Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2025-005505
First-tier Tribunal No: PA/10274/2018

THE IMMIGRATION ACTS

Decision & Reasons Issued:

On 1st of September 2026

Before

UPPER TRIBUNAL JUDGE LANDES

Between

S F
(ANONYMITY ORDER MADE)
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Ms S Khan, Counsel instructed by Parker Rhodes Hickmotts
For the Respondent: Mrs R Arif, Senior Home Office Presenting Officer

Heard at Birmingham Civil Justice Centre on 15 May 2026

Order Regarding Anonymity

Pursuant to rule 14 of the Tribunal Procedure (Upper Tribunal) Rules 2008, the appellant is granted anonymity.

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

DECISION AND REASONS
Anonymity
1. The First-Tier Tribunal made an anonymity order. No doubt one was made originally because the appellant claimed asylum but before the judge whose decision is under appeal (“the FTTJ”) the appellant no longer claimed asylum or humanitarian protection. Nevertheless the FTTJ continued the anonymity order, and it was not suggested before me that it should not continue. I find it appropriate to continue the order. The appellant still claims to be at risk in his country of nationality and I consider the public interest in open justice is outweighed by the potential risks to the welfare of the appellant as a person with chronic paranoid schizophrenia, treated as a vulnerable adult, if not just his identity but personal details of his health conditions and treatment are publicly revealed.
Background
2. The appellant is a national of Ethiopia in his late thirties, who has lived in the UK since he was 15 years old, obtaining indefinite leave to remain. The respondent first notified the appellant of her intention to deport him on 8 February 2017 and rejected his human rights claim on 18 January 2018. Following further offending the respondent issued a supplementary decision on 3 February 2020 and it was against that decision that the appellant appealed. His appeal from that decision was allowed in the First-Tier Tribunal on human rights grounds only (he had claimed international protection) but the decision was set aside by the Upper Tribunal (with the finding that the appellant was excluded from the prohibition on expulsion in the Refugee Convention preserved) to be remade in the First-Tier Tribunal and hence came before the FTTJ, who dismissed the appeal on Article 3 and Article 8 grounds by decision promulgated on 30 April 2025. The appellant appeals that dismissal with permission granted by the Upper Tribunal.
3. By the time of the hearing before the FTTJ, the respondent agreed the appellant’s length of residence, that his parents and siblings lived in the UK, that he had been diagnosed with chronic paranoid schizophrenia and that he was a “seriously ill person” within the meaning of the case law relevant to Article 3 ECHR. The respondent also did not challenge the expertise or qualifications of the medical expert Dr Sen, or the country expert Dr Allo (who gave evidence over a video link) [31].
4. The FTTJ’s fact-finding was extensive, careful, and detailed. He made positive findings in the appellant’s favour in many aspects and most of his findings are not challenged, the challenge is rather to the application of those findings. He:
(i) Attached significant weight to the expert reports of Dr Sen [42];
(ii) Found the appellant experienced positive symptoms of schizophrenia such as delusions about having special powers and also presented with negative symptoms such as a lack of motivation and apathy which manifested in a deterioration of personal hygiene. His illness was complex and severe in intensity, and his symptoms were not in full remission despite years of antipsychotic treatment, and he was susceptible to the side effects of treatment [46];
(iii) Found the appellant had recently received an increased dose of his depot antipsychotic and remained in regular contact with the mental health team whilst in prison. He was regularly seen by a nurse and reviewed by a psychiatrist every three months and it was expected treatment would need to continue for the foreseeable future. He was offered support with activities such as education, prompting to keep his room clear and to manage his personal hygiene [47];
(iv) Placed weight on Dr Sen’s conclusions as to treatment required [53] and so found the appellant would, on release from prison, ideally need support from a forensic mental health service in the community with regular contact with a substance misuse service due to the severity of his illness and its link with risky behaviour such as sexually inappropriate behaviour and violent behaviour [48];
(v) Placed weight on Dr Sen’s conclusions as to the treatment required and the response to treatment [53] and so found that the doctor was rightly guarded about the appellant’s prognosis; the appellant found it difficult to function in prison without support from the mental health team and had spent periods in highly supported settings due to conflicts and sexually inappropriate behaviour and would find it difficult on release without a high degree of support from a highly resourced mental health team, ideally in a setting with 24 hour staffing and would also need the support of his family [49];
