RG (Suicide - Risk - Razgar Considered) Sri Lanka [2005] UKIAT 00072
Date of hearing: 19 November 2004
Date Determination notified: 23 March 2005
RG |
APPELLANT |
and |
|
Secretary of State for the Home Department | RESPONDENT |
Note:
This determination is being reported as it deals with the effect of the House of Lords decision in R (Razgar) v SSHD [2004] UKHL 27 on the consideration of claims that either Article 3 or Article 8 of the European Convention will be engaged by virtue of a claimed suicide risk on or following removal of a claimant.
For this reason, after reviewing the factual basis of the claimant's history and the changes which have taken place in Sri Lanka at paragraphs 5 and 6 of the determination, the psychiatric evidence before the tribunal is then set out at length at paragraphs 10 to 23 (evidence before the Adjudicator) and at paragraphs 29 to 34 (additional evidence before the Tribunal).
Paragraphs 37 to 47 are concerned with the Article 3 claim, taking account of N [2003] EWCA Civ 1369 in the light of the guidance of the House of Lords in Razgar and conclude that Kurtolli [2003] EWHC 2744 (Admin) can no longer be regarded as raising any arguable issue that the ratio in N is not of general application including application to suicide risk claims. In order to succeed under Article 3 a claimant's case would have to be exceptional in the way found by the European Court in D v United Kingdom.
Paragraphs 48 onwards consider the Article 8 claim, again by extensive reference to the guidance in Razgar. At paragraphs 58 to 63 the degree of deference to be accorded to the Secretary of State' views and the continuing effect of the starred decision of the Tribunal in M (Croatia) is considered. Paragraphs 64 to 71 are concerned with the speculative nature of claimed suicide risk by reference to Tribunal jurisprudence (paragraph 67 and 71) with fuller consideration of the ratio of Bensaid v United Kingdom in this respect at paragraphs 68 to 70 below.
It is hoped that the sub-headings will be of some assistance in conjunction with this note in identifying the issues considered but neither form part of the determination itself.
The Appellant's claim
Effect of changed situation in Sri Lanka
Dr Botting's report
Dr Coleman's reports
"He described to me how he had settled down to live in Newham at 39 Melford Road where he had been helped considerably by a group of friends who were very supportive towards him. He told me how he had been registered since June 1998 with Dr Venugopal, a well-known General Practitioner in Newham. He said that he had with the help of the London Oriental Academy enrolled in a computer class and also English classes. Of perhaps greater significance he described to me a very supportive uncle who lived in East Ham, and whom he was able to visit on a regular basis to obtain whatever help he needs whether financial or social. ... He said that if he were forced to go to Belgium he would lose everything and have to restart his life all over again. He said that he had no friends in Belgium, did not know the language, had no social connections, no relatives and no hope of setting up the networks of social support that he had developed here in Newham. … He said that he felt a sense of despair and suicidal thoughts were prominent. He said to me without hesitation that he would certainly attempt suicide in this country before his removal to Belgium."
"Mr Gopalasingham suffers from severe post traumatic stress disorder (PTSD), as evidenced by a history of both physical and mental torture, followed by the development of nightmares, flashbacks, hyper-vigilance, phobic avoidance and the development of depressive illness."Mr Gopalasingham suffers from severe depressive illness, as evidenced by a deeply despondent state of mood, suicidal thoughts, loss of energy, lethargy, physical retardation, social withdrawal, severe insomnia, loss of appetite, loss of concentration and forgetfulness.
As described above, Mr Gopalasingham has suffered from an episode of torture within circumstances which were not only designed to inflict physical pain and agony, but also to ensure that mental torture occurred at the same time."
The report then goes on to deal with the views of Dr Coleman that on the basis of his account the dehumanisation process during detention was particularly severe in that he was treated with utter contempt, forced to stay in the torture room after the period of torture, refused toilet facilities, refused hygiene and given little in the way of food or fluid.
He then deals with suicide risk in the following terms:
"When studying suicide risk one has to consider various 'load factors' which progressively increase the risk of an individual committing suicide. Depressive illness in itself is probably the major cause of the vast majority of suicides. The addition of another mental illness, such as post traumatic stress disorder, adds to the suicide risk. Chronic physical disability as, for example, caused by torture, once again adds to the risk. Unemployment, isolation from family and being a single male, are other factors adding to the risks. Mr Gopalasingham therefore has all the factors that make him a very high risk suicide. The change from potential suicide to actual suicide usually occurs when a person feels that he is placed in intolerable circumstances from which there is no way out, or there is a certainty that they will be placed back in circumstances which they know will be intolerable to bear. In the case of Mr Gopalasingham, there is a substantial risk that he will commit suicide if he believes that he is going to be removed to Belgium or Sri Lanka. The whole point about suicide is that it is based on the distorted judgment of the future. The suicide occurs because the individual has a conviction, sometimes a greatly distorted conviction, that only endless mental anguish awaits him in the future. He does not wait for this anguish to arrive. In effect, the individual has reached a point of total despair about the future and cannot see any way out except suicide. Mr Gopalasingham, therefore, has a substantial risk of committing suicide in this country if he believes that he is going to be removed to Belgium or Sri Lanka. To the rational mind, Belgium may seem like a reasonable destination for Mr Gopalasingham. Mr Gopalasingham's mind, however, is not rational, it is grossly distorted by the effects of progressive illness and post traumatic stress disorder. When an individual suffers from a severe mental illness, such as depressive illness, a secure and stable locality, with friends, familiar faces and sights, supportive carers, a caring General Practitioner and, in time, a local care and psychiatric unit, are absolutely vital in the treatment of the illness. However, Mr Gopalasingham's worst fear, and his most likely reason for attempting suicide in this country if sent to Belgium, is that he is convinced that he will be transferred from Belgium back to Sri Lanka. In my opinion Mr Gopalasingham has a total conviction about his fate in Sri Lanka."
"In the case of Mr Gopalasingham a 'community' has gradually been set up consisting of a network of friends, Mrs Verisingham, Dr Venugopal, a group of friends in Melford Road and regular treatment in the form of counselling for post traumatic stress disorder. The overwhelming consensus in psychiatry would agree that this 'community', set up to ensure the rehabilitation of Mr Gopalasingham, is critical for the resolution of his severe mental illnesses, and also his eventual rehabilitation in the wider community. The consensus view in psychiatry would also agree that his enforced removal to Belgium would be regarded as a shattering blow to his treatment and rehabilitation, not simply because of his arrival in a strange country, but because his 'community' was being shattered causing a critical dispruption of the treatment and rehabilitation processes at a very important stage in his rehabilitation. For self-evident reasons Mr Gopalasingham's 'community' cannot be transferred to Belgium and as a result his progress and treatment and rehabilitation will be set back for many years. Indeed, many experts in community psychiatry will say that it is the shattering of this 'community', rather than anything else which is the main risk factor in potential suicides."
