“25. Dr. Singh set out her diagnoses at §12. She considered that Ms. Wyrȩbek suffered from a depressive episode, with symptoms which included a loss of capacity for enjoyment, interest and concentration, anhedonia, anergia, amotivation, sleep disturbance characteristic of depression, and changes in her attention and concentration. She stated her opinion that the severity of Ms. Wyrȩbek’s depression fluctuated between moderate and severe and that it had been ‘on the severe side’ since November 2020 (when she was arrested in extradition proceedings). She noted that severe depression often requires in-patient treatment. At §7.3, she records that Ms. Wyrȩbek had suffered from mental health problems in Poland, soon after the sentencing hearing, and that as a result of the stress of the proceedings she had to be admitted to a psychiatric unit. Ms. Wyrȩbek also told Dr. Singh that she had been prescribed antipsychotic medication. This information is repeated at §8.2 of Dr. Singh’s report. 26. Under the heading ‘Diagnosis – ICD-10 F33 Recurrent Depressive Disorder’ Dr. Singh stated, ‘from the developmental history as indicated by Miss Wyrebeck and her brother I am of the clinical opinion that she has mild to moderate degree of learning disability. Although I do not have a formal IQ test score, her presentation, and history is highly consistent with Learning disability”
“In cross-examination, Dr. Singh confirmed that she had no documents from Poland regarding Ms. Wyrȩbek’s medical history. Nevertheless, she considered herself an experienced clinician able to assess a patient’s mental health from first presentation. Asked about the possibility of fabrication, she stated that there is always this possibility but that Ms. Wyrȩbek would need to have knowledge of mental illness She did not find Ms. Wyrȩbek to have exaggerated her symptoms.”
“In Poland, in 2009, Ms. Wyrȩbek was diagnosed with a sleep disorder. More recently, Dr. Singh found her to be depressed with some anxious theme during a mental state examination. She became frequently tearful during the interview. Separation from her close family will have a detrimental effect on her mental health and wellbeing.”
“3.01. Miss Wyrebek’s extradition was ordered by District Judge Baraitser, in May 2021, to serve a one year and six month sentence related to eight offences of fraud. These offences formed the basis of a European Arrest Warrant. Miss Wyrebek was assessed by Dr Singh, Consultant Psychiatrist, prior to this hearing and she concluded that Miss Wyrebek presented with a mild to moderate degree of learning disability. The District Judge rejected this diagnosis as no formal assessments for learning disability were completed. A psychological assessment of Miss Wyrebek was therefore sought to determine if Ms Wyrebek has a learning disability or learning difficulty, and the extent. 3.02 Following the assessment, I was of the opinion that Miss Wyrebek has a borderline learning disability and specific learning difficulties with processing speed and verbal comprehension. These difficulties are life-long, have been present since her childhood and impact on her daily functioning. Miss Wyrebek finds it difficult to understand and use spoken language, especially if she does not have the time that she needs to process it. This leaves Miss Wyrebek vulnerable to other people taking advantage of her. She has a very concrete thinking style, and is likely to agree to things without fully understanding the nuances of the situation. Miss Wyrebek’s performance on the verbal tasks may have been impacted, as the assessment is British oriented. Miss Wyrebek is also suffering from poor mental health. However, despite these factors, in my opinion, it is a valid and reliable measure of her functioning. Further details are provided in the response to instructions.”
“7.01 Following the assessment, I am of the opinion that Miss Wyrebek has a borderline learning disability and specific learning difficulties with processing speed and verbal comprehension. 7.02 A learning disability is a global developmental delay that affects all areas of learning and functioning. To diagnose a learning disability, a person has to meet three criteria: (i) an IQ of less than 70; (ii) onset during childhood, and; (iii) problems in independent living and adaptive functioning. I will discuss each of these areas in relation to Miss Wyrebek. 7.03 In terms of an IQ of less than 70, Miss Wyrebek has a full scale IQ of 67 (95% confidence interval, 64 – 72), indicating a learning disability. This result falls within the extremely low range, and less than 2% of other people her age would perform at this level. Caution is needed when interpreting this overall result, as there is significant variation in Miss Wyrebek’s index scores. There were two areas of particular deficit for Miss Wyrebek and two areas of relative strength. Miss Wyrebek has specific difficulties with processing speed and verbal comprehension and relative strengths with perceptual reasoning and working memory.”