(vi) Placed weight on Dr Sen’s conclusions as to compliance and response to treatment [53] and so found that the risk of both violent and sexual offences increased when there was a relapse of the appellant’s symptoms; the appellant had demonstrated difficulties even when in prison with fellow prisoners and sexually inappropriate behaviour and provided delusional explanations for the same. There was a risk that the appellant would become involved with illicit drugs again which would result in a further deterioration of his symptoms and an increased risk of offending, including of acquisitive offending to obtain funds for drugs [50];
(vii) Found the appellant had missed appointments with healthcare professionals even in prison, finding it difficult to trust them and requiring active support from family whilst in the community, which required careful management as he had been violent towards them [51];
(viii) Accepted Dr Allo’s conclusions that it was unlikely that the level of care required by the appellant would be available to him in Ethiopia, that the appellant would face stigma, that illicit drugs were widely available and that he would not be able to obtain financial or other forms of support from the authorities [59];
(ix) Accepted that the financial support the appellant’s family in the UK could provide to him was relatively limited, averaging around £30 a week [61];
(x) Found that the appellant’s only relative in Ethiopia was an elderly grandmother who required care herself and there was nothing to suggest the carer would be willing or able to care for the appellant; the funds the family currently spent on the carer, if diverted to the appellant would leave the elderly grandmother without support [62];
(xi) Found that there was a real risk that the intensive level of care which the appellant required would not be available to him in Ethiopia [64];
(xii) Found that it was not likely that the appellant would receive any significant support from the community and it was not reasonably likely that he would have maintained any significant friendships or could draw upon any other source of local support in Ethiopia [65];
(xiii) Found that the appellant’s family would be unable to manage his condition remotely [66];
(xiv) Attached some weight to the appellant’s oral evidence that he would not take medication in Ethiopia [68];
(xv) Was satisfied that any treatment available in Ethiopia would not be accessible to the appellant [68];
(xvi) Concluded that there was a real risk that the appellant would experience a deterioration in his health on return to Ethiopia [69];
(xvii) Accepted that the appellant had experienced incidents of self-harming such as burning with cigarettes, had gone out at night without any clothes and shoes and had run into the road on one occasion. There had been issues with personal hygiene, and the appellant had failed to pay bills [71];
(xviii) Concluded that there was a risk of harm to the appellant when he did not engage in treatment [71] [72];
(xix) Placed little weight on the aspect of Dr Sen’s report which considered the appellant to be at risk of suicide [78] because the suggestion appeared more speculative than anchored on the appellant’s past behaviour, with far more limited evidence to support the risk of suicide (i.e. as opposed to the risk of failing to take care of himself, self-harming and engaging in risky or criminal behaviour) [77] [78];
(xx) Concluded that it had not been shown that there was a real risk that the appellant would try to take his own life were he not to receive the required treatment [78];
(xxi) Found that the appellant had suffered significant relapses in his condition in the UK and had demonstrated non-compliance with treatment and his condition had not significantly improved notwithstanding treatment [82];
(xxii) Found that the appellant had been recalled to prison a number of times and had continued to present a risk to female members of prison staff, had engaged in inappropriate sexual behaviour and had not entirely engaged with his treatment plan; he had been violent towards his family and they had been unable to prevent him from re-offending [83];
(xxiii) Found that to any extent that the appellant’s condition was currently being managed this was largely due to his being in detention and that when his detention and therefore current treatment ended it was reasonably likely that he would again stop engaging and relapse into drug use and re-offending [84].
5. The FTTJ concluded that in the absence of treatment there would be very serious and detrimental effects to the appellant [74] but was not satisfied that they amounted to “intense suffering” (he considered the issue of suicide separately) and considered that the risk was greater to others than to the appellant himself [74].
