“It is clear that the Defendant gave very careful consideration to Dr Bell’s report. There is nothing to suggest that the Defendant failed to have regard to his undoubted expertise. The decision letter contains a careful analysis of the contents of the report. However, in my judgment the Defendant was entitled to take into account all of the other material which was available to her. On any view, Dr Sultan and Dr Burrun had far more information available to them than Dr Bell and had been better placed to assess the Claimant. … The Defendant could not ignore Dr Bell’s opinion, but she was entitled to take the limitations of his review into account in deciding what weight to attach to it when viewing the case in the round. In my judgment, the Defendant was entirely justified in reaching the conclusion that there was no prospect of the Claimant successfully demonstrating to a Tribunal that the ‘high threshold of Article 3’ had been met in the present case.”
“Impression / Adjustment Reaction causing Depression c- Risk of Self Harm PLAN / 1) Offered to start on Mirtazapine 15 mg very reluctant 2) Referred to Counselling for Supportive Counselling 3) ACDT to continue 1:1 observation due to potential risk 4) Fit for detention to monitor further progress/improvement 5) Next F/U Follow up. 2/52”
“Not fit to fly due to Clinical Depression and risk of self harm as part of ? Adjustment Reaction/Bereavement.”
“Reviewed again Continues to claim that he has decided to end his life and is not bothered if he is deported. Mood remains flat. Didn’t explain how he would kill himself but keeps referring to the stated fact that there is no hope or to look forward in his life. No evidence of psychosis Very reluctant to engage c- treatment plan Plan / 1) To offer anti-depressant (Mirtazapine) as prescribed. 2) To offer Counselling Support. 3) ACTD to continue till next review in 2/52”
“Thank you for your fax of23 September 2012 in which you stated that Mr Aboro was not fit to fly. We would be most grateful [if] you would urgently advise us as to [whether] Mr Aboro will be fit to fly on our charter flight to Nigeria on Wednesday10 October 2012 . Please kindly note that this special flight will have qualified medics on board and in constant attendance with any specified medicines in accordance with Healthcare advice. In addition if Mr Aboro is able to travel on this flight he will be on constant watch and will be given an advance supply of any required medicines to cover several weeks after his arrival home in Nigeria. Furthermore UKBA Immigration Officers and escorts will be on board with him for the entire journey. We can also confirm that should you advise that Mr Aboro will be fit to fly under the aforementioned circumstances, UKBA will be happy to comply with any other recommendations you may have for the flight.”
“Reviewed again today. Says he is absolutely fine and is capable to take his own decisions. Wouldn’t like to take any medication as he believes his problems cannot be helped by medicine. He wants to go back to Nigeria as he is not happy here in IRC/Prison in UK and can do whatever he wants to do in Nigeria. On asking about his thoughts of harming himself he said he would not like to discuss it any further. Mood was Subjectively OK sleep ✓ app Appetite ✓ con Conversation ✓ Objectively Flat Denies any thoughts of self harm now but says as he has no hope in life eventually he would like to kill himself when he gets chance in Nigeria. No evidence of psychosis. Not willing to accept any Medication. Plan / Counselling Support to be continued. Letter to UKBA – completed for Fit to Fly under special arrangements”
“Richard was reviewed on 7/10/12. I have assessed him at least 3 times in past 4/52. I believe although Richard has some symptoms of depression and insomnia (on & off), his claims about ending up his life are part of manipulation due to possible underlying diagnosis of Borderline Personality Disorder. He continues to refuse medications but accepts Counselling Support now. He has not self-harmed in last 4/52 as reported. On MSE Mental State Examination today, his mood was objectively flat was able to talk rationally and clearly c- good TVP Tone, volume and pressure of speech. . He has denied any thoughts of self-harm in near future but says he would eventually like to kill himself but didn’t elaborate on it. Additional Comments: I have received letter from UKBA dated 4/10/12 and I believe that Richard is fit to fly back to Nigeria. I understand he will be deported via charter flight with medics, UKBA officer who will be constantly monitoring and observing him. I will also recommend to handover the care of Richard to Nigerian Mental Health Team for further assessments of his mental health needs once he is there.”
“Mood remains euthymic, sleep ✓ app ✓ con ✓ Denies any thoughts of self harm at present but says he has nothing to live for. Wouldn’t mind to go back to Nigeria on 8/11/12 (charter flight). No evidence of psychosis. Plan / 1) Counselling support to be offered 2) Refusing to take or accept any medication. Hence not prescribed. 3) F/u in 2/52 if not deported. 4) Fit to fly.”
