Detention, Decompensation, and the Psychiatric Opinion Letter in Immigration Cases

Stephan M. Carlson, MD, MBA, FAPA · Immigration and Trauma

A detained client who is deteriorating presents a specific forensic problem: was this person already ill, or did confinement make them worse, and can the record actually tell the two apart? An opinion letter that asserts the second without showing its work is the one that gets discounted. What "decompensation" has to mean in the letter Decompensation is not a diagnosis and not a synonym for distress. It is a described change in function over time—worsening psychotic symptoms, a shift from managed to active suicidality, a loss of previously intact daily functioning—measured against a stated baseline. An opinion that uses the word as a conclusion, without anchoring it to observable before-and-

Most relevant service: Istanbul Protocol & Asylum Evaluations