The culture within the Healthcare department

28. In a report on immigration detention published in 2016, Mr Stephen Shaw (former Prisons and Probation Ombudsman) noted “a culture of disbelief” that pervaded healthcare and immigration casework.¹ He pointed to:

• a lack of trust among detained people in the GPs operating within IRCs to provide independent advice to the Home Office in reports made under Rule 35 of the Detention Centre Rules 2001 (discussed in Chapter D.5);
• the readiness of caseworkers to reject medical opinion on fitness for detention;²
• inadequate mental health provision for detained people; and
• inadequacies in the Assessment Care in Detention and Teamwork (ACDT) process (a process for managing those at risk of self-harm and suicide in detention, through constant supervision, discussed in Chapter D.5).

29. The Inquiry heard evidence from formerly detained people which indicated that doctors and nurses were, on occasions, dismissive of detained people and exhibited a lack of care or empathy during the relevant period.

29.1 D643 believed that Healthcare staff were frustrated with him for being mentally unwell and when he asked for help. They were not “sympathetic” to his suffering with PTSD and he “was treated as an inconvenience”.³ When he asked one of the GPs for a Rule 35 assessment, it was refused; he was spoken to “very harshly” and interrupted when he tried to explain his PTSD symptoms.⁴

29.2 D1473 stated that he “felt that healthcare at Brook House was really on the side of the detention centre rather than being focussed on looking after vulnerable detainees”.⁵ He said:

“Healthcare at Brook House never sent a Rule 35 report to the Home Office about my situation, despite knowing that I was a victim of torture and was suffering from serious mental health problems.”⁶

29.3 D687 told the Inquiry that, when he disclosed a past history of trauma and suicidal intentions to a nurse for the first time on 7 March 2017, “The nurse didn’t take it very seriously.”⁷ He stated:

“I wasn’t given any medication, just referred to an ‘art and craft class’ and a ‘victim awareness group’. I did not receive a Rule 35 appointment, or any other appointment to see a doctor. I continued to struggle with my mental health throughout the rest of my detention at Brook House.”⁸

29.4 D2077 committed an act of serious self-harm in Brook House by sewing his lips together. In his witness statement to the Inquiry, he said:

“I did not have any confidence in the healthcare system at Brook House. I felt that the doctors and nurses were part of the system and they had the same lack of care and disrespect for the detainees as the guards. I do not feel as if they truly wanted to help and were mainly concerned with trying to help the Home Office try to remove us.”⁹

30. In my view, this dismissive attitude of some Healthcare staff and their failure to fulfil their obligations under Rule 35, as well as failing to provide adequate healthcare, exposed vulnerable detained people to a risk of suffering harm in detention. In some cases, detained people’s mental health deteriorated as a result.¹⁰

1. INQ000060_167-168 para 7.53[↩]
2. INQ000060_028 para 1.78; INQ000060_186 para 10.7; INQ000060_187 para 10.9[↩]
3. DL0000228_010 para 44[↩]
4. DL0000228_011 para 47; INQ000060_085 para 4.12. See also DL0000222; DL0000226_036-037 paras 143-151; DPG000021_046 para 137; DPG000021_053 para 146; BHM000039_009-010 para 48[↩]
5. BHM000039_009-010 para 48; HOM029928_020-021[↩]
6. BHM000039_009-010 para 48; HOM029928_020-021 [↩]
7. DPG000021_046 para 137; DPG000021_053 para 146[↩]
8. DPG000021_046 para 137; DPG000021_053 para 146 [↩]
9. DL0000226_036 paras 144-145[↩]
10. Dr James Hard 28 March 2022 49/6-21, 85/23-86/20, 100/25-105/12; INQ000112_025-027; INQ000112_029-030; Dr Rachel Bingham 14 March 2022 22/8-23/14; CJS000887_036[↩]