCR 2001) within 24 hours of their arrival to the detention centre. It also explains that if a detained person refuses this initial offer, they can change their mind at a later date and request an appointment. People in detention are also entitled to be examined by a GP of the same sex, under Rule 33(10) DCR 2001.

Rule 30 of the STHF Rules 2018 (i.e. the process for short-term holding facilities) states:

“Medical screening

30.

(1) Subject to paragraphs (2) and (4), a detained person must be screened by a healthcare professional within two hours of admission to a short-term holding facility.

(2) A detained person's consent must be obtained before screening.

(3) Subject to paragraph (4), a detained person is entitled, if they so request, to be screened only by a health care professional of the same sex and the manager must ensure that a detained person is aware of that entitlement prior to any screening.

(4) In the event that a healthcare professional of the same sex is not available within the two hour time period, the manager must ensure that the screening is conducted as soon as practicable.”

Identifying concerns at healthcare screening on arrival

There is guidance on the approach to reception and induction that applies to both IRCs and STHF. For safeguarding purposes, the guidance is clear that a detained person should be seen within two hours of arrival for an initial healthcare screening. The guidance requires the clinician completing this exercise to:

identify any medical needs
consider if reasonable adjustments[1] are needed
note if mobility aids are required
consider if a single occupancy room is medically indicated

[1] This is widely defined in the Vulnerable Adult Care Plan policy as identifying any “reasonable adjustments that can be made to mitigate any identified risks or vulnerabilities. Extra support provided to the individual can include assistance with mobility, assistance with medication or attending medical appointments, regular observations or any other adjustment that will help the individual overcome the impact that such vulnerabilities may have on his or her experience of detention.” The itself gives examples of conditions and disabilities such as reduced mobility, learning disabilities, speech or hearing impairment, dyslexia and severe disfigurement.

Healthcare safeguarding reports: Rule 35 and Rule 32

Any clinician assessing a detained person has a duty under either Rule 35 DCR 2001 or Rule 32 of the STHF Rules 2018 to complete a report if any of the following apply:

(1) The detained person’s “health is likely to be injuriously affected by continued detention or any conditions of detention”

(2) The clinician “suspects [the detained person] of having suicidal intentions”

(3) The clinician is “… is concerned [the detained person] may have been the victim of torture”

There is a distinction as the DCR 2001 which apply in IRCs require that these safeguarding reports can only be completed by a GP. In STHF, the 2018 Rules that apply there, allow both nurses and GPs to complete them.

The safeguarding reports are commonly referred to by the number of the Rule (i.e. Rule 35) and the corresponding number of the individual circumstances (i.e. 1, 2 or 3 of the sub-headings above). For example, a ‘Rule 35(1) report’ is one completed by a GP at an IRC who considers that their patient’s health will be adversely affected by detention. Or a ‘Rule 32(3) report’ which would be completed by a nurse at a STHF concerned that their patient had disclosed a history of torture.

The guidance states that where a detained person falls within more than one category, the clinician must complete a separate report for each element of R35/32. Each time a report is completed a copy must be given to the detained person.

A key aspect to understand about the healthcare safeguarding reporting process is that the only standard time that a detained person will be considered for a Rule 35 or Rule 32 assessment is following their arrival in a place of detention, i.e. when they are offered screening when they are taken into detention or if they are transferred within the detention estate.

However, it is possible for the detained person to request a Rule 35/32 assessment at a later stage in their detention, although there is no time limit for any such appointment to be arranged. It is also possible for clinicians in STHF or IRCs to complete an assessment and safeguarding report of their own volition, but this is dependent on training for clinicians to recognise the need for this, rather than policy itself that timetables such an assessment.

Types of Rule 32/35 safeguarding reports

R35/32(1) report: a person’s health is likely to be injuriously affected by continued detention or the conditions of detention

Where a clinician considers that the person’s health is likely to be worsened by detention then they need to complete set out in the guidance. This requires an explanation of the following issues:

“Why is the detainee’s physical and/or mental health likely to be injuriously affected by continued detention or the conditions of detention?”
What treatment is the detainee receiving? Is specialist input being provided, either within the IRC/STHF or as a hospital outpatient or inpatient?
In the case of mental health problems, has there been a detailed mental health assessment and, if so, carried out by whom and with what result/recommendation? If not, is an assessment scheduled to take place and, if so, when?
What impact is detention or the conditions of detention having (or likely to have) on the detainee’s health and why?

R35/32 (2) report: the clinician suspects the detained person of having suicidal intentions

Again, there is that clinicians are required to complete. This addresses the following issues:

Please state the reasons for suspecting that the detainee has suicidal intentions?
Is the person detained being managed under Assessment Care in Detention Teamwork (ACDT) arrangements? If not, why not?
Can the suicide risk be managed/reduced satisfactorily through ACDT, medication and/or appropriate interventions such as talking therapies?
What arrangements might be needed to manage the detainee’s suicide risk in a non-detained setting?

R35/32 (3) report: the clinician is concerned the detained person may have been the victim of torture

The explanation of the concept of torture has been the subject of litigation, but the requires the clinician to focus on whether the person was in a situation of powerlessness.

The definition of torture included in the guidance is ““Any act by which a perpetrator intentionally inflicts severe pain or suffering on a victim in a situation in which

(a) the perpetrator has control (whether mental or physical) over the victim, and

(b) as a result of that control, the victim is powerless to resist.”

The template report requires the clinician to explain the detained person’s account of their torture including, if possible “when, where, how, over what timeframe and why the torture is said to have happened.” The form seeks to gather both the detained person’s account of their experience (as well as their explanation of any injuries, scarring or physical or psychological symptoms caused by this) and also a brief medical assessment. The report requires the clinician to provide details of their own observations and findings concerning their patient including:

“details of all scarring or other physical marks, psychological symptoms, physical disability or impairment.
details of any medical or professional treatment or support that the detainee has received (including outside the UK) or is receiving and from whom.
any information in respect of previous or current physical or mental health problems which may be a result of having been tortured.”

