Immigration detention is the practice of holding migrants for periods of time, either during the processing of their application for UK residency or, if their application has been refused, the time preceding their removal from the UK.  Many of those held are refugees who have made applications for asylum. The existence of and conditions within these detention centres have become controversial topics for the government among the many other issues regarding immigration that are currently being discussed. With the rising prominence of the refugee crisis, the detention centres have come under increasing scrutiny and the welfare of those being held is the principle concern of many non-governmental organisations lobbying for the rights of refugees.
The UK has some of the largest detention facilities in Europe, with a total of 32,446 men, women and children entering detention in 2015, and 2,607 being held at the end of that year.  41 of these individuals were held in detention by the Home Office for at least two years. 128 of those entering detention were children, although this represents a fall of 89% compared when data started to be collected – 1,119 children were being held in detention at the end of 2009.  With so many migrants experiencing detention in the UK, some for significant periods of time, it is important that the effects of detention are fully understood, especially with regards to health.
Theresa May, the current Home Secretary, commissioned an independent review of the welfare of those detained in February 2015 in an attempt to clarify the practices taking place and to look for possible improvements in detention centres.  This was completed by Stephen Shaw in September 2015, and published early this year. A significant section of the publication examined the healthcare provided for those in detainment, with a particular focus on mental health. Shaw identified the prominence of mental illness and its treatment and detection as a major concern.  He found that the services available to patients in the community or hospitals were not provided to those living in the detention centres, with large variations in available treatments between the various centres. Depression, anxiety and post-traumatic stress disorder (PTSD) were found to be the most common mental health conditions among detainees, however, many other serious mental health conditions, for example psychotic episodes or severe PTSD after suffering torture were also identified. Disturbingly, it was recognised that the services being provided did not meet the care needs of these detainees suffering more serious mental health conditions. 
As a further part of the review, Shaw had a literature review conducted to examine studies concerning the impact of immigration detention on mental health. The research consistently showed that immigration detention had negative impacts on mental health, and that this increased with longer periods of detention. It also showed that the negative effects on mental health endured long after individuals were released from detention.  In response to these findings Shaw recommended that the Home Office commission more research on the effects of immigration detention. He also recommended that the Home Office, NHS England and the Department for Health jointly plan to improve the provision of mental health services to those living in immigration detention.
The government response to this has been to establish a mental health action plan which will be published in April 2016 by the Department of Health, NHS and Home Office.  It is hoped that this plan will provide better mental health services to those being held and that this will help to improve their health outcomes. It is evident that much needs to be done to provide satisfactory healthcare to those held in detention. Where possible, the government should endeavor to provide the services that are currently available to NHS patients in the community and at hospitals to those in detention. Whether these improved services will be enough to overcome the negative impacts of time in detention itself however, remains to be seen.
Esme Goudie is a first year medical student studying at UCL. She has a special interest in healthcare services and how they can be improved as countries develop.
 Detention Action. FAQs [Internet]. Detentionaction.org.uk. 2016 [cited 25 March 2016]. Available from: http://detentionaction.org.uk/frequently-asked-questions
 Home Office, National Statistics. Detention – GOV.UK [Internet]. Gov.uk. 2016 [cited 25 March 2016]. Available from: https://www.gov.uk/government/publications/immigration-statistics-october-to-december-2015/detention
 Home Office. Home Secretary announces independent review of welfare in detention – News stories – GOV.UK [Internet]. Gov.uk. 2015 [cited 25 March 2016]. Available from: https://www.gov.uk/government/news/home-secretary-announces-independent-review-of-welfare-in-detention
 Shaw S. Review into the Welfare in Detention of Vulnerable Persons. 2016. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/490782/52532_Shaw_Review_Accessible.pdf
 Brokenshire J. Immigration Detention: Response to Stephen Shaw’s report into the Welfare in Detention of Vulnerable Persons:Written statement – HCWS470 [Internet]. UK Parliament. 2016 [cited 25 March 2016]. Available from: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-01-14/HCWS470