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Immigration Removal Centres in England: A mental health needs analysis

Between March 2015 and March 2016, over 30,000 people were held in UK immigration detention. Many of these people had experienced torture, trauma and oppression in their countries of origin.

In response to the Shaw Report (2016) which highlighted the poor mental wellbeing of people detained in Immigration Removal Centres (IRCs), Centre for Mental Health was commissioned by NHS England to conduct a rapid mental health needs analysis of IRCs in England. The resulting review aims to support NHS England and the Home Office in planning to meet the wellbeing and mental health needs of people held in IRCs.

To gain a full oversight of mental health needs in IRCs, we conducted interviews with staff and detainees, asked managers to complete a survey, and conducted observations of each IRC. Ten IRCs (or ‘holding facilities’) were included in the needs analysis.

Mental health and immigration detention

Research into the impact of detention has consistently highlighted that:
• Immigration detention has a negative impact on mental health
• The longer someone spends in detention, the more negative an impact it has upon their mental health
• Depression, anxiety and post-traumatic stress disorder are the most common mental health problems

A study conducted across four UK IRCs in 2009 found that four out of five detainees met a clinical threshold for depression.

Mental wellbeing in IRCs

All immigration detainees will face challenges to their wellbeing during their stay. Even if they do not reach a clinical threshold, the distress they experience is still disabling and even lifethreatening.

Across the IRCs in our needs analysis, the most commonly reported problem was depressed mood and anxiety problems, and the most severe reported problems were hallucinations or delusions. Most of the detainees we interviewed had experienced some form of trauma in their life before detention, e.g. fleeing a country where they were being persecuted; witnessing loved ones being killed; experiencing domestic violence, sex trafficking or female genital mutilation; or fleeing a death sentence. They also highlighted issues of mental health stigma and language barriers in discussing wellbeing.

Impact of detention on mental wellbeing

Detainees and staff both described the impact of detention on people’s wellbeing. The challenges to wellbeing were partly caused by loss of liberty, the feeling of staying in a prison-like regime, and uncertainty about their future. Additionally, confusion about the legal procedures caused a huge amount of distress to detainees.

"Being here is reliving my trauma because it feels like the captivity I experienced when I was a sex slave..."

"Things I've buried deep inside I'm having to share and now I'm reliving my past. But I don't feel as if I get any support for this..."

"I have never committed a crime and they...left me in a police cell"

Services in IRCs

The mental health provision across the IRCs we visited varied significantly from centre to centre, from predominantly medication management, to varying psychological therapy provision and emotional wellbeing groups. Especially wellreceived practice included:

• Psychological interventions (as it was generally recognised that the primary need across the IRC estate was for talking treatments)
• Wellbeing groups
• ‘One contact’ approaches (useful in situations where the length of detention stay is unknown)
• Psychological formulations to understand the context and needs of the individual
• The support offered by chaplaincy teams and religious groups

Most of the centres were developing or had plans for developing Improving Access to Psychological Therapies (IAPT) type services, similar to those available in the community. These services will need to be adapted to meet the specific needs of the IRC population, taking account of language, culture and short and unpredictable durations of stay.

Challenges

A wide range of challenges exacerbate the difficulties experienced by detainees and staff in IRCs. Despite an expressed desire from NHS England and the Home Office that vulnerable people should not be detained, there is no clinical screening in place to detect vulnerability before deciding to detain an individual.

Most detainees perceived that they were not listened to, not taken seriously and treated as if they were lying if they disclosed vulnerability to either heath care or security staff. And some staff members reported that it was easy to become part of a culture which disbelieved detainees.

Mental health care staff face a number of ethical challenges in working with immigration detainees, including ensuring continuity of care for those being ‘removed’ and even for those being released (always at short notice) to the community; but also in maintaining therapeutic relationships when a decision to ‘remove’ a detainee is withheld by Home Office Immigration Enforcement (often due to a perception that such knowledge increases risk of risk of self-harm and suicide).