The complexity of this assessment is underlined by the guidance that accompanies Rule 32(3) / Rule 35(3) reports which also requires the clinician to include an explanation of whether the “torture allegation” derives from “low or limited evidence” in support of the person’s account. The Adults at Risk Guidance (January 2025) gives more detail about how a clinician should approach assessing whether a person is a victim of torture.

Actions once a Rule 32/35 report has been completed

Any time a Rule 35/32 report is made the detained person must give consent to share this information with the Home Office.[1] If consent is not given then the report goes no further and there is no review of detention. A detained person must also be given a copy of the report.

If consent to share the report is given, it is sent by healthcare to the Home Office. The guidance sets out in some detail the internal process within the Home Office for circulating this information, documenting that this has happened and assessing whether the relevant information is contained in the report. The Home Office must review the person’s detention (by applying the AAR policy) by the end of the second working day after receipt of the report. This triggers a decision to either maintain detention or release the individual, with an accompanying obligation to provide a written response to the detained person, their legal representative (if they have one) and to the detention site’s healthcare. Further, under the guidance, clinicians have a responsibility to escalate their safeguarding concerns if they do not think their concerns have been properly addressed by the Home Office.

Independent medical reports

Detained people are entitled to be seen by their own doctor under Rule 33 (7) DCR 2001 or Rule 31(7) STHF 2018 subject to the discretion of the detention site’s manager. This means in practice that an independent clinician (usually organised by an NGO or a legal representative) should have access to see a detained person in order to complete a medical assessment and report. This is a core aspect of the work undertaken by Medical Justice who can organise of an independent medical assessment for people in detention. These medical assessments when written up are often known as medico-legal reports as they are drafted by the clinician to explain their findings with input from people with legal training.

The guidance states that where reports from “third parties about a detainee’s health or allegations that they are the victim of torture” are received, as a matter of best practice these documents should be sent to the detention site’s healthcare practitioner who should review whether or not to make a Rule 32 or 35 report. Independent medical reports should also be sent to the Home Office decision-maker who will review this evidence in light of AAR and so decide whether the person should be released, but the guidance is silent on the timeframe for this decision except to say they are not subject to the same strict timetable as when a Rule 32/35 report is provided.

Where an independent report states a detained person is feeling suicidal then this needs to be brought to the immediate attention of IRC/STHF healthcare and the Home Office.

The importance of Rule 34 screening in conjunction with Rule 35/32 assessment and reporting

Caselaw has established the importance of Rule 34 and Rule 35 in ensuring that detention is lawful in individual circumstances. The Courts have been clear that there is an obligation on detaining authorities to provide a mechanism to ensuring safeguarding happens.[2] This includes medical assessments which identify people who fall within the terms of Rule 35/32 and so trigger a review of detention. Where no such assessment was offered, or the Home Office decision-makers did not properly consider a medical report in accordance with policy, then the person may be unlawfully detained. If the person remains in detention at the time of the court’s decision, then the judge can order the release of the individual. People who have been unlawfully detained are also likely to be entitled to financial compensation.

[1] There is (May 2016) on sharing of information in these circumstances

[2] R (on the application of D and K) v. Secretary of State for the Home Department [2006] EWHC 980 (Admin)

Challenges and concerns about reporting under Rules 32/35

Widespread failings within immigration detention to safeguard people are well documented, with fundamental flaws identified at each stage of the process. Safeguards are not considered by specialist organisations or official reviews to offer satisfactory protection to people in detention. Individual examples of failures in safeguarding decisions regularly form the basis of successful legal claims against the Home Office. These systemic shortcomings are also regularly mirrored in the experience of visitors groups and testimonies of people in detention.

Concerns about the Home Office’s key safeguarding policy: Adults at Risk (AAR) are set out in Ongoing Criticisms and Developments.

This section concerns the role of healthcare departments in identifying people who are particularly at risk within the detention environment and reporting their concerns to the Home Office, a process known as Rule 32 within STHFs, and Rule 35 for IRCs. The policy framework for this process of identification and reporting is set out in detail above. In essence the Home Office requires clinicians in detention sites to make written reports to the Home Office in three situations:

Rule 32/35 (1) where a person’s health may be “injuriously affected by detention.”
Rule 32/35 (2) where a person is suspected of having “suicidal intentions.”
Rule 32/ 35 (3) where a person “may have been the victim of torture.”

The purpose of these reports is to trigger a review of the person’s detention by the Home Office following the AAR policy.

The Home Office publishes quarterly statistics on both the numbers of Rule 35 reports and whether they result in the individual’s release.[1] These show consistent data trends dating back to 2015 that reports made under Rule 35(1) and 35(2) are very infrequent compared to reports made under Rule 35(3). The numbers of people released following any type of Rule 35 report are very low. Official data is not published regarding Rule 32 in SHFTs, however monitoring reports tasked with considering this process[2] reflect the experience of visitor groups that such reports are very infrequently completed.

As a result, people who have been tortured, who are suicidal, or whose health is at risk, continue to be detained for reasons including:

Clinicians do not complete Rule 35(1) and Rule 35(2) reports.
The Rule 35 reports when they are completed are poor quality.
The Home Office refuses to accept medical evidence when this is provided.

In addition to clinical flaws in the operation of Rule 32/35, a culture of disbelief of detained people in healthcare facilities has also been documented. The overriding theme of safeguarding failures in detention has been an entrenched reluctance by the Home Office to accept medical evidence of harm and to release detained people because immigration enforcement matters are considered to outweigh all other considerations.

Failure of clinicians to complete Rule 35 (1) and Rule 35(2) reports

The limited number of Rule 35(1) reports documenting the risk of harm of detention compared to reports under Rule 35(3) documenting a history of torture is difficult to reconcile with the research evidence and testimonies of detained people about the prevalence of symptoms of mental illness in torture survivors (and who should therefore have both a Rule 35 (3) report and Rule 35 (1) report) and the known adverse effect of detention on people with such conditions.