6. That part of his reasons on which challenge is particularly focussed in respect of detrimental effects to the appellant himself other than suicide is at [73].
“With the exception of the potential suicide risk, which I will return to below, I am not satisfied that the potential harm described here crosses that threshold. Social stigma, for example, may amount to discriminatory treatment but is unlikely to result in intense suffering. Likewise, incidents of self-harm causing minor injury, while clearly unpleasant and involving some suffering, do not in my view amount to the level of intensity that is envisaged. In respect of potential accidental harm such as from running into the road, the nature of one-off events such as this means that it is impossible to say with any degree of likelihood that something similar would occur again. How the Appellant will behave will instead inevitably be dictated by the circumstances at the time and cannot be predicted with any degree of accuracy, such as to say that this is a real risk. Furthermore, even where such events have occurred in the past, they did not ultimately result in the Appellant coming to any significant harm and there is little reason to conclude that the situation would be different in the future”.
7. When considering whether there would be a significant reduction in life expectancy in respect of risk said to arise from suicide the FTTJ drew on his conclusions at [77] and [78] (see 4 (xix) and (xx) above) and found that he was not satisfied that the appellant was likely to face a significant reduction in life expectancy on account of any risk of suicide [79].
8. Alternatively, the FTTJ was not satisfied that there was a causal link between the appellant’s removal and any intense suffering or significant reduction in life expectancy. Relying on his findings at [82] - [84] (see 4 (xxi) - (xxiii) above) he expressed himself satisfied that any causal link between the appellant’s removal and a deterioration in his condition would be broken as the decline had to be “on account of” the absence of appropriate treatment, but the appellant did not fully engage even where treatment was available, the prognosis remained guarded, and there had been no significant improvement in the appellant’s circumstances [86] [87].
9. The FTTJ considered the argument that on return to Ethiopia the appellant would engage in negative (I assume he meant antisocial conduct falling short of criminal) or unlawful conduct, the reasonably foreseeable consequence of which was that the appellant would be exposed to conditions which amounted to persecution, ill-treatment or destitution. The FTTJ found that this would also not result in a breach of Article 3 ECHR due to lack of a causal link [90].
10. The FTTJ also considered that there were too many speculative links in the chain for there to be an arguable breach of Article 3 ECHR based on the consequences of the appellant’s negative/unlawful conduct on return. The appellant was arguing that he may behave in a manner which may result in his arrest, which may result in his being detained in conditions breaching Article 3. The link between removal and any conditions which would possibly breach Article 3 ECHR was not a sufficiently foreseeable consequence to engage an obligation on the sending state [91].
11. In respect of Article 8 ECHR, the FTTJ was satisfied that Article 8 (1) was engaged, but was not satisfied that the appellant was socially and culturally integrated into the UK [100] – [107]. He was however satisfied that the appellant would face very significant obstacles on return to Ethiopia bearing in mind his mental health difficulties, the lack of availability of treatment, stigma, lack of family ties, length of time in the UK and the very significant difficulties he would face supporting himself, obtaining employment and integrating into a largely unfamiliar culture [109]. The appellant had no genuine and subsisting parental relationship with his two children [112] so that the terms of the family life exception did not apply (the exception itself would not as the appellant was a serious offender).
12. On taking the balance, the FTTJ gave very significant weight to the nature and circumstances of the offending and that the appellant continued to present a risk to members of the UK community, and concluded that the factors raised by the appellant did not come close to outweighing the public interest in his removal [119].
Grounds and their development at the hearing
13. I draw together the grounds as they appeared in both sets of permissions to appeal and were developed in the skeleton argument and the oral submissions of Ms Khan to me. There was no rule 24 response, but I summarise as relevant the oral submissions of Mrs Arif, who also appeared before the FTTJ. The composite bundle before me contained the documentary evidence before the FTTJ.
Ground 1