“1. In what way do Ms Wyrebek’s learning disability/difficulties contribute to the following two issues that were previously identified in the psychiatric assessment by Dr Singh and the judgement of the District Judge: - Ms Wyrebek’s risk of exploitation within a custodial setting - Possible deterioration in Ms Wyrebek’s mental health whilst in a custodial setting. 2. When questioning a person with learning disabilities, such as Ms Wyrebek in the context of a police station or prosecution interview or in court, what steps should be taken to ensure they have understood the question and given a reliable response ? What can be said about the reliability of their responses where no such steps are taken ?”
“Further to the psychological report dated22nd November 2021 , additional questions were instructed. Specifically, Ms Wyrebek’s risk of exploitation and possible deterioration in her mental health, whilst in a custodial setting; recommendations for questioning a person with learning disabilities; and the reliability of their response where no such steps are taken. The previous report identified that Ms Wyrebek has a borderline learning disability and specific learning difficulties in verbal comprehension and processing speed. I am of the opinion that Ms Wyrebek’s cognitive profile places her at a greater risk of exploitation within a custodial setting, due to impaired understanding and communication skills. I am also of the opinion that Ms Wyrebek’s mental health will be vulnerable to further deterioration when in a custodial setting, and psychological therapy, such as cognitive behaviour therapy, will not fully prevent this. A detailed list of recommended ways of working with people with learning disabilities is provided, and the potential for inaccurate responses is identified, if these are not used. Further details and responses are provided in the response to instructions.”
“4.02 People with a learning disability are in general at greater risk of exploitation and abuse. This is because they may not understand that what is happening to them is wrong, they may find it hard to communicate to others about what is happening to them, and they may also not fully understand how to report it (Mencap, 2021). These vulnerabilities are particularly relevant for Ms Wyrebek as she has a borderline learning disability and specific learning difficulties in verbal comprehension and processing speed. Ms Wyrebek is very concrete and literal in her understanding and is likely to believe that she has understood information, without fully comprehending the nuances or subtleties, especially if she is under time pressure. Therefore it is very likely that if Ms Wyrebek is exploited, she will not at first understand that what is happening to her is wrong, and also struggle to verbally explain the situation to others. Within a custodial setting there is a clear demarcation of prison staff, which would benefit Ms Wyrebek in terms of reporting exploitation. However, people with learning disabilities find it hard to communicate to others when they are being exploited, and therefore it is recommended that those close to them are vigilant for changes in their behaviour to indicate exploitation (Mencap, 2021). As Ms Wyrebek will be away from her family, and those that know her well, this will be harder to observe. It is for these reasons that in my opinion, Ms Wyrebek will be at increased risk of exploitation whilst in a custodial setting. 4.03 In my opinion, Ms Wyrebek’s mental health will be vulnerable to further deterioration if she experiences significant life stressors, of which the on-going extradition case and a custodial sentence would be. I have seen this repeatedly occur within my clinical work. This is in agreement with Dr Singh’s report, which identified that imprisonment would be further detrimental to Ms Wyrebek’s mental health. Dr Singh recommended management of Ms Wyrebek’s mental health through Cognitive Behaviour Therapy (CBT) and anti-depressant medication. Ms Wyrebek medical records detailed that she is prescribed Mirtazapine (an anti-depressant medication) since May 2021. There was no report of psychological therapy. When I met with Ms Wyrebek (05/11/2021 ) her presentation was congruent with Dr Singh’s report of recurrent depressive disorder. Ms Wyrebek was emotionally distressed, tearful and reported feeling overwhelmed. At assessment I did not assess Ms Wyrebek’s mental health with psychometric measures, as this question was not within the original instructions. However, in my clinical opinion Ms Wyrebek was continuing to present with symptoms of depression.”
“The Appellant’s measured IQ is 67; she is a vulnerable, easily led woman who was likely the victim, rather than the perpetrator of the index offences of fraud. The fresh evidence confirms that she was very likely taken advantage of in the commission of a fraud which she lacked the ability to understand, still less knowingly commit; there is no evidence her mental health condition was ever taken into account in the Polish proceedings or could be now. The impact of extradition and imprisonment on her mental well-being would be devastating. The near-two years she has spent subject to a curfew and reporting conditions is sufficient to address any suggestion of impunity and reduces the public interest in her extradition.”
“Dr. Singh diagnosed Ms. Wyrȩbek with a learning disability, which she described as mild to moderate. This diagnosis, it seems, was primarily based on Ms. Wyrȩbek’s account, supported by her brother, that she struggled academically in school. Dr. Singh did not carry out an IQ test, or request psychometric tests from a psychologist. No school records or reports were provided to her. When the basis for her diagnosis was challenged by Ms. Beatty, Dr. Singh could only refer to the accounts of Ms. Wyrȩbek and her brother regarding her academic performance at school.”