“The Tribunal may have made a material error of law in failing to consider evidence of the appellant’s attempts at suicide … and in failing to deal with the risk of the appellant committing suicide in Burundi, which omission appears obvious from reading the determination.”
“This is a case in which, despite its long history, I should, if I had retained the power to do so, have consulted the parties with a view to setting aside this determination and ordering a rehearing.”
“Currently [the appellant’s] mental state has significantly deteriorated, our Crisis Resolution Team is seeing him regularly, and hospitalisation may be inevitable. [His] mental state began to deteriorate on the26th May 2006 when he presented to our services with a significant increase in his ongoing psychotic symptoms and a substantial deterioration in his mood and was suicidal. In order to appropriately manage [his] fluctuating mental state, we are hoping to register him for Cloziral. Unfortunately [he] had abnormal blood tests and the CPMS have requested a full haematology report prior to registering him.”
“We note that the medical reports confirm that the appellant is receiving Amitripline, Olanzapine (an anti-psychotic drug) and Venlaxfine. We note that the country of origin information request of October 2005 confirmed from the Foreign and Commonwealth Office who had been in contact with the British Embassy Liaison Office in Burundi, that anti-depressant and anti-psychotic drugs were available in Burundi. We also note from the objective evidence that medical services are available, but they are not on a par with those available in the United Kingdom. Access to healthcare varies considerably from one province to another; vital equipment and supplies may take time to get through to the appropriate locations. There are hospitals for treating cholera, malaria, HIV/Aids. Having had sight of the country information report and the Burundi crisis profile, we note that the latter in particular states that although availability of health services is reasonably good with approximately 80% of the population living within a 5 km radius of a health facility, public, private missionary, access to quality services are insufficient to address the basic health needs. There is a shortage of medical practitioners. We note that in none of the medical reports that we have seen … has there been any report of any specific instance that the appellant has tried to commit suicide. We note that it is stated that he has suicidal tendencies but he has not taken steps to harm himself and we have not read any reports that he has harmed himself or has attempted to do so. We note also from the reports that it is stated that one of the main reasons for his post-traumatic stress disorder syndrome is because he is concerned about his immigration status. We note it is stated in the medical reports that the appellant is a suicide risk, but, as we have noted, there is no evidence that he has tried to do so.”
“In essence it states that comparative disparity in medical treatment will not found an Article 3 claim save in extreme and exceptional circumstances … we do not consider having regard to the case of N that this appellant’s medical condition has reached such a critical stage (ie that he is dying) that there are compelling humanitarian grounds for not removing him to Burundi which may lack medical and social services available in the United Kingdom. The threshold under Article 3 for such cases unrelated to the asylum claim is very high and the case of N demonstrates this to be so. The appellant before us has not reached that high threshold.”
“We have considered the following stages therefore: (1) where the appellant is informed that a final decision has been made to remove him to Burundi; (2) where he is physically removed by aeroplane to Burundi; (3) after he has arrived in Burundi.”
“We consider that in relation to Article 3 it is necessary to show strong grounds for believing that the appellant if returned would face a real risk of being subjected to torture or to inhuman or degrading treatment or punishment. Upon the evidence that we have heard and read, we do not consider that the effect of the applicant’s removal would be to expose him to other consequences of such an extreme kind as to amount to a violation of Article 3 … Mechanisms such as the use of escorts and the availability of in-flight medical facilities are factors we take into account when assessing whether there is a real risk that a decision to remove the appellant would breach Article 3. We consider upon all the evidence that the risk of suicide in the UK upon this appellant learning of a final decision to remove him would be adequately managed by the relevant authorities … When the appellant’s partner gave evidence she was asked whether she would be prepared to go with the appellant back to Burundi. She did not say that she was not prepared to go with him. She was very supportive and indeed without hesitation she said if his health improves she will go with him. This indicates to us her concern about the appellant. She has been supportive of him in the past and at present and we considered her evidence to be credible and also noted that she formed a very important part of the appellant’s life with their daughter. We consider that from the evidence this witness gave she would assist the appellant to make suitable arrangements for his return to Burundi and indeed her evidence indicated that she would be prepared to go with him. We consider therefore that the risk of suicide on route to Burundi would be below the Article 3 threshold because of the medical support and escorts that the appellant would have from the UK authorities and the real likelihood that the appellant’s partner and her daughter would accompany the appellant … In conclusion therefore we consider that this appellant has not reached the high threshold under Article 3 as required by the cases of N and J.”
“[CN] has been assessed as posing a significant threat to himself (including self harm via cutting and hanging) … due to the ongoing paranoid delusions that he experiences.”
“[CN’s] mental state deteriorates with stress … [he] has made several serious attempts to harm himself when unwell.”
“What medical treatment is available in Burundi for people suffering from mental health problems, specifically depression and post-traumatic stress disorder? Are anti-depressants readily available, specifically Escitalopram?”
“You asked for details on the availability in Burundi of drugs for treating depression and post-traumatic stress disorder. I have consulted the British Embassy Liaison Office in Burundi. They have confirmed that Amitripiline and Escitalopram are both available. They added that a similar drug, Fluoxetine, is also available.”
“She did not say that she was not prepared to go with him. She was very supportive and indeed without hesitation she said that if his health improves she will go with him.”
“In our judgment, there is no doubt that in foreign cases the relevant test is, as Lord Bingham said in Ullah, whether there are strong grounds for believing that the person, if returned, faces a real risk of torture, inhuman or degrading treatment or punishment.”
“… a further question of considerable relevance is whether the removing and/or the receiving state has effective mechanisms to reduce the risk of suicide. If there are effective mechanisms, that too will weigh heavily against an applicant’s claim that removal will violate his or her Article 3 rights.”
“It is difficult to see that risks of self harm or suicide from mental illness or personality disorder should be approached very differently from other illnesses which may lead to a painful death in an awareness that such a death is increasingly imminent.”