“In my view the medical records do not report any full psychiatric assessment. Much of the record reports what Mr Oboro has said gives very little further information. It needs to be stressed that a proper psychiatric examination involves a good deal more than reporting what is said but by necessity should include a full report of the psychiatrist’s assessment of the significance of what is said and also should include a detailed account of the objective features noted in the interview. Further it also needs to be borne in mind that a psychiatric opinion as to the presence of psychiatric disorder and of risk should rely upon a thorough examination of the mental state and take into consideration previous records and any other knowledge of the patient. Mental states can fluctuate but in many cases this will not alter an opinion as to the presence and nature of the psychiatric disorder which has to be an opinion ‘in the round’. From the records it seems clear that Mr Oboro has been considered to be depressed and at serious risk of self-harm/suicide. The fact that he fluctuates in what he says on any particular day may be of little relevance once one considers the picture in the round. I note that he is currently under constant observation, given the high risk. Given that there is ample evidence of the existence of psychiatric disorder and that the risk of suicide/self-harm has been and is regarded as high enough to require constant observation, it seems entirely reasonable to me to assume that deportation will bring a very high risk of suicide or self-harm. … At present, Mr Oboro’s mental disorder is not stable or controlled, and for this reason, he is no[t] fit to fly.”
“Seen today. Still wishes to kill himself. No reports of attempts to self-harm whilst in ACDT. Mood - but not severely depressed Energy, appetite Cognition No evidence of psychosis. Has full capacity. ? mild anxiety & depression but no evidence of severe & enduring mental illness ? Personality disorder Plan / 1) Detailed letter written for UKBA. … 2) Refusing meds but accepting counselling. 3) Fit for detention + Fit for Fly.”
“I assessed Mr Aboro in Psychiatric Clinic today along with my RMN colleague Jean Tebek. Mr Aboro continues to claim that there is nothing left in his life due to the various losses in his life and would like to commit suicide. He today asked me to prescribe poison for him which was a new development in his wishes. However on objective assessment he was very articulate and co-operative. His speech was normal in tone, volume and pressure. His mood remains [a] little depressed but there is no evidence of any psychotic symptoms. There [have] not been any reports of attempts of self harm whilst on ACDT. He is refusing to accept any medications (anti-depressants) and only attends counselling sessions at present. He has full capacity at present. Additional Comments: I believe Mr Aboro does not suffer from any severe and enduring mental illness and his wishes or thoughts of eventually killing himself are not consistent [with] severe depression or any mental illness. Those wishes are more suggest[ive] of frustration and anxiety and despair due to [being] in custody and his immigration matter. I believe he is Fit for detention and also is Fit to Fly back to Nigeria.”
“I assessed Mr Aboro today in my psychiatric clinic… I believe Mr Aboro suffers from anxiety and depressive symptoms as part of Adjustment Reaction but he doesn’t have severe and enduring mental illness like Recurrent Depressive Disorder. He keeps on claiming that he would like to finish his life but there is no record of any incidents of attempts to [commit] deliberate self-harm. Today, he was offered anti-depressant but again he refused to accept it. His mood remains [a] little agitated today [with] good energy level, good appetite and no active plans to harm himself at present. He has full capacity and I believe he does not require any transfer to Psychiatric Hospital. Additional Comments: He is fit for detention & Fit to Fly and I believe UKBA should be able to take further action after seeing my current & previous responses to queries.”
“ Pt is very alert & animated today Continues to express same views He has “things going on in his head that he cannot explain” “Constant ? voices”
“Reviewed today along with RMN. At present he remains on constant watch in healthcare due to refusing to eat & drink properly, claiming to hear voices & having thoughts of self-harm. O/E: On examination Appears dehydrated & have lost some weight but stated he is fed up being locked up & wants to [be] released and doesn’t want to go back to Nigeria. Mood was ? agitated & frustrated due to ongoing detention and appears to be low in self-esteem & affect. Denies any current plans to harm himself but says he would do it at some point. appetite. ? Protesting c- hunger Claims to hear voices inside head but cannot elaborate on it & is not distractible or distressed due to them. No visual hallucinations. ? Depressive symptoms as part of Personality disorder. No evidence of Major Depressive Disorder. Frustrated, angry and [?] due to ongoing situation Plan / 1) Anti-depressant c- anti-anxiety with hypnotic effect was offered but Richard refused. He wants to have ?traditional Nigerian medication which is not able to explain. 2) Advised to continue having Counselling Support 3) To remain on constant watch due to unpredictable behaviour secondary to ? personality disorder and not wanting to fly back to Nigeria 4) Fit for detention + Fit to Fly. 5) Next f/u in 4/52 but RMN & GP should assess the physical needs & provide support.”
