Fitness to Fly and Removal: What a Psychiatric Opinion Should Address

When removal directions are set and your client’s mental health is in doubt, the clinical evidence often amounts to a short fitness to fly letter. An independent psychiatric opinion deals with removal itself: the risk, how it can be reduced and when your client may become fit.

The Home Office starting point

Home Office guidance assumes that a detained person is fit to be removed unless advised otherwise. Where there is significant doubt about fitness to fly, whether physical or mental, the caseworker must ask the healthcare provider to confirm fitness before removal goes ahead (Arranging removal, version 7.0, December 2025). The decision remains the Home Office’s (DSO 01/2016, paragraph 19).

What the opinion should cover

DSO 01/2016 asks a clinician who finds a person unfit to give a prognosis, an assessment of the clinical risk of flying and any measures that would reduce it, such as a medical escort (paragraph 26). A psychiatric opinion should therefore address:

• current mental state and diagnosis
• suicide and self-harm risk when removal directions are served, during escort and the flight, and on arrival
• whether escorts, a supply of medication or handover arrangements would reduce that risk
• capacity, where it is in doubt
• fitness to be detained pending removal
• a prognosis for when your client may become fit, if unfit now

A medical escort is not required simply because a detainee is on medication (DSO 01/2016, footnote 4), so ask the expert to explain why any escort is clinically necessary.

Psychiatric, not physical, fitness

Physical fitness to fly, such as oxygen needs, recent surgery or pregnancy, is assessed against airline criteria by a doctor in that field. A psychiatrist answers the mental health questions, including the likely effect of escort and restraint on someone who is mentally unwell.

Why an independent opinion matters

The Brook House Inquiry found that there “appeared to be no adequate physical or mental examination” before some fit to fly letters were written (Volume II, Part E, paragraph 58). An independent consultant assessment sets out the clinical basis that a brief letter may lack.

What to send

• Letter of instruction setting out the questions
• Removal directions and flight details
• Removal centre healthcare records
• Any existing fitness to fly letter
• GP and psychiatric records, and any earlier reports

Instruct as soon as removal directions are set. Urgent and detention matters are prioritised, and we confirm the assessment date and report deadline before you instruct.

Related service: fitness to fly assessments for removal cases. To instruct an expert, send us the case details and we will come back with the proposed expert’s CV, quotation and availability.