14. This ground avers that the FTTJ failed to consider whether the appellant’s medical condition per se met the test of “intense suffering”. It was submitted that the Grand Chamber had not decided that matter in Savran v Denmark [2021] ECHR 1025, but in that case the applicant was aware of his condition, knew of the need for treatment, was co-operative and the consequences for non-compliance with treatment were risks to others rather than to himself. The point had been made in argument for the appellant; it was a specific point and needed to be considered. Ms Khan submitted at the hearing that even in prison the appellant’s condition was managed but not fully controlled, he was still responding to auditory hallucinations; it had been shown in the evidence what would happen if he did not have treatment, but the condition per se with its restrictions on social functioning and the like would lead to intense suffering. I queried with Ms Khan whether there was really a difference between ground 1 and ground 2 asking rhetorically how one could judge whether a person was undergoing intense suffering other than by observing their behaviour (the risky behaviour, self-harm, self-neglect etc identified in ground 2). Ms Khan acknowledged that there was an overlap between grounds 1 and 2 but she maintained there could be a distinction bearing in mind the delusions the appellant suffered which were exacerbated when unmedicated, and as I have said, the restrictions on social functioning, in other words that I could and should take into account the subjective effect on the appellant.
15. Mrs Arif submitted that there was no requirement on the FTTJ to consider whether the condition itself would cause intense suffering; the FTTJ assessed the likely consequences on return such that reliance on Savran was misplaced.
Ground 2
16. Ground 2 averred that the FTTJ had failed to consider the appellant’s condition cumulatively when finding he had not established a serious, rapid and irreversible decline in his health resulting in intense suffering or a significant reduction in life expectancy. Intense suffering was not simply physical injury but included mental suffering and restrictions on social functioning. There was direct evidence of self-harm as set out in paragraph 14 of the initial grounds, and not simply self-harm but self-neglect and declining social engagement not all examples of which the FTTJ had mentioned. The appellant self-harmed either to stop the delusions or as directed by his delusions and this happened with some intervention. The FTTJ should have assessed risk based on no medical treatment and support i.e. when the appellant’s delusions were in full effect when he stopped eating and drinking or looking after himself. The FTTJ had not taken everything together cumulatively. There were multiply documented events where the appellant had acted in ways which could lead to serious self-harm, not one-off events, and the reason why the appellant was receiving the level of support he was, was because it was believed these events would occur again.
17. Ms Khan took me at the hearing to the evidence that when the appellant was released from detention he could not manage his symptoms, the ability to look after himself declined and he self-harmed. He had to be recalled after release. By dividing the treatment, the FTTJ had not taken account of the full extent of the medical condition. Dr Sen had concluded (p 319 and p 337) that there was a high risk of suicide on return to Ethiopia and had grave concerns about the appellant’s ability to function (p 337). The appellant had no experience of living in Ethiopia and doing any activities or managing his condition.
18. Mrs Arif submitted that the assessment was a cumulative one; the judge considered self-harm, disinhibition and risky behaviour. He clearly concluded that cumulatively the evidence showed harm but did not meet the elevated threshold which was a high one. The conclusion was open to him.
19. I considered with Ms Khan whether it could not be said that at [80] when saying “drawing all of the strands above together it follows that I am not satisfied that the Appellant would suffer a serious, rapid and irreversible decline in his state of health resulting in intense suffering….” the FTTJ was explicitly dealing with matters cumulatively. She said that was a stock phrase, and she would still maintain her submissions that the FTTJ had not in fact looked at matters cumulatively.
Ground 3
20. This ground averred that the FTTJ erred in finding no causal link between the appellant’s removal and the consequences. It was submitted that the appellant did not harm himself and others to the extent he would do if he did not have the treatment and intervention he currently received. The appellant’s decline and the risk to him would be based on the lack of access to further treatment. The appellant’s condition was managed to the extent that the risky behaviour was reduced but if the appellant were removed there would be no scope for managing his risky behaviour. Ms Khan added in submissions that if the appellant were released in the UK, he would need intensive support as Dr Sen had said, and not taking medication would be picked up and dealt with.
