Detention of Vulnerable Persons

Debate between Lisa Cameron and Fiona Mactaggart

Tuesday 14th March 2017 Westminster Hall

[Dr Cameron]

I thank the Minister for that response. I shall come on to the concerns that I have. The situation involves some detail on which we need further information.

The time afforded for clinical assessment is extremely brief—perhaps only an hour. Meeting clients in Dungavel, alongside an interpreter, makes it even more difficult, because more time is needed to get accuracy. In my experience, the time afforded has not been enough. Building rapport in clinical practice takes time. To expect professionals to do a full, thorough assessment within a snapshot of time is not realistic. It takes repeated appointments. Trust must be built. After all, it is expected that people will open up about some of the most traumatic incidents or experiences of their lives. That does not happen in a few appointments. Clinically, that approach is not good practice, and from the point of view of humaneness it could be re-traumatising. Post-traumatic stress disorder and its symptoms mean avoidance and suppression of emotion, so people are being asked to do something very difficult in the context of their disorder.

Another issue that I found was that the background information needed for a full diagnosis was often not available. Perhaps it has not travelled with the person, or not much is known about their background, meaning that even more careful consideration and lengthier assessment are merited. How many trained psychologists are working in detention centres, and what time and space are they afforded to complete mental health assessments? My concern is that people are slipping through the net; that PTSD is not being diagnosed, that mental illness is not being recognised and that vulnerable and unwell people are being detained when they should not be.

Individuals with learning disabilities are likely to be extremely vulnerable, and in my opinion they should not be detained at all. Assessment to detect individuals’ IQ and history of developmental delay and significant impairment in everyday functioning is even more complex than mental health assessment, and IQ tests are often not culturally transferable. Once again, information for such individuals is often lacking, although background information on development is necessary. It can take multiple sessions speaking to numerous people involved in someone’s care to avoid missing critical information.

[Fiona Mactaggart (Slough) (Lab)]

The hon. Lady is describing powerfully the clinical issues that affect the diagnosis of vulnerable people who are detained. Does she agree that there is an additional layer involving trust? People who are detained may see clinicians as representing the authorities, which creates an additional barrier that must be penetrated in order to make an effective diagnosis.

[Dr Cameron]

I thank the right hon. Lady for that excellent point. I agree; that has certainly been my clinical experience. It is obvious that someone undergoing a clinical assessment will wonder about the motive for and outcome of the assessment, which will affect their level of trust and ability to open up. Once again, it shows just how lengthy and detailed an assessment must be, and that it must be built up over time.

How many people in detention are currently being assessed for learning disability, how is that being undertaken and are appropriate resources available for professionals? Such individuals are very vulnerable. If someone is presumed to have a learning disability, they should not be detained, because of that vulnerability. If there is any question of that, are alternatives sought straight away?

Thirdly, I have a concern about detaining foreign national offenders who may be sexual or violent offenders alongside those who are already traumatised. Often, information is lacking. When I visited Dungavel, I was told that sometimes when people come from prison, their records do not follow. That poses a clear risk to staff, because they do not know how high risk the individual is, and to the people alongside them in detention. We must ensure that information follows the person in order for a proper risk assessment to be made.

There is a clear risk to people with post-traumatic stress disorder following torture, rape or other trauma if they are detained alongside sexual offenders. That should not happen, but I know from my visits that, although some risk management procedures are in place, it sometimes happens; people speak about having been assaulted or sexually assaulted in detention. The risk management measures must be firmed up. What risk assessment and management measures are standardised to ensure that people are not at risk of further abuse? People with mental illnesses, learning disabilities or post-traumatic stress disorders should not be detained, and certainly not alongside offenders, which can re-traumatise and re-victimise them while they are in our care.