“…He admitted feeling stressed when is detained in IRC and is very anxious about his immigration issues. He is threatening to kill himself if he is deported back due to backlash from the opposition group in Nigeria. Feels that he would feel better if is allowed to stay in UK.”
“21. It is clear to me that Mr Aboro suffers from psychiatric disorder. His condition would satisfy the diagnostic criteria for Severe Depressive Disorder with psychotic features… That is, he shows the typical features of profound despair and nihilistic thoughts; no hope for the future; suicidal ideation with a history of suicide attempts (I noted in my previous report that he has been on suicide watch); profound feelings of self-blame and guilt; poor appetite and sleep, inner voices telling him to kill himself (pseudo-hallucination). 22. The aetiology of his condition would appear to be complex. Although it is possible that his view of his life is coloured, retrospectively, by his current Severe Depressive Disorder, I think it is more likely that there has been in reality psychological disturbance for much of his life. That is, it seems that since he was a child he was traumatised by being separated from his parents. He was unhappy at school where he was bullied and socially isolated. Another significant factor is that there is a family history of Severe Psychiatric Disorder. I refer here to the suicide of his brother. These features suggest the presence of a disorder of personality development of a type that is depressive that is also reflected in his difficulties with interpersonal relationships. People suffering from this kind of personality disorder are predisposed to becoming severely depressed and are vulnerable to environmental stressors. 23. Other events of etiological importance are the multiple bereavements and also the extremely traumatic event of his wife being murdered. 24. In my view, the psychiatric disorder as I have described it is real. I have considered the possibility that it is fabricated and I am clear that this is not the case. I do not think it would be possible to fabricate this kind of psychiatric disorder, or to maintain it over this long period of time.”
“Currently there is a moderate to high risk of self-harm and suicide. This should be kept under regular review by competent psychiatric authorities. It is my view that this can only be carried out outside the context of detention as the context of detention acts as a potent stressor and because there is not available in this context the appropriate kind of help. … He will require specialist psychological help, particularly given that this is a complex case that is, a mixture of psychiatric disorder and a background of personality disorder. Psychological treatment would be of a specialist type and would be necessary for a number of years. He will also need various forms of support to help him manage day to day living in the community.”
“O/E: He presented well with good eye contact and reasonable personal hygiene. Speech was coherent & relevant, good rate & volume. Mood subj says that he is low anxious Obj: Euthymic Says that he would consider ending his life if he is deported back to Nigeria but denies any intent or plans to end his life at the moment. No evidence of any psychotic symptoms. He talked at length about the tragic loss of his wife and family and the difficulty he is now having to come to terms with this major loss. He was reluctant to engage in counselling. Cognition was intact. He has good insight into the nature of his problems. PLAN 1) Mr Aboro has a diagnosis of Personality Difficulty with Adjustment reaction. He will benefit from counselling and 1:1 support by RMN. 2) He is currently fit to be detained. 3) He is also fit to fly.”
“I have seen him a couple of times outside my surgery about lunch time, crossing the road looking happy and very articulate over the mobile speaking to a friend”
“73. He is genuinely uncertain about his future. He is not genuinely suicidal and his comments in that regard are limited to his saying that he is better off dead if Boko Haram are going to kill him. His statements about hearing voices and fearing he would be killed were not accompanied by any particular expression of emotion and in that sense his affect was inappropriate to what he was saying. 74. I found him evasive throughout. … 75. He is clearly aware of his circumstances. He was fully oriented in time, place and person. He appeared to be of average intelligence.”
“He appears to have reported his history inaccurately when telling the experts that he tried to kill himself in prison. I have not seen a record of anything other than the sort of gestures that one encounters in patients who are attempting to manipulate those around them. The request for poison from a doctor was probably such a gesture and it would be a very odd way for a truly suicidal man to behave.”