Dr Patterson's report of 13 December 2003
"He said that about eighteen months ago he had become so convinced that he would be deported that he took an overdose of Anadin Extra intending to kill himself. He told me: 'It was all too much to bear.' He said that his flatmate had discovered the empty packet and taken him to Accident and Emergency. [He] said that he would take another overdose if he were told for certain that he must return to Sri Lanka. He recounted that his 'worst worry' is that he would not be able to stay in the UK. He told me that the support that he has in the UK from his flatmates and several others, including Mr Sivasubramanian and Ms Veerasinngham …. is keeping him alive. He said that in Sri Lanka he does not know the whereabouts of his family and fears that he would have no-one to turn to. In Belgium he told me that he does not know anyone. He recounted that, because of the uncertainty of his asylum situation, he is unable to escape from the endless fear of the future. He said that as time elapses he becomes increasingly hopeless about his situation. … [He] related that he is so preoccupied by the past and terrified of the future that he is unable to concentrate upon the present in the UK. He told me, for example, that he forgets what he has been asked to do and loses his possessions. He related that his concentration is so bad that he has hardly learned any English in six years and has now stopped trying to study. He related that he is always afraid that something bad will happen to him again. Mr Gopalasingham said, for example, that he is easily startled by the slightest noise and badly frightened by loud noises in the street or the sound of raised voices. He also says that he is afraid that the police would arrest him every time he signs on and he would be sent back to Sri Lanka. … He said that he often bangs doors and hits his head and arms against the wall. [His evidence before the Adjudicator was that he had done this on one occasion.] He told me: "I just want to smash something." He explained that his mind seems to go blank in the aftermath of his rage. He said: "At the time I think that I know what I am doing when I hit the wall and then afterwards I think: 'Why am I doing this, what have I done?' ". Mr Gopalasingham also recounted pervasive sadness. He told me that he is unable to take pleasure or find meaning in anything in life. He related that he has lost interest in everything."
"First, from his account he has suffered severe, cumulative trauma during late adolescence.
Secondly, he was not assured of being allowed to remain in the UK.
Thirdly, he may have to face further trauma with regard to being separated from the supportive community in the UK that constitutes, in my opinion, a surrogate family upon whom he is crucially reliant.
Fourthly, he is still faced with negotiating adolescent developmental tasks, at the later age of 25, underlined by the vicissitudes of cultural displacement.
Without treatment, he is unlikely to recover or to negotiate the transition from adolescence to adult independence. There is a risk that he will develop an enduring change of personality because of the trauma he has recounted.
Finally, his mental state is deteriorating, untreated, over time.
If he can be helped to engage in treatment, in the UK, it is probable that, in time, his symptoms of depression and PTSD may be partially alleviated. It is unlikely that he will ever recover completely, however, particularly if he has to endure further trauma and loss."
"In my opinion, his repeated statements that he would kill himself, in the UK, rather than be returned to Belgium, should be taken very seriously.
Mr Gopalasingham explained his conviction that being sent to Belgium would only be a short step in the process of returning him to Sri Lanka. From his account, he equates being sent to Belgium with being returned to Sri Lanka.
In evaluating the risk of suicide it is important to consider, first, that suicide is significantly more frequent in patients with severe depression, like Mr Gopalasingham, compared with the general population. Approximately 15% of severely depressed patients go on to kill themselves (Gelder, Mayou and Geddes [1999]).
Secondly, Mr Gopalasingham describes two previous suicide attempts in the context of being told that he was unlikely to be successful in his application for asylum. Individuals with a history of deliberate self-harm have a 100-fold increased risk of suicide compared to the general population. The presence of previous suicide attempts is a high-risk factor for later suicide.
Thirdly, Mr Gopalasingham has described the intensification of suicidal ideation with the continual delay in deciding upon his asylum claim.
Finally, for Mr Gopalasingham, faced with being sent back to Sri Lanka via Belgium, committing suicide, in the UK, is likely to represent the only way in which he is able to try to assert the vestiges of his arrested personal autonomy that has been devastated by his ordeal and to save himself from the further torture and death that he is convinced awaits him."
"First, from his account, he is overwhelmed by profound hopelessness. In my opinion, this was confirmed by his presentation at interview in which I noted his despair and passivity.
Secondly, he was clear, at interview, that he did not believe any treatment could help him while he was afraid of being sent back to Sri Lanka. As I have already described, Mr Gopalasingham equates being sent back to Belgium with an inevitable return to Sri Lanka.
Thirdly, in my opinion, Mr Gopasalingham has become trapped in a vicious circle from which he is unable to see any escape. He recognises that he needs treatment but the symptoms of his mental illness, such as the predominant experience of himself as a passive victim, characteristic of PTSD and the hopelessness characteristic of severe depression, prevent him from seeking the help he needs.
These dilemmas have prevented him from effectively seeking treatment in the UK where any contact with medical services has been initiated by his flatmate, Mr Premathas.
The vicious circle I have described is likely to be exacerbated by the deterioration in his mental state on being sent to Belgium."
"I have already described the delay in deciding his claim for asylum and the consequent current uncertainty of the asylum situation as significant factors that perpetuate Mr Gopalasingham's disturbed state of mind, maintaining his symptoms of PTSD and depression and increasing the risk of suicide.
Being sent back to Sri Lanka will undoubtedly, in my opinion, be experience of yet another life-threatening ordeal for Mr Gopalasingham.
Mr Gopalasingham told me that he is unable even to contemplate going back to Sri Lanka. He maintains that he will be arrested, tortured and murdered by the SLA or LTTE if he is returned. At interview, with me, it was difficult to explore his ideas about any future in Sri Lanka because he continued to say: "I will be killed."
First, this may be understood as a rational fear of what might actually happen in the future based upon his history of previous traumatic experiences in several episodes of detention, interrogation and multiple torture. His conviction that he is in danger is strengthened by the knowledge that the LTTE are free to operate throughout Sri Lanka, following the ceasefire and by news from Sri Lanka that he recounts of the continuing murder of Tamils by the security forces in the north of Sri Lanka.
