Why is TID needed?

Many people seeking asylum have experienced human rights abuses. Survivors of torture have been estimated to make up around one third.  Others have experienced different types of violence and the vast majority are thought to have been affected by violence. A significant proportion will have been subject to modern slavery, gender based violence, female genital mutilation or child abuse.   

Such individuals have high levels of health problems. Many also have physical and psychological evidence that supports their allegations of abuse.  However they face numerous barriers to having their health needs identified and to obtaining documentation of the clinical evidence of abuse.  

Most have no access to a specialist health assessment to document the effects of the abuse that they have experienced.  Through our work with people who have applied for asylum in different medical and legal settings, we have seen significant numbers of people who have reported torture or other forms of human rights abuse who have never had even a basic clinical assessment of the consequences of this. In fact many people have not even been asked about the possibility of human rights abuses, despite claiming asylum and coming from high risk countries. The NHS is under pressure and very few NHS services offer any tailored care to consider human rights abuses. Within the medico-legal field there is a very limited pool of suitably trained and experienced clinicians available to conduct specialist assessments and legal representatives frequently have difficulty identifying appropriately qualified clinicians to prepare the reports needed for asylum claims.    

Those who do get a specialist assessment rarely do so at an early stage in their asylum claim. In view of the limited availability of suitably trained and experienced clinicians, legal representatives usually reserve requests for specialist assessments for clients whose claims have already been refused, or who are making fresh claims after all appeal rights have been exhausted.  

In routine healthcare, the health consequences of torture and other forms of human rights abuse are frequently missed. Patients frequently have difficulty both in accessing health care and in disclosing in full what has happened to them. There are multiple reasons for this, including not being asked, the limited time available and their mistrust of authorities, shame and embarrassment or post-traumatic symptoms. When mainstream health care providers are unaware of the history of torture or abuse then the health consequences of this may not be recognised.  

In routine health care, where health consequences of abuse are identified, the nature of the documentation may not be helpful to asylum decision making.Such documentation includes copies of medical records prepared for clinical rather than legal purposes, or brief letters from GPs that do not comment on links between human rights abuses and injuries or mental health problems. Routine notes are particularly likely to be of limited value where services are working under pressure and unable to offer adequate assessment.

Not having access to an adequate health assessment means unmet needs may not be identified and people then do not access appropriate treatment. This contributes to psychological and physical ill health and can lead to avoidable deterioration in health, and increased risk of suicide. Unless the physical, psychological and social consequences of human rights abuse are recognised, people who have experienced such severe ill-treatment are unlikely to be rehabilitated.  

Not having access to an adequate health assessment means that very few people have the opportunity to present adequate clinical evidence in support of their allegation of torture or other human rights abuse. Without specialist reports, or documentation by appropriately trained professionals, clinical evidence of abuse is usually unavailable to asylum decisions makers and courts to assist in the task of assessing claims. Many people find their reports of human rights abuses are not believed and that this leads to their being inappropriately refused asylum. Many are overturned at appeal or at a later stage.  

Refusals of asylum claims are not only distressing but also a frequent cause of adverse mental health consequences.  It is often only after years of appeals, and sometimes only after repeated fresh claims for asylum, that people are finally granted asylum.  Not having a decision on their asylum claim means people do not know if they will be returned to a situation of danger, and are unable to settle, work and begin to rebuild a life in the UK. This has a huge impact on their health and wellbeing, often leading to triggering or worsening of post-traumatic disorders and other mental health difficulties. 

Clinical evidence can make a difference. In many of those who are initially refused asylum, it is clinical evidence that eventually enables them to be recognised as refugees by Home Office or Tribunal decision makers.  Making such decisions earlier can in turn have an extremely important therapeutic impact assisting rehabilitation through helping to avoid delays in granting refugee status.  Clinical assessments can also identify where interviewing, immigration detention or removal from the UK would be clinically unsafe or aggravate ill health.