Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2024-005094
First-tier Tribunal No: PA/51933/2022
IA/05187/2022

THE IMMIGRATION ACTS

Decision & Reasons Issued:
On 21 July 2026

Before

UPPER TRIBUNAL JUDGE JACKSON

Between

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Appellant

and

KM by his litigation friend GB
(ANONYMITY ORDERS MADE)
Respondent

Representation:
For the Appellant: Mr K Pullinger of Counsel, instructed by Law Lane Solicitors
For the Respondent: Mr K Ojo, Senior Home Office Presenting Officer

Heard at Field House on 28 April 2026

Order Regarding Anonymity

Pursuant to rule 14 of the Tribunal Procedure (Upper Tribunal) Rules 2008, the Appellant and his litigation friend are granted anonymity.

No-one shall publish or reveal any information, including the name or address of the Appellant and his litigation friend, likely to lead members of the public to identify the Appellant and/or his litigation friend. Failure to comply with this order could amount to a contempt of court.

DECISION AND REASONS
1. In a decision promulgated on 4 March 2026, I found an error of law in the decision of First-tier Tribunal Judge Taylor promulgated on 1 September 2024, in which KM’s appeal against the decision to refuse his protection and human rights claim dated 16 May 2022 was allowed on Article 3 grounds. For the reasons set out in that decision, annexed to this one, that decision was set aside. This is the re-making of the KM’s appeal on human rights grounds only as there are preserved findings of fact dismissing the KM’s protection claim which have not been challenged or pursued further by either party. For ease I refer to the parties in this decision as they were before the First-tier Tribunal, with KM as the Appellant and the Secretary of State for the Home Department as the Respondent.
2. The Appellant is a national of Albania born on 17 February 1996, who first entered the United Kingdom in 2015, further to which he was encountered by the police on 4 April 2016 and made an asylum claim on 5 May 2016. That claim was withdrawn by the Appellant on 14 April 2017 and he was removed to Albania on 4 May 2017. The Appellant claims to have re-entered the United Kingdom on 9 March 2019 and made further submissions on 21 May 2019. The basis of his protection claim was that he would be at risk on return from both his family and society as a gay man and separately feared a family of a person that the Appellant beat up in Albania, the family having police and political connections.
3. The Respondent refused the application the basis that it was not accepted that the Appellant was at risk on return to Albania on either basis as he had not credibly established that he was gay or that the family he feared had any political or police connections. The Appellant was able to safely return to Albania between 2017 and 2019 without any issue. In any event, there would be a sufficiency of protection available to the Appellant in Albania. There were no grounds on which the Appellant would be entitled to a grant of humanitarian protection.
4. In relation to Article 8, the Respondent refused the application on the basis that the Appellant had not established any family life in the United Kingdom for the purposes of Appendix FM to the Immigration Rules and he did not satisfy the requirements of paragraph 276ADE of the Immigration Rules for a grant of leave to remain on private life grounds. The Appellant would be able to reintegrate in Albania, where medical treatment was available for his mental health and which he has accessed there in the past. He would be returning with family support.
5. In relation to Article 3 and the Appellant’s mental health, the Respondent considered that the high threshold was not met to establish any risk of breach of Article 3 based on the Appellant’s health, for which treatment is available on return to Albania and there is a lack of evidence to establish substantial grounds for believing the Appellant would face a real risk of either a serious, rapid, and irreversible decline in their state of health resulting in intense suffering, or a significant reduction in life expectancy.
6. Finally, there were no exceptional circumstances for a grant of leave to remain outside of the Immigration Rules.
The appeal
Legal Framework
7. The test for a breach of Article 3 on health grounds is set out by the Supreme Court in AM (Zimbabwe) v Secretary of State for the Home Department [2020] UKSC 17 and helpfully distilled following this and the case of Sarvan v Denmark (application no> 57467/15) by the Upper Tribunal in AM (Art 3; health cases) Zimbabwe [2022] UKUT 131 (IAC) as follows:

1. In Article 3 health cases two questions in relation to the initial threshold test emerge from the recent authorities of AM (Zimbabwe) … and Savran v Denmark …:
(1) Has the person (P) discharged the burden of establishing that he or she is “a seriously ill person”?
(2) Has P adduced evidence “capable of demonstrating” that “substantial grounds have been shown for believing” that as “a seriously ill person”, he or she “would face a real risk”:
(i) “on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment,
(ii) of being exposed
(a) to a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering, or
(b) to a significant reduction in life expectancy”?
2. The first question is relatively straightforward issue and will generally require clear and cogent medical evidence from treating physicians in the UK.
3. The second question is multi-layered. In relation to (2)(ii)(a) above, it is insufficient for P to merely establish that his or her condition will worsen upon removal or that there would be serious and detrimental effects. What is required is “intense suffering”. The nature and extent of the evidence that is necessary will depend on the facts of the case. Generally speaking, whilst medical experts in the UK may be able to assist in this assessment, many cases are likely to turn on the availability of and access to treatment in the receiving state. Such evidence is more likely to be found in reports by reputable organisations and/or clinicians and/or country experts with contemporary knowledge of or expertise in medical treatment and related country conditions in the receiving state. Clinicians directly involved in providing relevant treatment and services in the country of return and with knowledge of treatment options in the public and private sectors, are likely to be particularly helpful.
4. It is only after the threshold has been met and thus Article 3 is applicable, that the returning state’s obligations summarised at [130] of Savran become of relevance – see [135] of Savran.
8. In MY (Suicide risk after Paposhvili) [2021] UKUT 232 (IAC), the Upper Tribunal confirmed that where an individual asserts that he would be at real risk of (i) a significant, meaning substantial, reduction in his life expectancy arising from a completed act of suicide and/or (ii) a serious, rapid and irreversible decline in his state of mental health resulting in intense suffering falling short of suicide following return to the receiving State and meets the threshold for establishing Article 3 harm identified at [29] – [31] of the Supreme Court’s judgment in AM (Zimbabwe), when undertaking an assessment the six principles identified at [26] – [31] of J v Secretary of State for the Home Department [2005] EWCA Civ 629, as reformulated in Y (Sri Lanka) v Secretary of State for the Home Department [2009] EWCA Civ 362 apply. These are as follows:
26. First the test requires an assessment to be made of the severity of the treatment which it is said the applicant will suffer if removed. This must attain a minimum level of severity. The court has said on a number of occasions that the assessment of its severity depends on all the circumstances of the case. But the ill-treatment must ‘necessarily be serious such that it is ‘an affront to the fundamental humanitarian principles to remove an individual to a country where he is at risk of serious ill-treatment’.
27. Secondly, a causal link must be shown to exist between the act or threatened act of removal or expulsion and the inhuman treatment relied on as violating the applicant’s Article 3 rights. Thus, in Soering at para [91], the court said:
‘Insofar as any liability under the Convention is or may be incurred, it is liability incurred by the extraditing contacting state by reason of its having taken action which has a direct consequent the exposure of an individual to proscribed ill-treatment’ (emphasis added).
See also [108] of Vilvarajah where the court said that the examination of the Article 3 issue ‘must focus on the foreseeable consequences of the removal of the applicants to Sri Lanka …’
28. Thirdly, in the context of foreign cases, the Article 3 threshold is particularly high simply because it is a foreign case. And it is even higher where the alleged inhuman treatment is not the direct or indirect responsibility of the public authorities of the receiving state, but results from some naturally occurring illness, whether physical or mental. This is made clear in para [49] of D and para [40] of Bensaid.
29. Fourthly, an Article 3 claim can in principle succeed in a suicide case (para [37] of Bensaid).
30. Fifthly, in deciding whether there is a real risk of a breach of Article 3 in a suicide case, a question of importance is whether the applicant’s fear of ill-treatment in the receiving state upon which the risk of suicide is said to be based is objectively well-founded. If the fear is not well-founded, that will tend to weigh against there being a real risk that the removal will be in breach of Article 3. To which is added, what may nevertheless be of equal importance is whether any genuine fear which the appellant may establish, albeit without an objective foundation, is such as to create a risk of suicide if there is an enforced return (para 16 of Y).
31. Sixthly, a further question of consideration relevance is whether the removing and/or the receiving state has effective mechanisms to reduce the risk of suicide. If there are effective mechanisms, that too will weigh heavily against the applicant’s claim that removal will violate his or her Article 3 rights.
9. In relation to Article 8, the relevant provision in the Immigration Rules was, at that the relevant time of this decision under appeal, that contained in paragraph 276ADE(1)(vi) which refers to an applicant who has lived in the United Kingdom for less than 20 years and “there would be very significant obstacles to their integration in the country of return”. Integration was explained in Kamara v Secretary of State for the Home Department [2016] EWCA Civ 813 as follows:
“14. In my view, the concept of a foreign criminal’s ‘integration’ into the country to which it is proposed that he would be deported … is a broad one. It is not confined to the mere ability to find a job or sustain life while living in the other country. It is not appropriate to treat the statutory language as subject to some gloss and it will usually be sufficient for a court or tribunal to simply direct itself in the terms that Parliament has chosen to use. The idea of ‘integration’ calls for a broad evaluative judgment to be made as to whether the individual will be enough of an insider in terms of understanding how life in the society in that other country is carried on and a capacity to participate in it, so as to have a reasonable opportunity to be accepted there, to be able to operate on a day-to-day basis in that society and to build up within a reasonable time a variety of human relationships to give substance to the individual’s private or family life.”
10. The very significant obstacles requirement was considered by the Court of Appeal in Parveen v Secretary of State for the Home Department [2018] EWCA Civ 932, who in paragraph 9 held:
“9. … It is fair enough to observe that the words “very significant” connote an “elevated” threshold, and I have no difficulty with the observation that the test will not be met by “mere inconvenience or upheaval”. But I am not sure that saying that “mere” hardship or difficulty or hurdles, even if multiplied, will not “generally” suffice adds anything of substance. The task of the Secretary of State, or the Tribunal, in any given case is simply to assess the obstacles to integration relied on, whether characterised as hardship or difficulty or anything else, and to decide whether they regard them as “very significant”.”
11. Outside of the Immigration Rules, when considering an individual’s right to respect for private and family life in accordance with Article 8, then the usual step-by-step approach set out in Razgar [2004] UKHL 27, applies as follows:

