Use of force against unwell detained people

55. Force was used inappropriately against detained people who were physically and/or mentally unwell. It was often unnecessary in the circumstances since the threat to officers was low and there was little or no resistance from the detained person. The type and duration of the force used in many cases was disproportionate in light of the detained person’s health condition. Prior consideration of whether and how much force ought to be used on vulnerable detained people in any particular circumstance was not given. Additionally, as discussed in Chapters C.4 and C.6 in Volume I and in Chapter D.8, Healthcare staff failed to recognise their role in safeguarding the health and welfare of detained people – rather, they facilitated the use of force. Some examples are set out below, although it is likely that there have been many more in practice.
56. Physically vulnerable detained people were the subject of force. For example, following refusal of food and fluids by D2159 and the raising of serious concerns by Healthcare staff about his condition, a decision was taken to move him to E Wing for “his own welfare and health and safety of others”.¹

56.1 Handheld camera footage of the use of force showed Mr Dix looking through the cell window and then instructing officers to go immediately into the cell.² When the door opened, D2159 was lying on the bed. Three officers and Mr Dix then entered the cell wearing full PPE, including helmets and shields. DCO Neil Timms led the way, placing a shield on D2159’s chest. After officers physically restrained him, D2159 was handcuffed. He appeared very weak and entirely passive throughout the incident.

56.2 Prior to the use of force incident, Ms Christine Williams (Clinical Lead at Brook House) recorded in D2159’s medical records “restraints may be used”.³ This reflected an inappropriate and concerning practice by Healthcare staff of pre-sanctioning use of force. Their focus ought to have been on safeguarding. This issue is covered in more detail in Chapter D.8.

56.3 It is alarming to see how quickly officers resorted to the use of force in this incident, especially when the detained person appeared to be weak and unresponsive, rather than deliberately uncooperative. Mr Collier told the Inquiry that, given what was already known about the state of health of the detained person, Mr Dix ought initially to have gone into the cell with a member of the Healthcare team to check on D2159’s health before force was used.⁴ It is clear from the footage that, although the shield was placed on D2159 for only a short time, force should not have been used at all, as D2159 posed little or no threat.⁵ He could not have been described as non-compliant. The use of handcuffs was also inappropriate, as was the use of any other C&R techniques, given (as Mr Collier put it) “there is no clear risk presented and D2159 appears weak and unable to walk”.⁶ The use of force was entirely disproportionate in this instance. I agree with Mr Collier that “a full assessment before the intervention would have identified the level of risk and the response should have been proportionate to that risk”.⁷

