“10.10 Ivor Fletcher also has a history of self-harming behaviour that has previously been closely linked with the mental disorders from which he suffers. Impulsivity appears to have been a particular issue, as it often is with people who present with traits of emotionally unstable personality disorders, in both his previous self-harming behaviour and in his previous suicidal acts. This background of recurrent self-harming and suicidal thoughts and behaviour, upon background diagnoses of depression and personality disorder, indicates that there is an elevated risk of suicide in this case. 10.11 Each of these factors - depression, personality disorder, history of self harming and suicidal thoughts and behaviour - is, on its own, associated with an elevated risk of suicide, however the risk is likely to be further enhanced when they appear together, as in Ivor Fletcher’s case. 10.12 When they are also associated with specific suicidal ideas and plans that have been researched, as described by Ivor Fletcher in section 9 of this report, in my opinion the risk of suicide should then be considered substantial. In my view, the risk of completed suicide is likely to be greatest in the period following an extradition decision and, given the statements he has made, likely to persist during the period of preparation for removal, while in transit, and after arrival in prison in India. … 10.14 Ivor Fletcher cites the treatment he received in Indian prisons, the conditions he experienced there, and his belief that he will be physically harmed by having his legs broken if he is returned to India, as a key factor in his suicidality. When this is taken at face value, it appears that Ivor Fletcher is able to think through how and when he will act, however an important factor to consider is the influence of his underlying personality disorder which introduces a strong element of impulsivity. In my opinion, and despite the plans Ivor Fletcher has described, it is likely that any future suicidal acts will be underlain with this impulsivity, arising from underlying personality disorder, as they appear to have previously been.”
“I am entirely satisfied that the Indian authorities know their obligations to deal appropriately with such medical issues as the Appellant may present, and that they will abide by such obligations. Accordingly, such challenge under s. 91 of the 2003 Act must fail”
“10.7 I remain of the opinion, as outlined in paragraph 10.11 of my earlier report in this case, that each of the identified factors in this case – depression, personality disorder, history of self harming and suicidal thoughts and behaviour – is, on its own, associated with an elevated risk of suicide, and that the risk is likely to be further enhanced when these features appear together, as they do in Ivor Fletcher’s case. 10.8 An additional factor to consider is Ivor Fletcher’s age. He is aged 57 and it is known that suicide rates are increased in middle aged and older men 10.8 Ivor Fletcher currently describes the presence of suicidal thoughts on a daily basis, with suicidal intentions and specific plans should extradition proceed. Despite this, he has also said that ‘no immediate threat’ arises, largely because he still thinks ‘there is a glimmer of hope’ (by which I understand him to mean that he is awaiting the outcome of this appeal). 10.9 However, despite this partial reassurance, I am of the opinion that his risk of suicide should presently be considered very high. This is because he presents with a number of risk factors, including severe depression, personality disorder (with a resulting strong element of impulsivity which he is unable to control), a history of self-harming behaviour and suicidal acts, and because he has described the presence of daily suicidal thoughts, with both suicidal intentions and specific plans. 10.10 Given this risk, I have written to Ivor Fletcher’s GP, with his consent, to communicate what I believe is a very high risk of completed suicide. 10.11 In my opinion, the risk of completed suicide is likely to rise sharply if he loses this appeal and it is likely to remain very high during the period of preparation for removal, during removal itself, and following arrival in prison in India.”
“(1) This section applies if at any time in the extradition hearing it appears to the judge that the condition in subsection (2) is satisfied. (2) The condition is that the physical or mental condition of the person is such that it would be unjust or oppressive to extradite him. (3) The judge must— (a) order the person’s discharge, or (b) adjourn the extradition hearing until it appears to him that the condition in subsection (2) is no longer satisfied.” (a) order the person’s discharge, or (b) adjourn the extradition hearing until it appears to him that the condition in subsection (2) is no longer satisfied.”
“It would… be oppressive to order his return when there is, on any view on the evidence, such a substantial risk that he will commit suicide. It is not as if this is an appellant who is threatening to commit suicide without any history of having tried to do so. Not only is he threatening that he will commit suicide and the doctor believes him but he has in fact, for the same reason, attempted to commit suicide in Wormwood Scrubs Prison and very nearly succeeded in doing so. In reaching the conclusion that it would be oppressive to return him, this is not a reflection on the ability of the Latvian prison authorities to protect him and provide the necessary treatment. But an assessment, so far as the evidence enables one to do so, that the risk that he will succeed in committing suicide, whatever steps are taken, is on the evidence, sufficiently great to result in a finding of oppression….”
“(1) The court has to form an overall judgment on the facts of the particular case… (2) A high threshold has to be reached in order to satisfy the court that a requested person’s physical or mental condition is such that it would be unjust or oppressive to extradite him… (3) The court must assess the mental condition of the person threatened with extradition and determine if it is linked to a risk of a suicide attempt if the extradition order were to be made. There has to be a ‘substantial risk that [the Appellant] will commit suicide’. The question is whether, on the evidence the risk of the Appellant succeeding in committing suicide, whatever steps are taken is sufficiently great to result in a finding of oppression… (4) The mental condition of the person must be such that it removes his capacity to resist the impulse to commit suicide, otherwise it will not be his mental condition but his own voluntary act which puts him at risk of dying and if that is the case there is no oppression in ordering extradition… (5) On the evidence, is the risk that the person will succeed in committing suicide, whatever steps are taken, sufficiently great to result in a finding of oppression?... (6) Are there appropriate arrangements in place in the prison system of the country to which extradition is sought so that those authorities can cope properly with the person’s mental condition and the risk of suicide? (7) There is a public interest in giving effect to treaty obligations and this is an important factor to have in mind.”
“The key issue, as is apparent from propositions (3), (5) and (6), will in almost every case be the measures that are in place to prevent any attempt at suicide by a requested person with a mental illness being successful.”
“… the question in Proposition (3) is to be approached as the ultimate determinative question – when Proposition (3) is read with propositions (5) and (6) – is as follows (the encapsulation is mine): The question is whether, on the evidence, whatever steps are taken – and even if the Court is satisfied that appropriate arrangements are in place in the prison system of the country to which extradition is sought so that those authorities will discharge their responsibilities to prevent the requested person committing suicide – the risk of the requested person succeeding in committing suicide, by reason of a mental condition removing the capacity to resist the impulse to commit suicide, is sufficiently great to result in a finding of oppression. As it seems to me, this composite approach makes best sense of the phrase ‘whatever steps are taken’ in Turner propositions (3) and (5). It is a mistake to treat the Turner Propositions as being a sequential flowchart – like a ‘route to verdict’ – such that Proposition (6) provides an answer notwithstanding that the ‘question’ described in Proposition (3) has previously been answered ‘yes’. Putting the same point another way, the phrase ‘so that those authorities can cope properly with’ in Proposition (6) would need to entail ‘steps’ being ‘taken’ which will reduce the risk so that it is no longer ‘sufficiently great to result in a finding of oppression’ for the purposes of Proposition (3) and (5).”
“… Notwithstanding the ability of the German authorities to discharge the responsibilities by making appropriate arrangements, on the evidence such is the mental condition of the Appellant linked to the risk of suicide – where the condition is such as to remove the capacity to resist a suicidal impulse – that the risk of the Appellant succeeding in committing suicide, whatever steps are taken, is sufficiently great to result in a finding of oppression…”