The European Committee for the Prevention of Torture (CPT) has raised concerns at the failure to complete Rule 35(1) reports where an individual disclosed a history of torture. Research within the sector also provides evidence that both Rule 35(1) and Rule 35(2) is not properly used by clinicians working in detention sites. This is further supported by Medical Justice’s analysis from their casework, evidencing a troubling lack of Rule 35(1) and Rule 35(2) reports. As highlighted above, their report , published in 2022, analysed evidence from 45 people in detention between July and December 2021 who had medico-legal reports (MLRs) completed by Medical Justice’s independent clinicians. Of this group, 82% experienced a deterioration in their mental health as a consequence of their continued detention and 87% expressed suicidal thoughts. However, none of these people had the equivalent Rule 35 reports. These concerns were repeated in the charity’s follow-up published in September 2023. Here a review of MLRs and medical records of 66 people in detention undertaken between 1 June 2022 and 27 March 2023 found 64 had experienced a deterioration in their mental state by the time of assessment and all were at risk of deterioration, yet only 5 individuals had a Rule 35(1) report completed.

Poor quality Rule 35 reports

A further concern is the fact that, even when Rule 35 reports are completed the assessments are inconsistently completed and do not address the relevant issues. The CPT concluded: “Too many Rule 35 applications are not properly filled out and many do not contain information on the impact of detention.” The last annual inspection completed by the Independent Chief Inspector of Borders and Immigration noted “a lack of consistency in the approach, content and conclusions of R35 reports across IRCs and between different doctors at the same IRC, leading to varying quality of reports…”[3]

A detailed clinical analysis of the Rule 35 mechanism commissioned by the Brook House Inquiry into its operation at Brook House IRC between 1st April 20217 to 31st August 2017 was completed by an independent GP, Dr Jake Hard. He found around 75% of Rule 35(3) reports he examined were inadequately completed. In particular, he noted that there was either no conclusion regarding the possibility of previous ill treatment being torture, or no conclusion on the impact of ongoing detention.

Culture of Disbelief

The nature of a culture of disbelief concerning the experiences of people in detention is difficult to directly evidence. However, this is an endemic theme referenced in academic research throughout the UK’s system of assessing asylum claims as well as explained in NGO evidence to reviews of immigration detention since 2016. This is also echoed by visitor groups and testimonies from people with lived experienced of detention.

Further detailed research addressing this endemic cultural issue for mental health staff working in IRCs is set out in Durcan G, Stubbs J, Boardman J. (2017) Immigration Removal Centres in England: A mental health needs analysis. This study sets out how a combination of lack of supervision of mental health practitioners was allied to development of such endemic disbelief “as a defence and coping mechanism to working in such a difficult environment with minimal support. Staff discussed how everyday they witness such distress and hear “these awful stories and there is nothing you can do to help.” They discussed how it resulted in people becoming “desensitised.”

The recognition of a culture of disbelief within immigration detention healthcare has permeated official reviews such as the report of Stephen Shaw (2016) which found such a culture within clinical staff dealing with healthcare issues of detained people. More recently the Brook House Public Inquiry report referenced a culture of disbelief as one of the key factors underpinning the Chair’s recommendation that a review of Rule 35 was required.

Home Office refusal to accept medical evidence

There are numerous examples of decisions by UK courts where the Home Office has not correctly assessed a detained person’s situation following receipt of a Rule 35 report and has refused to release that person as required by its policies. This has then led to a legal claim and payment of compensation. In addition to individual legal claims, systemic analyses of the Home Office’s approach from various reviews have raised concern that decisionmakers regularly refuse to accept medical evidence that demonstrates a detained person should be released. This emerged from the conclusions of the Shaw Review (2016), and the Home Affairs Select Committee (2019).

Recognition of the problem by investigative, regulatory and professional bodies

In summary there has been longstanding and widespread recognition that Rule 32/35 is ineffective in protecting detained people from harm. The need for change has been recognised in Parliament and by the key professional organisation, the British Medical Association, representing GPs who work in detention.

Independent thematic reviews of practice in immigration detention such as those undertaken by Stephen Shaw in both 2016 and 2018 clearly identified the need for reform. Detailed analysis undertaken by the Independent Chief Inspector of Borders in reports published in 2020, 2021 and 2023, have repeatedly identified systemic problems with this central safeguarding process. A recognition of the failure of the process and recommendation for reform was also set out in trenchant terms by the Brook House Public Inquiry. And, the European Committee for the Prevention of Torture (2024) confirmed the problem remains.

Further Reading

, British Medical Association
, by the Independent Chief Inspector of Borders and Immigration (ICIBI). Further reports from ICBI available.

[1] These statistics are published by the Home Office in excel spreadsheet form

[2] Pg 5

Key Points for Visitors

Whilst AVID and visitor groups in the AVID network recognise the inherent flaws of these safeguards, they remain an important mechanism for visitors and people in detention to be aware of as the main safeguard in detention and, ultimately, a primary means of release. Visitors play a vital role in making people aware of these safeguards and making sure people in detention understand what to expect and what they can do, as is discussed in the next section of this chapter. It is important for visitors to be aware of these challenges when talking to people in detention about Rule 35/Rule 32 so that they can provide people in detention with an understanding of their rights, what they can expect and what to look out for. It is also important to note that the guidance that supports the Adults at Risk policy[1] recognises the role of visitors and that they may be able to identify vulnerabilities of the people they are visiting in IRCs. Where a visitor raises a concern about risk to a member of staff then this should lead to notification to the healthcare department and the detention engagement team at the IRC, i.e. the Home Office team responsible for face to face interactions with detained people.

It is also important that visitors support people in detention and work with their co-ordinator to hold the system to account.

The ACDT System

People who are identified as being at risk of self-harm or suicide are monitored and managed in all centres in the first instance by custody officers rather than health care staff, through the Assessment care in detention and teamwork (ACDT) system. This is a process imported from the prison system, which allows any member of Home Office staff, supplier or healthcare staff who has identified concerns that a detained person is at risk of self-harm or suicide to start the ACDT process. The policy sets out potential situations of heightened risk (see page 7 of the ACDT Detention Service Order). ACDT is a highly document heavy process with many requirements for strict timing and recording of decisions about the person and sharing this information within the detention estate.

