Resource

Medico-legal reports (MLRs) play a crucial role in UK asylum applications by providing medical evidence of physical or psychological trauma linked to persecution or ill-treatment such as physical injuries or psychological conditions. MLRs are often used in legal or immigration proceedings to support asylum application or appeals. The importance of MLRs as evidence in asylum claims is internationally recognised, as their contents can make a difference between being granted or refused asylum.

It requires ‘enormous trust and courage to allow yourself to remember’ (van der Kolk, 2014) in the aftermath of severe trauma. This is particularly challenging within a legal context, when the validity of someone’s memories and experiences are scrutinised.

MLRs require detailed recall of traumatic memories, and therefore clinicians are typically trained to work in a trauma-informed way, to reduce the risk of re-traumatisation. Although MLR assessments are potentially distressing, they may also have some therapeutic elements, such as having someone ‘bearing witness’ to your ill-treatment.

This is the first research project to explore asylum-seekers' personal experiences and perceptions of undergoing a medico-legal reports. We interviewed six people to try to understand how asylum-seekers make sense of and experience undergoing an MLR, and specifically which parts may be distressing or potentially therapeutic.

Three themes emerged from the data:

Uncertainty – the tension between negative and positive expectation

• Participants described a sense of fear and anxiety in the lead up to the MLR. Some felt unsure about what the assessment would involve, but knew they had to attend out of necessity rather than choice.
• Uncertainties about the assessment and fears of discussing their past traumas were offset by the hope that it would help them in being granted asylum and protection.

“It’s a horrible process but it has to be done because I need to be here, I want to be safe.”

“… being an asylum-seeker, you feel you don’t have the rights for a lot of things, so when you get a little bit of help you feel like ‘oh at least I’m blessed, I’m getting this’ although it’s so painful getting this kind of help.”

The pain of having to share and remember

• All participants described the distress caused by talking about past painful experiences. Some experienced flashbacks during the assessment, and an increase in trauma symptoms in the days after the assessment.

“In a moment, everything comes back as strong as it was … as powerful’.

Therapeutic impact.

• Participants spoke of a sense of release that they experienced through putting words to their painful memories and feelings.

• Some participants (although not all) spoke of the healing effect of having painful experiences validated and heard, with their relationship with their assessing clinician being a key factor in supporting them through the assessment.

“Talking about it helped me to, you know, release some pain”

“. . .She didn’t need to [reassure me] because at the end of the day she’s just writing the report, she would say something along the lines of ‘ but you do understand this was never your fault?’ . . . at the time it felt really comforting.”

Implications & Recommendations

For MLR assessors

This research highlights the need for trauma-informed support before, during and after the MLR and for careful consideration to be given to how asylum-seekers can be supported to share painful details of trauma in a way that maximises their sense of safety.

Recommendations for MLR assessments:

• Provision of clear information about the role of the MLR assessment in the asylum process and begin to build a rapport with the person seeking-asylum in the lead up to the assessment.
• Systematic post-assessment follow-up to monitor distress and provide necessary care.
• Allowing time to establishing connection/rapport with the person being assessed and to acknowledge and validate their experiences.
• Specialist training on conducting MLR assessments should include teaching on the potentially therapeutic component of establishing a containing relationship.

Recommendations for Home Office asylum procedures

• Specific training for asylum decision-makers who evaluate MLRs on the difficulties and complex tensions that people face when disclosing traumatic experiences within an MLR. Building an awareness that inconsistencies or omissions often relate to the asylum seeker’s psychological trauma rather than an attempt to mislead.
• Training and ongoing supervision for Home Office decision makers so that they are able to understand the process of disclosure in its complexity with the aim of making the interview environment conducive to gaining asylum seekers’ trust and making them feel safe enough to disclose their full history.  This is in line with previous HBF research which indicates that asylum-seekers often encounter a culture of disbelief during their Home Office asylum-interview, which can make disclosure of traumatic memories even more challenging.

Read the full article in Psychiatry, Psychology and Law.