Outsourcing morality: the dangers of private detention in mental health and beyond 

By Kieran Lewis, Policy Assistant
Content note: this article references neglect, abuse and deaths in detention (mental health facilities, immigration removal centres, and prisons) 

What is outsourcing, and where does it happen? 

Private involvement in public life in the UK has increased significantly over the past 30 to 40 years. Private interests and influence are deeply embedded in public service provision, primarily through the process of outsourcing. This happens when third-party companies provide services on behalf of a company or government. Nowhere is the reach of these interests more clearly illustrated than in privately operated spaces in which people are detained – particularly inpatient mental health facilities, Immigration Removal Centres (IRCs) and prisons.  

A significant proportion of these services are operated by ambiguously defined multinational ‘service companies’ like Serco, Mitie and G4S. These companies typically hold lucrative government contracts across areas from security and defence to healthcare and digital services. Such firms also hold contracts to provide operational support for the NHS. Outsourced clinical service provision, especially in mental health, is dominated by a small group of healthcare-specific providers including Cygnet Healthcare, the Priory Group and Elysium Healthcare. These providers are often financed by private equity-backed multinationals and are sustained by millions of pounds’ worth of NHS contracts

While inpatient mental healthcare facilities, IRCs and prisons may not seem like natural points of comparison, closer inspection reveals a disturbing trend of neglect, preventable suffering and impunity that is common across these settings. Contracts to run these spaces are increasingly being awarded to private companies with dubious records and little apparent regard for the welfare of people being detained in unacceptable conditions.  

What is the evidence? 

As difficult as it can be to get to the bottom of what goes on it privately operated spaces, the continued efforts of survivors and their family members, along with charities like Inquest and some high-profile media investigations, have allowed us to build a reliable picture. Across mental health facilities run by Cygnet, Priory and Elysium, at least 37 serious failures to properly meet patients’ needs have been identified and linked to inpatient deaths in recent years, including those of young people. The work of Inquest has been instrumental in bringing to light the harrowing details of this neglect, documenting the insufficient observation of inpatients, failure to remove dangerous items from patients’ rooms and the improper administration of medication. All of these practices have been listed as contributing factors to deaths in NHS-funded, privately operated mental healthcare facilities.  

This disturbing pattern of fatal neglect also runs through immigration detention – a notoriously secretive system, through which the Home Office can arbitrarily detain people in IRCs run by for-profit firms. Despite the opaque nature of the system, Medical Justice found that 35 people died in immigration detention in the UK between 2000 and 2015, amid reports of physical and verbal racial abuse in many cases. The Home Office has paid for the funerals of at least a further six people who have died in detention since 2017. The most recent death – that we are aware of, at least – is that of Frank Ospina, who reportedly died by suicide in Colnbrook IRC, operated by scandal-hit outsourcing company Mitie, in March this year.  

Predictably, but no less concerningly, such reports are also common across the prison system, where many facilities are operated by the likes of G4S, Serco and Mitie. HMP Birmingham, previously run by G4S, saw reports of squalid conditions and the serious mistreatment of inmates experiencing distress. Such was the state of the facility under private operation that HMP Birmingham was brought back under public control in 2018. Elsewhere, privately run prisons in the UK have also drawn headlines for allowing an 18-year-old to give birth alone in a cell and forcing inmates to leave without stable housing upon their release. 

Where is the accountability? 

Each one of these cases is deeply unsettling in its own right, but arguably even more so when viewed as part of such a clear pattern of neglect in privately run spaces where people are detained. Despite the literally deadly track records of many outsourcing companies, the state seldom expects them to take meaningful responsibility for their actions.  

Just a few years after G4S presided over the shocking deterioration of HMP Birmingham and physical abuse at Brook House IRC, for example, the company was awarded a £300 million contract by the Ministry of Justice to run a large prison in Northamptonshire. While G4S no longer runs Brook House, the infamous IRC is now in the hands of Serco, a company plagued by allegations of neglect and sexual abuse in its facilities for almost ten years.  

Elsewhere, in mental health settings, the outlook is no brighter. Despite the well documented failings of Cygnet, Priory and Elysium, the companies continue to dominate private provision in the UK, receiving the majority of the £2 billion that the NHS spends on mental healthcare annually.  

Why do we stand against outsourcing? 

It has long been apparent that increased private involvement in public service provision is bad news for the basic rights of service users and detainees. What is often overlooked, however, is how the convergence of this neglect across privately run spaces further stigmatises and harms the already marginalised groups most likely to experience detention – poorer people, racialised people and people who experience mental ill-health.  

There is a wealth of evidence, even aside from the many cases cited in this article, that outsourcing puts people at risk. We must remember that it does this as part of the same policy agenda that dehumanises non-citizens and sanctuary seekers, sustains a deadly disability benefit system and detains people experiencing distress without exploring alternatives.  

It is by acknowledging the intersections of these struggles and listening to those with lived experience that we can build the solidarity we need to push back against the oppressive systems that outsourcing represents.