The ACDT process involves documentation of identified risks, triggers and protective factors for the individual, with regular multidisciplinary case review meetings to consider what actions can mitigate the overall risk to the person. In practice this generally means placing the person under regular observations and contact with staff. In some cases, this can involve periods of constant observation where the person is not permitted to be alone and is continually in the presence of staff. It can also result in moving the person within the detention site to places to manage the risk. This can include accommodation in Enhanced Care Unit within the healthcare environment or placing the person in segregation conditions and so separating them from the rest of the detained population. Other options include considering the availability of additional support, including contact with people from outside detention. Although visitors are not mentioned in the policy, the requirement to consider external sources of support may offer the opportunity for increased contact with the person being visited.

Whilst a person is under the ACDT process they should not generally be transferred to another detention site. If this happens then there is a procedure for information about the person to be shared with the receiving institution. Where a person is released from detention whilst still under the ACDT process then there is a limited obligation on the Home Office to signpost the person to sources of support in the community and to share information with other agencies such as social services or the NHS or other medical organisations.

The ACDT process is only permitted to end after a case review which decides that the individual is no longer at a raised risk and where all actions initiated as part of the case reviews are complete. The final action is a further review meeting held seven days after the decision to end placing the individual under ACDT processes.

Key Documents

The is the document that sets out the detail of how the policy is supposed to work and applies to all IRCs, pre-departure centres and residential short term holding facilities. Separate has been drafted for prisons. All IRCs are also required to have local arrangements specific to that detention site which are annually reviewed.

Challenges and concerns

The ACDT process - a process of documentation, supervision and risk management - is not a clinical response and does not involve therapeutic invention. It has been criticised by Medical Justice for being run by custodial staff, not healthcare professionals and so is therapeutically inadequate. The Brook House Inquiry also highlighted that it does not address the underlying causes that result in self-harm or suicidal thoughts.

Rather, the process of constant observation can be distressing especially when combined with a culture of Disbelief. This was the case for Marcin Gwoździński whose distress was not taken seriously and for whom ACDT monitoring was closed before he took his life in 2017. A letter written by friends of Marcin's in detention stated:

“For a long time he asked officers, psychologists and doctors for help. He was ignored. Many times he asked for help. Therefore myself and other detainees are very anxious and depressed about the situation. It is a disgrace that nobody has been [made] accountable for such poor care. We are human beings not animals.”

Despite the ACDT DSO stating that the use of segregation should be exceptional, there has been an overuse of segregation powers for people distressed and at risk of self-harm and suicide in detention. This was echoed in evidence heard during the Brook House Inquiry of people under ACDT being inappropriately placed in segregation conditions which in turn increased distress and the risk of suicidal thoughts.

Nonsensically, the process of information gathering and assessment of risk of suicide and self-harm for the individuals under ACDT is not required to engage with safeguarding mechanisms for reviewing detention such as Rule 35 process or the Adults at Risk policy. Therefore, people in detention might be placed on ACDT but not have a Rule 35 (2) report completed on their behalf.

Use of Segregation

There are parallel provisions in the Detention Centre Rules 2001 and the Short-term Holding Facility Rules 2018 which allow for individuals in detention to be separated from the rest of the detained population. This is known as segregation.

Segregation can arise:

Where “it appears necessary in the interests of safety and security” of the IRC/STHF, the detained person or the detained population (R35 STHF 2018 and Rule 40 DCR 2001).
Where a person is “refractory or violent” (R42 DCR 2001) or is “unmanageable or violent (Rule 37 STHF 2018) they can be placed in “special accommodation.”

Home Office guidance (January 2025) states these Rules “must be used as a measure of last resort, when all other options have been exhausted, and/or when these other options have been assessed as likely to fail or to be insufficient as an effective response to the risk to safety or security presented by the detained individual.” They must be used for the “minimum time necessary in all the circumstances”, with “an individual assessment of the circumstances on a case-by-case basis, as and when an incident occurs.”

The Rules also state explicitly that these provisions must not be used as a punishment. Each facility must have a published procedure for the use of these powers. The use of segregation must be justified by a risk assessment which explains why the decision to segregate has been taken and how often the assessment will be reviewed.

Segregation can lead to draconian conditions. There are minimum requirements that the accommodation is “adequate for health” with provisions for “size, lighting, heating, ventilation and fittings adequate for the maintenance of health and safety” and the detained person must be able to communicate at any time with an officer. Every person should have “access to toilet articles necessary for health and cleanliness and access to washing facilities”. But access to washing facilities will be “in line with individual’s risk assessment.” The Rules also allow for removal of furniture and bedding and for their replacement with “anti-ligature bedding” (i.e. removal of parts which might be used for self-harm or suicide) and collapsible mattresses. Home Office staff can also remove possessions from the detained person under these Rules and the supporting guidance.

There are time limits to the use of segregation. People separated from the general population under Rule 40 must have this considered by the Home Office within 24 hours and there is a maximum time period of segregation of 14 days. People placed in segregation under Rule 42 can be placed there for 24 hours with the Home Office needing to approve further time in such conditions up to a maximum of 3 days. The IMB, manager of religious affairs and GP (or member of nursing staff if it is a STHF) must be informed of the decision “without delay” and in practice this should be within 30 minutes.

There is a regime of documenting segregation decisions and reviewing them, the level of seniority of role of those making these choices and information sharing about the individual within the Home Office. Detained people must be given a written explanation of the decision to place them in segregation conditions. There is also provision for healthcare staff to attend review meetings about the person, to visit them daily and to decide “whether a physical health examination is required or whether a mental health assessment should be initiated.” Under Rule 40, if advised by a medical practitioner that it is necessary, the centre manager should remove the restriction (this option is not allowed for in the legislation on Rule 42).