21. Mrs Arif submitted that the deterioration must be caused by the absence of treatment, but the appellant had a history of non-engagement with mental health professionals and did not improve. Detention was only temporary as the FTTJ had noted at [84] – [85]. The deterioration was from the natural course of the illness rather than removal itself. Causation had been considered properly and correctly, and the conclusions were fully open to the FTTJ.
Ground 4
22. It was submitted that the FTTJ had erred in finding that there was no real risk that the appellant would engage in behaviour which would place him at risk. The offending history showed that the risk was not speculative and the appellant’s skeleton argument set out the conduct; when the appellant relapsed, he indulged in criminal behaviour. If he relapsed the appellant would re-offend and the chances of his relapse were greater when he was not under treatment; removal would mean he would not have access to treatment. Ms Khan added in submissions that the sort of conduct which would lead to the appellant bringing problems and persecution upon himself was well documented and had been set out in her skeleton argument before the FTTJ. It would lead him to detention in Ethiopia, and he had no control over it.
23. I raised with Ms Khan that she said the appellant had no control over his conduct, but the appellant had been fit to plead, stand trial and had been subjected to the usual criminal sentencing as opposed to a hospital order. I told her that I considered there might be said to be an issue of causation about any criminal offending or antisocial behaviour on return to Ethiopia as the appellant had been held responsible for his actions by the criminal courts in the UK. I asked whether any unlawful or anti-social behaviour towards others in Ethiopia would not be the appellant’s own responsibility as opposed to that of the respondent. Ms Khan repeated that there was a clear link between the appellant’s offending and his mental health; there was no speculation in terms of what would happen, he would commit further offences as he had been committing offences in prison directed towards his teachers and prison staff.
24. I put to Mrs Arif whether there was not a contradiction between the FTTJ’s conclusion at [84] (see 4 (xxiii above) that when he was released from detention it was reasonably likely that the appellant would stop engaging with treatment, relapse into drug use and re-offend and at [74] with the greater risk being to others rather than the appellant, with his conclusion that it was too speculative to say that there would be an arguable breach of Article 3 ECHR so far as the consequences of the appellant’s unlawful or anti-social behaviour were concerned [91] (see paragraph 9 above). Mrs Arif submitted that the FTTJ had accepted that there was some level of risk, simply not to the required standard, and the conclusion at [91] was open to him on the evidence.
Ground 5
25. It was submitted that the FTTJ had not taken sufficient account of the support system and measures in place to deal with the appellant’s condition in the UK which would not be available in Ethiopia. If I were to agree with the appellant that the FTTJ had erred in his treatment of the causal links, or the risk of being subjected to harsh conditions or treatment because of his criminal behaviour, then that undermined the Article 8 assessment. It was the appellant’s medical condition which created the very compelling circumstances in this case.
26. Mrs Arif submitted that the FTTJ had conducted a lawful balancing exercise with no misdirections.
Post hearing submissions
27. I reserved my decision having heard from both representatives. On 21 May, the decision in Secretary of State for the Home Department v OSB [2026] EWCA Civ 647 was published. I gave the representatives the opportunity to make further submissions in the light of that case, indicating that it appeared to have relevance to the ground in particular so far as the causation of risk resulting from criminal behaviour was concerned.
28. I received written submissions only from Ms Khan on behalf of the appellant. Ms Khan highlighted the specific factors which, she submitted made this appellant’s case materially different from that of OSB (for example there were findings that OSB could access treatment and medication for his condition in Nigeria and he had family support). Ms Khan submitted that whereas it was not inevitable in the case of OSB, in the case of the appellant it was inevitable that removal would mean the appellant would relapse, suffer delusions, self-neglect and cause harm to himself and others. There were not too many links in the chain from removal to the intense suffering; as there was no treatment and support available, the act of removal was central to the ultimate suffering the appellant would face. In relation to criminality, the chain was much shorter. Even with medication the appellant acted in a sexually inappropriate way and without treatment he would also behave in a violent and aggressive way. She listed specific references in the documentation and said that the potential for the appellant being detained was much greater because of his condition, the specific findings made in this case, and his past actions.
