HEALTH

Mental health (quotes from report):

At times of increased stress Mr Bedwell has demonstrated significant deterioration in his mood, and has made several serious suicide attempts. It is my greatest concern that this may become an imminent issue, since it is difficult to identify any protective factors in his life.

Mr Bedwell requires treatment in the form of ongoing mental health specialist input given the complexity of his physical and mental health problems. Ideally this will be in the form of Community Mental Health Team input (which has been requested by his GP Practice in mid-September). He requires ongoing treatment with antidepressant and anti-anxiety medications following National Institute of Health and Clinical Excellence (NICE) guidelines to increase and add medications as appropriate titrated to their response. In addition, Mr Bedwell would benefit from psychological support and interventions from the perspective of both his depression and anxiety management, and also, importantly, coping with the chronic manifestations of his skin condition on his life.

As indicated above, the risk of completed suicide is one of my greatest concerns in Mr Bedwell's current presentation and future response to stress. This is on the basis of the information available to me regarding previous suicide attempts, my assessment of his current mental health status, my opinion on the impact of stress on his mental state and coping, and the associated comorbidity of an unpleasant physical health condition. In addition, I have found it very difficult to identify any protective factors except, perhaps, Mr Bedwell's aged Aunt with whom he appears to have a good relationship. These taken together would lead me to conclude that his risk is currently moderate/high, and in the context of extradition proceedings may be high/imminent requiring immediate management in the manner I have described above through Crisis team involvement and to include consideration of hospital admission. I would include being in custody as a situation in which his suicidal risk would also be high.

I have not gone into full detail regarding health but needless to say I currently need fairly specific conditions to manage my condition, and from the evidence I present i do not accept i would receive this in the USA.

I think it is worth quoting parts of the professional report we have on the USA prison system here.

Comments about the initial prison I would be in pre-trial:

The evidence indicates Mr. Bedwell has a long history of anxiety, depression, and suicidal ideation. In my experience, mental health problems are exacerbated by incarceration, especially for someone held in a foreign country and facing an extremely long sentence. In his letter of July 13, 2018, Dr. Steven Wolf of the US Marshals Service lays out the mental health policies and medical personnel in place at that time at the Morgan County Jail. However, the US Federal Court in Northern Alabama - the same court in which Mr. Bedwell would be prosecuted - found a month later that the Morgan County Jail's actual practices were putting people with serious mental health needs at "substantial risk of serious harm." 

In its August 31 decision, the Federal Court agreed that there were no current and ongoing violations of the Constitution. As a result, it ruled in favor of the sheriff and terminated court oversight of the Jail. However, before doing so the Court also held there was "a substantial risk of serious harm" to people with mental illness incarcerated in the Morgan County Jail in four areas, which plaintiffs in the lawsuit summarized as: "(1) the failure to ensure adequate psychiatric staffing levels, resulting in long delays in the provision of mental health care; (2) the failure to routinely refer those who report or display signs or symptoms of serious mental illness at intake for prompt psychiatric assessment and treatment; (3) the abrupt withdrawal of psychotropic medication from class members at intake without any individualized determination by a psychiatrist that such withdrawal is medically necessary; and (4) the failure to schedule follow-up appointments with a psychiatrist after class members are prescribed new medications." 

In my experience meeting with and representing hundreds of people held in solitary confinement, isolation can have extremely deleterious effects on the physical and mental health of even the healthiest, most stable of people. After just a couple days in solitary, people often start to suffer from headaches, tinnitus, vertigo, heart palpitations, stomach pain, insomnia and lethargy. Many see their cognitive processes start to deteriorate, experiencing memory loss, impaired concentration, disrupted thinking, an inability to maintain a coherent flow of thoughts, and confusion and disorientation in time and space. People often experience deepening anxiety and paranoia and symptoms of psychosis. These effects tend to be worse for people who are already experiencing mental illness, like Mr. Bedwell. Many of my clients who suffered from these effects continued to experience them even after their time in solitary ended; the impact was long-lasting and chronic.

Mental deterioration suffered by Mr. Bedwell because of the conditions in solitary would likely harm his ability to communicate with his attorneys and participate in his defense. Many of my clients who were held in solitary became less and less able to be coherent, demonstrate linear thinking or reasoning, or recall facts. Some descended into debilitating psychosis and paranoia. The end result was many were no longer able to properly assist me with their cases, even if they had been fully capable of doing so before being subjected to these conditions.

Time in solitary also greatly increases the likelihood that an incarcerated person will attempt to commit suicide: approximately 50 percent of prison suicides in the US are committed by the 6 to 8 percent of people who are held in isolation. This is of particular concern given Mr. Bedwell's history of suicidal ideation.

Essentially I have to PROVE it will make me very unwell or kill me, despite the clear information above.

The USA's 'assurances' to what treatment I might or could get and the UK's reluctance to ever question their 'trusted partner' does not reassure me that my life is not in danger.