“155. … It appears that some of his complaints emerged when he was faced with deportation. If they were due to his experiences in Nigeria one would have expected them to be acute when he first arrived in the country. 156. He probably had symptoms of an adjustment disorder when first seen by Dr Sultan. It is difficult to know because the clinical picture was clouded by manipulative behaviour and exaggeration. I have great sympathy for the clinicians who looked after him because they were faced with malingering of a life-threatening illness, particularly in May 2013. 157. He has probably never suffered from a depressive episode. He definitely did not suffer from a severe depressive disorder with psychotic features during the time covered by the records I have seen. The observations taken as a whole are incompatible with such a diagnosis. 158. His statements that he will kill himself if returned to Nigeria, or that he would prefer to kill himself rather than be shot by terrorists, are not in any way typical [of] the way that severely depressed people talk when contemplating suicide. They are either expressions of frustration or attempts at manipulation. 159. He has in my opinion never been truly unfit to fly to Nigeria but the opinion given by Dr Sultan in that respect was a humane, sensible and cautious decision about a man with whom he had only brief acquaintance.”
“Most detention centers these days have decent and regular medical input from GPs and sometimes psychiatrists. Even at its highest, the treatment options for a patient so severely affected as Mr Aboro are much restricted. The section above discusses why. So although Mr Aboro’s mental health can be theoretically managed within detention, it is questionable that it can be ‘satisfactorily’ managed within detention. Dr Bell, way back in 2013, but faced with similar presentation from Mr Aboro. His opinion I have quoted above. This appears to be a reference to Dr Bell’s view that continuing detention is very harmful to the Claimant’s mental state. 3 years on, faced with similar presentation, I would repeat his opinion.”
“It is that some of RA’s symptoms may be functional i.e. whether consciously or unconsciously, they serve a psychological function or purpose. In fact, with the benefit of hindsight and having seen the updated assessments, I regret that I did not mention this third possibility when I reported on RA in 2014.” (§31) “… having had further experience of immigration cases since I saw RA in 2014, I would now give greater emphasis to the possibility mentioned above. Some of the inconsistencies in presentation, and the sometimes histrionic or exaggerated manner of presentation, may be explicable in terms of functional, stress-related symptoms. I have no doubt that RA has faced great stresses over the past few years. It would not be surprising for him to have developed some functional, stress-related symptoms. That is consistent with the view I expressed that this was never a straightforward case of depression or post-traumatic stress disorder. In reporting on immigration cases, I am struck by the fact that there tends to be far greater polarisation of views than there is in most civil litigation. The diagnosis of stress-related functional symptoms is in my view a possible explanation for symptoms that are inconsistent and exaggerated but may not be the result of conscious fabrication.”
“33. …On23 May 2013 Dr Labinjo finds RA to be displaying psychotic features and to be almost catatonic. This is very severe mental illness and Dr Labinjo correctly arranges transfer to hospital. I make no criticism of his practice. I hope I would have done the same in the circumstances. 34. However, in hospital the following day, the psychiatrist Dr Garcia finds that RA does not appear psychotic or depressed. She believes he ‘may have an agenda’. I make no criticism of her practice. 35. When writing my report, I carefully considered these records and I reached the conclusions set out at paragraph 150. Something very odd happened. Psychotic depression verging on catatonia does not improve overnight. Yet, when dealing with patients in custodial or forensic settings, it is relatively common for apparent severe illness to remit with a change of circumstances. The common explanation is not that the illness gets better but that the presentation in custody is consciously or unconsciously exaggerated. This is in no way a criticism of Dr Labinjo. Any psychiatrist who treats patients in secure settings will have been in the same position. 36. This episode is a key event. Any psychiatrist who formulates the case in terms of severe depression has to deal with the fact that when transferred to hospital in May 2013, RA was found within 24 hours not to have what had appeared to be depression of the most severe kind.”
“(4) For the purpose ofsection 3(5)(a) of the Immigration Act 1971 , the deportation of a foreign criminal is conducive to the public good. (5) The Secretary of State must make a deportation order in respect of a foreign criminal (subject to section 33).”
“Principles (ii) and (iii) are conceptually distinct. Principle (ii) is that the Secretary of State may not lawfully detain a person “pending removal” for longer than a reasonable period. Once a reasonable period has expired, the detained person must be released. But there may be circumstances where, although a reasonable period has not yet expired, it becomes clear that the Secretary of State will not be able to deport the detained person within a reasonable period. In that event, principle (iii) applies. Thus, once it becomes apparent that the Secretary of State will not be able to effect the deportation within a reasonable period, the detention becomes unlawful even if the reasonable period has not yet expired.”