Law relevant to Article 3 ECHR
29. The Upper Tribunal in the case of AM (Art 3; health cases) Zimbabwe [2022] UKUT 131 summarised the initial threshold test in Article 3 health cases as being:
(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”?
30. They continued that in relation to (2) (ii) (a) “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 was necessary will depend on the particular facts of the case.”
31. In the recent decision of the Court of Appeal in OSB, the Court of Appeal found that it was impermissibly speculative, or there were too many links in the chain of causation for the First-Tier Tribunal to find that there would be a real risk that OSB would fail to take his medication, his family would not intervene, he would then relapse, commit further offences, be remanded in prison for a considerable period, not have access to medication and his health would then undergo a serious, rapid and irreversible deterioration [30]. They also held that it was not a sequence of events for which the UK could sensibly be held responsible [31] as the consequences said to breach Article 3 ECHR were too remote.
32. They considered that “it would be a very substantial expansion of the reach of Article 3 for courts to hold that because on removal to a foreign state the applicant might commit further offences and then be incarcerated in unacceptable conditions, he should not be removed at all” [33] and that “If the argument were valid, it is difficult to see why it should depend on the applicant having a serious or potentially serious mental health condition. It might be said that a persistent offender, (for example a sex offender, or even a career burglar), if removed to his country of nationality might well resume committing offences and be sent to prison; and that the prison conditions in his country of origin may well not satisfy the demands of the Strasbourg jurisprudence. But that cannot, as I see it, be a bar to removal” [34].
33. The Court of Appeal noted that the decision of the First-Tier Tribunal did not refer to the critical phrase in case-law to the effect that it was not enough that removal would lead to a serious, rapid and irreversible decline in the applicant’s health, it also had to be shown that it would result in intense suffering or a significant reduction in life expectancy and no facts were set out which would indicate that the FTTJ had it in mind. The Court of Appeal concluded that taking that point in combination with the point about causation or impermissible speculation, the FTTJ’s conclusion was legally unsustainable.
Analysis and conclusions on the grounds
Grounds 1 and 2
34. I take these grounds together because as, I explain below, I do not consider that they can be separated. Ms Khan rightly reminds me that the European Court of Human Rights recognised in the case of Bensaid v UK (2001) EHRR 10 that the suffering associated with the relapse into hallucinations and psychotic delusions involving self-harm and harm to others could, in principle, fall within the scope of Article 3 ECHR. She says that in Savran v Denmark [2021] ECHR 1025 the Court did not find it necessary to decide in the abstract whether a person suffering from a severe form of schizophrenia might be subjected to intense suffering but in this case there was an invitation to the FTTJ to decide that point and “the nature of the appellant’s conditions and the impact on him was of such a severe and chronic nature that his condition per se amounts to intense suffering”, a point with which the FTTJ did not engage.
35. In the case of Savran, the Court noted at [141] that schizophrenia itself could not be regarded as sufficient to bring the applicant’s complaint within the scope of Article 3 of the Convention [141] and they found it unnecessary to decide in the abstract whether a person suffering from a severe form of schizophrenia might be subjected to “intense suffering” within the meaning of the test. I do not see how the FTTJ could possibly have been expected to decide whether in general terms the suffering of someone with severe schizophrenia could be intense enough to meet that test. Bensaid was authority for the proposition that someone experiencing hallucinations and psychotic delusions involving self-harm and harm to others could in principle fall within the scope of Article 3.
