Grant-Peterkin Hugh, Pickles Hilary, Katona Cornelius
1 Department of Psychiatry, East London Foundation Trust, UK.
2 Independent Public Health Consultant, UK.
Med Sci Law. 2016 Oct;56(4):285-292. doi: 10.1177/0025802416657263. Epub 2016 Jul 18.
Asylum seekers and migrants can be detained in immigration removal centres (IRCs) or, post sentence, in prison while the Home Office makes decisions on their immigration status and/or arrangements for their removal or deportation. Currently, there is no process for identifying detainees who lack the mental capacity to participate in decision making relating to their immigration situation. Mental illness and distress are common among detainees. There are often cultural and language barriers; there is no consistent system of advocates, and many detainees are without legal representation. Mental capacity is decision specific. Clinicians in IRCs have a duty to consider detainees' capacity for health-care decisions, but are not expected to carry out any assessment in the broader context of immigration decision making, and there is no set procedure for notifying immigration decision makers with any concerns about a detainee's capacity. The Home Office focusses on safeguarding vulnerable people in detention, but not on whether such detention should happen or whether individuals identified as especially vulnerable have the necessary capacity for immigration-related decisions. In the community, asylum seekers and migrants can be supported in their engagement with immigration officials by family and friends and other advocates of their choice. This is not the case for immigration detainees. The current arrangements carry a significant risk of unfair decisions being made on the most vulnerable detainees without their capacitous participation. Recommendations for changes are made, including the need for a high threshold to be applied to justify any detention of people who lack immigration-related decision-making capacity.
寻求庇护者和移民可能会被拘留在移民遣返中心（IRC），或者在被判刑后被关押在监狱，同时英国内政部对他们的移民身份和/或遣返或驱逐安排做出决定。目前，没有程序来识别那些缺乏参与与其移民情况相关决策能力的被拘留者。精神疾病和痛苦在被拘留者中很常见。通常存在文化和语言障碍；没有统一的倡导者体系，许多被拘留者没有法律代表。决策能力是因决策而异的。移民遣返中心的临床医生有责任考虑被拘留者做出医疗保健决策的能力，但预计不会在更广泛的移民决策背景下进行任何评估，而且没有既定程序将对被拘留者能力的任何担忧通知移民决策者。英国内政部专注于保护被拘留中的弱势群体，但不关注这种拘留是否应该发生，或者被认定为特别脆弱的个人是否有做出与移民相关决策的必要能力。在社区中，寻求庇护者和移民可以在与移民官员接触时得到家人、朋友和他们选择的其他倡导者的支持。但移民被拘留者并非如此。目前的安排存在重大风险，即在最脆弱的被拘留者没有充分参与的情况下做出不公平的决定。文中提出了变革建议，包括需要设定高门槛，以证明对缺乏与移民相关决策能力的人进行任何拘留是合理的。