“… In CCD cases concerning foreign national offenders, if detention is indicated, because of the higher likelihood of risk of absconding and harm to the public on release, it will normally be appropriate to detain as long as there is still a realistic prospect of removal within a reasonable timescale.”
“As has been set out above, public protection is a key consideration underpinning our detention policy. Where a foreign national offender meets the criteria for consideration of deportation, the presumption in favour of temporary admission or temporary release may well be outweighed by the risk to the public of harm from re-offending or the risk of absconding, evidenced by a past history of lack of respect for the law. However, detention will not be lawful where it would exceed the period reasonably necessary for the purpose of removal or where the interference with family life can be shown to be disproportionate. In assessing what is reasonably necessary and proportionate in any individual case, the caseworker must look at all the relevant factors to that case and weigh them against the particular risks of re-offending and of absconding which the individual poses. In balancing the factors to make that assessment of what is reasonably necessary, UKBA distinguishes between more and less serious offences. A list of those offences which UKBA considers to be more serious is set out at page 63.”
“As explained above, where the person has been convicted of a serious offence, the risk of harm to the public through re-offending and risk of absconding are given substantial emphasis and weight. While these factors remain important in assessing whether detention is reasonably necessary where a person has been convicted of a less serious offence, they are given less emphasis than where the offence is more serious, when balanced against other relevant factors. Again, the types of other relevant factors include those normally considered in non-FNO detention cases, for example, whether the detainee is mentally ill or whether their release is vital to the welfare of child dependants.”
“If removal is not imminent, the caseworker should consider the risk of absconding. Where the person has been convicted of a more serious offence … then this may indicate a high risk of absconding. An assessment of the risk of absconding will also include consideration of previous failures to comply with temporary release or bail. Individuals with a long history of failing to comply with immigration control or who have made a determined attempt to breach the UK’s immigration laws would normally be assessed as being unlikely to comply with the terms of release on restrictions. … The person’s family ties in the UK and their expectations about the outcome of the case should also be considered … The greater the risk of absconding, the more likely it is that detention or continued detention will be appropriate.” (original bold emphasis; underlining added) Paragraph 55.10: “suffering serious mental illness which cannot be satisfactorily managed within detention”
“These cases take the words of the phrase “suffering from a serious mental illness which cannot be satisfactorily managed within detention” as a whole. It is clear from them that the diagnosis is not in itself the key to the applicability of the policy, even if the individual has been referred for treatment by specialist secondary services. It is also necessary for the individual concerned to be “suffering” and for the illness to be one which “cannot be satisfactorily managed within detention”
“67. The authorities also show that the threshold for the applicability of the policy is that the mental illness must be serious enough to mean it cannot be satisfactorily managed in detention. As to satisfactory management, at the time detention is being considered, the Secretary of State, through her officials, should consider matters such as the medication the person is taking, and whether his or her demonstrated needs at that time are such that they can or cannot be provided in detention. Account should be taken of the facilities available at the centre at which the individual is to be detained, and the expected period of detention before he or she is lawfully removed. R (OM) v Secretary of State for the Home Department[2011] EWCA Civ 909 at [33] shows that some of those suffering significant adverse effects from mental illness may be managed appropriately in detention. OM had attempted suicide by hanging herself. She was diagnosed as having recurrent depressive disorder and emotionally unstable personality disorder which was not suitable for treatment under theMental Health Act 1983 . The views of the experts were divided but Richards LJ stated that the balance of expert advice was that her illness could be managed appropriately in detention.”
“25 One has some sympathy for the caseworker because the report of Dr Agnew-Davies had been submitted to the Home Secretary as relevant to an issue different from that of the legality of O’s continued detention in the short term. Nevertheless on any view the report bore some relevance to the Home Secretary’s policy relating to the detention of the mentally ill and should have been properly addressed in the reviews. The reviews: (a) failed to refer to Dr Agnew-Davies’s diagnosis of O as suffering PTSD; (b) indeed wrongly stated that the most recent diagnosis of O’s mental condition was that of Dr Ratnayake; (c) failed to refer to Dr Agnew-Davies’s assessment of O’s need for treatment at a specialist trauma-focussed psychiatric clinic; and (d) failed therefore to consider whether O could be ‘satisfactorily managed’ at Yarl’s Wood and, even if not, whether there were very exceptional circumstances which nevertheless justified her continued detention.”
