Psychiatric expert witness for the First-tier Tribunal (Immigration and Asylum Chamber)
A psychiatric report for the First-tier Tribunal (Immigration and Asylum) is prepared to a standard informed by the Istanbul Protocol and addresses the mental health questions that bear on protection and human rights grounds — the presence and origin of psychological trauma, the effect of continued proceedings and possible removal, and, where relevant, suitability for detention. He is instructed by representatives acting for appellants and, less commonly, by the Home Office.
These reports are read by First-tier Tribunal (Immigration and Asylum Chamber) judges who are experienced in weighing medical evidence against credibility findings, and the report has to be candid about what psychiatric opinion can and cannot establish: it can describe a disorder and its likely origin with reasoned confidence, but it cannot itself determine whether an account of persecution is true.
What Dr Qureshi can advise on
- Whether the appellant meets diagnostic criteria for post-traumatic stress disorder, depression or another recognised psychiatric disorder, using ICD-11 or DSM-5 criteria.
- The degree to which the clinical presentation, including any physical or psychological sequelae described, is consistent with the account of ill-treatment given, applying the framework in the Istanbul Protocol.
- The effect of memory, avoidance and dissociative symptoms on the appellant's ability to give a consistent and detailed account, relevant where inconsistency has been raised as a credibility point.
- The likely effect of removal to the country of origin on the appellant's mental state, including risk of relapse, self-harm or suicide, for the purposes of the human rights grounds relied on.
- Whether continued or renewed immigration detention is likely to have a significant adverse effect on the appellant's mental health, relevant to Home Office detention policy and to bail applications.
- The treatment the appellant currently requires, its availability, and the likely consequences of interruption to that treatment.
- The effect, if any, of the assessment process itself — including the use of an interpreter — on the reliability and completeness of the account obtained.
- Prognosis, and the extent to which any disorder is likely to improve, remain static or deteriorate depending on the outcome of the proceedings.
Where scarring or physical sequelae require specific forensic physical examination, that falls outside psychiatric practice and he recommends instruction of an appropriately qualified physician alongside the psychiatric opinion.
Typical instructions
- PTSD assessment supporting a protection claim
- An appellant describes detention and ill-treatment in the country of origin and presents with symptoms of intrusion, avoidance and hyperarousal. The report addresses diagnosis and consistency with the account, using the framework set out in the Istanbul Protocol, and states clearly the limits of what that consistency assessment can establish.
- Effect of removal on an existing psychiatric condition
- An appellant with an established depressive illness and a history of self-harm faces removal following an unsuccessful asylum claim. The instruction addresses the likely psychiatric effect of removal and of interrupted treatment, for the purposes of the human rights grounds relied on.
- Suitability for continued detention
- An individual held in immigration detention presents with deteriorating mental state. The report addresses whether continued detention is likely to cause significant harm, by reference to current presentation, risk indicators and the treatment available within the detention setting.
- Report required before a fixed hearing date
- A hearing before the First-tier Tribunal is already listed and a psychiatric report is required in time for the bundle to be lodged. Availability is confirmed against the hearing date before the instruction is accepted.
What the report includes
The report sets out the instructions received, the documents considered, the arrangements made for interpretation, and the account given at interview, distinguished clearly from information drawn from other sources such as GP, detention healthcare or prior medical reports.
The mental state examination and diagnostic formulation are followed by a structured consideration of consistency between the clinical presentation and the account given, expressed in the graded terms used in the Istanbul Protocol rather than as a finding on credibility, which remains a matter for the First-tier Tribunal (Immigration and Asylum Chamber).
The report addresses the specific legal question asked — whether on protection, human rights or detention grounds — in plain terms, states the limits of psychiatric opinion where relevant, and closes with the required declaration of independence and duty to the First-tier Tribunal (Immigration and Asylum Chamber).