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Use of force

  1. The term ‘use of force’ has a particular meaning in the context of immigration detention. It can only be used by officers on detained people in particular circumstances and as a last resort, reflecting the possibility of causing serious harm.
  2. However, the Inquiry heard evidence that unauthorised and potentially highly dangerous techniques were used on several occasions during the relevant period. This included the most serious incident where one officer – deliberately and intending to provoke and punish him – placed his hands around D1527’s neck and said: “You fucking piece of shit, because I’m going to put you to fucking sleep.1 On several occasions, staff used an unauthorised and dangerous technique, namely, the handcuffing of detained people with their hands secured behind their back when seated. This creates a risk of causing positional asphyxia (whereby a person’s ability to breathe is impeded because of the way they are being restrained). This practice was removed from the Use of Force Training Manual in 2015, following the death of Mr Jimmy Mubenga on 12 October 2010, after he was restrained by G4S officers. No explanation was provided about the continued use of this dangerous technique and I am therefore recommending that the Home Office ensure that all staff are aware that it is not permitted.
Recommendation 14: Handcuffing behind backs while seated

The Home Office and contractors operating immigration removal centres must ensure that all staff are aware that the technique of handcuffing detained people with their hands behind their back while seated is not permitted, given its association with positional asphyxia.
  1. Staff also incompetently used authorised techniques (such as the ‘prone position’) in a way that became dangerous and increased the risk of injury.
  2. There was also considerable evidence that, during many incidents, officers were too quick to employ force. Attempts to de-escalate incidents were often non-existent, compounded by the unnecessary use of Personal Protective Equipment (PPE), reflecting a “cultural process of automatically resorting to PPE” among Brook House staff.2
  3. Many of the above issues demonstrate that the application of Prison Service Order 1600: Use of Force (the Use of Force PSO) to govern the use of force inside immigration removal centres (IRCs) is inappropriate. IRCs have a different purpose, populations and issues when compared with prisons. Reliance by IRC staff on a variety of sources for rules and guidance on the use of force (including the Use of Force PSO, the Detention Centre Rules 2001 and the Detention Services Operating Standards Manual) has created unnecessary complexity and confusion. This is best demonstrated by the majority of the 109 use of force incidents recorded during the relevant period being in order to “maintain good order and discipline”.3 However, this is not listed as a justification for force in Rule 41 or any of the other Detention Centre Rules, nor is it mentioned in the Detention Services Operating Standards Manual. Given the breadth of significant issues identified by the Inquiry, I am recommending the introduction of comprehensive and mandatory guidance about the appropriate use of force in IRCs.
Recommendation 15: A new detention services order about the use of force

The Home Office must introduce, as a matter of urgency, a new and comprehensive detention services order to address use of force in immigration removal centres.

The detention services order must include the following issues:

●  the permissible justifications for the use of force within immigration removal centres, based on the key principle that force must not be used unnecessarily and must be used only as a last resort;
●  the use of Personal Protective Equipment (PPE), including that it must be subject to a dynamic risk assessment before and during any use of force incident;
●  the protection of dignity when force is used on a naked or near-naked detained person;
●  the circumstances in which force can be used against a detained person with mental ill health; and
●  monitoring, oversight and reporting of use of force by contractors and by the Home Office.

The Home Office must ensure that training about the application of the new detention services order and use of force techniques takes place on a regular (at least annual) basis for all detention staff as well as healthcare staff. Attendance must be mandatory for all staff working in immigration removal centres and those responsible for managing them. The training must be subject to an assessment.

In anticipation of a new detention services order on the use of force in immigration detention, the Home Office must issue an immediate instruction to its contractors managing immigration removal centres that force must be used only as a last resort, using approved techniques.
  1. The Inquiry also saw force being routinely used on mentally unwell and vulnerable detained people, with an “unusually high” number of instances.4 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. There was routine and quick resort to force in response to incidents of self-harm. Use of force can lead to a serious worsening of symptoms of mental ill health and deter detained people from engaging with clinical care. 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. I am therefore recommending, in advance of the introduction of a new detention services order, that there be a thorough review of the use of force on detained people with mental ill health.
Recommendation 16: Urgent review of use of force on detained people with mental ill health

The Home Office must urgently commission an independent review (with the power to make recommendations) of use of force on detained people with mental ill health within immigration removal centres.