Segregation powers are often used on the most highly vulnerable individuals and so the guidance links to other policies about people placed on ACDT suicide and self-harm policies, people who may lack decision-making capacity and adults at risk. The guidance states these powers should not “be used as a routine means to manage detained individuals with serious psychiatric illness or presenting with mental health problems. These rules should be used in relation to detained individuals with mental health problems “only where justified on the basis of the risk presented…”

The guidance is also clear that individuals at risk of suicide or self-harm must not be placed in segregation conditions unless this is “deemed necessary, having considered the potential adverse effect on the individual” and it is “for the shortest time necessary; and as a last resort where all other options for managing the behaviour have been considered and exhausted or considered to be inappropriate.”

Key Documents

Detention Centre Rules 2001 and Short-term Holding Facility Rules 2018

January 2025

Challenges and concerns

The psychological and physical impact of segregation is widely recognised. Its use in detention has been subject to criticism from monitoring bodies, NGOs and international human rights directives.

Despite the fact that Home Office guidance states segregation should be used in the most minimal way not be used punitively, there has been continued evidence that this approach has not been adopted. The Brook House Public Inquiry made detailed findings about the inappropriate use of segregation including its use on people who were severely mentally ill and being used as a punishment (for issues as minor as stealing coffee). The evidence heard by the Inquiry in 2022 led the Chair to conclude in her report the problematic practice of segregation used “for the convenience of staff under Serco’s management of Brook House.” More recent evidence from HMIP’s inspection of Harmondsworth IRC conducted 12 – 29 February 2024 found that segregation conditions were unlawfully used as a punitive measure for detained people who did not want to share a cell. Concerns were also raised about the deteriorating condition of the unit set up to manage people separated from other people in detention and failure in documenting the treatment of people held there.

Anecdotally, AVID has heard reports from visitor groups about the overuse of segregation, including:

Segregation cells or units being used inappropriately to manage people detained who are mentally unwell, especially if their behaviour is viewed as challenging and sometimes for very long periods. Often it is neglect of their mental illness on entering detention which has led to a deterioration in their mental health.
People who have been subject to torture (which may have included the use of solitary confinement), or who are at risk of self-harm, may be managed by the use of segregation, despite the risk that exposure to segregation or removal from social contact with others may worsen.
Segregation is not always correctly authorised and may be used for periods of weeks or even years in individual cases, certainly far in excess of the permitted 3 days.
Segregation being used as a punishment or when someone refuses to share a room, despite this being expressly excluded in the legislation. There is no adjudication system in detention centres which would enable detainees to challenge the use of segregation.
People held under Rule 40 or Rule 42 are not easily able to access legal advice via legal advice surgeries.

These safeguarding failings need to be understood in the context of the significant impact of segregation on detained people:

“… it is well established that by depriving people of meaningful social interaction and any sense of control, confinement causes damage to individuals’ mental health, which can last beyond release. It can cause deterioration in those with pre-existing mental health conditions and precipitate the onset of new conditions.” (Medical Justice and Bail for Immigration Detainees 2021).

Further Reading

. This report details the impact of solitary confinement and segregation on people detained under immigration powers in prisons during the Covid-19 pandemic. In the report, confinement was described as “psychological torture”, feeling “trapped”, “hopeless” and “suffocated”. Symptoms were incredibly severe, including involuntary shaking, memory loss, physical pain and insomnia.

This reflected in : The overuse and misuse of segregation in IRCs across the UK”, Medical Justice (2015)

National Referral Mechanism

The National Referral Mechanism is the UK’s framework for identifying victims of modern slavery and trafficking to ensure they can access support and time to recover. The process provides for information about people who may be survivors to be referred to the NRM. There are a number of organisations known as ‘first responders’ who have a duty to refer adults to the NRM, but this can only happen with the agreement of the individual in question. In a potential conflict of interest, first responders include Home Office staff. Other first responder organisations are listed on the government website and include the Salvation Army, local authorities, the Refugee Council and Migrant Help. AVID and visitors are not first responders and have no such legal duties to identify potential victims and to make referrals to the NRM.

The Single Competent Authority (SCA) and the Immigration Enforcement Competent Authority (IECA) – two bodies within the Home Office - take decisions on receiving a NRM referral. This is a two-stage decision-making process. Initially there is a decision about whether there is evidence that there are ‘reasonable grounds’ to decide that the person is a victim of trafficking or modern slavery, and if the person passes that stage, a second decision as to whether there are ‘conclusive grounds’ for deciding the person is a victim. Essentially this is a process of evidence gathering to decide both tests, with the evidence needed for a reasonable grounds decision being much lower than the subsequent test.

When a reasonable grounds decision has been made, the person is generally entitled to a recovery period of at least 30 days, with the possibility of extensions to this. Where a conclusive grounds decision has been made, a person is entitled to at least 45 days of support, with separate further decision-making about when it is appropriate to end this support.

Where a person who may have been a victim is held in detention the relevant competent authority which takes decisions about them is the IECA [1]. This is the organisation has been set up separately from the SCA which deals with all other cases.

If the person in detention receives a reasonable grounds decision then attempts to remove them from the UK must be paused for a minimum of 30 days. Despite this – as outlined in the – detention is considered as possible “appropriate accommodation for those observing the recovery and reflection period.” This is despite the fact that the recovery period is in part intended to support recovery from the trauma of what a person has been through.

However, when a detained person has been referred to the IECA or identifies themselves as a victim then this also engages the adults at risk policy (AAR) and the possibility that they will be released. Detailed information about the is here.

As AAR applies to potential victims of trafficking and modern slavery, limited weight is given to people who self-identify as a survivor, with greater weight given to people who have a reasonable or conclusive grounds decision. Once a person receives a reasonable grounds decision this triggers a review of their detention on the basis that they will be considered at least at level 2 under AAR. However, even people who have a positive decision by the NRM continue at level 2 of the adults at risk policy. As explained in the AAR policy summary in the handbook it is much easier for the Home Office to decide that continued detention is justified for individuals placed at level 2.

A person’s recognition as a survivor is potentially an ever-changing situation as people who are taken out of the NRM process at any stage no longer fall within AAR and consideration for release, unless they have another factor relating to their vulnerability in detention. The key protection for people accepted into the NRM is that they cannot be removed or deported from the UK.

