Distrust and confusion stopping immigrants detained in UK Immigration Removal Centres from seeking healthcare

The research uncovered a number of barriers to detainees accessing healthcare

Social psychologists at Nottingham Trent University (NTU) carried out in-depth interviews at two Centres to investigate why detained migrants resist accessing the health services that they are entitled to when they feel unwell.

Detainees were asked to reflect on their experiences of seeking help and healthcare satisfaction, while staff - who held a variety of roles within the IRCs - were asked about their experiences and understanding of detainees looking for support with health-related issues, and the quality of care they receive.

The analysis revealed that mental distress and health concerns are very common among detainees, linked to their detainee status and the uncertainty surrounding it. Some participants argued that any health-related help that detainees receive within IRCs is likely to be fundamentally inappropriate and ineffective unless it can address the cause of their suffering, namely the inequalities associated with their detainee status.

Results also showed lack of trust in officials and lack of knowledge about their healthcare rights, as well as dissatisfaction with healthcare services when help was sought. Practical constraints on healthcare provision within IRCs, for example lack of staff time and health resources and the unpredictable nature of detention, are shown to be exacerbating existing complex and conflictual relationships between staff and detainees.

Dr Blerina Kellezi, Associate Professor in Social and Trauma Psychology at NTU’s School of Social Sciences, said: “If people are put in a vulnerable situation like that of unlimited immigration detention, it is essential that they are provided with appropriate mental and physical healthcare. However, detainees find it very difficult to trust the help offered to them, and they remain confused about their healthcare rights and how their help-seeking would be perceived by officials. The views of IRC staff confirmed that detainees who seek health-related help could be perceived as having underlying motivations for their request, for example to benefit their legal case. This, combined with the uncertainty of detention, makes it very difficult for IRC staff to design and provide effective and satisfying healthcare for detainees.

“To help address these issues, healthcare professionals working within IRCs must be aware of how issues such as stigma and lack of trust prevent detainees from feeling satisfied with the healthcare they receive and may prevent them seeking healthcare altogether.

“Our findings have implications for government policy during and beyond the COVID-19 pandemic. The findings reflect some of the challenges that minority groups who have experienced continuous discrimination and alienation from host societies experience as they make decisions about seeking help. They also highlight the dangers of attempting to provide healthcare and other services without addressing fundamental issues such as stigma, discrimination, and distrust, which can prevent minority groups from accessing much-needed support, including crucial COVID-19 support, such as vaccination.

“Ultimately, the risk is that the needs of such groups are underestimated, and their disengagement with healthcare and other services is perceived as problematic behaviour. To avoid such outcomes, governments must ensure that they address these wider societal challenges faced by minority groups that may prevent them from seeking healthcare, and from perceiving that healthcare as satisfying and effective.

“By recognising and addressing the health-related inequalities faced by minorities, both during the COVID-19 pandemic and beyond, governments have the best chance of ensuring that all groups feel able to exercise their fundamental right to effective healthcare access.”

Healthcare provision inside immigration removal centres: A social identity analysis of trust, legitimacy and disengagement has been published in the journal Applied Psychology: Health and Well-being. The study was carried out by Dr Blerina Kellezi, Dr Juliet Wakefield, Dr Mhairi Bowe Professor Clifford Stevenson, and Dr Niamh McNamara from the Department of Psychology at NTU’s School of Social Sciences.