Secondly, Mr Gopalasingham's perception of the danger that awaits him may also be understood as an unresolved symptom of PTSD, a further "flashback" phenomenon, in which the past trauma is alive, not only in the present but is also projected into the future. His evaluation of the danger awaiting him is also based, therefore, on perceptions that are distorted by symptomatic mental illness.
Thirdly, for Mr Gopalasingham, being sent back to Sri Lanka is likely to be experienced as a further major, stressful life event, removing any vestiges of hope and personal autonomy that remain to him.
From his account, he will also lose the physical sanctuary of the UK where he feels safe from the constant danger that he perceives of being arrested, tortured and murdered by the SLA or LTTE in Sri Lanka.
He will also lose contact with his small community in the UK who are providing the only support for his fragile mental functioning.
In my opinion being returned to Sri Lanka would, therefore, precipitate a worsening of both PTSD and depression and further undermine his already vulnerable mental state substantially increasing the risk of suicide."
Sustainability of the Adjudicator's findings
Further evidence before the Tribunal
"I note further, Mr Gopalasingham's additional statement (not before the Adjudicator) that he thought that ten Anadin tablets, five times the recommended dose, would be sufficient to kill him. In assessing the seriousness of the suicide attempt, it is crucial to determine the perception of the patient as to the lethality of the method. Mr Gopalasingham states that he thought that it would kill him. In my opinion, this adds significant gravity to his attempt.
I note Mr Gopalasingham's further statement in which he recounts that the medication that he was given in hospital was to make him sick. In my opinion, this would be in keeping with the routine treatment for overdose."
We note at this point that similar statements as to his intention to kill himself by taking the Anadins are in any event contained in the report which was before the Adjudicator on the basis of which Dr Patterson had concluded in her earlier report that the appellant had made "two previous serious suicide attempts", a view which we assume to be entirely dependent on the way in which he describes his intentions as opposed to the reality that neither of the two "attempts" could rationally be regarded as likely to have led to death or serious harm to him.
"In my opinion, Mr Gopalasingham's understanding of the consequences of his appeal being dismissed is NOT that he would be returned to Belgium but that he would be returned via Belgium to Sri Lanka. I think that this is based upon his symptoms of PTSD and depression.
In conclusion, I do not think that the Adjudicator has taken full account of the meaning and gravity of Mr Gopalasingham's mental state. In particular, the effect of his mental illness upon his capacity for thinking and making rational decisions about any matter relating to his previous ordeal or being returned to Belgium. I think, furthermore, that he has not considered my account of how the trauma has seriously arrested his adolescent development and left him highly dependent upon his surrogate family in the UK, especially with regard to his capacity to manage the everyday tasks of living and attend for the treatment that he requires. In my opinion, there remains a high risk of suicide in the UK as I describe fully in my previous report, if he is told for certain that he is to be sent back to Belgium or Sri Lanka."
The Convention basis of the human rights claims
"No-one shall be subjected to torture or to inhuman or degrading treatment or punishment."
That is an unqualified right.
"(i) Everyone has the right to respect for his private and family life, his home and his correspondence.
(ii) There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interest of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others."
If Article 8 is as a matter of fact engaged it is accepted that the regular enforcement of immigration control is one of the bases on which removal in breach of the protected human right may be proportionate under the derogation provisions of Article 8.2.
The Article 3 claim
"In N [the reference is to the Court of Appeal decision in [2003] EWCA Civ 1369], the Court of Appeal considered an Article 3 claim based on the fact that the applicant could not afford HIV treatment in the destination country. The court rejected the claim. Laws LJ held that in cases dependent on the difference in treatment between the UK and the destination country, recourse to Article 3 was only justified 'where the humanitarian appeal of the case is so powerful that it could not reasonably be assisted by the authorities of a civilised country'. That standard was not met in that case.
In Kurtolli [full reference [2003] EWHC 2744 (Admin)], a certification case, the respondent sought to extend this reasoning to suicide risk cases. Silber J firmly rejected that argument, on two broad bases: first, the facts in the N were of a very different nature. The issue of the difference between standards of care and the availability of psychiatric care in the UK and the destination country did not arise. Secondly, the law continued to be governed by the Court of Appeal's decision in Soumahoro, one of the cases conjoined with Razgar (see paragraph 79 for a summary of Silber J's reasons for not extending N to suicide cases).
In Soumahoro, which was also a manifestly unfounded certification case, the facts were somewhat similar to the present case (they are summarised in Silber J's consideration of the case at paragraph 44 of his judgment). Dyson LJ, who was part of the majority in N, noted in Soumahoro that there was uncontroverted evidence that if removed to France, there was a real risk that the appellant would commit suicide:
'If it was arguable on the evidence that there was a real risk of a significantly increased risk that, if she were removed to France, the appellant would commit suicide, then in our view her claim based on Article 3 could not be certified as manifestly unfounded.' (Paragraph 85).
Whilst all cases must depend on their specific facts and the evidence in support, the above cases suggest that where there is clear evidence that removal will give rise to a serious risk of suicide, an appeal under Article 3 should be allowed. If this were not correct, both of the appeals in Soumahoro and Kurtolli would have failed."
"This view is not I think shifted, but if anything confirmed, by what was said by the court in Pretty v United Kingdom [2002] 35 EHRR 1 at para 52:
'The suffering which flows from naturally occurring illness, physical or mental, may be covered by Article 3, where it is, or risks being, exacerbated by treatment, whether flowing from conditions of detention, expulsion or other measures, for which the authorities can be held responsible (see…D…and also Bensaid…)'
This court's obligation under Section 2(1) of the Human Rights Act 1998 is to 'take into account' (rather than follow) the Strasbourg jurisprudence. However, despite my reservations I am clear that it would not be right to hold that D v United Kingdom…should not be followed in our domestic jurisdiction. No such submission was made to us, and we must surely bear in mind what was said by Lord Slynn of Hadley…
'In the absence of some special circumstances it seems to me that the court should follow any clear and constant jurisprudence of the European Convention on Human Rights.'