(i) Will the proposed removal be an interference by a public authority with the exercise of the applicant’s right to respect for his private or (as the case may be) family life?
(ii) If so, will such interference have consequences of such gravity as potentially to engage the operation of Article 8?
(iii) If so, is such interference in accordance with the law?
(iv) If so, is such interference necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others?
(v) If so, is such interference proportionate to the legitimate public ends sought to be achieved?
12. As to the question of whether there is family life between adult siblings under Article 8(1), the Court of Appeal set out the test in IA & others v Secretary of State for the Home Department [2025] EWCA Civ 1516 as follows:
116. We are clearly of the view that the correct test is the one enunciated by the ECtHR in Kumari at [35] and by the House of Lords in Beoku-Betts at [39]. Bearing in mind the huge amount of authority cited and summarised at [42]-[84] above, we should perhaps, despite the common ground between the parties, explain that conclusion in a little further detail.
117. First, this is an area in which the domestic courts have universally demonstrated their willingness to follow the consistent jurisprudence of the ECtHR. Even if some of the domestic decisions may have provided divergent interpretations of the additional elements of dependency test, none has suggested that they wanted to depart from ECtHR jurisprudence.
118. Secondly, many of the cases, both ECtHR and domestic, actually concern family life between parents and adult children, rather than between adult siblings. No case has suggested that the legal test is different in the two types of case.
119. Thirdly, all the cases make clear that the exercise of deciding whether there are the necessary additional elements of dependence involving more than the normal emotional ties is a fact-sensitive exercise that is to be decided on a case-by-case basis.
120. Fourthly, financial dependency and dependency created by physical or mental disability both play a part in the evaluation. It is not, however, necessary to show that one sibling is completely reliant on their care and support in their daily life. In other words, none of the cases go so far as to require exclusive or complete dependency.
121. All these points are, in our judgment, pretty well self-explanatory from our summary of the cases at [42]-[84] above. But there are two points that merit a little more explanation: (a) the meaning and function of what we have described as the "real, committed or effective support" test taken from Sedley LJ's judgment in Kugathas at [17], and (b) why exclusive or complete dependency is not required.
122. The real, committed or effective support test is, in our judgment, as we have already intimated at [68], on a proper analysis different from the additional elements of dependency test. Dependency may in one sense be the other side of the support coin. But "real support" may be provided without any serious dependency. Even "effective support" might be provided without there being meaningful dependency. As Sedley LJ himself acknowledged in Kugathas, the real, committed and effective support test was a reading down of the additional elements of dependency test. The FTT said the same at [25] where it acknowledged that the sponsor's real, committed and effective support of family was short of the family being dependent on the sponsor.
123. In our judgment, it would be going too far to say that it is wrong to test whether there are additional elements of dependency by reference to the real, committed or effective support provided. But real, committed and effective support is not the test itself, because the level of real support, for example, may be minor or insignificant, whereas the word "dependency" denotes a significant relationship. This is not a semantic point. The ECtHR used the word "dependence" in S v. UK in the context of "cohabiting dependents", which were its starting point (see [42] above).
124. The domestic cases (e.g. PT Sri Lanka at [30]) were not wrong, for example, to point out that a cohabiting child would not necessarily lose their family life with its parents or even their siblings on their 18th birthday. But that is because the relationship of dependence would subsist at that point.
125. In our judgment, it is undesirable to lay down hard and fast rules as to how the additional elements of dependency test should be applied. It obviously requires some dependence, and dependence is more than the existence of support, even if that support is qualified by the adjectives real, committed or effective. Kumari makes clear that it is harder for adults to demonstrate the necessary dependency because family life is normally limited to the core cohabiting family. The examples in Kumari at [38]-[39] (see [50] above) make clear the kinds of physical or mental dependency that might qualify. They are not exhaustive, and dependency may take many forms, as Kumari at [37] and [41]-[43] also reminds us. So far as exclusive dependency is concerned, on the particular facts of that case, Alvarado made clear that it was not always required to establish family life. Moreover, whilst one person being completely dependent on another might normally satisfy the additional elements of dependency test, it is not the only way that the test can be satisfied as the cases we have cited demonstrate.
The witness evidence
13. The Appellant has been assessed as not having capacity to participate in these proceedings and there is no recent written statement or evidence directly from him in support of his appeal (although there are some older statements from around 2016 and 2017 in the historical papers). The witness evidence in support of his appeal is from his brother, PM and his litigation friend, GB (who is PM’s partner).
14. In his written statement signed and dated 15 March 2023, PM refers to the Appellant being gay and his belief that the ridicule and abuse he suffered in Albania because of this was the main trigger for his poor mental health. He refers to the Appellant running away from hospital on two occasions whilst detained under section 3 of the Mental Health Act 1983 (the “MHA”); during one of which he attempted suicide and was only calmed and talked down by PM and another person and on another occasion when the Appellant pulled out a knife in public, it was PM who calmed him down to drop it.
15. PM was concerned about the Appellant’s return to Albania initially because of his sexuality, but now also because of his mental health that he would not manage alone and would be a danger to himself. PM states that family would not take the Appellant back because of his sexuality and therefore he would be left on the streets and be vulnerable to gangs, illegal work and traffickers.
16. In his written statement signed and dated 21 August 2024, PM refers to incidents in August 2024 when the Appellant tried to attack him with a knife, hurt himself and damaged property. He was found naked in a cemetery and taken to hospital and whilst waiting for a mental health bed, escaped. At that time, the Appellant was hallucinating, was paranoid and hearing voices such that it was expected that he would again be detained under the MHA when found.
17. In his written statement signed and dated 7 April 2026, PM states that he has always had a close relationship with his brother and over time, has effectively become the Appellant’s primary carer and support, particularly following repeated hospital admissions and the death of their mother in 2022, which affected him badly. The Appellant is heavily dependent on PM emotionally, practically and medically, telling PM that he is the only person he trusts and the only person with whom he feels safe. Around others, the Appellant can become distressed and anxious, expressing fear and mistrust.
18. PM has leave to remain in the United Kingdom pursuant to his relationship with GB and their daughter, born in September 2025 (both of whom are British citizens). The family live together in Wallington and GB supports PM with his responsibilities towards the Appellant.
19. The Appellant has suffered from serious mental health problems for many years and PM has supported him through multiple crisis, including episodes where he has been detained under the MHA; periods when the Appellant has stopped taking his medication and his mental health has deteriorated rapidly and during incidents where the Appellant has put himself at risk of serious harm. These situations include when the Appellant climbed on to a roof, when PM intervened to stop him jumping; when police were called when the Appellant was agitated in public and when the Appellant absconded from hospital when PM assisted in locating him. PM requires close supervision and support to keep him safe.
20. PM states that he provides ongoing, hands-on care for the Appellant, which includes speaking to him daily and spending time with him to reassure him; to help him calm down during episodes of anxiety or distress and to encourage him when he feels hopeless or suicidal; to ensure he takes his medication correctly; to ensure he attends medical appointments and understands medical advise; reminding him to eat and maintain personal hygiene; to manage appointments and paperwork; to communicate with professionals directly and help with tasks that the Appellant can not do independently. PM considers that the Appellant needs daily emotional support; supervision and monitoring; assistance with healthcare; support with daily living and that his current level of stability has only been possible because of ongoing professional support, structure accommodation and PM’s constant involvement in his care.
21. If the Appellant were removed to Albania, PM is concerned that the Appellant would not be able to access or engage with treatment there independently; he would be isolated and unable to cope; his mental health would deteriorate rapidly and that he would consider ending his life.
22. PM attended the oral hearing, adopted his written statements and gave oral evidence through a court appointed Albanian interpreter. He confirmed that the Appellant had last been sectioned under the MHA between September 2024 and April 2025 and is now living in hospital accommodation where a team from the hospital takes care of everything for the Appellant.
23. In cross-examination, PM confirmed that he had been granted leave to remain in the United Kingdom such that he is now able to travel to and from Albania, but stated that his wife and 7 month old child are in the United Kingdom. In Albania, the Appellant has his father, one brother and two sisters who are all married and his mother has passed away. PM has been in the United Kingdom for 12 years and doesn’t have much contact with family there, although he has more contact with his sister who he last spoke to a week before the hearing and does speak to the others.
24. PM states that he speaks to the Appellant daily, visits him, cleans his house, buys things for him and is generally always there for him. PM last lived with the Appellant before he was admitted to hospital in 2024. When asked if he was living with his partner at that time, PM stated that yes, he was living with her in 2024 and because of the address, he was forced to have another house and a friend helping him pay rent, whilst the Appellant did not have a fixed address so he had to live with him. When asked again, by reference to his application for leave to remain which stated PM had been living with his partner since January 2023, he stated that was correct; but when asked if the Appellant lived with them, PM stated that he got a flat in 2022 as the Appellant did not know where to go so he left him to stay at a different address, not with his partner. PM then stated that his brother never lived at his partner’s address and since January 2023, he was going to see his brother and at times he was in hospital. The Appellant changed addresses a number of times since 2021 and had lived with someone else during that time, including in council accommodation, home office accommodation and in a shared room.
25. The Appellant returned to Albania for around one and a half years after he signed papers to return and could not explain a document he had in another name. PM knew he returned to the United Kingdom having been told by members of the Albanian community that the Appellant was living on the street here. PM does not know what the Appellant did in Albania when he was there, although he had stayed with his mother, but she was ill with cancer and could not care for him. PM thought the Appellant had medication from a doctor in the United Kingdom and then got the same in Albania, but he was not sure if he actually received and the nearest GP and hospital were both two to three hours away from their home village. PM was not in direct contact with the Appellant in the period he returned to Albania, only talking directly to their mother.
