Commentary
This case should be read alongside Ojikutu v The Secretary of State for the Home Department [2025] UKAITUR UI2024005652. They are both concerned with deterioration. In Ojikutu the issue was the evidence for a deterioration. In this case the issue was the extent or degree of the deterioration, its real world impact in terms of effect on daily life and ability to cope and the mitigating effects of help and treatment.
Learning points:
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When predicting a decline in mental health, it is necessary to explain the extent or degree of that decline and what impact it will have in real terms on daily life and ability to cope.
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Be able to explain why it will not be possible to rely on help and treatment from medical professionals to stop or reduce a decline in mental or physical health.
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Where spouses may be separated, address the impact of separation, specifically its consequences.
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Where a recommended treatment plan does not appear to have been actioned, by a general practitioner, it is necessary to address this.
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Particularise which symptoms would be exacerbated if the spouse returns alone and what impact this will have in real terms upon the spouse's daily life.
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The tribunal needs a detailed and reasoned explanation of how the spouse's mental health would evolve if returned to their home country alone.
Cases
The issue was whether, in the event that the Appellant returned to India alone, it would be unduly harsh for Mrs Kaur, his wife, and her adult children to remain in the UK.
Expert evidence
There was an unchallenged psychiatric report about Mrs Kaur prepared by Dr Kashmiri. Based on this report, it was submitted that there would be a deterioration in Mrs Kaur's mental health if she was separated from the Appellant. It was accepted that Mrs Kaur suffers from major depressive disorder and generalised anxiety disorder. The key part of the expert report was considered to be where Dr Kashmiri addressed whether Mrs Kaur's mental health condition would deteriorate if the Appellant was to return to India alone. This was the expert's opinion;
"Mrs. Kuldip Kaur is at risk of declining mental health if her husband is returned to India as she shares a close emotional bond as well as an inter-dependent relationship with him in terms of emotional and family support. She will constantly be worried about his well being. The distance is likely to be a barrier to their ability to provide support for each other which in turn will have a negative effect on both their mental health and quality of life. The effects of separation as a result of the deportation extend beyond impacts on socio-economic status and private life. Forced removal from a country is a traumatic experience for both the individual (deportee) and his family. Use alternative means of communication such as WhatsApp or Skype, cannot replace the intimacy and feelings of safety that are brought about by being able to stay in close proximity with a partner. This could bring about strain in relationships between spouses, causing a further negative effect on their mental health."
This was considered to offer limited assistance for the following reasons;
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The Tribunal accepted that there is a risk of a decline in Mrs Kaur's mental health but the expert had not explained the extent of that decline and what impact it would have on Mrs Kaur in real terms. The issue before the Tribunal was whether the decline in Mrs Kaur's health would be unduly harsh. Without specific details on how that decline would present itself and the impact on her life, the Tribunal was unable to assess its severity.
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The report recorded that Mrs Kaur, "seemed to have reasonable insight into her condition as she understood she was experiencing mental health symptoms and was willing to accept help and treatment if offered ." The expert did not explain why Mrs Kaur would not be able to rely on help and treatment from medical professionals to stop or reduce a decline in her mental or physical health in the event that she were to be separated from the Appellant.
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The expert set out her discussion with Mrs Kaur about why she did not want her husband to be deported. The expert's opinion was that the Appellant's deportation would have a significant negative psychological impact on the family as a whole. The expert does not specifically address the impact of being separated from the Appellant and the specific consequences for Mrs Kaur.
By the time of the hearing Dr Kashmiri had prepared a second report in which she noted the Appellant’s reported worsening symptoms and a lack of improvement to his condition despite treatment.
Dr Kashmiri attributed the decline in the Appellant's mental health and the lack of improvement to the ongoing immigration matter. The Tribunal noted however, that in her first report Dr Kashmiri recommended that the Appellant should be treated with an antidepressant, psychological/psychotherapeutic approaches, and that he should be referred to the local mental health team for further assessment and management of his mental health needs. However, despite the first report being sent to the appellant's GP, the treatment plan did not appear to have been actioned. Dr Kashmiri did not address this in her addendum report. She also recommended that he 'continue' to take amitriptyline although GP notes recorded that the Appellant was taking mirtazapine and had not taken amitriptyline since July 2023 which in the Tribunal’s judgement caused some confusion about whether or not Dr Kashmiri considered the appellant to be on the recommended treatment. The Tribunal noted that by the time of the hearing, the Appellant stated that he was currently taking medication to help him sleep but he was not aware what medication he was on. This added to the confused picture about the appellant's treatment, whether or not he had had the recommended treatment and what, if any, impact any departure from the recommended treatment might have had on his symptoms and recovery.
Where Dr Kashmiri spoke more about the Appellant's current symptoms, she did not particularise which of the Appellant's symptoms would be exacerbated if he returned alone. Neither did she say what impact that would have in real terms, upon the Appellant's daily life. In our judgement, the report falls short of setting out a detailed and reasoned explanation of how the Appellant's mental health would evolve if he returned to India alone.
There was a significant gap in the medical evidence about the degree of deterioration in the Appellant's mental health, and the impact it would have in real terms on his daily life and his ability to cope in India. The Tribunal was not satisfied that the expert evidence on its own was sufficient to conclude that the impact upon the appellant's mental health following deportation to India amounts to a very compelling circumstance.