"But I am no less clear that D v United Kingdom should be very strictly confined. I do not say that its confinement is to deathbed cases; that would be a course rule and an unwise one: there may be other instances which press with equal force. That said, in light of the considerations I have described I would hold that the application of Article 3 where the complaint in essence is of want of resources in the applicant's home country (in contrast to what has been available to him in the country from which he is to be removed) is only justified where the humanitarian appeal of the case is so powerful that it could not in reason be resisted by the authorities of a civilised state. This does not, I acknowledge, amount to a sharp legal test; there are no sharp legal tests in this area. I intend only to emphasise that an Article 3 case of this kind must be based on facts which are not only exceptional, but extreme; extreme, that is, judged in the context of cases all or many of which (like this one) demand one's sympathy on pressing grounds. On its facts, D was such a case. I consider that any broader view distorts the balance between the demands of the general interest of the community, whose service is conspicuously the duty of elected government, and the requirements of the protection of the individual's fundamental rights. It is a balance inherent in the whole of the Human Rights Convention: see, for example Soering v United Kingdom [1989] 11 EHRR 439, at para 89."
"We have not heard extended argument upon this appeal as to the scope of Article 8 in such circumstances. While I apprehend with respect that nothing I have said here is inconsistent with the court's reasoning in Razgar, it may be that the position regarding Article 8 will want some further scrutiny if my view of this case were to prevail."
"The distinction is vital to the present case. In a domestic case, the state must always act in a way which is compatible with the Convention rights. There is no threshold test related to the seriousness of the violation or the importance of the right involved. Foreign cases, on the other hand, represent an exception to the general rule that a state is only responsible for what goes on within its own territory or control. The Strasbourg Court clearly regards them as exceptional. It has retained the flexibility to consider violations of Articles other than Articles 2 and 3 but it has not so far encountered another case which was sufficiently serious to justify imposing upon the contracting state the obligations to retain or make alternative provisions for a person who would otherwise have no right to remain within its territory. For the same reason, the Strasbourg Court has not yet explored the test for imposing this obligation in any detail. But there clearly is some additional threshold test indicating the enormity of the violation to which the person is likely to be exposed if returned. …"
"54. How then should the health cases be regarded? By a 'health case', I mean one in which the applicant's health needs are being properly or at least adequately met in this country and the complaint is that they will not be adequately met in the country to which he is to be expelled. Thus far, in my view, these have all been regarded as 'foreign' cases. They date back to D v United Kingdom…, in which the proposed expulsion of a drugs smuggler apprehended on arrival but in the terminal stages of AIDS after serving his sentence was found in breach of Article 3:
'Aliens who have served their prison sentences and are subject to expulsion cannot in principle claim any entitlement to remain on the territory of a Contracting State in order to continue to benefit from medical, social or other forms of assistance provided by the expelling state during their stay in prison. However, in the very exceptional circumstances of this case and given the compelling humanitarian considerations at stake, it must be concluded that the implementation of a decision to remove the applicant would be a violation of Article 3." (Paragraph 54).
55. This principle is repeated in the very similar case of Henao v Netherlands (application no. 13669/03 (unreported)) 24 June 2003, where there was no breach because the humanitarian considerations were not as strong. It has also been applied in cases where the applicant has been properly resident for some time but remains subject to expulsion, either because of criminal offences, as in BB v France, Reports of Judgments and Decisions 1998 – VI, page 2595, or because of immigration control, as in SSC v Sweden [2000] 29 EHRR CD 245. In all of these the health complaint depended on Article 3, although in BB v France, there was also a complaint of potential deprivation of moral support of family and friends.
56. This brings us to Bensaid v United Kingdom. … As with the HIV/AIDS cases, this was a case based upon the risk of injury to health in removing someone from a place where his health needs were being adequately addressed to a place where it was alleged that they would not be. As for the HIV/AIDS cases, the main complaint was raised under Article 3. The applicant was a schizophrenic who required medication. Without it, there was a risk of relapse into hallucinations and delusions involving a risk of self-harm and harm to others both here and in Algeria. The fact that his circumstances in Algeria would be less favourable than here was not decisive. The risks were speculative. There was a high threshold, especially when the case did not concern the direct responsibility of the state for inflicting harm. It did not fall into the exceptional category covered by D v United Kingdom.
57. The court's case law did "not exclude that treatment which does not reach the severity of Article 3 treatment may nonetheless breach Article 8 in its private life aspect where there are sufficiently adverse effects upon physical and moral integrity" (paragraph 46). "Mental health must … be regarded as a crucial part of private life associated with the aspects of moral integrity… The preservation of mental stability is…an indispensable precondition to effective enjoyment of the right to respect for private life [protected by Article 8]" (paragraph 47). But it had not been established that the risk of damage to his health in returning him to his country of origin will substantially affect his moral integrity to a degree falling within the scope of Article 8. Even assuming the dislocation caused by his removal could be regarded as affecting his private life – the relationships and support established here – it was justified under Article 8(2) (paragraph 48).
58. In my view, the court was here drawing a distinction between the 'foreign' and 'domestic' aspects of the case. The 'foreign' aspect was the difficulty in accessing appropriate psychiatric treatment in Algeria. This fell mainly to be dealt with under Article 3, although the court did not rule out that it might be dealt with under Article 8 if the threat to moral integrity was sufficiently severe. The court did not in so many words repeat the 'high threshold' point made in relation to Article 3 but if it applies to Article 3 it ought logically to apply to Article 8, unless this is thought unnecessary because the interference will always be justified under Article 8(2) unless the high threshold is reached. The "domestic" aspects might have been the dislocation in his private life here caused by removing him, but that was clearly justified under Article 8(2).
59. Although the possibility cannot be excluded, it is not easy to think of a foreign health care case which would fail under Article 3 but succeed under Article 8. There clearly must be a strong case before the Article is even engaged and then a fair balance must be struck under Article 8(2). In striking that balance, only the most compelling humanitarian considerations are likely to prevail over the legitimate aims of immigration control or public safety. The expelling state is required to assess the strength of the threat and strike that balance. It is not required to compare the adequacy of the health care available in the two countries. The question is whether removal to the foreign country will have a sufficiently adverse effect upon the applicant. Nor can the expelling state be required to assume a more favourable status in its own territory than the applicant is currently entitled to. The applicant remains to be treated as someone who is liable to expulsion, not as someone who is entitled to remain."
