Letters Asylum seekers’ health needs

Transfer care to the NHS

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4694 (Published 27 August 2010) Cite this as: BMJ 2010;341:c4694
  1. Hilary G Pickles, independent public health consultant1
  1. 1Twickenham, Middlesex TW1 2DD
  1. hilary.pickles{at}brunel.ac.uk

    The current unsatisfactory healthcare provision for immigration detainees1 is likely to worsen with the proposed cutbacks in funding to the UK Border Agency. Hence full transfer to the NHS has to be accelerated, while noting the paradox that this group becomes entitled to full free NHS care only because of being detained. In the proposed new world, detainee health care looks right for central commissioning and could sit alongside prison medical services.

    The Care Quality Commission has newly acquired responsibility for health care in some detention centres, and healthcare providers will need to work with it to improve standards. The many issues include non-referral for secondary care or transfer or deportation before it can be taken up, and failure to complete treatment, including for serious infectious diseases. The difficulty of the job expected of healthcare staff in immigration removal centres also needs to be appreciated, including the many constraining rules.

    The problem of mental ill health is not helped by the unclear demarcation of responsibilities between the UK Border Agency and the NHS for secondary mental health care. An increasing proportion of detainees are foreign national ex-prisoners awaiting deportation. The interaction between pre-existing mental illness, being convicted by a court, being judged fit for detention or deportation, and being incarcerated is complex. An added complication is the ability to dissemble severe mental illness.

    The right answer may be not only to improve mental health services for detainees but also to stop detaining those who are mentally ill and to identify and treat early those mentally ill prisoners destined for deportation.

    Detaining children is no longer considered appropriate. Perhaps the rest of the detention policy also warrants overhaul.


    Cite this as: BMJ 2010;341:c4694


    • Competing interests: HGP completed a health needs assessment on Colnbrook and Harmondsworth detention centres for Hillingdon Primary Care Trust in February 2010.


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