The review must consider:

●  how, when and whether to use force on detained people with mental ill health (including the application of pain-inducing techniques);
●  the likely effect of the use of force on a detained person’s mental health;
●  the use of individual risk assessments for detained people, which could be conducted by personal officers and healthcare professionals; and
●  the increased use and prioritisation of de-escalation techniques for those who have mental ill health.

The review must take place in consultation with relevant stakeholders, including detained people’s representative groups and mental ill health experts.

The recommendations of the review must be incorporated in the new detention services order regarding the use of force (see Recommendation 15), in respect of which additional, regular (at least annual) training must then be provided.
  1. These serious problems with the way force was used at Brook House were not identified or rectified, because the system of reviewing and monitoring use of force incidents was completely ineffectual. The lack of managers to supervise and witness how staff were behaving was particularly acute during use of force incidents and, in my view, their absence allowed (and in some cases may have encouraged) the Detention Custody Officers and Detention Custody Managers to act with impunity. Despite policies in place during the relevant period, the Inquiry found that there was no body worn or handheld camera footage for a large number of use of force incidents during the relevant period. The Inquiry was not provided with many videos of debriefs conducted by officers after use of force incidents, although it is unclear whether the debriefs did not occur or were not filmed.
  2. The internal review process was cursory and of poor quality, with long delays between the incident and the review, and scrutiny meetings with more senior G4S staff were often cancelled due to the lack of another Control & Restraint (C&R) coordinator and C&R trainers to view the footage. The Home Office’s role in the oversight of use of force was also inadequate, with a failure to make inappropriate use of force incidents themselves into contractual performance measures. Use of force incidents must be comprehensively reviewed to ensure that force has been used appropriately and to identify any necessary improvements to practice or training. I am therefore recommending urgent action to address this, in advance of the introduction of a new detention services order.
Recommendation 17: Urgent improvement of use of force reviews

The Home Office must ensure, as a matter of urgency, that training is delivered on how to conduct an effective use of force incident debrief, ensuring that issues of detained person and staff welfare, as well as training needs, are covered. The training must be mandatory for all immigration removal centre contractor employees who conduct such reviews and those who manage them.

The Home Office must also require that use of force incidents be reviewed, at a minimum, at the following levels:

●  Within 36 hours of each use of force incident, the Use of Force Coordinator must conduct a thorough incident review, ensuring that all documentation and footage are collated and preserved, and with a view to taking emergency action in instances of unlawful or inappropriate force. On a weekly basis, all use of force incidents must be reviewed (including all necessary paperwork and available video footage) at a formal meeting by the Use of Force Coordinator and a suitable manager in order to review each incident and to identify any issues or further action required.
●  On a monthly basis, immigration removal centre contractor senior management must arrange meetings with other stakeholders (including detained people and representatives of non-governmental organisations) to review use of force trends.
●  Periodically, the Home Office (or its Professional Standards Unit if the Home Office considers it more appropriate) must review use of force at
Brook House and across the immigration detention estate, to identify trends and to direct the implementation of any changes and improvements that are required.

This review process must be reflected in the new detention services order regarding the use of force – see Recommendation 15 – in respect of which additional, regular (at least annual) training must then be provided.


  1. Day 2 AM 24 November 2021 00:53-01:23:53 (KENCOV1007 – V2017042500021). See also INQ000111_013 para 29; INQ000111_146 para 637[]
  2. INQ000185_039; INQ000111_145-146 para 636 (use of force incidents involving D1914 on 27 May 2017 [134/17], D1234 on 28 March 2017 [81/17], D2054 on 28 June 2017 [162/17], 86/17 and 108/17); INQ000111_011-012 paras 19-20; Jonathan Collier 30 March 2022 91/7-10; INQ000111_012 para 24; INQ000111_156 para 658 (incidents 164/17 and 165/17[]
  3. CJS000905_006; CJS000908_010; CJS000914_008; CJS000910_010; CJS000619_10[]
  4. Jonathan Collier 30 March 2022 61/22-62/8. See, for example, Day 41 AM 30 March 2022; CJS0074115 UOF 88 17 BWC 8:50-17:35; INQ000111_076 para 302; Day 41 PM 30 March 2022  00:34:02-00:40:32 (S1970002 [CJS0074113]); SER000437_006 para 22[]