“51. … [Counsel for the Secretary of State, Ms Anderson] asked whether, in every case where a detainee presents as suffering from a mental illness, the Secretary of State is required to consider whether that mental illness can be satisfactorily managed in detention, i.e. whether the policy is engaged. She submitted that the Secretary of State should not be required to do this. As to whether the duty to consider whether the policy applies arises, she submitted that in this case the duty only arose at the point when the policy was engaged, which the judge determined was on receipt of the second Rule 35 report. 52. This question was considered by Elisabeth Laing QC in R (BA) v Secretary of State for the Home Department[2011] EWHC 2748 (Admin) where she stated: ‘183. The other issue of construction is what is meant by the phrase, ‘those suffering from serious mental illnesses which cannot be satisfactorily managed in detention’. The issue concerns the stage at which this part of the policy is engaged. Mr Kellar’s submission is that the policy is only engaged if the detainee is currently, and obviously, suffering from a condition which cannot be managed in detention. This part of the policy was not engaged in the initial stages of BA’s detention, because when he was discharged from hospital he was stable, and, indeed, euthymic. Mr Buley submits that this part of the policy is engaged when the Secretary of State is deciding whether or not to detain a person who is suffering from a mental illness which may mean that his illness cannot be managed satisfactorily in detention, even if he is well at the time his case is considered. Here, on the information available to UKBA, there was a clear risk that BA, though initially stable, could quite quickly deteriorate, and as a result of detention, to a point where his illness would not be manageable in detention. 184. I prefer Mr Buley’s submission. It seems to me that Mr Kellar’s interpretation of the policy is likely to lead to the very problems which occurred here. The laissez faire approach entailed in this construction would permit the Secretary of State to detain someone who is potentially unsuitable for detention, and to forget about him, leading to risks that the detainee’s condition will not be monitored, and of deterioration to a point where the illness cannot be managed. Mr Buley’s construction, on the other hand, is likely to lead to a more conscious approach to the identification, and care and custody, of those with serious mental illnesses, because it requires the Secretary of State to confront this issue at the outset, to make plans for the detainee’s welfare if the decision is to detain, and to be alert, in detention reviews, for signs of deterioration which may tilt the balance of factors against detention.’ Ms Anderson submitted that this decision was made ‘without an understanding of the systems in place’. I consider that submission to be entirely unfounded. 53. It is clear from Richards LJ’s judgment in LE’s case and the cases referred to in it (see [2012] EWHCA Civ 597 at [33] and [35]) that there is a ‘seriousness threshold’ before the policy is engaged. I also accept there may be cases where a detailed consideration of whether the policy applies may be unnecessary. The case of a detainee suffering mild depression which is being treated by medication may be such a case. The circumstances of this appellant, however, are fundamentally different. Subject to that, however, I agree with the approach of the Deputy Judge in the paragraph of her judgment in BA’s case set out above. I reject the submission that a duty to consider whether the policy is engaged only arises once the policy is actually engaged.”
“Conditions rendering person suitable for detention only in very exceptional circumstances (see section 55.10 of Enforcement Instructions and Guidance)”
“There must be a sufficient prospect of removal to warrant continued detention when account is taken of all relevant factors.”
‘• Detainees should receive health care equivalent to that available to the general population in the community with access to services based on clinical need and in line with the Detention Centre Rules; and • Health and wellbeing services in IRCs should seek to improve health and wellbeing (including parity of esteem between services which address mental and physical health) …’ 30. In relation to the detention of those suffering from mental health problems, the Home Secretary's Policy Equality Statement dated26 November 2014 recorded her agreement with NHS England that the provision of healthcare at a standard equal to that provided in the community was a “core principle”. She noted, however, that respondents to her consultation had suggested that in IRCs there was an insufficiency of specialist mental health interventions, with the result that adherence to the principle was not achieved. Although both the Partnership Agreement and the Equality Statement post-date 2011, the Home Secretary does not suggest that they are irrelevant to the interpretation of the policy then applicable to O.” ‘• Detainees should receive health care equivalent to that available to the general population in the community with access to services based on clinical need and in line with the Detention Centre Rules; and • Health and wellbeing services in IRCs should seek to improve health and wellbeing (including parity of esteem between services which address mental and physical health) …’