1. Dr Jane Herlihy Clinical and Research Psychologist Director, Centre for the Study of Emotion and Law Psychological evidence and refugee protection © Centre for the Study of Emotion and Law 2012

2. Independent research centre Hypothesis testing Statistical; ‘averages’ (cf. finding one) Conducting primary (data collection) and secondary (reviews) empirical research Providing information to all actors Aim = “a better informed asylum process” Centre for the Study of Emotion and Law

3. A Judicial comment… “In the case of country evidence, expert evidence can be evaluated against other material” “In contrast, there will be no similar breadth of evidence to assist in the evaluation of expert medical evidence” Barnes (2004)

4. Study : Memory 27 Kosovan and 16 Bosnians programme refugees interviewed on two occasions. asked to recall a traumatic and a non traumatic event from their past. On both occasions, they were asked a series of standard questions about these events. Would they give the same answers each time? (No obvious motivation for deception...) Herlihy, Scragg & Turner (2002)

5. Repeated Memory Task First interview free recall 15 questions central/peripheral rating Second interview prompt same 15 questions Herlihy, Scragg & Turner (2002)

6. Detail questions (examples) who was with you? what were you wearing? what day of the week was it? Herlihy, Scragg & Turner (2002)

7. Discrepant Memories I Herlihy, Scragg & Turner (2002)

8. Discrepant Memories II Herlihy, Scragg & Turner (2002)

9. A refugee has a well-founded fear of persecution …

10. Being a refugee is not a diagnosis increased risk of emotional disturbance

11. Common problems PTSD 9% of 6743 refugees in western countries Depression – very co-morbid 4-6% (Fazel, Wheeler, & Danesh, 2005)

12. “Refugees based in western countries could be about ten times more likely than the age- matched general American population to have posttraumatic stress disorder.” (Fazel, Wheeler, & Danesh, 2005)

13. Diagnosis and Trauma Absence of a diagnosis does not disprove trauma history. Presence of a diagnosis does not prove any particular trauma.

14. PTSD A : Exposure to a trauma (tightly defined) B : Persistent reexperiencing C : Persistent avoidance and numbing D : Persistent increased arousal E : Duration over 1 month F : Clinically significant distress or impairment

15. Persistent re-experiencing Recurrent and distressing recollections, including images, thoughts or perceptions Recurrent distressing dreams of the event Acting or feeling as if the traumatic event were recurring Intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the trauma Physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the trauma

16. Avoidance and Numbing Efforts to avoid thoughts, feelings or conversations associated with the trauma Efforts to avoid activities, places or people that arouse recollections of the trauma Inability to recall an important aspect of the trauma Markedly diminished interest or participation in significant activities Feeling of detachment or estrangement from others Restricted range of affect (eg unable to have loving feelings) Sense of a foreshortened future (eg does not expect to have a career, marriage, children, or a normal life span)

17. Hyperarousal Symptoms Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hypervigilance Exaggerated startle response

18. Dissociation “disruption in the usually integrated functions of consciousness, identity, memory or perception” (DSM-IV) often related to a history of extreme interpersonal trauma (abuse/torture) 1. Peri-traumatic (implications for memory) 2. Dissociative flashbacks 3. Protective ‘spacing out’ NOT under the individual’s control

19. Correlations Difficulty in disclosure positively associated with higher levels of: PTSD overall severity PTSD avoidance Shame Depression Dissociation n=27; (Bogner, Herlihy & Brewin, 2007)

20. Dissociation “I tried to talk, but my mind kept wandering off and I kept thinking about the trauma and my family that I lost. Everything seemed unreal to me, I felt like I was dreaming. I found it hard to focus on the interview and answer questions”

21. Lawyers ‘clinical’ decisions when do legal reps consider a MLR? knowledge of PTSD from training, experience own comfort levels categories assuming vulnerability e.g. rape ‘anxious’ presentation of PTSD not depression (Wilson-Shaw, Pistrang & Herlihy, 2012)

22. Depression Depressed mood most of the day, nearly every day Markedly diminished interest or pleasure in all or almost all activities Significant weight or appetite change Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive/inappropriate guilt Diminished ability to think or concentrate Recurrent thoughts of death (not just suicide)

23. A Judicial comment… “In the case of country evidence, expert evidence can be evaluated against other material” “In contrast, there will be no similar breadth of evidence to assist in the evaluation of expert medical evidence” Barnes (2004)

24. See www.csel.org.uk/csel_publications for links to the latest research from CSEL & other relevant publications. References