26. When asked if PM could return to Albania for a short period with the Appellant to help him, such as for travel through the airport or meeting family members, he stated he would not be able to and when asked why not, he stated he did not understand. When asked again, PM stated that he can do everything possible for the Appellant but would not know where to bring him or what family to contact and that it would be very difficult for him to go back to his home area because of bullying and his mental health. PM did not think family in Albania would be able to look after the Appellant or help him access treatment there because the siblings are married, have children and are working, as well as living far away from each other, so would not have time. PM has not discussed the possibility of the Appellant’s return with any other family members. PM also stated that treatment in Albania costs money, both for hospitals and medicines (although he did not know how much) and he did not know who would manage this for the Appellant or make sure he takes any medication.
27. I asked PM a number of questions for clarification. As to the Appellant’s current living arrangements, PM stated that the accommodation is for a number of people and is staffed 24 hours a day. The staff give the Appellant his medication three times a day, take him to hospital for any appointments and generally look after him. PM is not allowed to stay with the Appellant at this accommodation, nor could the Appellant live with PM because of the small baby and because he needs the nurses to look after him all the time.
28. As to where PM was living and with whom, he stated that the Appellant was living at an address in Aurelia gardens until 2024 during which time PM was always staying and visiting him; but that PM was also living with his partner from January 2023 at a different property and he could not explain the various references to living at different addresses during the same period nor how he could live with both the Appellant and his partner in different accommodation at the same time.
29. In her written statement signed and dated 8 April 2026, GB describes her role as litigation friend to the Appellant because he can not understand legal proceedings, give clear instructions, or engage consistently with his case. She has witnessed the Appellant become easily confused and overwhelmed, struggling to process information and being unable to manage independently. GB refers in very similar terms to PM as to the Appellant’s presentation and difficulties, as well as to PM’s support to the Appellant; as well as to her relationship with PM and their daughter. GB also personally supports the Appellant by being present at times of distress; showing patience and understanding towards his condition and helping to create a calm and stable environment for him; as well as supporting PM in his role. GB expresses similar concerns to PM as to what would happen if the Appellant were returned to Albania, removing him from his current support network.
30. GB did not attend the oral hearing to give evidence.
The medical evidence
i) Ms Hoxha report dated 7 April 2026
31. The latest medical evidence is a Psychological Therapy Report from Elida Hoxha, Counsellor and Psychological Therapist, FMBPS, MBACP, MHPSS, dated 7 April 2026. She assessed the Appellant over three, 90 minute sessions conducted via a video call and with reference to the previous appeal bundle, psychiatric and community health letters, inpatient and support letters and current medication information. The Appellant’s mental health is summarised as a severe and enduring mental illness with repeated psychiatric admissions and detention under the MHA with impaired day-to-day functioning and day-to-day reliance on others for support and stability. There are references in his medical records to unspecified non-organic psychosis complicated by illicit drug use, schizoaffective disorder, paranoid schizophrenia and schizophrenia; which in broad terms shows a serious psychotic-spectrum illness marked by relapse, impaired functioning and the need for sustained psychiatric care. Ms Hoxha describes the Appellant’s emotional world as being shaped by mistrust, fear, dependency, shame, grief and hopelessness, with reference to dependence and trust only on his brother. His psychometric scores are consistent with severe depression, severe anxiety, very high general distress and a marked trauma-related symptom burden; although Ms Hoxha interprets the results cautiously as part of the wider clinical picture. The death of the Appellant’s mother in 2022 is referred to has having a profound emotional impact with a loss of protection. As to return to Albania, the Appellant expressed this as a state of danger, abandonment, collapse and suicide with a list of ways he could achieve the latter if told to return to Albania; albeit he had no immediate plan or intent and there are currently protective factors including his brother and current accommodation with round the clock support.
32. The report sets out the Appellant’s background and medical history in more detail and includes the following as to his psychological formulation and diagnosis:
10.1 [The Appellant’s] presentation is best understood as involving two overlapping layers of difficulty.
10.2 The first is the severe psychotic-spectrum illness already documented across the psychiatric and community records. This includes repeated relapse, poor insight, paranoia, agitation, social withdrawal, and the need for long-term treatment and supervision.
10.3 The second is a strong layer of trauma-related, depressive, and anxiety-based distress, reflected in his psychometric profile, fear, hopelessness, mistrust, exhaustion, and difficulty maintaining emotional steadiness.
10.4 Shame and stigma deepen that picture. His account suggests a man who has carried the pain of being different, being misunderstood, being bullied, and fearing how others may see or expose him.
10.5 The death of his mother in 2022 is also central. He described her as the one person who understood him, looked after him, understood his paranoid fears, and made him feel protected. That loss appears to have left him with grief he cannot easily explain and with the sense that a unique source of safety has gone.
10.6 At present, his brother appears to be the only remaining person he experiences as safe. This explains the degree of dependence evident across both the records and the assessment.
…
33. In terms of the Appellant’s functioning and support needs, Ms Hoxha states that the records repeatedly identify PM as a central source of care, medication support, mediation and safety with the Appellant stating that he would not know what do to without his brother, particularly after the loss of his mother. The Appellant’s current accommodation is a protective factor as it has 24-hour support, medication provision and help with necessities, so is a meaningful part of the Appellant’s current stability.
34. The report refers to evidence of past risk to the Appellant, including specific incidents with a history of self-harm, suicidal behaviour and poor judgment. The current risk factors are said to be a sense of hopelessness and a link between forced return and suicide. The protective factors are the Appellant’s brother, current accommodation and no immediate plans for harm. The risks are likely to increase with acute stress; perceived threat; destabilisation of treatment; reduced support from his brother or services; and fear of removal or worsening uncertainty. Overall, the risk is described as serious but not static; with a worsening on removal to Albania and a suicide risk which is not symbolic or remote.
35. Ms Hoxha also refers to the Appellant’s ability to engage with his appeal and to give evidence, which I do not set out here as it is not in dispute, a litigation friend has been appointed for him and he has not in any event given evidence.
36. Ms Hoxha expressly does not give an opinion as to the availability of treatment in Albania as a country expert, instead setting out what the Appellant requires as: continued psychiatric monitoring and medication management; a structured environment; psychological support delivered in a careful and containing way; support with routine, safety and medication adherence; and trusted people around him who understand his difficulties. Ms Hoxha refers to the Appellant’s presentation of fear and mistrust as being major barriers to him engaging with care; as well as the level of stigma felt. There may also be practical concerns for a vulnerable person accessing treatment relevant to finances, geographical access and need to be able to independently navigate services. Ms Hoxha doubts taking all of this together whether the Appellant would be able to realistically obtain and sustain treatment in Albania in the way it is currently being provided and supported in the United Kingdom.
37. As to future prognosis, Ms Hoxha states that with ongoing treatment, structured accommodation, medication support and continued psychological input, some degree of stability can be maintained, but the Appellant’s vulnerability remains high and progress is likely to be fragile. Without this, there is a likelihood of relapse and further deterioration, both in the United Kingdom and in Albania; the latter being of a higher risk of worsening mental instability and deterioration.
ii) Dr Hameed report dated 24 April 2024
38. An earlier report dated 24 April 2024 from Dr Azmathulla Khan Hameed, Consultant Psychiatrist is also available. In that report, it is stated that the Appellant came to the United Kingdom in 2016, with prior residencies in Italy, Germany and France and at the time of the report, resided with his cousin who provided him with financial support. In the following paragraph, it is said that the 1.5 hour assessment was completed together with PM who the Appellant resides with (who is also described later in the report as a ‘cousin brother’, although there is also a different named cousin identified as being involved with the Appellant’s mental health) and PM was very helpful when the Appellant struggled with communication. Dr Hameed spoke via video call to the Appellant twice and had reference to a number of medical documents and reports (although it is not clear if this included the Appellant’s GP records or how comprehensive the records provided otherwise were).
39. The report sets out the Appellant’s mental health problems, starting in August 2016 with symptoms following three months’ use of cannabis and spice; following which medication was prescribed but not complied with, an A&E visit and admission under the MHA in August 2016 and discharge in November 2016. At this time the Appellant was diagnosed with unspecified non-organic psychosis. The next referend is to an informal admission to hospital in May 2019 due to a deterioration in mental health, with behaviour putting himself at risk and contemplation of jumping from a second-floor window. The Appellant was formally detained under the MHA on 24 May 2019 and by November 2019 he was under the care of the community mental health team for Paranoid Schizophrenia. There was a further admission on an unknown date and discharge on 6 December 2021; followed by admission again on 26 August 2022 (after he expressed suicidal thoughts and had a knife with him in public, a period of deterioration in his mental health following the death of his mother) under the MHA and discharged on 12 October 2022. The report refers to various medications, compliance (or lack thereof) with medication, diagnosis, symptoms and periods of improvement at times.
40. Dr Hameed refers to the Appellant as suffering from an enduring and chronic mental illness with poor insight; with contributing factors of stress of survival, lack of financial support and uncertainty surrounding his immigration status and fear of return to Albania. Even with medication, the Appellant can become unwell enough to require hospital admission. The long-term prognosis was not favourable due to the Appellant’s psychiatric vulnerability, inadequate coping mechanisms and that he has not yet achieved full remission and there is a risk of deterioration if returned to Albania, as well as an increased suicide risk. Removal from the Appellant’s social network of his friends and brother would also have negative emotional consequences which in turn may impact on his mental health recovery. There was also a risk of detrimental impact on the Appellant’s health if the current care and treatment was withdrawn.
41. The report also covers matters such as fitness to fly and ability to give evidence, which I do not refer to given the age of this report and more up to date information being available.
iii) GP records
42. The Appellant’s GP notes, up to 7 April 2026 identify his brother, PM as his next of kin and to whom there is reference in the records to making appointments and discussion with him about the Appellant. In terms of consultations, the records show an exchange in March this year between the Appellant’s consultant and the GP with regards to the GP taking over prescribing and monitoring of a number of medications (Docusate, Macorogol, Priadel, Metformin, Hyoscine hydrobromide and Senna), save for clozapine which will sill be supplied and monitored via the consultant. A mental health review on 24 February 2026 (the most recent entry) states the Appellant is “Doing well compliant to medicine”, he is “On Clozapine and Lithium” and has “No suicidal thoughts”. In the comments section it is said that “Schizoaffective schizophrenia in remission”. In a second entry on the same date, there is reference to hallucinations, no thought disorder, patient has insight of their illness and no thoughts of deliberate self-harm. It is said that the Appellant lives alone, agrees to his mental health care plan and is under the care of the mental health team at Jeanette Wallace House. There is also reference to early warning sign of possible relapse, but it is not clear whether this was identification of possible early warning signs to be aware of or whether one was actually present on this date.