"30. In his clear and comprehensive opinion in the linked appeals of R (Ullah) v Special Adjudicator and Do v Secretary of State for the Home Department [2004] UKHL 26, Lord Bingham has drawn attention to the wholly exceptional nature of the deporting state's responsibility for ill-treatment or harm subsequently suffered in the receiving state. It is unnecessary to repeat all the citations but it is relevant to note that the Strasbourg Court's insistence on the need for "very exceptional circumstances" continues to be maintained in the most recent jurisprudence: see the admissibility decision in Henao v Netherlands…
31. In N v Secretary of State for the Home Department…Laws LJ (with whom Dyson LJ agreed, although Carnworth LJ dissented) accepted the submission of Counsel for the Secretary of State that the well-known case of D v United Kingdom…was an "extension of an extension". (Para 37). He concluded (paras 40 and 42):
"…that the application of Article 3 where the complaint in essence is of want of resources in the applicant's home country (in contrast to what has been available to him in the country from which he is to be removed) is only justified where the humanitarian appeal of the case is so powerful that it could not in reason be resisted by the authorities of a civilised state".
and
"…that the position regarding Article 8 will want some further scrutiny if my view of this case were to prevail".
In my opinion those conclusions are justified by the Strasbourg jurisprudence.
32. In his opinion in Ullah and Do Lord Bingham approved the formulation of the Immigration Appeal Tribunal in Devaseelan v Secretary of State for the Home Department ([2002] UKIAT 00702*):
"The reason why flagrant denial or gross violation is to be taken into account is that it is only in such a case – where the right will be completely denied or nullified in the destination country – that it can be said that removal will breach the treaty obligations of the signatory state however those obligations might be interpreted or whatever might be said by or on behalf of the destination state".
I respectfully agree. I also respectfully agree with Lord Bingham's observation in this appeal (para 10 above) that where the appellant's case is based on his need for medical treatment or on his welfare, he could never hope to resist expulsion without showing "something very much more extreme than relative disadvantage" (as between the deporting state and the receiving state)."
The Article 8 claim
"17. In considering whether a challenge to the Secretary of State's decision to remove a person must clearly fail, the reviewing court must, as it seems to me, consider how an appeal would be likely to fare before an Adjudicator, as the Tribunal responsible for deciding the appeal if there were an appeal. This means that the reviewing court must ask itself essentially the questions which would have to be answered by an Adjudicator. In a case where removal is resisted in reliance on Article 8, these questions are likely to be:
(i) Will the proposed removal be an interference by a public authority with the exercise of the applicant's right to respect for his private or (as the case may be) family life?
(ii) If so, will such interference have consequences of such gravity as potentially to engage the operation of Article 8?
(iii) If so, is such interference in accordance with the law?
(iv) If so, is such interference necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others?
(v) If so, is such interference proportionate to the legitimate public ends sought to be achieved?
18. If the reviewing court is satisfied in any case, on consideration of all the materials which are before it and would be before an Adjudicator, that the answer to Question (i) clearly would or should be negative, there can be no ground at all for challenging the certificate of the Secretary of State. Question (ii) reflects the consistent case law of the Strasbourg Court, holding that conduct must attain a minimum level of severity to engage the operation of the Convention: see, for example, Costello Roberts v United Kingdom [1993] 19 EHRR 112. If the reviewing court is satisfied that the answer to this question clearly would or should be negative, there can again be no ground for challenging the certificate. If Question (iii) is reached, it is likely to permit of an affirmative answer only.
19. Where removal is proposed in pursuance of a lawful immigration policy, Question (iv) will almost always fall to be answered affirmatively. This is because the right of sovereign states, subject to treaty obligations, to regulate the entry and expulsion of aliens is recognised in the Strasbourg Jurisprudence (see Ullah and Do, para 6) and implementation of a firm and orderly immigration policy is an important function of government in a modern, democratic state. In the absence of bad faith, ulterior motive or deliberate abuse of power it is hard to imagine an Adjudicator answering this question other than affirmatively.
20. The answering of Question (v), where that question is reached, must always involve the striking of a fair balance between the rights of the individual and the interests of the community which is inherent in the whole of the Convention. The severity and consequences of the interference will call for careful assessment at this stage. The Secretary of State must exercise his judgment in the first instance. On appeal the Adjudicator must exercise his or her own judgment, taking account of any material which may not have been before the Secretary of State. A reviewing court must assess the judgment which would or might be made by the Adjudicator on appeal. In Secretary of State for the Home Department v Kacaj [2002] Imm AR 213, paragraph 25, the Immigration Appeal Tribunal…observed that:
"although the [Convention] rights may be engaged, legitimate immigration control will almost certainly mean that derogation from the rights will be proper and will not be disproportionate."
In the present case, the Court of Appeal had no doubt (paragraph 26 of its judgment) that this overstated the position. I respectfully consider the element of overstatement to be small. Decisions taken pursuant to the lawful operation of immigration control will be proportionate in all save a small minority of exceptional cases, identifiable only on a case by case basis."
"It is the Convention itself and, in particular, the concept of proportionality which confers upon the decision-maker a margin of discretion in deciding where the balance should be struck between the interests of an individual and the interests of a community. A decision-maker may fairly reach one of two opposite conclusions, one in favour of a claimant, the other in favour of his removal. Of neither could it be said that the balance had been struck unfairly. In such circumstances, the mere fact that an alternative but favourable decision could reasonably have been reached will not lead to the conclusion that the decision-maker has acted in breach of the claimant's human rights. Such a breach will only occur where the decision is outwith the range of reasonable responses to the question as to where a fair balance lies between the conflicting interests. Once it is accepted that the balance could be struck fairly either way, the Secretary of State cannot be regarded as having infringed the claimant's Article 8 rights by concluding that he should be removed."
"…then the Adjudicator cannot characterise that a decision 'not in accordance with the law' and so, even if he personally would have preferred the balance to have been struck differently (i.e. in the appellant's favour), he cannot substitute his preference for the decision in effect taken."
"41. Where the essential facts found by the Adjudicator are so fundamentally different from those determined by the Secretary of State as substantially to undermine the factual basis of the balancing exercise performed by him, it may be impossible for the Adjudicator to determine whether the decision is proportionate otherwise than by carrying out the balancing exercise himself. Even in such a case, when it comes to deciding how much weight to give to the policy of maintaining an effective immigration policy, the Adjudicator should pay very considerable deference to the view of the Secretary of State as to the importance of maintaining such a policy. There is obviously a conceptual difference between:
(a) deciding whether the decision of the Secretary of State was within the range or reasonable responses; and
(b) deciding whether the decision was proportionate (paying deference to the Secretary of State so far as is possible). In the light of Edore v SSHD…we would hold that the correct approach is (a) in all cases except where this is impossible because the factual basis of the decision of the Secretary of State has been substantially undermined by the findings of the Adjudicator. Where (a) is impossible, then the correct approach is (b). But we doubt whether, in practise, the application of the two approaches will often lead to different outcomes."
