CEDH · CASELAW;JUDGMENTS;GRANDCHAMBER;ENG — 7 décembre 2021

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display:inline-block } .s90A14307 { width:6.51pt; text-indent:0pt; display:inline-block } .s64A09B87 { width:5.18pt; text-indent:0pt; display:inline-block } .sD93FE46F { width:8.51pt; text-indent:0pt; display:inline-block } .s3BF0B6C7 { margin-top:14pt; margin-left:25.5pt; margin-bottom:12pt; text-indent:-17pt; text-align:justify; page-break-inside:avoid; page-break-after:avoid } .s4E40DB89 { width:1.67pt; text-indent:0pt; display:inline-block } .s7C9EDFAD { margin-top:14pt; margin-left:34pt; margin-bottom:6pt; text-indent:-17pt; text-align:justify; page-break-inside:avoid; page-break-after:avoid } .s68520B7C { width:6.99pt; text-indent:0pt; display:inline-block } .s6A89B52E { width:5pt; text-indent:0pt; display:inline-block } .s7ED160F0 { text-decoration:none } .s3DC36BA9 { font-family:Arial; text-decoration:underline; color:#0069d6 }   GRAND CHAMBER CASE OF SAVRAN v. DENMARK ( Application no. 57467/15)     JUDGMENT   Art 3 • Expulsion of foreign national with schizophrenia to his country of origin, without health risks reaching high threshold for application of Art   3 • Confirmation of Paposhvili v.   Belgium [GC] threshold test and its applicability to removal of mentally ill persons Art 8 • Expulsion • Private life • Permanent exclusion order against long-term settled migrant with schizophrenia, despite progress after years of compulsory care, on account of violent offences • No consideration given to applicant’s lack of criminal culpability on account of mental illness • Failure of authorities to take into account and balance interests at stake and all relevant factors   STRASBOURG 7 December 2021   This judgment is final but it may be subject to editorial revision. In the case of Savran v. Denmark, The European Court of Human Rights, sitting as a Grand Chamber composed of:   Robert Spano, President ,   Jon Fridrik Kjølbro,   Ksenija Turković,   Síofra O’Leary,   Yonko Grozev,   Dmitry Dedov,   Egidijus Kūris,   Branko Lubarda,   Armen Harutyunyan,   Gabriele Kucsko-Stadlmayer,   Pere Pastor Vilanova,   Alena Poláčková,   Georgios A. Serghides,   Tim Eicke,   Ivana Jelić,   Lorraine Schembri Orland,   Anja Seibert-Fohr, judges , and Søren Prebensen, Deputy Grand Chamber Registrar , Having deliberated in private on 24 June 2020, 14 April and 8 September 2021, Delivers the following judgment, which was adopted on the last ‑ mentioned date: PROCEDURE 1.     The case originated in an application (no. 57467/15) against the Kingdom of Denmark lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Turkish national, Mr Arıf Savran (“the applicant”), on 16 November 2015. 2.     The applicant was represented by Mr Tyge Trier and Mr   Anders   Boelskifte, lawyers practising in Copenhagen. The Danish Government (“the Government”) were represented by their Agent, Mr   Michael Braad, from the Ministry of Foreign Affairs, and their Co ‑ Agent, Ms Nina Holst ‑ Christensen, from the Ministry of Justice. 3.     The applicant complained that his removal to Turkey had constituted a breach of Article 3 of the Convention as he did not have a real possibility of receiving the appropriate and necessary psychiatric treatment, including follow-up and supervision, in connection with his paranoid schizophrenia, in the country of destination. He also alleged that the implementation of the expulsion order had been in breach of Article 8 of the Convention. 4.     The application was allocated to the Fourth Section of the Court (Rule   52 § 1 of the Rules of Court). On 20 June 2017 the Government were given notice of the application. On 1 October 2019 a Chamber of the Fourth Section, composed of Paul Lemmens, Jon Fridrik Kjølbro, Faris Vehabović, Iulia Antoanella Motoc, Carlo Ranzoni, Stéphanie Mourou-Vikström, Jolien Schukking, judges, and Andrea Tamietti, Deputy Section Registrar, delivered its judgment. It declared the application admissible and held, by four votes to three, that the applicant’s expulsion to Turkey would give rise to a violation of Article 3 of the Convention and that it was not necessary to examine his complaint under Article 8 of the Convention. The joint dissenting opinion of Judges Kjølbro, Motoc and Mourou-Vikström and a separate dissenting opinion of Judge Mourou-Vikström were annexed to the judgment. 5.     On 12 December 2019 the Government requested that the case be referred to the Grand Chamber in accordance with Article 43 of the Convention, and the panel of the Grand Chamber accepted the request on 27   January 2020. 