43. The GP records also refer to discharge from hospital on 14 April 2025 and on examination on 28 May 2025, “MH fairly good – cheerful and speech appropriate (NB on no medication)”. In terms of the Appellant’s history, the GP records refer to attempted suicide and repeated overdose on 6 April 2020 (together with history of substance misuse); suicidal thoughts on 25 August 2022 and 12 October 2022 and references to various mental disorders. There are some limited references to minor physical health problems.
iv) Other medical evidence
44. In a letter dated 18 April 2024 from South London and Maudsley NHS Foundation Trust, a care co-ordinator stated that the Appellant was under the care of the community mental health team with a diagnosis of schizoaffective disorder and has poor insight into his condition and avoiding treatment such that he is at risk of relapse. The Appellant is said to be living with his brother, PM in Aurelia Gardens and supported by him to attend medical reviews, depot appointments and GP appointments.
45. In a letter dated 1 April 2025 from the South London and Maudsley NHS Foundation Trust, Dr Barker states that the Appellant is currently an inpatient pursuant to section 3 of the MHA following admission on 6 October 2024 and at that date, there was no planned discharge date.
46. In a letter dated 26 June 2025 from the Croydon North Locality Team within the South London and Maudsley NHS Foundation Trust, Winifred Quashie, an Advanced Practitioner in Mental Health states that the Appellant is under the care of the Community Mental Health Team, who co-ordinate his care. His current medication is listed as Clozapine, Lithium, Diazepam, Docusate, Macrogol and Senna.
47. There are various other letters from medical professionals from earlier dates and extensive medical records (such as observation records), which I have considered but which are not necessary to refer to individually.
Other documentary evidence
48. The bundle contains various other documents relating to these appeal proceedings, the Appellant’s immigration history, the Appellant’s mental capacity assessment and PM’s appeal (which was initially joined with this appeal but withdrawn prior to the re-making hearing); none of which are necessary to refer to individually in this decision.
49. There is a letter from PM’s GP dated 11 April 2024 stating that following a request for a supporting letter, it is confirmed that PM is the Appellant’s carer, cooking for him and managing his finances, taking him to appointments. The Appellant has a history of mental health problems and suicide attempts, and has stopped taking his medication for the past three months.
50. The bundle contains a thesis by Laura Loli-Dano dated December 2018, titled ‘Do Albanian Mental Health Services Meet Human Rights Standards? A Critical Application of the World Health Organization Quality Rights Toolkit at Albania’s Psychiatric Hospitals’. Neither party placed any specific reliance on this report, which I note is now over seven years’ old and addresses a wide variety of matters not directly relevant to this appeal, such that I find it to be of little assistance in addressing the live issues at the current time in this appeal.
51. Although a copy was not provided within the composite bundle, I have also had regard to the County policy and information note: mental healthcare, Albania, January 2025 as the most up to date version of the relevant CPIN (the May 2020 version being quoted in the original decision letter) and as referred to and relied upon by Mr Ojo in closing submissions on behalf of the Respondent.
52. In section 2 of 2025 CPIN, the structure of the mental health care system in Albania is set out, which details in 2.2 primary care provided by family doctors and nursing staff as well as specialised outpatient services in both public and private facilities and in 2.5 private sector facilities and services. Sections 2.3 and 2.4 state:
2.3 Community Mental Health Centres and Supported Homes (‘Shtëpizat’)
2.3.1 The Mental Health Plan 2023-2026 states:
‘The hub of the integrated mental health service system is the Community Mental Health Center. So far, 10 CMHCs have been set up, 4 of which have multidisciplinary teams dedicated to children and adolescents, and have facilitated and supported persons with mental health disorders, focusing on severe disorders to live in the community.
‘[Fourteen Supported Homes’ have been set up and are operating …, in which rehabilitating treatment is provided on an individual basis, for people with chronic mental health disorders, mainly former chronic residence of psychiatric hospitals. The “residents” age group ranges from 27 to 79 years old, presenting a great challenge for the design and implementation of individual rehabilitation and support plans, which dictates the need for the categorization of these services, within the typology of “supported homes”. This reorganization should also address the growing need from the community for short-term rehabilitation services in order to avoid frequent and long hospitalizations of people with chronic and serious mental health disorders.
2.3.2 Considering how community-based health centres are staffed, in 2016, Rebecca Muelle, of the Indiana University School of Public health, noted: ‘Community health centres are staffed by an interdisciplinary team including at least one psychiatrist, psychiatric nurse, clinical psychologist and social worker. Staff members held office appointments and made home visits, often following up with consumers who had recently been discharged from hospital stays or were known to need extra support due to an especially difficult home situation.
2.3.3 Regarding Supported Homes, Mueller explained:
‘Most Shtëpiza residents spend several months to perhaps two years at the Home, engaging in daily activities like communal cooking and cleaning, personal hygiene routines, walks, shopping trips, and other outings (A much touted different between Hospital and Supported Home is the substantial amount of freedom that residents enjoy over their everyday schedules, and the fact that they can come and go as they please, without restrictions. A stay at the Home theoretically prepares residents for the next and final stage of transition: a return to life with family members in their home communities. However, a large percentage of residents across Albania’s Supported Home facilities … are “kronike” without any prospect of homecoming.
2.4 Psychiatric hospitals and psychiatric departments in general hospitals
2.4.1 There are four in-patient psychiatric facilities in Albania: University Hospital ‘Mother Theresa’ in Tirana, Shkoder Inpatient Mental Health Service, Elbasan Psychiatric Hospital and Vlora Psychiatric Hospital. Reconsideration/modernisation work is underway at Elbasan and Vlora under the 2023-2025 Plan.
2.4.2 It was noted in the Mental Health Action Plan 2023-2026:
‘The introduction of new typologies of specialized community-based mental health services, respectively of CMHCs and Supported Homes led to reducing the number of hospital beds/ inpatient psychiatric services, with a particular focus on reducing the number of chronic residents accommodated in these services (persons with mental health disorders or mental disabilities accommodated for more than 5 years at these service centers).Such intervention enabled the two inpatient mental health service centers, in Tirana and Shkodra respectively, to now function as acute / subacute service centers, according to the mandate of these services and within the framework of international strategies and guidelines supporting deinstitutionalization and transition to mental health services in the community. In this context, the process of reducing the number of psychiatric beds, implemented in parallel with the addition of community-based services, has dropped the number of beds in mental health services from 900 beds in 2000 to 600 in 2023.
2.4.3 There are strict criteria for admission to in-patient treatment facilities, including psychiatric hospitals and psychiatric in-patient wards in general hospitals. A patient is referred by a Community Mental Health Center or a specialist doctor after all existing opportunities for health treatment in the community are exhausted and the necessary treatment is provided only through hospitalization in mental health services.[footnote 27] Under Law 44/2012 (Article 19), the informed consent of the patient is required; involuntary admission is only permitted in circumstances detailed in Article 20 of the same Law.
2.4.4 Musta and Bogdanova stated in October 2021, ‘As hospitalization is the most restrictive of mental health services, its purpose is to stabilize acute symptoms so that the patient can return to the community as soon as possible, or to other services provided at that level.
2.4.5 The University Hospital Centre ‘Mother Teresa’ (UHC ‘Mother Teresa’; QSUNT or QSUT is the Albanian abbreviation) is the largest general health institution in Albania. It is a public hospital complex and is financed from the Health Insurance Institute and Ministry of Health. The medical and administration staff numbers over 2,700 in total. The hospital draws patients from all over Albania for tertiary level treatment.
2.4.6 The Psychiatry Service at UHC ‘Mother Teresa’, according to the hospital website,’…offers comprehensive continuous care, including inpatient service for acute patients, day services in observation, intervention and treatment of psychiatric emergencies and emergencies, outpatient consultations and specialist consultations at other QSUNT services for comorbidities with psychiatric diseases…’
2.4.7 The section of this CPIN on Paediatric care includes detailed information on psychiatric treatment for children at UHC ‘Mother Theresa’.
2.4.8 The Elbasan Psychiatric Hospital, according to Musta and Bogdanova, was opened in 1963 in order to treat neurological and psychiatric patients. Before the 1990s the number of in-patients reached up to 800 people. Since then the number of users has decreased significantly and there are now 310 beds covering a population of about 1.3 million inhabitants in an area that includes districts in central and southeastern Albania. Emergency services are available; treatment/rehabilitation services are provided through wards for sub-acute patients, who need longer-term treatment than that provided in the functions of the reception service.
53. The CPIN goes on in section 4 to consider specific conditions, which so far as relevant to this appeal are set out in section 4.5 and 4.6 as follows:
4.5 Risk of suicide
4.5.1 According to WHO data, in 2019 Albania had a suicide rate of 4.3 per 100,000 population. For context, the UK had a suicide rate of 7.9 per 100,000 in the same period.
4.5.2 It was observed in the Mental Health Plan 2023-2026 that the mortality rate from suicides in Albania in 2018 was significantly below the European average.
4.5.3 MedCOI reported in January 2020 that the University Medical Centre of Tirana ‘Mother Teresa’ was prepared and equiped for Crisis Intervention in case of a suicide attempt.
4.6 Chronic psychotic disorders, including schizophrenia
4.6.1 According to the WHO Mental Health Atlas, 21,746 cases of psychosis (inpatient or outpatient) were treated in Albania in 2020; 12,414 patients were men and 9,332 were women.
4.6.2 MedCOI advised that the following treatment is available at the UCM ‘Mother Teresa’ in Tirana:
• Outpatient treatment and follow up by a psychiatrist
• Inpatient treatment by a psychiatrist
• Outpatient treatment and follow up by a psychologist
• Inpatient treatment by a psychologist
• Psychiatric clinical treatment in a closed ward/setting (not necessarily forced admittance)
4.6.3 Special outpatient services for patients with psychotic disorders, according to Musta and Bogdanova, include: ‘community-based multidisciplinary mobile teams, day care centers, support homes for former chronic patients in psychiatric hospitals, support homes for psychotic patients, day care/recreation centers, etc.[
4.6.4 See Medication available in Albania (as of 1 May 2022) to check for the availability of specific medicines in Albania. The section on Psychiatric hospitals and psychiatric wards in general hospitals provides details of psychiatric hospitals and psychiatric wards in general hospitals.
54. Section 6 of the same CPIN sets out the medication available in Albania, including those reimbursable from the Compulsory Health Care Insurance Fund (therefore free of charge to patients) which includes diazepam, lithium carbonate and clozapine; and has a link to the complete list of available drugs in Albania (albeit not necessarily free of charge) which together includes metformin.
55. Section 7 of the CPIN sets out the geographical locations of mental health provision, which are primarily in Shkodra, Tirana, Elbasan and Vlore (including supported homes and hospital facilities) with community mental health cenres also in Korca and Gramsh.
56. Finally section 8 refers to the cultural context and stigma, with societal attitudes in Albania perpetuating stigma and limited effective health-care and help-seeking behaviour together with objectives in the Mental Health Action Plan for Albania 2023-206 including increasing awareness to address stigma, social exclusion and discrimination and development of advocacy skills among users of mental health services, their caregivers and family members.

