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

对于难民和寻求庇护者来说，心理健康状况普遍存在，而且往往不同于其他受创伤人群的经历，这不仅是因为他们在移徙前经历了战争、酷刑和迫害等事件，而且还因为他们在移徙后面临无数恶劣条件，包括与家人分离、移民拘留、经济困难以及在文化和语言上适应新环境的挑战。这些经历导致难民和寻求庇护者容易出现一系列心理健康问题，包括抑郁、焦虑、适应障碍和创伤性疾病。本文将考虑庇护当局是否以及在多大程度上根据医学发展调整决策政策，重点关注两个主要问题-个人（庇护申请人或被拒绝的庇护申请人）的移民身份是否应该确定获得医疗保健的权利和医疗保健专业人员提供治疗的医疗义务，而本文的第二部分将分析谁有资格确定庇护的心理健康需求申请人以及是否出于医疗或移民身份的目的。因此，本文将考虑医疗当局作出的决定与移民当局就庇护申请人的精神健康状况作出的决定之间的差异，依次审查每一项决定，并确定这些评估所涉及的一致性和不一致性。庇护申请人通常提交符合《伊斯坦布尔议定书》规定的标准的医疗文件，以协助证实其酷刑或虐待的主张，并对其患有的任何精神健康障碍提供临床诊断。本论文将适当考虑《伊斯坦布尔议定书》的目标、其在国际法中的地位以及它如何在庇护程序中适用，包括庇护申请人在获得符合《伊斯坦布尔议定书》标准的医疗报告方面面临的障碍。将对英国政府和难民署的关键立法、判例法和指导进行分析，以确定评估庇护申请中的医学证据的正确方法。毫无疑问，不驱回原则是保护难民和寻求庇护者的基石，因此必须考虑精神疾病的诊断是否和在多大程度上构成禁止将其驱逐的充分理由，因为精神疾病本质上是个人过去遭受酷刑或虐待行为的证据。将根据国际难民法和人权文书对禁止驱回进行分析，重点是1951年《难民公约》所规定的“有充分理由担心受到迫害”的定义。

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.