Section one Context All IMBs acknowledged improvements in health care over the years, but concern, particularly about the mental health of detainees, remained. One of the most serious indicators of vulnerability by virtue of mental ill-health is the number of detainees who are sectioned under the Mental Health Act. In 2019, seven detainees at Harmondsworth were sectioned; at Yarl’s Wood, five were. The figure for Yarl’s Wood includes a woman who had previously been sectioned in 2014. She was immediately identified as an Adult at Risk and was subsequently sectioned again, but because of administrative problems in the area where she had previously been registered, there was a delay of 49 days from sectioning before she was transferred to a mental health bed.170 A second indicator of vulnerability and harm in detention is self-harm, which IMBs reported as still being a worrying feature of life in detention. At Yarl’s Wood, there were 54 cases of self-harm during 2019, which is more than the total for 2018, even though there were fewer detainees. At Harmondsworth, there was an average of two to three incidents of serious self-harm, requiring external medical attention, per month. At Morton Hall, there were 202 incidents of self-harm in 2019, which equated to a similar rate to 2018.171 There were also examples of detainees with other vulnerabilities, such as physical or other disabilities, being detained, with inadequate provision for their needs. At Harmondsworth, the IMB reported that detainees included those who use wheelchairs as well as those who are partially sighted or have learning difficulties. The Board did not consider the IRC to be suitable for these detainees, particularly as there is no provision for social care, and cited a continuing problem with an unreliable main lift.172 At Tinsley House, Yarl’s Wood and Dungavel, IMBs reported that levels of violence were low during 2019. The Tinsley House Board in particular described the atmosphere in the IRC as being very safe. At Harmondsworth, Morton Hall and Brook House, however, IMBs were concerned about levels of violence. The Brook House Board reported 20 detainee-on-detainee assaults, 260 threats of violence, 24 fights and 82 assaults on staff during 2019.173 HMI Prisons found that physical security arrangements remained disproportionate in IRCs which were inspected during the reporting year. Detainees were often confined to their rooms for prolonged periods, and handcuffs were also used excessively for some detainees attending outside appointments.174 In 2018, IMBs at Harmondsworth, Campsfield House (now closed) and Brook House IRCs had reported unacceptably high rates of handcuffing of detainees on external visits – for example 92% of detainees were handcuffed on 170 IMB, October 2020, Immigration Detention Estate: Annual Report 2019, https://s3-eu-west-2.amazonaws.com/imb-prodstorage-1ocod6bqky0vo/uploads/2020/10/IDE-National-Annual-Report-for-publication.pdf [accessed 10/11/2020] 171 IMB, October 2020, Immigration Detention Estate: Annual Report 2019, https://s3-eu-west-2.amazonaws.com/imb-prodstorage-1ocod6bqky0vo/uploads/2020/10/IDE-National-Annual-Report-for-publication.pdf [accessed 10/11/2020] 172 IMB, October 2020, Immigration Detention Estate: Annual Report 2019, https://s3-eu-west-2.amazonaws.com/imb-prodstorage-1ocod6bqky0vo/uploads/2020/10/IDE-National-Annual-Report-for-publication.pdf [accessed 10/11/2020] 173 IMB, October 2020, Immigration Detention Estate: Annual Report 2019, https://s3-eu-west-2.amazonaws.com/imb-prodstorage-1ocod6bqky0vo/uploads/2020/10/IDE-National-Annual-Report-for-publication.pdf [accessed 10/11/2020] 174 HMI Prisons, October 2020, Her Majesty’s Chief Inspector of Prisons 2019-20 Annual Report, https://www. justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2020/10/HMI-Prisons_Annual-Report-and-Accounts2019-20-WEB.pdf [accessed 30/10/2020] 55