Closing submissions on behalf of the Respondent
57. On behalf of the Respondent, Mr Ojo relied on the reasons for refusal letter. In relation to the mental health parts of the claim, it was accepted that the Appellant was a serious ill person for the purposes of the test in AM (Zimbabwe), but not that the Appellant had demonstrated a real risk of a serious, rapid or irreversible decline causing intense suffering on return to Albania. At best, the evidence showed only the possibility of a deterioration in the Appellant’s mental health and his GP records shows his mental health condition was in remission. The Appellant has not submitted any expert report as to the availability of medical treatment in Albania and has not challenged the information available in the CPIN on this. Mr Ojo further noted that there is no requirement for treatment to be of the same level or standard as available in the United Kingdom.
58. In relation to the Appellant’s return to Albania, he has a family network there and PM would also be able to assist him on return even for a short period, with ongoing financial and emotional support which can continue as it has in the United Kingdom and visits. PM’s circumstances in the United Kingdom are also similar to what he described for his siblings in Albania and Mr Ojo submitted that PM was evasive in his evidence as to family support and he was unable to provide any credible reason as to why family that he is in touch with would not support the Appellant on return.
59. In relation to suicide risk, Mr Ojo noted that the Appellant had previously returned to Albania voluntarily for an extended period of time and could do so again. There would be an available escort for the journey back if necessary, or PM could accompany the Appellant and there is both a family network and medical treatment available on return as needed, including crisis intervention. There is no evidence from the Appellant as to the cost of any treatment in Albania, nor that it would not be affordable for him to access the same. Nor has the Appellant established that he would be destitute on return to Albania. Mr Ojo also submitted that the Appellant’s protection claim has been refused and appeal dismissed on that basis (after the Appellant did not pursue it before the First-tier Tribunal), such that he has not established either a well-founded or a subjective fear on return to Albania.
60. Overall, Mr Ojo submitted that the Appellant had not met even the prima face requirements for Article 3 to shift the burden to the Respondent and his appeal on this ground should be dismissed.
61. As to the Appellant’s Article 8 claim, Mr Ojo noted that without more, this would not succeed on mental health grounds where the appeal fails under Article 3 for these reasons. In terms of whether there would be very significant obstacles to reintegration, Mr Ojo submitted that any obstacles caused by mental health would be mitigated by available family support and treatment. The Respondent did not accept that family life was established such as to engage Article 8 in accordance with the decision in IA & others, in circumstances where there was no more than normal emotional ties between the Appellant and PM and the evidence did not reliably establish that they had lived together even prior to 2024.
62. In any event, even if family life has been established in this case, taking into account the public interest factors in section 117B of the Nationality, Immigration and Asylum Act 2002, the Appellant’s removal would not be a disproportionate interference with his right to respect for private and family life. The Appellant has never had any lawful leave to remain in the United Kingdom and his stay has at best always been precarious. He has returned voluntarily to Albania once with the Respondent’s assistance and then re-entered again unlawfully. He has made an unsuccessful protection claim and has extensively used NHS services which he has not contributed to or paid for. There is no evidence as to the Appellant’s English language ability. The public interest factors in this case are strong and the balance in clearly in the Respondent’s favour.
Closing submissions on behalf of the Appellant
63. On behalf of the Appellant, Mr Pullinger relies on the supplementary skeleton argument prepared in 2023 and the medical evidence, which together shows an up-to-date assessment of the Appellant’s mental health and even though stated in the GP notes as in ‘remission’ it is still listed as an active health problem. At present, the Appellant’s mental health is managed by the community mental health team with regular checks and ad hoc reviews. It is accepted that at present the Appellant’s mental health is stable and that he is in stable, supported accommodation; however, the position would be different if returned to Albania where the Appellant has a subjective fear of return (albeit he has not stated specifically on what basis) and has stated that he would attempt suicide. Ms Hoxha’s report assessed the Appellant’s suicide risk as moderate, with an increased risk on removal; taking into account his current presentation and history of self-harm and suicide attempts (including in 2019).
64. Ms Hoxha’s report also gives information about barriers to accessing treatment in Albania for the Appellant, albeit not as a country expert on healthcare there. She notes the issue of stigma, finances and geographical access as well as the risk to deterioration in his mental health. As to family support on return, Mr Pullinger acknowledged the Appellant had an elderly father and siblings in Albania, but relied on PMs evidence that they would not be able to provide the Appellant with support in the way that he does based on his strong relationship with the Appellant and that any move would significantly disrupt the current support in place, which would increase the risks to the Appellant. As to accessibility of treatment, Mr Pullinger also relied on the CPIN referred to above that mental health support was centred in Tirana and Shkodra but the Appellant’s home area is in the north-east of Albania. He further noted that there was no information as to whether there was spare capacity in any of the facilities or a waiting list, nor as to the effectiveness of such treatment. As to stigma, the CPIN refers to social stigma and a prejudice against schizophrenia, add to which the Appellant has poor insight in to his mental health and an inability to function independently.
65. Overall, Mr Pullinger submitted that there was sufficient evidence to establish substantial grounds for believing that there would be a reduction in the Appellant’s life expectancy through a completed act of suicide if returned to Albania and the information in the CPIN would not dispel such concerns.
66. In relation to Article 8, Mr Pullinger submitted that family life had been established between the Appellant and PM in the United Kingdom, on which there is consistent evidence of a strong relationship and this is a sufficient factor over and above the medical grounds considered under Article 3. PM has provided the Appellant with continued and consistent support in the United Kingdom and is viewed as the Appellant’s only safe person. He requires the daily, in person or by phone presence of his brother to meet his basic needs and separating them would be a disproportionate interference. In any event, the Appellant would face very significant obstacles on return to Albania as he is not capable of operating day-to-day there to re-integrate given the likely deterioration in his mental health and lack of accommodation.