Further Resources

If you are an AVID member, sign into our training space and watch this training video on trafficking and the national referral mechanism in detention:

Complexity of the process of recognising people as victims

The process for recognition as a survivor is highly contested and there is a complex system set up as to how this affects detention decisions. People can be taken out of the NRM process at a variety of moments because the IECA takes decisions that they are disqualified or do not meet the evidential tests for a reasonable grounds or conclusive grounds decision.

Disqualification from the NRM is a key issue. If a person is found to be disqualified then the protections of the NRM framework cease. This can arise where there are grounds relating to “public order” or “bad faith”. Broadly the former applies where the person is considered a threat to public on terrorism grounds or has committed serious criminal offences[2] .The latter concerns where the person or a person acting on their behalf “knowingly made a dishonest statement in relation to being a victim of modern slavery.”

Where a detained person has a reasonable grounds decision the Home Office is required to undertake a modern slavery needs assessment to identify their ‘recovery needs’ and any support that is required, but only where the IECA has already stated that the person requires a recovery period. This assessment entails an interview with a member of the Home Office to identify any specific recovery needs. This is followed by a healthcare assessment of any physical or mental health recovery needs and a decision about whether they can be met in detention.

The information obtained by the Home Office interview and healthcare assessment are reviewed for a further decision to be taken internally within the Home Office to decide if “suitable assistance” can be provided in detention. The detained person should be issued with a documented explanation of this decision in form “AAR MS 0003”. Where suitable assistance is deemed to be available within detention the individual will be placed at level 2 of the adults at risk policy, and where it is not available the individual will be placed at level 3. A new needs assessment is required if an individual is transferred within the detention estate or if a member of Home Office staff or the individual believes that their recovery needs have changed.

After the initial recovery period of 30 days where an individual cannot be removed and their needs and suitability for detention are considered, there is the possibility of further recovery periods being issued. However, these are difficult to obtain as the policy states there is a presumption against this.

People held in prison

There is a slightly difference process for people in prison in terms of who within the Home Office is responsible for information gathering and decisions about detention. But the key difference is that any decision to release a person from the prison estate has to be authorised at a more senior level within the Home Office, i.e. at strategic director level.

Where the IECA decides a person is a victim on conclusive grounds

If a person receives a conclusive grounds decision then they will remain at least at level 2 of AAR. This cannot be changed where a person has a public order disqualification, but this can be revoked if there is a subsequent decision that this was obtained as a result of “bad faith”.

Historically all people accepted as a victim on conclusive grounds were generally granted temporary permission to stay in the UK and released. Broadly, this was on a short-term basis to allow time to recover from any physical or psychological harm, to allow people to engage with compensation schemes or to enable cooperation with the investigation of their exploitation by the police or other public authorities. There was no legal obligation to provide victims with a long-term basis to live in the UK unless they made further immigration or asylum applications.

The general approach to granting leave for people with a criminal conviction who also have a history of trafficking or modern slavery and are subject to deportation processes has been temporarily paused as of February 2025 whilst the government reviews its position.

Key Documents

(October 2024)
(January 2025)

Future watch:

Look out for changes to the Home Office position on the release and grant of temporary leave to people who are accepted as victims of trafficking or modern slavery but also subject to deportation proceedings.

[1] The IECA takes decisions about:

All adult "Foreign National Offenders" (FNOs) detained in an Immigration Removal Centre.
All adult FNOs in prison where a decision to deport has been made.
All adult FNOs in prison where a decision has yet to be made on deportation.
Non-detained adult FNOs where action to pursue cases towards deportation is taken in the community .

[2] The test is set out in S63(3) of the Nationality and Borders Act 2022. The modern slavery guidance defines this as including “the person has been convicted of a terrorist offence; the person has been convicted of any other offence listed in Schedule 4 to the Modern Slavery Act 2015 anywhere in the United Kingdom, or of a corresponding offence; the person is subject to a TPIM notice (within the meaning given by section 2 of the Terrorism Prevention and Investigation Measures Act 2011); there are reasonable grounds to suspect that the person is or has been involved in terrorism-related activity within the meaning given by section 4 of that Act (whether or not the terrorism-related activity is attributable to the person being, or having been, a victim of slavery or human trafficking); the person is subject to a temporary exclusion order imposed under section 2 of the Counter-Terrorism and Security Act 2015; the person is a foreign criminal within the meaning given by section 32(1) of the UK Borders Act 2007 (automatic deportation for foreign criminals); the Secretary of State has made an order in relation to the person under section 40(2) of the British Nationality Act 1981 (order depriving person of citizenship status where to do so is conducive to the public good); the Refugee Convention does not apply to the person by virtue of Article 1(F) of that Convention (serious criminals etc); the person otherwise poses a risk to the national security of the United Kingdom.

Challenges and concerns

There have been a number of concerns[1] about the decision to divide decision-making about the NRM and to have a separate organisation, the IECA, with dual responsibility for immigration enforcement and removal, whilst also making life changing decisions about recognising victims of trafficking and modern slavery. This was seen as a conflict of interest, creating a discriminatory two-tier system with less protection for those without a secure immigration status and likely to result in victims being less willing to come forward and seek help. This change fails to take into account the relationship between having an insecure immigration status and being a victim of modern slavery.

The IECA was subject to an inspection by the Independent Chief Inspector of Borders and Immigration in January – June 2024, published in December 2024. This found systemic organisational flaws, with issues with training, advice, guidance, evidence-gathering and poor decision-making. The IECA was judged to take insufficient account of the potential impact on individuals of poor-quality decisions and with underdeveloped thinking and resourcing for safeguarding issues.