"Incarceration and custody is causing a relapse on the progress Mr Ali has made during treatment. He would be deprived of his support network from family [cousin and friends], when he is removed to Germany. He would not have access to medication or Cognitive Behaviour Therapy as he would only be given temporary immigration status by the authorities. His accommodation in a refugee camp will cause flashbacks of his incarceration in prison in Iraq and worsen his depressive mood and sense of despair. I feel that sending him back to Germany of even to Iraq would be very detrimental to his mental and physical well-being. I think he would make a serious attempt to kill himself."
"… Question (v), being more judgmental, is more difficult and, as already observed, the Secretary of State and the judge did not consider it. The Secretary of State, moreover, failed to direct himself that Article 8 could in principle apply in a case such as this. Question (v) is a question which, on considering all the evidence before him, an Adjudicator might well decide against Mr Razgar. If, however, his phobia of returning to Germany were found to be genuine (whether well-founded or not), and if his account of his previous experience (including his account of the severe brutality he claims to have suffered) were found to be true, I do not think one can rule out in limine the possibility of a finding, properly made, that return to Germany would violate Mr Razgar's rights under Article 8. It follows that in my opinion … the Secretary of State would not properly certify this claim to be manifestly unfounded."
Lord Steyn simply agreed with the judgment of Lord Bingham but in so doing Lord Carswell gave a reasoned judgment. It is appropriate that we should quote at some length from his judgment because of the light it sheds on the general approach both under Article 3 and Article 8:
"72. For the reasons given by your Lordships in the appeals of R (Ullah) v Special Adjudicator and Do v SSHD [2004] UKHL 26, it must now be accepted that in principle Article 8 could exceptionally be engaged by the foreseeable consequences for health of removal from the United Kingdom pursuant to an immigration decision, even though they do not amount to a violation of Article 3. In order to bring himself within such an exceptional engagement of Article 8 the applicant has to establish a very grave state of affairs, amounting to a flagrant or fundamental breach of the Article, which in effect constitutes a complete denial of his rights. It is necessary accordingly to consider the present case in order to determine whether an Adjudicator could arguable find that the removal decision is a breach of Article 8.
73. I would not regard the conditions in which the appellant may be detained in Germany, taking the case at its height in his favour, as capable in themselves of constituting such a flagrant breach. They may be regarded as somewhat Spartan and it would be legitimate to argue that they are repressive, but in my judgment they fall a long way short of a flagrant violation of the appellant's Article 8 rights. If he is to make out any case under Article 8 I consider that it must be founded on the possible effect on his mental health.
74. The precise extent of the interests which Article 8 is capable of protecting still remains to some degree uncertain and, as my noble and learned friend Lord Walker of Gestingthorpe pointed out in his opinion in the present appeal, the language of some of the statements in the Strasbourg Jurisprudence must be treated with some caution. It does appear to be clear enough, however, from pages 219-220 para 47 of the judgment in Bensaid v United Kingdom … that the preservation of mental stability can be regarded as a right protected by Article 8. The issue therefore is whether the removal of the appellant to a third country, Germany, could arguably be said to amount to a flagrant denial of his Article 8 right to the preservation of his mental stability.
75. It is, I think, important to note that the deleterious effects on the appellant's mental health described by Dr Sathananthan appear to stem from his fear that Germany will decide to return him to Iraq. It is to be assumed that Germany will observe its obligations under the Geneva Convention and the European Convention on Human Rights and will properly and conscientiously apply their provisions. If that be so, then the appellant's fear should be regarded as lacking in rational foundation. If they nevertheless exist in an extreme form, sufficient to make him suicidal at the prospect of removal to Germany, even if unjustified or irrationally held, the question has to be considered whether that may arguably be sufficient to found an allegation that his Article 8 rights have been violated.
76. In my opinion it could in principle be sufficient on a tenable view of the facts placed before us. It seems to me that the decider, whether it be the Secretary of State, an Adjudicator or the court, should base a decision on the actual state in which the appellant may find himself, whether or not it is rationally justifiable. This appears to be consistent with the emphasis in the judgment of the E Court HR in Tomic v United Kingdom (Application no 17837/03) (unreported) 14 October 2003 upon the risk of harm capable of engaging the responsibility of the respondent government. That decision concerned the admissibility of an application founded on the claim that Article 3 was engaged, but the principle seems to me to be the same, founded upon the effect of powerful humanitarian considerations. Similarly, in D v United Kingdom … the court, in admitting a claim under Article 3, was concerned with the effects upon the applicant and the certainty that he would suffer severely in the absence of suitable medical facilities in St Kitts to treat his condition. I would mention also that this should not entail the adoption of a process of comparing levels of care in the expelling country and the receiving country, and I fully agree with the observations of my noble and learned friend Baroness Hale of Richmond in that respect in paragraph 63 of her opinion.
77. On the facts which were before your Lordships – which I would emphasise are far from up-to-date – I am compelled to conclude that an Adjudicator might arguably hold that a sufficiently fundamental breach of the appellant's Article 8 right to the preservation of his mental stability had been established to engage that Article. The Adjudicator would then have to consider the effect of Article 8(ii), which will require the striking of a fair balance, in the manner referred to by Lord Bingham of Cornhill in paragraph 20 of his opinion. This has not received consideration by the Secretary of State or the judge. The factors which would have to be assessed on the application of Article 8(ii) are potent indicators in favour of upholding the operation of immigration control and affirming decisions to refuse entry to persons such as the appellant. I could not be fully satisfied, however, that the case is so clear in favour of upholding the decision to remove the appellant that no reasonable Adjudicator could hold otherwise.
78. I accordingly conclude, not without very considerable hesitation, that for the reasons which I have given the decision of the Secretary of State must be set aside. In so holding, however, I have to emphasise that the decision of the House goes no further than to determine the question of law submitted to it whether the Secretary of State was justified in ruling out an appeal in limine on the ground that the appellant's allegation was manifestly unfounded. We cannot attempt to say how the case will appear before an Adjudicator who has full information of the current state of the appellant's mental health and the facilities which will be available to him in Germany and is in a position to test the evidence of the appellant and the reliability of any medical opinions adduced. Still less can we give any indication how we think the Adjudicator is likely to decide the substantive issue if an appeal is brought from the decision to remove the appellant."