Findings and reasons
67. There are two issues remaining this appeal, first, whether there would be a real risk of breach of Article 3 on medical grounds if the Appellant were returned to Albania, and secondly, whether his removal would be a disproportionate interference with his right to respect for private and family life contrary to Article 8.
68. I start with consideration of the Article 3 test in accordance with AM (Zimbabwe), MY (Suicide risk after Paposhvili) and J (as reformulated in Y) as set out in more detail above in paragraphs 7 and 8.
69. There is no dispute between the parties that the first question in AM (Zimbabwe) is satisfied, that the Appellant is a seriously ill person. The medical evidence clearly shows that to be the case where he has a significant history of very serious mental health problems dating back at least to 2016 and which has necessitated multiple admissions under the MHA (as well as some informal admissions) for lengthy periods of treatment and a pattern of relapsing and remitting poor mental health; including instances of self-harm, suicidal ideation and suicide attempts.
70. As to the second question, the evidence is far less clear and there is lack of any detailed and up to date medical evidence from the Appellant’s current treating clinicians (for example, the community mental health team who have had responsibility for his care in supported accommodation since his discharge from inpatient care under the MHA in April 2025, or his care co-ordinator who seems him regularly) and there is a lack of any specific expert evidence as to available treatment and/or accessibility in Albania.
71. In relation to question (2)(i) as to whether the Appellant has adduced evidence capable of demonstrating that substantial grounds have been shown that as a serious ill person he would face a real risk on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment, I do not find that the Appellant has established that he would. First, the only evidence as to availability in Albania of mental health treatment is that contained in the CPIN from 2025; which has not been challenged or contradicted in any way by the Appellant and on its face shows that there is an established system in place in Albania for mental health care, including for schizophrenia (and similar type illnesses, the Appellant having had a number of diagnosis across a similar spectrum over the years) which includes both in-patient hospital care, supported accommodation (as he is in now) and community mental health care with a number of geographical locations spread across Albania. The type of structural mental health support which the Appellant has accessed in the United Kingdom in recent years is all available in Albania as well.
72. At present, the Appellant’s prescribed medication includes clozapine and metformin, both of which are available free of charge in Albania; and other branded prescriptions for laxatives and anti-sickness medication, which although are not identified by name as being available in Albania from the list available in the CPIN, are not relevant to his mental health (or the test in Article 3, there being no suggestion that lack of access to this specific medication would have any significant adverse impact at all) and it would in any event be expected that some form of that type of medication would be available in Albania given its standard nature. The Appellant has previously been prescribed lithium and diazepam; both of which are also listed as available free of charge in Albania.
73. For these reasons, there is nothing at all to suggest that appropriate treatment is not available to the Appellant in Albania.
74. Secondly, there is an absence of evidence that the Appellant would not be able to access the treatment available in Albania. It appears that he was able to do so when he returned there previously (although the detail of such treatment was lacking, PM at least thought he could get his medication there) and at its highest, Ms Hoxha refers, somewhat hypothetically, to potential practical concerns being finances, geographical access and the need to independently navigate circumstances. There is however no claim by the Appellant that he would be destitute on return nor have any financial barriers to treatment, which in any event from the CPIN would be free of charge (including for the main prescribed medication) to him and no evidence of the cost of any other treatment. In terms of geographical access, there are mental health facilities in various parts of Albania, some of which are 2-3 hours away from his home area but there are no reasons given as to why this would mean he was unable to access such services, particular for an inpatient or home support care where he would be there to live in any event. The final practical point raised was as to the need to ‘independently navigate circumstances’ which is not specified or explained by Ms Hoxha, nor is it related at all to any of the Appellant’s personal circumstances or why this would mean he would be unable to access appropriate treatment. In any event, I find the Appellant has family support available on return and from his brother PM (either initially to establish himself and treatment, but also by phone as per his current support in the United Kingdom) and in particular, if in patient care is needed or used, there would be no need for independent access as the Appellant would be supported in all aspects of care in any event. As to family support, the Appellant has his father and three siblings in Albania. PM stated that their father is elderly (although without specifying any health conditions or other reasons why that would preclude support) and the siblings would be too busy as they are married with children; albeit PM himself is in a stable relationship with a young baby and therefore in a comparable situation and on his own account provides significant support to the Appellant. PM’s evidence as to family support was quite vague and provided no rational reason why other siblings, whom he is in contact with, would not provide any level of support at all and I do not find it credible that they would not, as PM has done.
75. The separate point raised by Ms Hoxha that may be relevant is the Appellant’s presentation of fear (although not specified of what in particular), mistrust of others and stigma. However, although the Appellant refers to PM as his only safe person, he has been engaging with medical professionals in the United Kingdom (including in the community and with his GP) and no reason has been given as to why he would be able to do so here but not with comparable medical professionals in Albania. There is no objective basis for any fear on return to Albania given the dismissal of the Appellant’s protection claim and there is a lack of evidence of any basis for a subjective fear. It is for example, entirely unspecified whether this is a fear based on his claimed sexuality, based on any particular experiences, of the family he originally claimed to fear as long ago as 2016, of medical professionals or on stigma grounds, or in fact for any reason at all. The evidence of fear is so vague and generalised that it can not be a basis to support any suggestion that this would prevent the Appellant from accessing appropriate medical treatment. Similarly, there is a lack of any detailed evidence of stigma being a basis for lack of access to medical treatment, particularly for a person who (a) has accessed medical treatment in the UK and likely in Albania in the past; albeit without consistency in terms of compliance with medication; and (b) has family support to do so.
76. For these reasons, the Appellant’s Article 3 claim on medical grounds must fail as he does not meet the first part of question 2 following from AM (Zimbabwe) as it has not been established that even if there were a real risk, it would be on account of absence of appropriate treatment in Albania or lack of access to such treatment. In any event, I find that he also fails on the second part of the question 2 as there is insufficient evidence showing that he would be exposed to (a) a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering, or (b) to a significant reduction in life expectancy by reason of completed act of suicide for the following reasons.
77. I have considered both of these points by reference to the test in J as reformulated in Y. There is in this case no real risk of serious ill-treatment by the receiving state, Albania and only from some naturally occurring mental illness, in which case the threshold is particularly high; albeit in principle it can be met in a suicide case. For the reasons already given, the Appellant has not established that he has an objectively well-founded fear on return to Albania (and did not in fact even pursue his protection claim) which tends to weigh against a real risk of breach of Article 3. The evidence even on a genuine, but subjective fear is also lacking given that no reason has been given by the Appellant for this fear in any recent time period, the existence of a fear is simply recorded by Ms Hoxha as stated by the Appellant if he were returned given his stated intention of suicide if he is (and any previously expressed fear from many years ago was solely linked to the protection claim not pursued). In any event, even if there is a subjective fear, the Respondent has practical means in place by way of medical escort on return if needed (or PM can accompany the Appellant) and crisis care has been shown in the CPIN to be available in Albania, as well as longer term mental health treatment in hospital and in the community. For these reasons the very high threshold test in J has not been met.
78. Further and also in any event, the Appellant’s evidence is not capable of demonstrating, even taken at its highest and taking into account his history of very poor mental health and suicide attempts (most recently in 2022), substantial grounds for believing that there would be intense suffering or a significant reduction in life expectancy if return to Albania. As above, there is no up to date or detailed evidence from the Appellant’s treating clinicians who know him best and the evidence from his GP does not address this issue. The report from Ms Hoxha, at its highest, refers to an increased risk or worsening of the Appellant’s mental health if removed to Albania (for various reasons, including his history and a link between forced return and suicide), but protective factors including the Appellant’s brother and potential round the clock care (which is available in supported accommodation or inpatient care if needed in Albania) would also still be present; with the risk being described as serious but not static and that there is any event a risk of relapse and further deterioration even in the Untied Kingdom. The suicide risk is expressly referred to as one which is not symbolic or remote, but is not assessed further, nor is it categorised as being high or even reasonably likely. That is no higher or more detailed than the previous similar assessment by Dr Hameed in April 2024 of an increased risk of deterioration and suicide if returned, or then current treatment withdrawn. There is nothing at all in any of the medical evidence that even comes close to establishing substantive grounds for believing the Appellant would face a real risk of intense suffering or completed act of suicide on return to Albania; at best, there are vague references to the risk of deterioration but with no analysis or detailed consideration of what in reality that would mean for this Appellant.
79. I would add that the Appellant also returned to Albania between 2017 and 2019, initially at a time when he already had very poor mental health and there is nothing to suggest that on his last return there was a serious, rapid or irreversible decline in his or her state of health resulting in intense suffering and self-evidently, no completed act of suicide at that time either. There is nothing to suggest that the situation would be materially different now, particularly given the Appellant is currently stable and compliant with treatment, being described by his GP as being in ‘remission’ which is something not previously achieved since 2016 and has family support on return.
80. For all of these reasons, the Appellant’s appeal is dismissed on Article 3 grounds.
81. I turn now to the Appellant’s Article 8 claim, considering first whether he meets the test of ‘very significant obstacles to reintegration’ in Albania set out in paragraph 276ADE(1)(vi) of the Immigration Rules. The Appellant has been in the United Kingdom since an unknown date in 2019 (and had previously been here from 2016 to May 2017) and as such has been away from Albania most recently for some seven years. There is no evidence, from him or from PM as to whether he has been in contact with family or anyone else during that time, although PM has maintained contact with his siblings and there is nothing to suggest that the Appellant could not re-establish such contact as well even if he has not maintained it in the same way as PM. There is no evidence at all about any other ties the Appellant may or may not have to Albania beyond family, although I take into account that he is likely to continue to speak the language (having been born and lived there for the majority of his life, completing at least some education there) and to retain familiarity with customs and norms in Albania.
82. Although the Appellant has not claimed or established he would be destitute on return to Albania nor that he would not be able to support himself through work; I find that given the severity of his mental illness and current treatment, it is very unlikely that he would be able to gain employment to support himself completely. However, PM states he has financially supported the Appellant in the past and there is no reason as to why he would not continue to do so (his evidence being he would do everything he could to support the Appellant), nor was it suggested that other family in Albania could not or would not provide any financial support.
83. The most significant obstacle to reintegration in Albania for the Appellant is his mental health and current lack of independence or recent experience of fully independent living away from a healthcare setting for a period approaching two years in the United Kingdom (and with repeated similar periods of inpatient care and support over a longer period). It would be reasonable to expect that the Appellant would be in the same or similar position at least in the short-term on return to Albania and potentially in the long-term given his history of relapsing and poor mental health.
84. The ultimate question for integration is whether taking into account all of the Appellant’s circumstances, he is enough of an insider in terms of understanding how life in Albania is carried on and a capacity to participate in it, so as to have a reasonable opportunity to be accepted there, to be able to operate on a day-to-day basis in Albanian society to build up within a reasonable time relationships to give substance to his private or family life. Undertaking a broad evaluative judgment, the Appellant would have sufficient familiarity with life, language and culture in Albania to reintegrate and would have both family support and medical treatment available there to support him to reintegrate there. There is a question over his capacity to participate in society given the severity of his mental health problems and his lack of independent living for an extended period of time due to his mental health which would be a clear obstacle to him operating on a day-to-day basis in Albania; but not materially different to exactly the same issues he faces in the United Kingdom for the same reasons. The Appellant would be able to maintain, or re-establish family relationships in Albania (PMs evidence was, at its highest, that they would not have time to give him the same level of support as he does, despite the similarity of all of their personal circumstances, not that there would be no contact or family relationship with them) and build relationships with those around him, including healthcare professionals, as he has done in the United Kingdom. The Appellant would be able to establish or re-establish private and family life in Albanian of the same extent and quality as he currently has in the United Kingdom. In all of the circumstances, whilst I find that there are likely to be significant obstacles to reintegration in Albania for the Appellant primarily due to his poor mental health, there is medical treatment available to him there for this, as well as family support and familiarity with life in Albania, such that I do not find that these would meet the required threshold of ‘very significant’.
85. As the Appellant does not meet the requirements of the Immigration Rules for a grant of leave to remain on private life grounds and there is no basis upon which it is said he could meet any of the family life requirements in Appendix FM either, I undertake the final Article 8 assessment outside of the Immigration Rules.
86. As to family life, the test to be applied as to whether the Appellant has established family life in the United Kingdom with PM is set out in (IA) (paragraph 12 above) which requires there to be additional elements of dependence involving more than emotional ties, with financial dependency and dependency created by physical or mental disability playing a part in the fact sensitive evaluation.
87. There is evidence, from PM and GB as well as contained in some of the medical evidence as to the close relationship between the Appellant and PM; with PM being listed as his next of kin, his only safe person, of attending medical appointments and assessments with him (at least in more recent times) and evident from his involvement in this appeal and the involvement of GB, his partner, as the Appellant’s litigation friend. However, I did not find PMs evidence as to the nature and extent of support he claims to give the Appellant to be reliable or credible.
88. In particular, the evidence from PM as to whether or not he lived with the Appellant at anytime prior to October 2024 (there being no dispute he has not since then as the Appellant has been in hospital or supported living accommodation) was almost incoherent. For the purposes of this appeal and his own earlier appeal, PM stated, including in his written statements as to his personal details accompanied by a statement of truth, that he was living with the Appellant at an address in Aurelia Gardens. However, for his latest application for leave to remain, he stated that he has been living in Wallington with GB since January 2023. PM’s oral evidence was that he was living with both at different addresses, but could not explain how, what time was spent at each or why different information was given in different contexts. There is a lack of documentary evidence supporting either address and some evidence in Dr Hameed’s report that the Appellant was living with a cousin at least in 2022 (although there are also references to living with PM, it is inconsistent on this). I am not persuaded that the Appellant lived together with PM for any significant period of time, if at all and that PM has changed his account of who he lived with and where depending on whether he was pursuing an appeal based on providing support for the Appellant/in support of the Appellant’s appeal, or pursuing an application for leave to remain as GB’s partner; but I do not accept he was cohabiting with both at the same time at different addresses.
89. PM’s most recent written evidence was on the basis that he undertook a significant number of daily care tasks for the Appellant, including emotional support, taking medication, attending medical appointments, reminding him to eat, maintaining basic hygiene, managing all tasks that most people do independently and constantly monitoring and supervising the Appellant to prevent harm. However, it was only in response to a clarification question that it was clear that the Appellant was currently living in accommodation provided by his mental health team, which offered 24-hour care and support, including taking care of him, ensuring he takes his medication, taking him to appointments and so on. When asked specifically to clarify his evidence that PM claimed personally to be doing all of these things daily, he only stated that he is not able to stay with the Appellant and he needs someone to look after him all the time. Whilst I accept that PM has regular contact with the Appellant and provides some emotional support and reassurance, attending some medical appointments with him, I find that the list of claimed daily activities for him was grossly exaggerated and not credible as all of these were in fact provided within the 24 hour care setting the Appellant lives by the professionals available there and not at all by PM. The Appellant’s care and daily living needs arising from his poor mental health are almost exclusively provided for by the NHS and not by PM as claimed, and have been so since at least October 2024 when he was last detained under the MHA.
90. In these circumstances, whilst PM offers a degree of emotional support for the Appellant, and may in the past (prior to October 2024) have also offered some further practical support; this does not extend at the present time (nor has it since at the latest October 2024) to anything amounting to additional elements of dependence as required to establish family life for the purposes of Article 8. Any financial support given by PM (who stated that he had bought things for the Appellant when needed) would not be sufficient to establish this even together with the emotional support provided. The Appellant has not established any family life in the United Kingdom to engage Article 8, however I do take into account the relationship with PM as part of his private life.
91. The Appellant has been in the United Kingdom since an unknown date in 2019 (with a year or so here between 2016 and 2017 as well) during which he has spent significant periods of time detained under the MHA and/or in 24 hour supported accommodation under the care of the community health team (and constantly so in one or the other since around October 2024). There is no evidence as to any substantive private life developed in the United Kingdom during this time beyond his fluctuating engagement with healthcare professionals. There is, for example, no evidence as to any education or work here, no participation in any particular groups or activities, and although there are historical references to other family and friends, there is no evidence from any to suggest any strong or even current relationships with anyone other than PM and GB. The Appellant has not shown any private life of substance established in the United Kingdom and the only interference with this from his removal would be to his regular contact with PM (and to a lesser extent, with GB), which by phone and visits, could to a significant extent be maintained from Albania. All other elements of his private life could be re-established in Albania.
92. The Appellant’s removal to Albania would constitute a very limited interference with his right to respect for private life in the United Kingdom, in circumstances where he has only a very limited private life established here and the relationship with PM could be maintained from Albania to a significant extent. Any interference would be in accordance with the law as the Appellant does not meet any of the requirements for a grant of leave to remain in the United Kingdom and would be in accordance with a legitimate aim.
93. The final question is whether the Appellant’s removal would be disproportionate. In considering the public interest in removal on the Respondent’s side of the balancing exercise, I take into account the factors in section 117B of the Nationality, Immigration and Asylum Act 2002. Those include that there is a public interest in the maintenance of immigration control, in particular for a person who has entered the United Kingdom unlawfully twice and has remained here for some seven years without any leave to remain since his last entry; that little weight should be attached to his private life for that reason; that the Appellant is not financially independent and to the contrary has been a significant burden on public health expenditure given the extent of treatment has had here without any contribution and there is no evidence that he can speak English.
94. On the Appellant’s side of the balancing exercise, I take into account all of the matters already set out above, including in particular the length of time he has spent in the United Kingdom and support network he has here, from both health professionals and PM; as well as the difficulties he is likely to face on return to Albania particularly due to his poor mental health, albeit that treatment is available there for him.
95. Overall, having weighed up all of the facts and circumstances, this is a case where the Appellant’s removal would not be a disproportionate interference with his right to respect for private life and there would be no breach of Article 8. There is a strong public interest which easily outweighs the Appellant’s very limited private life here which he could re-establish in Albania, where he has family support, medical treatment available and can maintain his relationship with PM.