A further area for concern is the application of AAR to victims of trafficking and modern slavery. It is particularly difficult for survivors to assemble the levels of evidence needed for the policy to be effective and operate to ensure their release. Instead the policy encourages a practice of waiting to see people deteriorate so that this can be documented, causing further avoidable harm.[2] In the meantime people identified as potential victims of trafficking and modern slavery can be routinely kept in detention during their period of recovery and so cannot benefit from this period, since detention and the fear associated with that environment can be a triggering reminder of their experiences. Moreover, detention is a place which inhibits disclosure of a person’s traumatic history which then in turn reduces people’s ability to provide the evidence for final decisions about their trafficking status.[3]

[1] Report dated November 2021 of Detention Taskforce, an organisation which included AVID and detention stakeholders: Helen Bamber Foundation (Chair) Focus on Labour Exploitation (FLEX) (coordinating organisation), Bail for Immigration Detainees, Anti-Slavery International, Latin American Women's Rights Service, Duncan Lewis Solicitors - Public Law, Medical Justice, Ashiana Sheffield, Jesuit Refugee Service UK, ECPAT UK, After Exploitation, Unseen UK

[2] of Helen Bamber Foundation, ATLEU, Focus on Labour Exploitation and Medical Justice (October 2022)

[3] by the taskforce on victims of trafficking in immigration detention (December 2022)

The Mental Capacity Act 2005

The Mental Capacity Act 2005 provides a legal framework in England and Wales for decision making on behalf of people aged 16 or over who cannot make decisions for themselves. The Mental Capacity Code of Practice sets out guidance and information about how the Act works in practice. This applies to all people in the UK across a number of situations including medical treatment and caring situations.

The Act sets out the legal test for people that may lack decision-making capacity and governs what should happen for those people who do not have capacity. Where a person lacks capacity, it is possible for others to take a decision for them and this should be made in their best interests.

The legal test for decision-making capacity is set out in two stages:

Does the person have an impairment of, or a disturbance in the functioning of their mind or brain? The Code of Practice explains this as “the person has an impairment of the mind or brain, or some sort of or disturbance that affects the way their mind or brain works.” This is a broad test, but some examples can include mental illness, significant learning disabilities, symptoms of alcohol or drugs use.
Does the impairment or disturbance mean that the person is unable to make a specific decision when they need to? A person is unable to make a decision if they cannot:

understand information about the decision to be made.
retain that information in their mind.
use or weigh that information as part of the decision-making process.

A further factor is whether the person can communicate their decision.

This second stage can only be met if the person has been given all practical and appropriate support and appropriate amounts of information to be able to make the decision, but despite this, at least one of these elements cannot happen.

The legal framework sets out that decision-making capacity may fluctuate depending on the person’s condition, and any determination of capacity is specific to the decision itself. In other words, there is not a general determination that a person lacks capacity, this is an issue to be addressed with each individual decision.

The Act also set up an Independent Mental Capacity Advocate service to provide independent safeguards for people who lack capacity to make important decisions and, at the time such decisions need to be made, have no-one else (other than paid staff) to support or represent them or be consulted. This applies to people who are facing issues about medical treatment or a long-term residential move.

The environment of detention and decision-making capacity

It is important to recognise that whether a person has capacity needs is considered in relation to each specific decision they are faced with. Here the fact that the person is held in detention may have an effect. One factor to consider is that detention has been shown to cause or exacerbate mental illness which may then affect whether a person has decision-making capacity. The Mental Capacity Act 2005 also requires that people should be given all practical and appropriate support to make decisions. This approach may be more difficult to adopt within the limitations and stresses of a detention environment.

Application of decision-making capacity issues in immigration detention

relies on detention staff to identify people who may lack capacity, draw this to the attention of the IRC duty manager and the vulnerability lead (onsite supplier manager in STHFs) and request an assessment by the healthcare department. There is also an obligation to share the initial information that capacity may be a concern internally within the Home Office using a form called IS91RA. This then triggers a review of the person’s detention and recognition that the person falls within the Adults at Risk policy.

When a person is assessed by healthcare this can lead to more information about them including recognition that the person needs further support or has other vulnerabilities. This is information must be relayed to the Home Office and triggers a further review of detention in line with the Adults at Risk policy. If detention is maintained, then a vulnerable adult care plan should be completed (see for more information on vulnerable adult care plans).

The policy also places an obligation on the member of staff to help the person to access legal representation.

Key Documents

(July 2023)

(2007)

Challenges and concerns

The Royal College of Psychiatrists have expressed concern about the Home Office’s approach to mental capacity decisions, in particular the difficulties of identifying people who may lack decision-making capacity in detention:

“ There are specific difficulties relating to the assessment of decision-making capacity in people with mental disorders in IRCs. The first is the problem of individuals who lack capacity but speak no or very little English, rendering their lack of capacity less obvious to staff. The second is the fact that capacity can fluctuate in people with mental disorders. The third is that the frequent movement of detainees from one IRC to another reduces the possibility for the sustained therapeutic relationship and for eliciting the consistent, sufficiently detailed psychiatric history that should inform any capacity assessment. Fourth, capacity is time and decision specific and depends on the nature and complexity of the decision in question. Specialist support would be required for individuals with complex needs and problems (including those arising from sociocultural factors) and/or multiple mental and physical conditions.”[1]

These concerns are in conjunction with the lack of screening for people who may lack capacity and the fact that the Home Office policy is reliant on detention staff, the majority of whom will lack clinical qualification, to identify possible situations of lack of capacity in highly challenging circumstances. These issues are further compounded by problems of access to legal advice.

A further factor, as recognised by the Brook House Public Inquiry is that detained people with mental ill health may be more vulnerable to losing decision-making capacity as a result of their detention. The Inquiry identified very serious examples where assessments of decision-making capacity were not carried out in relation to highly vulnerable people, suffering from serious mental illness and in acts of extreme distress such as food and fluid refusal. The report also raised broad concerns about the lack of policy safeguards for people who may lack decision-making capacity and problems with information sharing about people across the Home Office and detention estate. The report also highlighted systemic issues about the lack of independent advocates for people who had been identified as lacking capacity.

Age Assessments

The Nationality and Borders Act 2022 (‘NABA 2022’) provided the Home Office with much greater power and oversight over age assessments than before. Prior to NABA 2022, local authorities completed ‘Merton compliant’ age assessments. Merton Compliance takes it name from an immigration case[1] in which the High Court stated that local authority “cannot simply adopt a decision made by the Home Office” and outlined a number of criteria for a lawful assessment. To be “Merton compliant”, an assessment should be holistic and not made based solely on appearance but take into account - amongst other factors - the child's history in their home country, education and cultural information.