6.     The composition of the Grand Chamber was determined according to the provisions of Article 26 §§ 4 and 5 of the Convention and Rule 24. 7.     Leave to intervene was granted to the Governments of France, Germany, the Netherlands, Norway, Russia, Switzerland and the United Kingdom, and to Amnesty International and the Centre for Research and Studies on Fundamental Rights of Paris Nanterre University (CREDOF), and they all submitted written comments (Article 36 § 2 of the Convention and Rule   44 § 3). The Government of Turkey did not avail themselves of their right to intervene under Article 36 § 1 of the Convention. 8.     The applicant and the Government each filed observations (Rule   59   §   1) on the merits of the case. 9.     A hearing took place in the Human Rights Building, Strasbourg, on 24 June 2020 (Rule 59 § 3); on account of the public-health crisis resulting from the COVID-19 pandemic, it was held via videoconference. The webcast of the hearing was made public on the Court’s Internet site on the following day.   There appeared before the Court: (a)     for the Government Mr   M. Braad , Ministry of Foreign Affairs,   Agent , Ms   N. Holst-Christensen , Ministry of Justice,   Co-Agent , Ms   L. Kunnerup , Head of Unit, Ministry of Immigration and   Integration, Ms   A.-S. Saugmann-Jensen , Deputy Head of Division, Ministry of   Justice, Ms   Ø. Akar, Head of Unit, Ministry of Immigration and Integration, Mr   C. Wegener, Chief Adviser, Ministry of Foreign Affairs, Ms   S.L. V aabengaard , Head of Section, Ministry of Justice, Ms   C. Engsig Sørensen, Head of Section, Ministry of Justice , Ms   M. Korsgård Thomsen, Head of Section, Ministry of   Immigration and Integration, Ms   S. Bach Andersen, Head of Section,   Ministry of Foreign Affairs ,   Advisers . (b)     for the applicant Mr   T. Trier , lawyer,   Counsel , Mr   A. Boelskifte , lawyer,   Co-Counsel , Ms   S. Hussain , assistant lawyer, Ms   T. Husun, associate,   Advisers .   The Court heard addresses by Mr Trier and Mr Braad, and the replies given by them and by Mr Boelskifte to the questions put by the judges. The President of the Grand Chamber authorised the Government to produce additional information on the case in writing. Their submissions in that regard were received on 7 July 2020. The applicant’s comments on the information provided were received on 24 July 2020. THE FACTS 10.     The applicant was born in 1985 and now resides in the village of Kütükușağı in Turkey. 11.     In 1991, when he was six years old, the applicant entered Denmark together with his mother and four siblings to join his father. The latter died in 2000. 12 .     On 9 January 2001, by a judgment of the City Court of Copenhagen ( Københavns Byret – hereinafter “the City Court”), the applicant was convicted of robbery and sentenced to imprisonment for one year and three months, nine months of which were suspended, and placed on probation for two years. Criminal proceedings 13 .     On 29 May 2006 the applicant, as part of a group of several persons, attacked a man; several kicks or blows with cudgels or other blunt objects were administered to the latter’s head and body, thereby inflicting serious traumatic brain injury that caused his death. It appears that the applicant was caught by the police on the spot, whereas all the others involved in the incident managed to escape. First round of proceedings 14.     In connection with the above-mentioned incident, criminal proceedings were brought against the applicant, who was charged with assault with highly aggravating circumstances. Evidence examined by the courts (a)    Reports of the Immigration Service 15 .     In the context of those proceedings, on 17 September 2007 the Immigration Service ( Udlændingeservice ) issued a report on the applicant. It stated, in particular, that on 1 February 1991 the applicant had been granted residence, with a possibility of permanent residence under the Aliens Act, by reference to his father living in Denmark. On or before 11   May 2004 his residence permit had been made permanent. The report also stated that the applicant had been lawfully resident in Denmark for approximately fourteen years and eight months; that his mother and four siblings lived in Denmark; and that he had been to Turkey between five and ten times for periods of two months to visit his family. However, he had not been to Turkey since 2000. The report referred to the applicant’s statements to the effect that he had no contact with persons living in Turkey, did not speak Turkish and only spoke a little Kurdish. Also, he had stated that he heard voices and suffered from a thought disorder and that he was being administered sedatives. In view of the information given by the prosecution on the nature of the crime in conjunction with the considerations mentioned in section 26(1) of the Aliens Act ( udlændingeloven ; see paragraph 76 below), the Immigration Service endorsed the prosecution’s recommendation of expulsion. 