36. The phrase I have quoted in italics at the end of paragraph 34 above taken from Ms Khan’s skeleton argument before me is not the relevant test. It might be that a person suffering from severe schizophrenia experiences intense suffering even in the UK, but if so they would still have to show that there were substantial grounds for believing that they would face a real risk on account of the absence of appropriate treatment not being available or not being accessible to them of being exposed to a serious, rapid and irreversible decline in their state of health resulting in intense suffering or to a significant reduction in life expectancy (my underlining). The underlined words are relevant so that a person experiencing intense suffering even in the UK would have to show more to engage Article 3 ECHR on removal to his country of nationality.
37. Ms Khan meant I think, from her submissions to me, that the severity of the appellant’s mental health condition was such that if he did not receive treatment the condition itself would cause the appellant intense suffering. Of course, as I have noted above it was not for the FTTJ to consider the condition in the abstract, but rather to consider if in the appellant’s specific circumstances, there would be, without treatment, a serious, rapid and irreversible decline which would result in intense suffering. Looking at the skeleton argument before the FTTJ it did not clearly set out that the FTTJ should consider whether simply experiencing, without treatment, chronic paranoid schizophrenia of the type experienced by the appellant, would, breach Article 3 ECHR. At paragraph 21 of the skeleton argument Ms Khan made the point that the Court in Savran did not hypothetically consider a severe form of schizophrenia. She then explained how the appellant’s case was different to that of Savran. In the next paragraph (22), Ms Khan relied on the deterioration in the appellant’s mental health having an impact on him in the form of self-harming and increased suicide risk. The matters she listed in that paragraph that the appellant relied on were all objective behaviours which could be observed (apart from the possession of suicidal and self-harm ideation). It is not clear to me that Ms Khan relied on before the FTTJ (for example) the subjective distress the appellant might suffer from delusions as opposed to the manifestation of that distress (or indeed simply obeying the command of those delusions) in self-harm, or the subjective distress that the appellant felt from suicidal ideation. I observe it is not self-evident that a person with delusions and psychosis would be distressed by suicidal ideation. Of course, the appellant suffers from delusions even with treatment. It does seem to me that ground 1 is really an aspect of ground 2, that the FTTJ did not consider the appellant’s condition cumulatively.
38. It is right that the FTTJ does not go through every single aspect of paragraph 22 of the appellant’s skeleton argument separately. However, it is clear from authorities such as MA (Somalia) [2010] UKSC 49 (at [45]) that I should be slow to infer that a relevant point has not been taken into account just because it has not been specifically mentioned by the tribunal. The FTTJ wrote a long and detailed decision, and he clearly carefully read the reports of Dr Sen as he made the extensive and detailed factual findings I have set out above, making specific reference to the negative symptoms of the appellant’s illness as well as the positive symptoms of delusions. He heard evidence from the appellant and his parents and the parents’ evidence in their witness statements specifically referred to the effects on the appellant of lack of treatment. I put to Ms Khan in the hearing that at [80] the FTTJ concluded “drawing all the strands together”, but perhaps the better paragraph to make the point is [77] where the FTTJ referred to the thrust of Dr Sen’s reports being that the risks were that the appellant would fail to take care of himself, potentially self-harm, and/or engage in risky or criminal behaviour. He was clearly aware that he needed to consider all the points together and his overall conclusion was that he was not satisfied that the level of harm the appellant would personally face, which he acknowledged would be very serious and detrimental [74], crossed the required threshold.
39. I conclude that at [73] the FTTJ was considering whether particular aspects relied on would individually cause intense suffering, but that was because he was analysing the effect of the individual aspects he had listed. If for example he had concluded that the effect of self-harm on its own would result in “intense suffering” then he may have needed to go no further. It is evident as I have said that he did consider matters cumulatively but was not satisfied that the elevated threshold had been met. His conclusion was reasoned and it cannot be said to be perverse. It is right that the appellant was receiving a high level of support, but the FTTJ acknowledged the risk of harm to the appellant when he did not access or did not receive the relevant treatment. The treatment the appellant is receiving, and that it is planned he receive when his sentence ends, is to avoid harm to himself and others and to assist him insofar as it may be possible to integrate into the community, but the treatment is not for the purposes of avoiding intense suffering, it is to avoid a much lower level of harm than that.