57. Similarly, force was used disproportionately on 27 May 2017 against D1914, who had a heart condition and mental health problems. D1914 had refused to move to E Wing in order to facilitate his removal, which was due to take place the following day.⁸ I agree with Mr Collier that D1914 did not offer a level of threat to staff that justified force being used, and more time ought to have been given to persuade D1914 to comply with the instruction to move.⁹ The role of Healthcare staff in this incident was also concerning. Dr Husein Oozeerally (the lead GP at Brook House during the relevant period and at the time of the Inquiry’s public hearings) inappropriately pre-sanctioned use of force and failed to identify and raise clinical concerns when necessary.¹⁰ D1914 stated that he found this incident to be “One of the most disturbing and distressing events during my time in Brook House”, and that he was “worried he might have a heart attack” during the incident.¹¹ This incident provides yet another example of disregard shown by staff for the physical vulnerabilities of detained people.
58. The use of force against detained people with mental ill health was also common. It was often used as a response to, and a form of management of, symptoms of mental ill health, which were wrongly treated as non-compliance and disruptive behaviour.¹² There was a routine and quick resort to force in response to incidents of self-harm.¹³ It was also used to manage the behaviour of those with mental ill health and in order to move detained people to E Wing or the CSU (whether under Rule 40 of the Detention Centre Rules 2001 or informally to segregate them).¹⁴ One stark example of this was when a PIT was used on D1527 by DCM Michael Yates on 4 May 2017 when officers were trying to move D1527 out of D Wing in order to segregate him. The technique was not justified, especially as D1527 was severely mentally unwell, was securely in handcuffs, and there were at least four officers present.¹⁵ The use of a PIT was not reasonable or proportionate in the circumstances. I have made further findings in relation to this incident in Chapter C.4 in Volume I.
59. The Use of Force Training Manual provides brief and general guidance on the importance of considering the consequences of the use of force on a person in the context of Article 3 of the European Convention on Human Rights. It refers to the “physical or mental effects” of ill treatment and the importance of taking into consideration, among other factors, “the state of health” of a detained person.¹⁶ However, no relevant examples are given and there is no reference in the Use of Force Training Manual to the fact that the severity or impact of the use of force is likely to be much more significant where a person suffers from ill health. Mr Collier suggested that this lack of consideration was due to the fact that it was a “specific area”.¹⁷ He also suggested that staff perhaps could not relate to a detained person who experienced mental health problems, or who had suffered torture or abuse.¹⁸ He also confirmed that the test criteria used medically to evaluate the appropriateness and safety of the C&R techniques deployed within the IRC estate did not include consideration of mental illness or vulnerabilities, such as histories of torture or trauma, and that this was still the case now.¹⁹ In my view, staff ought to be provided with proper and specific training on how, when and whether to use force on detained people with mental ill health. The training should pay particular attention to evaluating dynamically and individually the likely effect of the use of force on a person’s mental health.
60. Dr Rachel Bingham, clinical advisor to Medical Justice (a charity that provides medico-legal reports and advice to detained people), told the Inquiry that use of force can lead to a serious worsening of symptoms of mental ill health and deter detained people from engaging with clinical care.²⁰ The use of physical restraint is likely to be traumatising in itself for detained people with pre-existing clinical vulnerabilities, and risks re-traumatising those with a past history of torture or trauma.²¹ Moreover, the use of certain restraints and PITs is of particular concern with respect to detained people experiencing mental illness, including those who have experienced trauma, given its triggering nature.²²
61. Dr Brodie Paterson provided evidence on behalf of Medical Justice that the current “prison-based model” of C&R deployed at Brook House is not equivalent to current practice and care within clinical settings, where force is only used “in extremis”.²³ I accept that the use of force model used in IRCs needs to be adapted in order to take into account the vulnerabilities of the detained population.²⁴ However, it is not clear whether adopting a C&R model used in clinical settings would be appropriate in the context of immigration detention, where other considerations apply.
62. Mr Collier suggested that consideration should be given to a bespoke package for staff working in IRCs to cover behaviour management and to be therapeutic-based, focusing on preventative strategies as opposed to reactive strategies when a situation has escalated.²⁵ Mr Collier also suggested that individual personal officers (ie DCOs assigned to each detained person to be an individual point of contact) could document how to engage with a detained person, understanding triggers for behaviour, and then employ tried and tested de-escalation methods.²⁶
63. Force was often used as an inappropriate response to detained people in the depths of mental health crises, including self-harm. In my view, a person’s mental health should be taken into consideration when deciding whether and when to use force and, in particular, if and when to apply certain techniques, such as PITs. This can only be done if officers understand the different considerations that ought to apply. This requires specific mental health training in relation to use of force, and may mean that the current model for the use of force needs to be adapted. There must be a stronger focus on prevention and de-escalation, both in general and particularly when force is used on detained people with mental ill health.²⁷ Although mental health first aid training is provided as part of the ITC, Serco does not provide specialist training regarding the particular considerations that ought to apply when using force on detained people with mental ill health.²⁸
64. Therefore, I am recommending, in advance of the introduction of a new DSO, that there should be a thorough review of the use of force against detained people with mental ill health in an IRC context. That review should draw on clinical expertise and input from those who specialise in mental health issues in immigration detention.²⁹

1. CJS005529_027[↩]
2. Day 41 PM 30 March 2022 00:34:02-00:40:32 (S1970002 [CJS0074113][↩]
3. CJS007001_001[↩]
4. Jonathan Collier 30 March 2022 116/19-117/12[↩]
5. INQ000177_005 para 10[↩]
6. Jonathan Collier 30 March 2022 117/4-121/20; INQ000177_005 para 10[↩]
7. INQ000111_036 para 133[↩]
8. SER000437_006 para 22[↩]
9. INQ000111_034 para 124[↩]
10. INQ000111_034 para 1 24[↩]
11. DL0000229_037 para 130; DL0000229_041 para 145[↩]
12. See, for example, Mr Dix’s attitude towards D1527 on the safety netting on 4 May 2017: Steven Dix 9 March 2022 56/21-25, 57/1-18[↩]
13. Dr Rachel Bingham 14 March 50/5-51/5; Theresa Schleicher 14 March 90/1-12[↩]
14. Theresa Schleicher 14 March 89/7-25, 97/25-98/22[↩]
15. Jonathan Collier 30 March 2022 133/3-137/12[↩]
16. NOM000001_029[↩]
17. Jonathan Collier 30 March 2022 140/3-141/2[↩]
18. Jonathan Collier 30 March 2022 140/ 3-141/ 2[↩]
19. Jonathan Collier 30 March 2022 141/3-23[↩]
20. BHM000033_050 para 133[↩]
21. BHM000030_038 paras 77-78[↩]
22. BHM000045_011 para 47[↩]
23. BHM000045 paras 1-9, 40-43[↩]
24. BHM000045_010-011 paras 44-47[↩]
25. INQ000111_148[↩]
26. INQ000158_057 para 24.7[↩]
27. Jonathan Collier 30 March 2022 141/22-23[↩]
28. SER000256_004[↩]
29. Jonathan Collier 30 March 2022 154/11-20[↩]