16 .     In a supplementary report of 2 April 2008 the Immigration Service reaffirmed its recommendation of expulsion. (b)    Medical opinions 17 .     A report on the examination of the applicant’s mental status dated 13   March 2008 which the Ministry of Justice ( Justitsministeriet ) obtained from the Department of Forensic Psychiatry ( Retspsykiatrisk Klinik ) concluded, in particular, that it was highly likely that the applicant had a slight mental impairment, but he was not found to be suffering from a mental disorder and could not be assumed to have been suffering from a mental disorder at the time when the crime had been committed. 18 .     The report furthermore stated that the applicant’s childhood and adolescence had been significantly lacking in stimulation and characterised by non-existent parental care and poor social conditions, and that he and his siblings had been forcibly removed from home and placed in foster care. According to the report, from his early childhood the applicant had displayed behavioural disturbance and a lack of social adaptation, and he had been attracted to criminal environments since his teens. Since that time, he had also smoked a lot of cannabis, which might have hampered his personality and intellectual development. Over the years, he had been placed in various socio-educational institutions but they had had difficulties accommodating his needs owing to his externalising behaviour, and the socio-educational support and therapy had not changed his condition and behaviour. 19.     The report also mentioned that, in the context of his medical assessment, the applicant had insisted that he had experienced both visual and auditory hallucinations, but no objective findings of hallucinations had been made. He had made similar claims in the course of previous medical assessments but those complaints had apparently ceased when the applicant had no longer found it relevant to make them. The report added that the applicant’s description of those symptoms did not correspond to the usual description of hallucinations, and it was thus found that his description had to be classified as simulation. The report stressed that the applicant needed long-term regular and well-structured therapy, and recommended that he should be committed to a secure unit of a residential institution for the severely mentally impaired. 20 .     In an opinion of 16 April 2008, the Medico-Legal Council ( Retslægerådet ) stated, among other things, that the applicant had had a disadvantaged childhood and adolescence, had presented a pronounced behavioural disturbance and had later become involved in criminal activities. It also stated that the applicant had a mental impairment, but otherwise showed no signs of organic brain injury; that he smoked a lot of cannabis; that he had previously been in contact with the mental health system several times, but no definite diagnosis of psychotic disorder had been made despite complaints of psychotic symptoms. In its assessment, the Medico-Legal Council found that the applicant’s complaints of auditory hallucination could be characterised as simulation. He was also found to be mentally impaired with a mild to moderate level of functional disability and to be suffering from personality disorder characterised by immaturity, lack of empathy, emotional instability and impulsivity. He had a strong need for clear boundaries to give him structure and support. Court decisions 21.     On 9 October 2007, the High Court of Eastern Denmark ( Østre Landsret – hereinafter “the High Court”) convicted the applicant of assault with highly aggravating circumstances under Article 246 and Article   245 §   1 of the Penal Code ( straffeloven ) (see paragraph 75 below) and sentenced him to seven years’ imprisonment and expulsion from Denmark with a permanent ban on re-entry. 22 .     On appeal, on 22 May 2008 the Supreme Court ( Højesteret ) quashed the judgment and returned the case to the High Court for a fresh examination. With reference to the available medical evidence (see paragraphs 17-20 above), the court stated, in particular, that it had doubts that the sentence of imprisonment had been justified in the circumstances of the present case. Second round of proceedings 23.     