Notice of Decision

For the reasons set out in the decision annexed, the making of the decision of the First-tier Tribunal involved the making of a material error of law and as such it was set aside.

The appeal is remade as follows:
The Appellant’s appeal is dismissed on protection grounds
The Appellant’s appeal is dismissed on human rights grounds (Articles 3 and 8 of the European Convention on Human Rights).

G Jackson

Judge of the Upper Tribunal
Immigration and Asylum Chamber

8th July 2026

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2024-005094
First-tier Tribunal No: PA/51933/2022

THE IMMIGRATION ACTS

Decision & Reasons Issued:

…………………………………

Before

UPPER TRIBUNAL JUDGE JACKSON

Between

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Appellant
and

KM by his litigation friend GB
(ANONYMITY ORDERS MADE)
Respondent

Representation:
For the Appellant: Mr E Terrell, Senior Home Office Presenting Officer
For the Respondent: Mr K Pullinger of Counsel instructed by Law Lane Solicitors

Heard at Field House on 2 February 2026

Order Regarding Anonymity

Pursuant to rule 14 of the Tribunal Procedure (Upper Tribunal) Rules 2008, the Appellant and his litigation friend are granted anonymity.

No-one shall publish or reveal any information, including the name or address of the Appellant and his litigation friend, likely to lead members of the public to identify the Appellant and/or his litigation friend. Failure to comply with this order could amount to a contempt of court.

DECISION AND REASONS
1. The Secretary of State appeals with permission against the decision of First-tier Tribunal Judge Taylor promulgated on 1 September 2024, in which the KM’s appeal against the decision to refuse his protection and human rights claim dated 16 May 2022 was allowed on Article 3 grounds. For ease I refer to the parties as they were before the First-tier Tribunal, with KM as the Appellant and the Secretary of State for the Home Department as the Respondent. This appeal was originally linked with that of PM (KM’s brother) in UI-2024-004856, however that appeal was withdrawn shortly before this hearing and KM’s appeal therefore proceeds now on its own.
2. It is not in dispute in this case that the Appellant suffers from severe mental illness and this hearing was previously adjourned to enable a mental capacity assessment to be made as to whether KM had capacity to pursue this appeal. In a report dated 11 August 2025 from Dr Khan, the conclusion was that KM did not have capacity, pursuant to which an application for a litigation friend was made. GB was appointed as KM’s litigation friend for the purposes of this appeal in directions sent to the parties on 12 November 2025.
3. The Appellant is a national of Albania born on 17 February 1996, who first entered the United Kingdom in 2015, further to which he was encountered by the police on 4 April 2016 and made an asylum claim on 5 May 2016. That claim was withdrawn by the Appellant on 14 April 2017 and he was removed to Albania on 4 May 2017. The Appellant claims to have re-entered the United Kingdom on 9 March 2019 and made further submissions on 21 May 2019. The basis of his protection claim was that he would be at risk on return from both his family and society as a gay man and separately feared a family with police and political connections of a person that the Appellant beat up in Albania.
4. The Respondent refused the application the basis that it was not accepted that the Appellant was at risk on return to Albania on either basis as he had not credibly established that he was gay or that the family he feared had any political or police connections. The Appellant was able to safely return to Albania between 2017 and 2019 without any issue. In any event, there would be a sufficiency of protection available to the Appellant in Albania. There were no grounds on which the Appellant would be entitled to a grant of humanitarian protection.
5. In relation to Article 8, the Respondent refused the application on the basis that the Appellant had not established any family life in the United Kingdom for the purposes of Appendix FM to the Immigration Rules and he did not satisfy the requirements of paragraph 276ADE of the Immigration Rules for a grant of leave to remain on private life grounds. The Appellant would be able to reintegrate in Albania, where medical treatment was available for his mental health and which he has accessed there in the past. He would be returning with family support. There were no exceptional circumstances for a grant of leave to remain outside of the Immigration Rules.
6. At the time of the hearing before the First-tier Tribunal, the Appellant had been detained under section 2 of the Mental Health Act 1983 and it was said that in any event by reason of his poor mental health he would not have been able to give evidence in his appeal. There was no objection to the hearing proceeding in the Appellant’s absence by the Respondent and no express further consideration by the First-tier Tribunal as to whether this was appropriate. I note with some concern that at this time there was already evidence on the appeal file that the Appellant did not have capacity to engage in proceedings, but this was not raised or expressly considered by the First-tier Tribunal and the appeal proceeded in the absence of a litigation friend or any other appropriate safeguards for a person who did not have capacity to act, a point only compounded by his detention under the Mental Health Act 1983 which of itself should have raised questions and further inquiry.
7. This matter has not been raised by either party as a ground of appeal or in any response, but gives rise to significant concern as to whether the appeal should have properly proceeded in the way that it did. As above, the issue has now been resolved for the proceedings before the Upper Tribunal and for the future with the appointment of a litigation friend (during significant adjournment of the error of law hearing and only with prompting by the Upper Tribunal for the issue to be addressed) and for the reasons set out below, a further hearing will be necessary to determine the appeal which will ensure no procedural unfairness to the Appellant. It remains a concern that in all of the circumstances, neither the Appellant’s solicitors nor the First-tier Tribunal grappled with the issue at the time of the first hearing, nor did the Appellant’s solicitors even at the time of the first listing of this appeal in the Upper Tribunal in January 2025 when the Appellant was still detained under the Mental Health Act 1983 and his solicitors had not taken any direct instructions from him for the purposes of this onward appeal.
8. Judge Taylor dismissed the Appellant’s appeal on protection grounds, it having been conceded on the Appellant’s behalf that there were evidential difficulties with the claim on these grounds and in any event it was not accepted that the Appellant was at risk on return for essentially the same reasons as given by the Respondent. The focus of the submissions made on the Appellant’s behalf at the First-tier Tribunal were on mental health grounds.
9. Judge Taylor allowed the Appellant’s appeal on human rights grounds, specifically Article 3 of the European Convention on Human Rights on the basis of the Appellant’s mental health, with the notice of decision recording that the appeal is allowed “for leave to be granted for a period to be determined by the respondent.” The sole findings on this point were as follows:
“23. The respondent accepted that the first appellant has a significant mental health disorder, namely paranoid schizophrenia. I accept the CPIN, dated December 2022, which is quoted in the refusal letter, that mental health services are available in Albania. The services ay not be as accessible or at the same level as the UK, but that does not bring the claim within the ambit of Article 3 ECHR. However, the first appellant has a very serious mental disorder, which has resulted in at least five admissions to hospital under the Mental Health Act, he was admitted in 2016, 2019, 2021, 2022 and the current admission is at least the fifth. He is currently at the Maudsley Psychiatric Hospital in south London, under S2 Mental Health Act, which is an emergency 28-day detention order, which indicates the medical staff considered that he was a danger either to himself or the public if he was not forcibly detained. The submitted medical reports provide a graphic account of the first appellant’s symptoms, including non-sensical speech, thought disorder, confrontation, verbally abusive, overfamiliarity, disinhibition, physical altercations, delusions, to name a few. The appellant is clearly in a current state of relapse, having only been admitted two days prior to the hearing after being found in a cemetery with no clothes. In the circumstances, even if it was possible to transport the appellant to Albania, I cannot be satisfied that the appellant has the capacity to be able to access health care in Albania if he was returned, such that a return would inevitably result in an immediate decline in his mental health, which would have a serious impact on his safety and wellbeing. Although there has been no formal assessment, I can be reasonably satisfied that it would not be safe to transport the appellant from the UK at this time. I therefore consider that to remove the first appellant from the UK at this time would be in breach of Article 3. It is of course open to the respondent to reconsider the position in the fullness of time once the first appellant recovers.”

The appeal
10. The Respondent appeals on the sole ground that the First-tier Tribunal erred in law in allowing the Appellant’s claim under Article 3 of the European Convention on Human Rights without reference to or application of the test in AM (Zimbabwe) v Secretary of State for the Home Department [2020] UKSC 17. Specifically, the Respondent highlights that the First-tier Tribunal failed to make any findings on key questions in that authority, including as to whether the Appellant’s removal would lead to a serious, rapid and irreversible decline in his health resulting in intense suffering, or a significant reduction in the Appellant’s life expectancy and on neither point could the First-tier Tribunal have been satisfied on the basis of the evidence before it.
11. At the oral hearing, on behalf of the Respondent, Mr Terrell relied on the written grounds of appeal which needed little amplification. The First-tier Tribunal had erred in law in failing to follow all of the required steps set out in AM (Zimbabwe). Whilst the First-tier Tribunal accepted that the Appellant was undoubtedly seriously ill (to which the Respondent made no objection), the First-tier Tribunal did not ask itself the right questions and or address the need for the Appellant to set out a prima facie case that he would be unable to access healthcare in Albania, with family or other support and in light of him being able to do so previously in Albania. These were all relevant points raised in the Respondent’s decision letter and not addressed.
12. On behalf of the Appellant, Mr Pullinger submitted that although the First-tier Tribunal had not expressly referred to AM (Zimbabwe), it was clearly aware of the case as it had been referenced in the Respondent’s decision letter summarised in paragraph 7 of the decision. Further, although the same wording as appears in AM (Zimbabwe) was not used in the First-tier Tribunal’s decision, Mr Pullinger submitted that the reference in paragraph 23 to would “inevitably result in immediate decline in his mental health” was in substance the same and sufficient. Overall, the wording and approach of the First-tier Tribunal was so closely aligned with that in AM (Zimbabwe) that there was no material error of law in the decision.
13. Mr Pullinger referred to the significant medical evidence before the First-tier Tribunal as to the Appellant’s poor mental health and the decision clearly referenced the severity of the same and relied in particular on the number of mental health hospital admissions when reaching its conclusions. The issue was not availability of healthcare, but accessibility to it and there was evidence of the Appellant’s history of lack of compliance with available treatment. Mr Pullinger accepted that the First-tier Tribunal did not consider possible family or other support to access treatment in Albania.
Findings and reasons
14. The test for a breach of Article 3 on health grounds is set out by the Supreme Court in AM (Zimbabwe) v Secretary of State for the Home Department [2020] UKSC 17 and helpfully distilled following this and the case of Sarvan v Denmark (application no> 57467/15) by the Upper Tribunal in AM (Art 3; health cases) Zimbabwe [2022] UKUT 131 (IAC) as follows:

5. In Article 3 health cases two questions in relation to the initial threshold test emerge from the recent authorities of AM (Zimbabwe) … and Savran v Denmark …:
(3) Has the person (P) discharged the burden of establishing that he or she is “a seriously ill person”?
(4) Has P adduced evidence “capable of demonstrating” that “substantial grounds have been shown for believing” that as “a seriously ill person”, he or she “would face a real risk”:
(iii) “on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment,
(iv) of being exposed
(c) to a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering, or
(d) to a significant reduction in life expectancy”?
6. The first question is relatively straightforward issue and will generally require clear and cogent medical evidence from treating physicians in the UK.
7. The second question is multi-layered. In relation to (2)(ii)(a) above, it is insufficient for P to merely establish that his or her condition will worsen upon removal or that there would be serious and detrimental effects. What is required is “intense suffering”. The nature and extent of the evidence that is necessary will depend on the facts of the case. Generally speaking, whilst medical experts in the UK may be able to assist in this assessment, many cases are likely to turn on the availability of and access to treatment in the receiving state. Such evidence is more likely to be found in reports by reputable organisations and/or clinicians and/or country experts with contemporary knowledge of or expertise in medical treatment and related country conditions in the receiving state. Clinicians directly involved in providing relevant treatment and services in the country of return and with knowledge of treatment options in the public and private sectors, are likely to be particularly helpful.
8. It is only after the threshold has been met and thus Article 3 is applicable, that the returning state’s obligations summarised at [130] of Savran become of relevance – see [135] of Savran.
15. In the present appeal, the First-tier Tribunal’s only reference to AM (Zimbabwe) was in the summary of the Respondent’s reasons for refusal. The legal test set out therein was not referred to or expressly addressed at all in the decision and for the reasons set out below, I do not find that in substance it was applied such that the First-tier Tribunal materially erred in law in allowing the Appellant’s appeal on Article 3 grounds.
16. The first question to be answered is whether a person is a “seriously ill” person, which is a straightforward one and one on which there was no dispute in respect of the Appellant for whom there was clearly sufficient medical evidence, in addition to his then current detention under the Mental Health Act 1983 to establish this.
17. The second question however requires a much more detailed analysis and requires more specific evidence as to the likely impact of removal and the availability and accessibility of health care on return to Albania. The First-tier Tribunal fails entirely to pose, engage with, or answer the second question at all and as such can not lawfully conclude that the Appellant has met the threshold for consideration under Article 3 on health grounds, nor that his removal would be in breach of Article 3.
18. In paragraph 23 the Judge (i) concludes that he cannot be satisfied that the Appellant has capacity to access health care in Albania, without any consideration of the availability of family or other support to do so, or reference to the Appellant previously having done so in Albania (or to the contrary, his history of non-compliance with treatment in the United Kingdom), or consideration of whether there is any system of compulsion for treatment as there is in the United Kingdom under the Mental Health Act 1983; (ii) concludes that the Appellant’s return would therefore inevitably result in an immediate decline in his mental health which would have an impact on his safety and well-being, again in the absence of any evidence or assessment of this from a medical professional; and (iii) acknowledges that there has been no formal assessment of whether the Appellant could safely be transported to Albania but infers the same in the absence of any evidence either way.
19. Although there was s significant volume of medical evidence in relation to the Appellant before the First-tier Tribunal; it did not address the questions the First-tier Tribunal was required to address above. The conclusions reached by the Judge appear to be based entirely on assumptions flowing from the Appellant having a serious mental illness rather than any proper consideration of the impact of removal.
20. At its highest, the First-tier Tribunal finds that the Appellant’s removal would inevitably result in an immediate decline in his mental health, which would have a serious impact on his safety and wellbeing. That can not, on any rational view, be equated with the test in AM (Zimbabwe) or a lawful answer on the second question. A decline in mental health is not sufficient and even with ‘an’ impact on him; can not rationally or lawfully be equated with a serious, rapid and irreversible decline resulting in intense suffering. I reject entirely Mr Pullinger’s submission on behalf of the Appellant that the First-tier Tribunal’s approach was so closely aligned with that in AM (Zimbabwe) that there was no material error, to the contrary, it failed entirely to engage with the second question it was required to or the high threshold to meet it.
21. The issue of whether the Appellant could be safely transported to Albania was not directly relevant at all to the test for healthcare cases to the purposes of Article 3 and again, it was an assumption reached without evidential foundation. Of itself, it could not justify allowing the Appellant’s appeal on Article 3 grounds either.
22. For these reasons the First-tier Tribunal’s decision involved a material error of law such that it is necessary to set aside the decision. I do so with preserved findings of fact on the protection aspects of the Appellant’s appeal which have not been challenged by either party. The appeal will be relisted in the Upper Tribunal for re-making on human rights grounds only, with directions for this set out below.
23. I would add one further separate note that the First-tier Tribunal had no power in the notice of decision to allow the appeal for a period of leave to be grated for a period to be determined by the respondent. The notice of appeal is defective as it should clearly state whether the Appellant’s appeal is allowed or dismissed on each ground, without more. If allowed on a particular ground, it is then solely a matter for the Respondent as to what action should be taken in response as to a grant of leave and if so, on what conditions. This defect can and will be remedied following the re-making of the appeal.
24. There is one final issue to deal with relating to the history of this appeal. There have been numerous adjournments and delays for which the Appellant’s solicitors have been given three separate notices to show cause as to their conduct; in particular in relation to the Appellant’s capacity and delay in obtaining a suitable assessment of this and as to their failure to attend the last hearing listed on 15 December 2025.
25. Whilst no further action will be taken in terms of a referral to the Solicitors Regulation Authority about conduct, this is a case in which I consider the conduct of Law Lane Solicitors (for the reasons set out in each of the notices to show cause) to be lower than the standard to be reasonably expected when representing a particularly vulnerable Appellant who lacked capacity and whose final determination of his appeal has been delayed for much longer than necessary as a result of that conduct.
26. The last notice to show cause was issued on 19 December 2025 specifically in relation to Law Lane Solicitors failure to attend the hearing listed for 10am on 15 December 2025 and then following a request for the hearing to be held remotely by CVP later that day, only a request for an adjournment being made when the hearing commenced. The notice gave Law Lane Solicitors an opportunity to respond to the concerns raised and make further representations, including as to whether wasted costs should be ordered in respect of the adjourned hearing on 15 December 2025.
27. In their response, Law Lane Solicitors accepted the procedural failings identified in the directions sent on 19 December 2025 which they said arose from an internal administrative error and with no intention to mislead the Upper Tribunal or waste judicial time and indicated that steps have been taken to ensure that such a situation does not recur. Law Lane Solicitors further accepted that the notice of hearing was received by them; the appeal was not adequately prepared for; Counsel was not instructed for the hearing and that an adjournment application was only made on the day of the hearing at a requested CVP hearing which it is acknowledged could not have substantively proceeded.
28. In conclusion, Law Lane Solicitors response on whether a wasted costs order should be imposed is unclear and contradictory. First, it is stated that they do not oppose any inclination to impose a wasted costs order; but secondly, then state that when confirming the amount to be paid (although no amount had been given), it would be disproportionate where (i) the fault has been accepted; (ii) the Appellants (as they then were, including PM whose appeal was subsequently withdrawn) were not responsible; (iii) the adjournment was granted in the interests of justice; and (iv) prompt remedial action has been taken. Thirdly, the Upper Tribunal was invited to conclude that a small wasted costs order should be made.
29. The first question to determine for wasted costs is whether the legal representative of whom complaint is made acted improperly, unreasonably or negligently? Secondly, if so, is it in all the circumstances of the case just to order the legal representative to compensate the Respondent for the whole or any part of the relevant costs?
30. I am satisfied that the conduct of Law Lane Solicitors, as largely accepted by them, was improper, unreasonable and/or negligent in this case for the reasons already set out.
31. In all of the circumstances, this is an appropriate case in which a wasted costs order should be made against Law Lane Solicitors. Their accepted conduct in failing to adequately prepare for or attend the hearing listed for 15 December 2025 fell below the standard of competence to be reasonably expected from an ordinary member of the profession and led to costs being unnecessarily incurred by the Respondent and court and judicial time wasted; for which the Respondent should be compensated. I therefore order Law Lane Solicitors to pay the Respondent’s reasonable costs of preparing for and attending the hearing on 15 December 2025. It is for the Respondent to identify such reasonable costs and for the parties to agree the same; failing which an application will need to be made for assessment of costs.

Notice of Decision

The making of the decision of the First-tier Tribunal did involve the making of a material error of law. As such it is necessary to set aside the decision.

I set aside the decision of the First-tier Tribunal.

Law Lane Solicitors to pay the Respondent’s reasonable costs of the hearing listed on 15 December 2025, to be assessed if not agreed, in wasted costs.

Directions

(i) The appeal to be relisted for a face to face hearing on the first available date from 6 April 2026 before UTJ Jackson with a time estimate of 2.5 hours. The Appellant to confirm if an interpreter is required as soon as possible, and if so, in what language.

(ii) The Appellant may file and serve any further evidence upon which he wishes to rely no later than 21 days before the relisted hearing. Any person who intends to give oral evidence at the hearing must file and serve a written statement (or updated written statement), signed, dated and accompanied by a statement of truth; to stand as their evidence in chief.

(iii) The Respondent may file and serve any further evidence upon which she wishes to rely no later than 7 days before the relisted hearing.

(iv) The Appellant to file and serve a single, composite bundle for the appeal no later than 3 days before the relisted hearing.

G Jackson

Judge of the Upper Tribunal
Immigration and Asylum Chamber

21st February 2026