40. Grounds 1 and 2 are not made out.
Ground 3
41. This ground is only relevant of course if the FTTJ erred as alleged at grounds 1 and 2 and I have found he did not, but I consider the ground for completeness’ sake and consider there is no merit in this ground. Clearly the comparison the FTTJ had to make was between the appellant being released for the purposes of removal and released when his sentence came to an end. The FTTJ was entitled to conclude from his detailed findings that the prognosis was guarded, that the appellant’s condition had not significantly improved despite all the treatment and that the history indicated that once the appellant was not detained, he would stop engaging. Ms Khan submitted that the appellant would receive intensive support on release, but the FTTJ was evidently aware of the same (see his findings at 4 (iv) and (v) above) and given the history of disappearances and the like was perfectly entitled to conclude that the appellant would stop engaging, at which point he would be subject to the same risks wherever he was.
Ground 4
42. The FTTJ’s primary conclusion was that there would be no causal link between the appellant’s removal and the consequences of negative or unlawful conduct.
43. I will return to that conclusion in the context of OSB.
44. Despite the careful findings of the FTTJ on which I have earlier remarked, I agree with Ms Khan that in respect of unlawful conduct the FTTJ did not adequately reason why he considered the links were too speculative. This is because the FTTJ specifically found that it was reasonably likely that when the appellant’s current treatment ended, he would again stop engaging and relapse into re-offending [84] – (4 (xxiii) above). Indeed, the appellant continued to present a risk to female members of prison staff even though he was receiving treatment in prison (4 (xxi) above). Although of course any individual incident might only lead to the appellant being arrested the FTTJ did not adequately reason why continuing to re-offend would not be likely to lead to his arrest as it would in the UK. The FTTJ did not make any findings on the expert report of Dr Campbell, but Dr Campbell’s report indicates that if the appellant were detained it would be in conditions which breached Article 3 ECHR, and this is what is submitted in paragraph 44 of the skeleton argument. Accordingly, if the FTTJ accepted the conclusions of that report, if the appellant were arrested and detained conditions amounting to a breach of Article 3 ECHR were not a mere possibility. If the FTTJ did not accept Dr Campbell’s conclusions, he should have given reasons for the same.
45. However, whether following the FTTJ’s conclusion there is no causal link, or whether the consequences are seen as too remote, the FTTJ was right to conclude that Article 3 would not be breached on the basis of the appellant engaging in unlawful conduct on return. Ms Khan’s additional written submissions have not answered the points which the Court of Appeal made in OSB which I have quoted at paragraph 32 above. The appellant has committed very serious offending in the UK for which he has been held criminally responsible, even though the sentencing judge took into account that his mental health contributed to his offending. Although a vulnerable witness, the appellant was able to give evidence in these proceedings and he is in prison, not a hospital. There is a real difference between holding a sending state responsible for intense suffering experienced by a person themselves because of a decline in their state of health on account of the absence of treatment, as opposed to holding a sending state responsible for conditions a person might experience because they offend in their country of nationality in the same way as they offended in the sending state.
46. The FTTJ made no material error therefore.
Ground 5
47. The appellant cannot succeed on ground 5 alone. The FTTJ realistically found that the appellant would face very significant obstacles to his reintegration into Ethiopia. However the FTTJ explained that the difficulties that the appellant would face did not come close to outweighing the public interest in the appellant’s removal, as he continued to present a risk to the community in the UK. In circumstances where I have found that the FTTJ made no error in the Article 3 assessment, the FTTJ also made no error in concluding that the public interest outweighed the appellant’s interests and therefore that the decision was proportionate and did not breach Article 8 ECHR.
Notice of Decision
The judge’s decision contains no material error of law and stands.
The appellant’s appeal fails and is dismissed.

A-R Landes

Judge of the Upper Tribunal
Immigration and Asylum Chamber

21 August 2026