Dr Alick Munro shares how doctors can get involved in writing medicolegal reports on asylum seekers
You are probably aware that there are many tens of thousands of asylum seekers awaiting assessment of their applications by the Home Office. If past performance predicts the future, some 53-66% of the claims will be approved by the Home Office. Most of the remainder will go to appeal by a legal tribunal and most of the appeals will be granted.
Medicolegal reports (MLRs), written in accordance with the Istanbul Protocol, play an increasingly important part in the assessment of these appeals. The Supreme Court has required that tribunals pay less regard to previous efforts by the Home Office to have medical evidence called excessively into question.
Some solicitors also commission MLRs to assist the Home Office to assess asylum claims. This can considerably reduce the time required for claimants to obtain the right to remain.
Most of the doctors who find time to write these reports are retired, semi-retired or have family responsibilities. The reports are commissioned by immigration solicitors. The payment, which is not commensurate with the time it takes to write an adequate MLR, usually comes from the Legal Aid Fund. MLRs that are intended for presentation to the Home Office are usually paid for by the claimant.
Interviewing a claimant usually takes several hours, as the histories are complex, the claimants are often in poor mental health and the language barrier usually requires the presence of an interpreter provided by the solicitor. It takes time to work through symptom checklists, psychological rating scales, examination for relevant observations and particularly checking skin marks and the claimants’ attributions of skin marks. Skin marks are often the most heeded evidence that the appellant is a victim of torture. The process usually requires two sessions, one of them usually as a teleconference or videoconference. Writing up the MLR also takes many hours. As a result, most of us who do this work find we can at most write one MLR per week.
Clinical plausibility is useful evidence. Useful reports include as much factual detail as possible in the report of events and the subjects’ reports on how these events affected their health and feelings. Our reports then include comments on whether the history and other documentation are in keeping with our own observations of the subject.
Content of a typical MLR on an asylum seeker
- Foreword
- Summary
- Solicitor’s instructions
- Circumstances of interview
- Background
- History of count of origin and during journey
- History while in the UK
- Current circumstances
- Past health
- Symptom checklist
- Physical examination
- Attributions of symptoms and signs
- Skin marks
- Attributions of skin marks
- Mental state examination
- Observations and rating scales leading to psychological diagnoses
- Suicide risk
- Mental health summary
- Clinical Plausibility
- Consistency with other documents
- Internal consistency
- Treatment needs
- Prognosis
- Ability to provide evidence
If you would like to get involved in writing MLRs you will benefit from initial tuition, sitting in with another writer when he or she is interviewing, commenting on that writer’s draft report, sharing template documents, sharing suggestions for reports with fellow writers, and taking part in post-graduate education activities with fellow writers. The immigration solicitors may have useful comments on your MLRs, after they have gone through them with the subjects. Immigration solicitors may ask immigration barristers to also review draft reports. Many reports are commissioned via charities that have the interests of asylum seekers at heart, and which act as intermediaries between MLR writers and commissioning solicitors. These agencies also have internal review systems for draft reports.
Agencies that train writers of MLRs, act as intermediaries and edit MLRs
Please get in touch with me if you would like to join in the development of a democratic professional association for writers of MLRs that can maintain standards, can provide initial tuition and continuing educational support, and can maintain a directory of reputable members for use by immigration solicitors.
Dr Alick Munro is a retired GP in Twickenham. If you are interested in writing medicolegal reports for asylum seekers, you can contact him here: alick@munro.com
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