Following the remittal of the case, the High Court examined the criminal case against the applicant anew. Additional evidence examined by the courts 24 .     In a report of 18 June 2009 a psychiatric specialist pointed out that the applicant suffered from a condition of mental bewilderment which, by that time, had been obvious for more than four weeks; and that his recent development raised doubts as to whether he most likely suffered from a permanent mental disorder, or whether, owing to his intelligence level combined with his deviating distinctive personality traits, he was suffering from a permanent condition comparable to mental impairment. 25 .     On 14 July 2009 the Medico-Legal Council stated, with reference, in particular, to the report of 18 June 2009, that the applicant suffered from a more permanent mental disorder and that he had probably also been suffering from a similar mental condition at the time when the crime with which he had been charged had been committed. The report further reiterated the finding of the report of 16 April 2008 (see paragraph 20 above), and stated that subsequent observations made at a residential institution for the severely mentally impaired – where the applicant had been placed – had revealed his ongoing threatening and physically aggressive behaviour. For a long period, the applicant had been considered to have been obviously mentally ill and to be suffering from paranoid delusions and formal thought disorder. The report pointed out that those were symptoms most likely linked to schizophrenia; if that was the case, it was very likely that the applicant had been suffering from a mental disorder at the time when the crime with which he had been charged had been committed. The Medico-Legal Council recommended in its report that, if found guilty as charged, the applicant should be committed to forensic psychiatric care. Court decisions 26 .     By a judgment of 17 October 2008 the High Court found that the applicant had violated Article 245 §   1 and Article   246 of the Penal Code but was exempt from punishment by virtue of Article 16 §   2 and Article   68 thereof (see paragraph 75 below). In that connection it referred to the reports of 13   March and 16 April 2008 (see paragraphs 17-20 above). It thus sentenced him to committal to the secure unit of a residential institution for the severely mentally impaired for an indefinite period. The court also ordered the applicant’s expulsion from Denmark with a permanent ban on his re-entry. 27 .     In respect of the expulsion order, the High Court referred to the reports of the Immigration Service dated 17 September 2007 and 2 April 2008 (see paragraphs 15-16 above) and emphasised that the applicant had moved to Denmark at the age of six when granted family reunification with his father, who lived in Denmark; that he had been lawfully resident in Denmark for about fourteen years and eight months; that he was not married and did not have any children; and that his entire family, comprising his mother and four siblings, lived in Denmark, the only exception being his maternal aunt, who lived in Turkey. It was also emphasised that he had attended elementary school in Denmark for seven years and had been attached to the Danish labour market for about five years, but that at the moment he received a disability pension; that he had been to Turkey between five and ten times for periods of two months to visit his family, but not since 2000, and that he did not speak Turkish, but only spoke a little Kurdish. On the other hand, it was emphasised that the applicant had been found guilty of a very serious offence against the person of another, which was a serious threat to the fundamental values of society. Against that background the High Court found, on the basis of an overall assessment, that expulsion would not be conclusively inappropriate under the relevant domestic law then in force, or in breach of Article 8 of the Convention. 28.     The applicant appealed against the judgment to the Supreme Court. 29.     In the meantime, on 11 March 2008, a supplementary interview was conducted with the applicant during which he stated, inter alia , that he had last visited Turkey in 2001, that he was fluent in Kurdish, and that his family in the village of Koduchar lived in a house owned by his mother. 30 .     