How do Domestic Asylum Authorities Adjust Decision-Making in Light of Medical Developments?

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For refugees and asylum seekers, the prevalence of mental health conditions is pervasive and often distinct from the experiences of other traumatised populations as a result of not only experiencing events such as war, torture and persecution prior to migrating but also due to the myriad of harsh conditions faced post-migration including separation from family, immigration detention, financial hardship and the challenge of adapting to a new environment both culturally and linguistically. These experiences lead to refugees and asylum seekers falling vulnerable to a constellation of mental health issues encompassing depression, anxiety adjustment disorders and trauma-based illnesses. This thesis will consider whether and to what extent asylum authorities adjust decision-making policies in light of medical developments by focusing on two main issues -whether the immigration status of an individual (asylum applicant or refused asylum applicant) should determine the right to access healthcare and the medical duty of healthcare professionals to provide treatment whilst the second part of this thesis will analyse who is qualified to determine mental health needs of asylum applicants and whether this is for medical or immigration status purposes. This thesis will therefore consider the difference between decision making by medical authorities compared to decisions made by immigration authorities regarding the mental health conditions of asylum applicants, examining each one in turn and determining the coherences and incoherence involved in these assessments.Asylum applicants often submit medical documentation compliant with the standards set out in the Istanbul Protocol in order to assist in substantiating their claim of torture or ill-treatment and to provide a clinical diagnosis of any mental health disorder they are suffering from. This thesis will give due consideration to the objectives of the Istanbul Protocol, its status in international law and how it is applied within the asylum process including the barriers asylum applicants face in obtaining medical reports which are in accordance with Istanbul Protocol standards. An analysis of key legislation, caselaw and guidance from both the UK government and the UNHCR will be carried out in order to determine the correct approach towards assessing medical evidence in asylum claims. There is no doubt that the principle of non-refoulement constitutes a cornerstone of the protection of refugees and asylum seekers and therefore it must be considered whether and to what extent a diagnosis of a mental health illness which is, in essence, evidence of an individual's experiences of past acts of torture or ill-treatment, will amount to sufficient grounds to prohibit their removal. An analysis of the prohibition on refoulement as per international refugee law and human rights instruments will be undertaken with a key focus on the definition of "a well-founded fear of persecution" as set out in the 1951 Refugee Convention.