Both Lord Walker of Gestingthorpe and Baroness Hale of Richmond took a different view in favour of allowing the appeal of the Secretary of State upholding his decision that the certification of Mr Razgar's case as manifestly unfounded was properly issued. After dealing with issues as to the likely treatment of Mr Razgar in Germany, Lord Walker continued as follows at paragraphs 37-39 of his judgment:
"37. … Even in the most enlightened host country asylum seekers often have to deal with bleak accommodation or even loss of liberty, public hostility and material deprivation and these (on top of their earlier, sometimes horrendous, experiences) naturally lead to anxiety, depression and feelings of hopelessness. But neither the truism of human imperfection, nor the evidence (taken at its highest) of conditions in Germany, leads to the conclusion that the appellant's treatment in Germany would probably be so much worse in his present condition as to amount to a flagrant infringement of his human rights – an infringement so serious as would (in the language used in Devaseelan) result in the rights in question being completely denied or nullified. In my view, it would need much clearer and more compelling evidence to lead to that conclusion.
38. The Court of Appeal … referred to the Dublin Convention but did not discuss its significance. It treated this as a "mixed" case to which it proposed (pages 538-539 para 22) a novel three-stage test requiring the prospect of harm sufficiently serious for Article 8 to be engaged, but not (as I read the judgment) anything wholly exceptional. The relevant paragraph is set out by Lord Bingham in his opinion (para 4 above). Lord Bingham does not consider that the Court of Appeal fell into the error of comparing levels of psychiatric care available in the United Kingdom and Germany respectively. But for my part I cannot avoid the conclusion that that was the Court of Appeal's only or principle concern, and that it did amount to a mistaken approach. On this point I respectfully prefer the analysis of my noble and learned friend Baroness Hale of Richmond, whose opinion I have also had the advantage of reading in draft.
39. Had the Court of Appeal not (as I think) erred in its approach, I would not differ from the experienced judges below in their rejection of the Secretary of State's assessment of the facts and his consequent certificate under Section 72(ii)(a). As it is, I differ from the courts below and from the majority in this House only with the greatest possible diffidence. I do so because in my opinion (even if it seems callous) this case is simply not exceptional in the way that the Strasbourg court had in mind in Bensaid and Henao. It is, sadly, all too common."
"61. … This is a 'foreign' case in which the United Kingdom's responsibility is only indirectly engaged as a result of what might happen to him if removed. The meat of his case, as summed up by Richards J, 'was that the claimant's health would suffer a serious decline in Germany by reason, in particular, of the lack of appropriate treatment; it would have to deteriorate to the point where his condition was acute, that it so say where he became a suicide risk, before treatment could be assured. By contrast, if he stayed in the United Kingdom he could expect to receive appropriate treatment and to make progress.' (Paragraph 51).
62. Dr Sathananthan had diagnosed post traumatic stress disorder and depression, for which the appropriate treatment was medication and cognitive behavioural therapy. The claimant had been receiving medication and some counselling but not the cognitive behavioural therapy, apparently because his English was not yet good enough. Such therapy is in any event in short supply, so that whether it would actually become available is a matter of speculation. But clearly, he was currently managing without it. Its aim would be to make him better, not to prevent a serious deterioration in his mental state. The fact that it might not be available to him in Germany does not engage his Convention rights under either Article 3 or Article 8. Nor does the evidence suggest that the medication is essential to prevent a serious deterioration: this is not a case of psychosis in which there is a very real risk of a return to hallucinations if medication is not available.
63. Similarly, the complaints he makes about life in Germany compared with life here cannot be sufficient to engage his Convention rights….The issue is whether his situation in Germany would raise the serious humanitarian concerns raised in D v United Kingdom … or otherwise constitute such a serious threat to his physical and moral integrity as to be disproportionate to the legitimate aim which his removal would serve.
64. Dr Sathananthan was of the opinion that 'sending him back to Germany or even to Iraq would be very detrimental to his mental and physical well-being. I think he would make a serious attempt to kill himself.' I accept entirely that the risk of suicide is capable of engaging the claimant's rights under Articles 2 and 3 and Article 8 and must be given very serious consideration by the decision-maker. There is a positive obligation under the Convention to take reasonable steps to prevent a vulnerable person in custody from committing suicide: see Keenan v United Kingdom [2001] 33 EHRR 913. If there were substantial grounds to believe that the authorities responsible for him in Germany would not take such steps, then I would accept that his Convention rights were engaged and that the Secretary of State could not properly certify that his claim was manifestly unfounded, at least without making further enquiries or seeking further assurances from the German authorities. This is not the case. Mr Koestler's report specifically states that 'your client will only receive medical treatment in case of actual danger to himself or to others'. The Secretary of State is entitled to asylum that the German authorities will observe their Convention obligations to the claimant unless there is better evidence than this that they will not.
65. For these reasons, I would hold that the Secretary of State was entitled to reach the conclusion he did on the material before him and would therefore allow this appeal. I appreciate that this may seem a harsh conclusion to draw. But this is a field in which harsh decisions sometimes have to be made. People have to be returned to situations which we would find appalling. The United Kingdom is not required to keep people here who have no right be here unless to expel them would be a breach of its international obligations. It does the cause of human rights no favours to stretch those obligations further than they can properly go. In my view, those obligations are not such as to require the United Kingdom to refrain from returning Mr Razgar to Germany in accordance with the Dublin Convention."
The approach to proportionality of removal
"Your letter of 9 July 2001 to the South-East Ports Surveillance Team refers. You claim that your client's return to Belgium would be in breach of his human rights under Articles 3, 5, 6 and 8 of the ECHR.The Secretary of State has given express considerations as to whether your client's return to Belgium would breach the United Kingdom's obligations under the ECHR and is confident that this would not be the case.
Your client now has a right of appeal against this decision under Section 65 of the Immigration and Asylum Act 1999. I attach the necessary appeal form should you wish to take this course of action."
