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Rapid response to:


Prison health: five minutes with . . . Alan Mitchell

BMJ 2021; 373 doi: (Published 18 June 2021) Cite this as: BMJ 2021;373:n1584

Rapid Response:

Re: Prison health: five minutes with . . . Alan Mitchell

Dear Editor

Bryan Christie’s interview with Alan Mitchell draws attention to the impact of increased restrictions and deprivation of liberty on those in prison during the pandemic, calling for a roadmap for prisons parallel to the roadmap outlining the easing of restrictions in the community. As Mitchell highlights, “Prisoners have been locked in their cells for much longer periods.”[1] In the UK, this has extended to confinement alone or with a cell-mate for 22-24 hours each day; a practice whose compatibility with individuals’ Article 3 right not to be subject to cruel, inhuman and/or degrading treatment has been called into question.[2]

Such conditions correspond, unsurprisingly, to a profound impact on mental health: A report by HM Inspectorate of Prisons (HMIP) in February 2021 found a “disturbing” decline in prisoners’ emotional, psychological and physical well-being.

A recent report by two charities, Medical Justice and Bail for Immigration Detainees (BID), describes how prolonged confinement during the pandemic has been experienced by people who are in prison solely due to their immigration status, not under an ongoing criminal sentence.[4] The individuals featured in the report described worsening symptoms of depression, severe anxiety, psychotic symptoms and exacerbation of post-traumatic stress disorder during their confinement, all of which are known mental health consequences of solitary confinement.[5-7] Rates of self-harm and thoughts of suicide are also increased in those who experience solitary confinement,[7] both of which were reported by people described in the report.

The UK remains the only country in Europe to sanction indefinite immigration detention: immigration detainees usually do not know how long they will be detained for. This uncertainty is considered particularly damaging to mental health.[8] This harm is compounded by solitary confinement, as research indicates that not having prior knowledge of the duration of solitary confinement increases its negative impact.[5] This was borne out by the experiences of detainees cited in the recent report, with the uncertain duration described as one of the worst aspects of prolonged isolation.

Medical literature predating the pandemic consistently shows that immigration detention has a negative impact on mental health, correlating with the duration of detention.[9] People with pre-existing mental health conditions or a history of trauma are at particularly high risk.[9] Furthermore there is unanimous expert consensus that detention is harmful to the health of survivors of torture.[10] Despite these pre-existing concerns, people with known vulnerabilities were detained in isolation for prolonged periods in the UK during the pandemic.

People held under immigration powers in prisons during the pandemic have been subjected to two lasting harms: Experiences of solitary confinement may have long term consequences,[6] while the negative mental health consequences of immigration detention, prior to the pandemic, were known to last well beyond release, with one study showing negative mental health sequelae persisting for three years.[11] The full impact of these combined harms remains to be seen.

The report by Medical Justice and BID calls for the release of immigration detainees from prison, for the use of prolonged segregation to be prohibited, for the UK government to adhere to UN minimum rules on the treatment of prisoners (the Mandela Rules), and in the meantime to implement further safeguards for people who are detained in prison under immigration powers.

As the first doctor to be elected president of the European Committee for the Prevention of Torture, Alan Mitchell is well-positioned to be able to highlight the health harms experienced by people held in prolonged segregation or solitary confinement, and we urge other health professionals witnessing these practices, and their harmful effects, to raise their own concerns.


01. Christie, B. Prison health: five minutes with … Alan Mitchell” BMJ 2021;373:n1584 doi:

02. The Joint Committee on Human Rights. The Government’s response to COVID-19: human rights implications. 2020. (accessed July 2021)

03. Her Majesty’s Inspectorate of Prisons. What happens to prisoners in a pandemic? A thematic review by HM Inspectorate of Prisons 2021; Paragraph 103 (accessed July 2021)

04. Schulkind R, Hanley I. “Every day is like torture”: Solitary confinement & Immigration detention. Bail for Immigration Detainees and Medical Justice 2021 (accessed July 2021)

05. Shalev S. A Sourcebook on Solitary Confinement. London, UK: Mannheim Centre for Criminology at London School of Economics and Political Science 2008 (accessed July 2021)

06. Grassian S. Psychiatric Effects of Solitary Confinement, Washington University Journal of Law & Policy 2006;22:325-383

07. Appel AM, Aon M, Cakal E. Solitary Confinement. DIGNITY Library 2018 (accessed July 2021)

08. The Royal College of Psychiatrists. Detention of People with Mental Disorders in Immigration Removal Centres (IRCs): Position Statement 2021. (Accessed July 2021)

09. M von Werthern, K Robjant, Z Chui, et al. The impact of immigration detention on mental health: a systematic review. BMC Psychiatry 2018;18:382

10. Faculty of Forensic and Legal Medicine. Quality standards for healthcare professionals working with victims of torture in detention. 2019

11. Steel Z, Silove D, Brooks R, et al. Impact of immigration detention and temporary protection on the mental health of refugees. BJ Psychiatry 2006;188(1):58-64. Doi:

Competing interests: Rachel Bingham is Clinical Advisor to Medical Justice Hilary Pickles is honorary treasurer and acting chair of Medical Justice

21 July 2021
Rachel Bingham
GP, Clinical Advisor
Hilary Pickles
East London NHS Foundation Trust; Medical Justice
Medical Justice, London