7.6 Specialist health care services and external appointments Allied health and specialist appointments are managed by a combination of regular onsite visits and external appointments. A visiting physiotherapist attends the centre weekly, a sonographer fortnightly, and an optometrist quarterly. The dental service is also provided by a visiting local dentist. IHMS advised the Commission that they were sourcing a visiting podiatrist. Services for people requiring specialist or intensive treatment are also delivered through arrangements with hospitals in Perth and elsewhere. In relation to attending external medical appointments, several people described being required to wear handcuffs when attending some appointments but not for others. The inconsistency of this practice and its impacts have already been raised in several of the Commission’s past inspections.80 Serco told the Commission that restraints are not necessarily used for every transfer or movement and that a choice was often made between mechanical restraints or enhanced escort, which involves more staff. One of the written submissions received by the Commission noted that ‘the use of handcuffs and other restraints discourages attendance at offsite medical and mental health appointments, potentially exacerbating existing health conditions and delaying diagnosis of others. It also further harms the mental health of detainees, many of whom are already suffering the adverse effects of prolonged detention’. While the Commission recognises that there may be a legitimate need to use physical restraints in certain circumstances, it is also important to acknowledge that the use of restraints may risk exacerbating some medical conditions (particularly mental health issues) and is particularly problematic with respect to individuals who have previously been victims of torture and trauma. Many people at YHIDC described the ordeal of being handcuffed as confronting and one person described the experience as extremely distressing due to his previous trauma experience, stating he would become very unwell during the journey as a result. Yongah Hill Immigration Detention Centre Inspection Report • 2024 • 41