"27. In each case, however, the appellate body has to have regard to the interests of immigration control, and it will usually be a very weighty consideration indeed. In view of the consistent recognition by the Court of Appeal in Edore, Razgar and Djali that the proportionality of removal is essentially a matter for the Secretary of State within the limits of individually defined reasonableness, the two approaches which we have discussed should not yield differing results as Dyson LJ expected. It was a pragmatic aim of enabling the decision-making process to proceed which underlay those decisions and not a desire for the judiciary to determine how significant immigration control and its procedure was. The way in which that independent decision is reached must reflect the Secretary of State's primary role in the assessment of proportionality, the fact that it is pragmatism which puts the judiciary in the position of making the assessment in certain circumstances and the judicial expectation that the two sources of assessment would rarely lead to different answers. In our judgments, Adjudicators and the Tribunal should grapple with the issue of proportionality in the following way, so as to achieve a degree of consistency and to recognise the weight to be attached to immigration control and the system for its maintenance.
28. The starting point should be that if in the circumstances the removal could reasonably be regarded as proportionate, whether or not the Secretary of State has actually said so or applied his mind to the issue, it is lawful. The Tribunal and Adjudicator should regard Shala, Edore and Djali as providing clear exemplification of the limits of what is lawful and proportionate. They should normally hold that the decision to remove is unlawful only when the disproportion is so great that no reasonable Secretary of State could remove in those circumstances. However, where the Secretary of State, e.g. through a consistent decision-making pattern or through decisions in relation to members of the same family, has clearly shown where within the range of reasonable responses his own assessment would lie, it would be inappropriate to assess proportionality by reference to a wider range of possible responses than he in fact uses. It would otherwise have to be a truly exceptional case, identified and reasoned, which would justify the conclusion that the removal decision was unlawful by reference to an assessment that removal was within the range of reasonable assessments of proportionality. We cannot think of one at present; it is simply that we cannot rule it out. This decision is starred for what we say about proportionality."
"The applicant obtained opinions from his psychiatrist as to the likely effect of removal to Algeria. In a letter dated 24 March 1998, Dr Johnson stated that there was a high risk that the applicant would suffer a relapse of psychotic symptoms on returning. The requirement regularly to undertake an arduous journey through a troubled region would make the risks still higher. She pointed out that when individuals with psychotic illnesses relapse, they commonly have great difficulty in being sufficiently organised to seek help with themselves or to travel. For this reason, it was necessary for the management of such illnesses to be local and readily accessible. It was therefore very unlikely in these circumstances that any relapse of the applicant would be effectively treated. In a supplementary report of 7 July 1998, Dr Johnson stated that any suffering which might accompany a relapse would be likely to be substantial. When the applicant's illness had been severe, he had lost all insight into the fact that he was ill and believed the persecutory delusions and abuse which he experienced, including voices telling him to harm other people. He had previously felt sufficiently depressed and hopeless that he contemplated suicide."
"In a further opinion dated 20 May 1999 sought by the Immigration Service with the applicant's consent, Dr Johnson reported that, when seen in February 1999, the applicant showed some signs of deterioration, with his auditory hallucinations having become more intrusive and with thoughts about harming himself and voices telling him to harm himself ('positive symptoms'). He had been unable to sleep because of this. His Olanzapine had been increased and he had responded to this. However, he continued to have considerable difficulties with motivation and social withdrawal ('negative symptoms'). The applicant's mental illness was likely to be a long-term one. She would expect that he would continue to have positive symptoms, which would persist and could worsen, though controlled to a substantial degree by Olanzapine. At times, he might require urgent help with these symptoms. There had been a significant deterioration in his level of social functioning likely to be attributable to negative symptoms and which was likely to be significantly handicapping in the coming years. With continuing medication and support from the mental health services, however, he would be likely to remain at the same level and not require very long periods of institutionalisation. Nor was he at a very serious risk of suicide. If however the applicant was returned to Algeria, she stated that she would be more uncertain of the prognosis. She thought it was:
'highly likely that stressful life events such as deportation together with the more stressful environment he would be likely to encounter in Algeria would trigger exacerbation of his symptoms as occurred on his last visit to Algeria…his fearfulness when unwell and also the motivational difficulties and flatness of affect makes it very difficult for him to seek appropriate help when he does become unwell…If he were unable to obtain appropriate help, if he began to relapse I think that there would be a great risk that his deterioration would be very great and he would be at risk of acting in obedience to the hallucinations telling himself to harm himself or others… Thus I do think that there is a substantial likelihood that forcible repatriation would result in significant and lasting adverse effect'.
"Turning to the present case, the court recalls that it has found above that the risk of damage to the applicant's health from return to his country of origin was based on largely hypothetical factors and that it was not substantiated that he would suffer inhuman and degrading treatment. Nor in the circumstances has it been established that his moral integrity would be substantially affected to a degree falling within the scope of Article 8 of the Convention. Even assuming that the dislocation caused to the applicant by removal from the UK where he has lived for the last eleven years was to be considered by itself as affecting his private life, in the context of the relationships and support framework which he enjoyed there, the court considers that such interference may be regarded as complying with the requirements of the second paragraph of Article 8, namely as a measure 'in accordance with the law', pursuing the aims of the protection of the economic well-being of the country and the prevention of disorder and crime, as well as being 'necessary in a democratic society' for those aims.
"23. … This part of the appellant's case does not revolve upon the adequacy of the facilities in the receiving state. Rather, it seeks to prevent the Secretary of State informing the appellant of an event that the appellant would construe as adverse. In our judgment, this is a far-reaching claim. It presupposes that the medical facilities within the United Kingdom will not be sufficient to contain the risk. Furthermore, it presupposes that, if the Secretary of State chooses to arrest and detain the appellant, the secure accommodation in which he will be kept will be insufficient to contain the threat of suicide.
24. We are bound to express our reservations as to whether this permits the appellant to prevent the Secretary of State (or the Adjudicator or the Tribunal) threatening to remove him. It is not a claim that is often raised in the context of civil litigation. If, for example, a person is threatened with eviction upon service of a notice to quit or court order, we doubt whether, if the litigant threatens suicide, Article 3 of the ECHR would prevent the service of either a notice to quit or a court order. We would expect the response to be that there are adequate medical or legal facilities in the United Kingdom capable of minimising the risk, albeit without preventing it completely. The risk of suicide cannot, in our judgment, be separated from the means of preventing it. In the case of this appellant the means are limited to the provision of medication, the level of which has varied from time to time as his condition has altered.
25. We do not think that the threat of removal or detention or the commencement of the process of removal in the United Kingdom would violate the appellant's human rights."
J BARNES
VICE-PRESIDENT