Guide for Visitors: Supporting People in Detention with Healthcare Needs

Medical Justice are a vital organisation to be aware of when visiting people in detention with healthcare needs. Medical Justice offer independent medical advice and assessments to people held in immigration detention.

You can find out more on their website.

Medical Justice have suggested the below actions that visitors may be able to take, where appropriate, to assist someone with healthcare needs that are not being met in detention. Download and print this guide here.

• Visiting people in immigration detention is incredibly valuable. Your support and solidarity is likely to make a huge difference to the person you are seeing. It is also emotionally intense work and will likely expose you to witnessing distress, trauma and the impact of violent policies by the UK state. To be able to do this work, first and foremost it is important that visitors consider and discuss with your visitors group what support you have in place for yourself. For more on visitor wellbeing, you can visit this section of the AVID handbook.
• When visiting someone you may have urgent concerns about their health or wellbeing. Your first port of call should be to discuss this with your visitors’ group coordinator who can provide advice and support you to take action as appropriate. You can also contact AVID for guidance. Your visitors group will have a safeguarding policy and policy on confidentiality in place which should be followed in these instances. Make sure you discuss your visitor groups confidentiality policy as early on as possible – re-iterating this when appropriate - with the person you are visiting so they know you may be discussing their situation with others, with who and in what circumstances.

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

• Establish the facts of the medical condition, any treatment, and any prescribed medication. If the person is happy for you to do so, you may consider requesting a copy of their healthcare records from the healthcare unit at the place of detention where they are being held. This can be done, with the person's consent, by writing to the healthcare unit.
• Encourage the person to seek the advice through the healthcare facilities at the IRC, RSTHF or prison where they are detained. Remind them that they can ask to be examined by a doctor of their own gender. If they are unsure about any advice received or feel any treatment they are receiving is not working or inadequate, encourage them to make another appointment. Most IRC healthcare units operate a nurse triage system, whereby it is relatively straightforward and quick to see a nurse, but there can be longer waits to see a GP.
• If you still have concerns that the person is not receiving adequate or appropriate treatment, consider making a referral - with their permission - either through their solicitor or direct to Medical Justice via their online referral form. Medical Justice may be able to offer them advice or a  second opinion for an external medical healthcare report . If you are unsure what to do, discuss with your visitors’ group coordinator, or call Medical Justice for advice. Caseworkers at Medical Justice are happy to discuss your concerns and suggest whether a referral to Medical Justice would be appropriate.
• If the person you are visiting has previously received treatment in the community (prior to being detained), it may be helpful for them, or - if they prefer - for you/someone else on their behalf, to speak to their clinician in the community. This is particularly important if there has been an interruption in provision of medication.
• Few people in immigration detention raise complaints when they are abused or unfairly treated. Where there are grounds for a complaint, it can be helpful to offer support with making the complaint. This should be discussed with your visitors group coordinator.

Adults at Risk policy

• It is well recognised that detention can be harmful to a person’s mental and physical health. Some people are known to be particularly at risk, including people with a history of trauma. The Home Office accept that this is the case and have a policy on identifying people who are at risk of, or currently suffering harm in     detention, in order to consider their release from detention. The current version of this policy is the ‘Adults at Risk policy, consisting of Statutory Guidance[1],     Caseworker Guidance[2] and a DSO on management of people who are Adults at Risk in detention[3].
• Some people have evidence of their health condition, trauma history of other vulnerability that they are able to submit to the Home Office (usually via their solicitor). Not everyone has this, and someone’s condition can change during their detention. The main mechanism for identifying people who this applies to in IRCs is called ‘Rule 35’ (equivalent to Rule 32 in RSTHFs).  Rule 35 of the Detention centre Rules[4][5] requires the GP at the detention centre to prepare a brief medical report (a ‘Rule 35 report’ using a template form) on any person in detention who:
  • (1) may be injuriously affected by detention
  • (2) in respect of whom there are suspicions that they are suicidal
  • (3) who may be a survivor of torture.
• If you suspect one of these criteria is met, it is important to raise this. This can be done by the person requesting a Rule 35 report, discussing appropriate steps with their solicitor or you contacting the healthcare unit with your concerns (with their consent). It may also be helpful to refer them to Medical Justice. We suggest you discuss the most appropriate action with your visitors group coordinator.  

Other steps that visitors can take to support someone’s healthcare needs whilst in detention

• Help them to contact family and friends who can provide an important lifeline.
• Depending on the remit of the visitor group that you are part of, you may be able to provide them with phone credit to facilitate communication with others or other forms of practical necessities.
• Encourage them to tell their legal advisor about their circumstances and current state of mental or physical health, explaining to them how this might help i.e. to identify further information for their application for release. With their permission, you can help facilitate communication with their lawyer, where this is a cause of additional stress.
• Encourage them to tell their legal advisor about their circumstances and current state of mental or physical health, explaining to them how this can help i.e. to identify further information for their application for release. With their permission, you can help facilitate communication with their lawyer, where this is a cause of additional stress.
• Help them to find a legal advisor if they don’t have one (Read more about this in AVIDs Handbook: Legal Advice).
• Explain how they can get independent help (an independent report, visiting psychologist, Samaritans, listeners in prisons, local authority adult social care assessment) and provide information on how to do this.
• Contact other specialist groups for advice with the permission of the person involved.
• It is common that a person’s difficulties don’t end on release from detention. Some visitor groups offered continued support when people leave detention. If this is the case for the group you are part of, you may be able to assist the person you are visiting by helping them register with a GP on release, ensuring their have appropriate accommodation and financial support. You can refer them to community organisations who can provide support after release or solicitors to assist them with accessing their entitlements. Your visitors group will be able to provide advice on this and information on what post-detention support they offer.

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[1] Statutory Guidance

[2] Caseworker Guidance

[3] DSO on management of people who are Adults at Risk in detention

[4] Detention Centre Rules, Part II, Healthcare, Rule 35

[5] DSO on Detention Centre Rule 35 and Short Term Holding Facility Rule 32

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