Screening for human rights abuses

TID’s main current focus is on piloting early brief clinical assessment for human rights abuses in recently arrived people who are seeking asylum.

Why have we chosen to look at clinical screening?

Identifying and supporting people who have experienced human rights abuses, at the earliest opportunity, allows swift assessment of physical and psychological complications and can help prevent unnecessary distress and deterioration in health.

Clinicians’ early documentation of human rights abuses in reports or letters, may offer asylum decision makers a fuller view of a person’s asylum application and help them understand how trauma can impact on an individual. Appropriate and timely medical evidence can transform the lives of people who have experienced abuse by helping them secure protection. The absence of mechanisms to feed medical evidence into the asylum decision making process can be devastating for people who have experienced abuse. Their accounts may not be believed and/or adjustments may not be made for them when their cases are heard.

Health and asylum are inextricably linked. When poor health and evidence of human rights abuses are not identified and documented, this can lead to problems within the asylum process. Decisions about accommodation, detention, interviews and giving evidence at hearings can all be affected by medical evidence. Too often evidence of human rights abuses comes to light far too late in the asylum process and can then exacerbate poor health, with subsequent impacts on health and care services trying to meet crisis needs.

To date, the main forms of organised medical evidence available to people seeking asylum have been expert-witness medico-legal reports. These are lengthy and complicated reports documenting injuries, mental health symptoms and applying the legal standards expected by the courts found in the Istanbul Protocol (a United Nations publication on the documentation of torture and other forms of severe ill-treatment). Such reports are almost always requested by asylum lawyers, but currently there is an ‘advice desert’ with only 50% of people claiming asylum having access to a legal representative. Only a small number of people have been fortunate enough to get one of these reports due to the resources required to prepare them. With the numbers of people claiming asylum increasing, there is a need for clinical assessments that are shorter, need  fewer resources, are accessible to many more people and produce more easily understood documentation for asylum decision makers.

The attrition of publicly-funded advice and representation for people seeking asylum, has affected asylum lawyers’ referrals for medical evidence. At TID we have noticed a decline in the number of referrals we have received from lawyers over time. GPs have also noticed a decline in requests for letters from lawyers. Instead there has been exponential growth in requests for copies of entire GP records because these attract no, or very low fees, to produce.  This results in inappropriate use of GP records as medical evidence in the asylum process. Please see our resources on safer use of GP records in ‘Summary of TID Projects’ .

For resources – please see also Info for Referrers and Info for Clinicians pages.

Current approach

When there is a possibility that a person has experienced human rights abuses, the patient is referred to a specialist GP who is offering TID clinical screening sessions. The doctor holds a 45-60 minute appointment during which they make an assessment of the patient’s physical and psychological health and of any risks. Details of the assessment, including clinical findings from it, are entered into the GP record using a specially designed template which forms the basis of a preformatted letter/report. Medical problems identified are then fed back into the GP practice and the assessment forms a permanent item in the patient record. The patient is also a offered a copy of the assessment for their own personal records.

 

The future

TID has plans to develop relationships with the voluntary sector. The voluntary sector are increasingly trying to plug a gap for legal assistance by for example helping people to prepare for their asylum interviews . We are developing a pathway for referring people who appear unwell, are struggling with explaining themselves or who may have medical evidence of human rights abuses.

TID will be working with other clinicians and organisations in the near future to roll out training and support for clinicians who are keen to learn how to screen for human rights abuses.

Project evaluation will be a constant component of our work. We are setting up an advisory panel of clinicians, lawyers and voluntary sector advisers to inform the development of this project.

Information for people reading TID screening reports

Please read the earlier sections of this webpage. A screening assessment is a one-off assessment and the findings are limited to what can be found in a targeted but time-limited appointment. The clinical picture can change over time. Psychological conditions such as PTSD and depression can worsen or improve. Risk assessments need to be conducted when there are changes in an individual’s situation. Suicide and other risks change over time and need to be repeated when there are changes in an individual’s situation or mental health.