13 Building trust in clinician-detainee interactions: the role of a boundary object

Background Detainees in Immigration Removal Centres (IRC) report distrust in interactions with staff and Home Office officials.1 Clinicians volunteering with NGOs offer independent medical assessments and write medico-legal reports to support detainees’ asylum claims. Outcomes could be impacted if insufficient trust is established, or if distrust develops, when discussing traumatic experiences that can recreate positions of powerlessness and vulnerability. The complex dynamics of trust-building with detainees have seldom been explored in IRC contexts, which typically preclude researchers’ direct access. Aim To identify processes that enable trust-building in clinician-detainee interactions in an IRC in England, using the qualitative tool of autoethnographic reflection. Methods I explored my own practice as a volunteer physician undertaking clinical assessments with detainees over a two-year period, through reflexive autoethnography. I used the conceptual lens of boundary-spanning work2 to explore trust-enabling processes within the particular social context of my interactions with detainees. Results As detainees shared emotional accounts of traumatic experiences, collaborative navigation of uncertainties replaced the traditional ‘history-taking’ performative of clinician-led interactions. The intended transformation of a narrative into a medico-legal report allowed an intermediary platform between detainees’ telling of individual experiences and my re-telling in the form of the ‘expert evidence’ required for asylum claims. Conclusion The objective of generating content for a detainee’s medico-legal report differs from the ‘usual’ circumstances of a medical assessment. Reciprocal processes of narration can rechannel power asymmetries inherent in the interaction, co-constructing some form of agency. Boundary objects between forms of knowledge might offer a platform for building trust in precarious clinical interactions. References Kellezi B, et al. Understanding and coping with immigration detention: Social identity as cure and curse. Eur J Soc Psychol 2019;49:333–51. Long JC, et al. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res 2013;13:158.