Key Documents

Challenges and concerns

Determining age on the basis of appearance is subjective, and quasi-medical assessments have a wide margin of error and have been discredited. Despite this, NABA 2022 allows the Home Office to make regulations for “scientific” age assessment methods and for a decision-maker to make adverse credibility findings against those who refuse to undergo these methods “without good reason.”

These failings are exacerbated due to the fact that separated children arriving in the UK may come from countries where precise age is not considered important, or lack any documentation, or have forged documentation to assist with their journey. Notwithstanding the impact of trauma and language barriers.

The consequences of being treated as an adult and held in immigration detention are unimaginable and unjustifiable. Children suffer the physical and emotional consequences of being detained as well as being unable to access education and support from local authority social services.

Food and Fluid Refusal

In England and Wales, provided that a person over 18 years old has the full mental capacity[1] they are considered free to make the decision not to eat or drink, even if this act leads to physical damage or ultimately to their death. In Scotland[2] and Northern Ireland[3], an individual over the age of 16 has the right for food/ fluid refusal. Someone with full mental capacity cannot be forced to undergo medical treatment and may refuse such treatment in advance while they still have capacity using an ‘advance directive’. Psychiatric reasons for refusing food or fluids should be excluded by a doctor.

The Home Office position on hunger strikes

Since the Shaw review (2015), the Home Office replaced the old Detention Service Order (DSO) 3/2013 with the new DSO 3/2017 on ‘Care and management of detained individuals refusing food and/ or fluid’ which was most recently updated in September 2022. This guidance does not apply to Short-Term Holding Facilities (STHF) as a result of their more limited medical facilities. Instead, where someone is detained in a residential STHF, the guidance recommends that transfer to an IRC is considered so that Home Office guidance can be implemented. Individuals on hunger strike who are detained in prison under immigration powers are subject to the Prison Safety Policy Framework (2024). This is an overall HMPPS framework towards safety in prison and addressing risks of harm. Food refusal is addressed on page 50 of the guidance.

The Home Office take a stringent approach when someone in detention makes the decision to refuse food or fluids, specifying at the outset that it will not trigger release from detention and escalating consideration for release to strategic director level (the Director of Casework and Returns) in all cases. The DSO sets out the process for close observation and ongoing monitoring by IRC staff, the healthcare teams, the Immigration Enforcement Detention Engagement team in IRCs and Home Office caseworkers.

In the first instance:

“The IRC supplier must keep a record of all detained individuals who have refused meals prepared and provided by the supplier for over 48 hours (6 meals) or refused fluid for over 24 hours… Where a detained individual is refusing both food and fluid this must be recorded separately.”

These records must be kept by the IRC supplier and shared with the Healthcare team (via Form A). This should be updated on a daily basis.

Once healthcare staff receive this form, they are required to offer the person in detention an appointment with a doctor. However, if the person in detention prefers an appointment with a nurse, this must be arranged.

If consent is given the:

“IRC Healthcare providers must provide the local DET team and the IRC supplier with a daily list of all detainees who have commenced or are continuing a food and/or fluid refusal”.

Daily appointments with healthcare should be offered where possible and, provided there is consent for them to do so, information should continue to be logged and shared with the DET team. This includes a risk assessment in accordance with the scale Black, Red, Amber, Green (BRAG) as set out in page 18 of the DSO, where Black is immediate risk of healthcare needs that cannot be managed in the IRC and Red is a threat of this being the case in the next 3-5 days.

Provided consent, the local DET will be updated on a daily basis and should pass information onto the Home Office caseworker using the consent form (Form C). It is also the responsibility of the local DET team to establish the reasons for hunger strike. They will establish whether they think there is a grievance and should support the individual in addressing this, advising on available complaints channels and how they can raise their concern to, for example the Independent Monitoring Boards (IMB) or centre management.

On receiving information from the DET team, the Home Office caseworker must review the individuals continued detention and consider actions to speed up case progression. For individuals who have been assessed as Red or Black on the BRAG scale, this should be escalated to the “Immigration Enforcement Food and Fluid Refusal tactical group” – a multi-disciplinary team who meet on a weekly basis. And, in all instances where release is being considered/proposed due food and/or fluid refusal, this must be referred to strategic director level for approval.

Throughout this process, there are important rights that people in detention should be aware of and which are set out in the DSO for “ Care and management of detained individuals refusing food and/or fluid ." These are:

People in detention should not – at any time - be forced to accept food or fluid.
People in detention are fully entitled to confidentiality, to retain responsibility for their own health wherever possible and their ability to give informed consent should be assessed by appropriately trained healthcare staff.
Consent should be sought for information to be shared with Home Office teams in IRCs and with Home Office caseworkers: “In seeking consent, it is essential that the purpose of the information sharing is made explicit and the person understands what will happen to their information” (page 5 of the DSO). A translator should be offered to ensure that information is understood.

Other actions that might be taken by the IRC and Home Office are:

The transfer of individuals to detention centres with enhanced care unit facilities such Harmondsworth IRC for men and Derwentside IRC for women.
An Assessment Care in Detention and Teamwork (ACDT) plan may be opened where a detained individual refusing food and/or fluid is also assessed to be a risk of suicide or self-harm.
The healthcare team should also complete a where the health of the person in detention is “likely to be injuriously affected by continued detention or any conditions of detention.”

Key Documents

The sets out mandatory requirements for staff to identify safeguarding concerns in prison and support those at risk . It was introduced in 2024 and replaced chapters 1-11 and 14 of PSI 64/2011 Management of prisoners at risk of harm to self, to others and from others (Safer Custody). Page 50 addresses food and fluid refusal.

The ( updated in September 2022 ) provides guidance to be followed in IRCs for detention centre staff and caseworkers.

[1] Mental Capacity Act 2005 sections 24-2

[2] Adults with Incapacity (Scotland) Act 2000

[3] Mental Capacity Act (Northern Ireland) 2016