Applying AM (Zimbabwe) in Medical and Psychiatric Evidence Requests

In the context of Article 3 ECHR claims based on health, the Supreme Court’s judgment in AM (Zimbabwe) v Secretary of State for the Home Department [2020] UKSC 17 established the legal framework for assessing the risk of inhuman or degrading treatment due to the lack of appropriate healthcare in a receiving state. For practitioners, understanding the intersection between this legal framework and clinical psychiatric assessment is essential to ensuring that reports address the issues identified by the First-tier and Upper Tribunals. AM (Zimbabwe) confirms that the test focuses on whether an applicant can demonstrate a real risk of a serious, rapid, and irreversible decline in their state of health, resulting in intense suffering or a significant reduction in life expectancy.

The AM (Zimbabwe) Framework and Psychiatric Assessment

The AM (Zimbabwe) framework necessitates clinical reporting that moves beyond a descriptive diagnosis. A psychiatric expert witness must address the specific vulnerabilities of the individual. When assessing the psychiatric sequelae of past trauma, the expert should establish a connection between the existing clinical condition and the impact of potential removal. This involves evaluating the availability and accessibility of appropriate treatment, not in the abstract, but as it relates to the specific needs of the claimant in the context of the proposed destination’s healthcare infrastructure.

Clinicians typically use diagnostic frameworks such as ICD-11 or DSM-5. However, in asylum casework, a formal diagnosis alone is rarely sufficient. The forensic psychiatrist must evaluate the claimant’s capacity to access services, potential cultural barriers to treatment, and the likely clinical trajectory if the current support system—often provided within the UK—is removed or becomes unavailable.

Evidential Standards and Credibility

The Devaseelan principle remains relevant for Tribunals when assessing how psychiatric evidence intersects with prior findings on credibility. A forensic psychiatrist must be aware that their role is to provide an expert opinion on whether the clinical presentation is consistent with the reported history of torture or ill-treatment, rather than to adjudicate on the truthfulness of an account. Reports should be prepared in a manner consistent with the Istanbul Protocol, ensuring that methodologies are transparent and that the distinction between clinical findings and the claimant’s narrative is maintained.

If the Tribunal has made adverse credibility findings, the psychiatric report may address how these influence the clinical presentation. Experts are often asked to consider whether a mental health condition might have contributed to inconsistencies in a claimant’s evidence, particularly in cases involving complex PTSD, where memory fragmentation and cognitive impairment are potential clinical features.

Practical Considerations for Instructing Solicitors

The timing of instruction remains a factor in the utility of expert evidence. A forensic psychiatric assessment is most effective when commissioned well in advance of the substantive hearing to allow for:

• A thorough review of available medical records, including GP notes, psychiatric history, and previous detention-related reports.
• An assessment of the claimant’s current presentation, including suicide and self-harm risk, to inform safeguarding requirements.
• An assessment of whether the claimant has the capacity to give oral evidence or requires specific measures under the Tribunal’s directions.
• The provision of sufficient information for the expert to comment on the impact of removal in light of the AM (Zimbabwe) thresholds.

Solicitors should ensure that the letter of instruction is specific regarding the issues to be addressed. It is essential that the expert has access to the background of the case, including relevant Home Office decisions, to ensure the opinion is rooted in the factual matrix of the appeal. While the expert’s overriding duty is to the Tribunal, ensuring they have the necessary case materials prevents delays and minimises the need for supplementary reports.

Consistency and Professional Independence

In cases where multiple experts are instructed, practitioners must be aware of the rules governing expert conduct in the Tribunals. Experts must remain independent and objective regardless of which party is funding the report. Where experts from different disciplines, such as a psychiatrist and a psychologist, are instructed, their findings should be reconciled where appropriate. Under the Tribunal Procedure Rules, the expert must maintain their independence, even if a discussion or a joint statement is directed by the Tribunal or arranged by the parties. A forensic psychiatrist’s report should be drafted with the expectation that it may be challenged in cross-examination; therefore, the scientific basis for any clinical conclusion must be clearly substantiated by the diagnostic evidence and relevant literature.

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