By a judgment of 10 August 2009, the Supreme Court changed the applicant’s sanction and sentenced him to committal to forensic psychiatric care, upholding the expulsion order. It took into account the medical reports of 18 June and 14 July 2009 (see paragraphs 24-25 above), and the applicant’s statements made during his supplementary interview (see the previous paragraph). The Supreme Court stated as follows: “[The applicant], who is now 24 years old, moved to Denmark from Turkey at the age of six. He has attended school in Denmark, and his close family members comprising his mother and his four siblings live in Denmark. He is not married and has no children. He receives disability pension and is not otherwise integrated into Danish society. He speaks Kurdish, and during his childhood and adolescence in Denmark he went to Turkey between five and ten times for periods of two months to visit his family. He last visited Turkey in 2001, where his mother owns a property. Having regard to the nature and gravity of the offence, we find no circumstances making expulsion conclusively inappropriate – see section 26(2) of the Aliens Act – nor do we find expulsion to be contrary to Article 8 of the Convention.” 31.     The decision on expulsion was made by a majority of five judges out of six. The dissenting judge stated as follows: “[The applicant] came to Denmark at the age of six. Accordingly, he spent most of his childhood and adolescence and went to school in Denmark, which is also where his closest family (his mother and his four siblings) live. He visited Turkey several times until the death of his father, but he has not visited the country since 2001. He does not have any contact with relatives or other persons living in Turkey. He speaks Kurdish, but not Turkish. Accordingly, I find that [the applicant’s] ties with Denmark are so strong and his ties with Turkey so modest that they constitute circumstances making expulsion conclusively inappropriate – see section 26(2) of the Aliens Act – despite the gravity of the offence. For this reason, I vote in favour of dismissing the claim for expulsion.” Revocation proceedings under section 50 a of the Aliens Act 32.     On 3 January 2012 R.B., the applicant’s guardian ad litem , requested that the prosecution review his sentence, and on 1 December 2013 the prosecution brought the applicant’s case before the City Court in accordance with Article 72 §   2 of the Penal Code (see paragraph 75 below), requesting that the sanction be changed from a sentence of forensic psychiatric care to treatment in a psychiatric department. Under section 50a of the Aliens Act (see paragraph 76 below), the prosecution also petitioned the court to decide simultaneously whether the order to expel the applicant was to be upheld. For its part, the prosecution argued that the expulsion order should be upheld. Medical opinions 33.     In that connection, on various dates medical statements were obtained from three psychiatrists (K.A., M.H.M. and P.L) who, at various times, had been responsible for the applicant’s treatment at the Mental Health Centre of the Hospital of Saint John. K.A.’s statement 34 .     On 5 April 2013 K.A. observed in a written statement, among other things, that the applicant had been in psychiatric care since 2008 owing to the diagnoses of paranoid schizophrenia, mild intellectual disability and cannabis dependence. However, it had been discovered during the relevant period that his intellectual capacity level was higher, for which reason he had not met the criteria for the diagnosis of mental impairment, and that diagnosis had been rejected. The initial three to four years of the relevant period had been characterised by continuous cannabis abuse, incidental abuse of hard drugs and numerous instances of absconding, but the applicant had made progress in recent years. He had quit his abuse of hard drugs, with the result that there had been a considerable reduction in his externalising behaviour; no instances of absconding had been recorded since autumn 2012. During the past two months the applicant had not abused any cannabis, and he was making targeted efforts to stay clean in the open psychiatric unit. He had previously been complicit in smuggling cannabis to fellow patients, which had been his “old” way of living, but he had managed to resist doing so in the past six months. The applicant was prepared to cooperate, and he had agreed without any problems to undergo antipsychotic therapy. It was therefore recommended that the current sanction be modified from a sentence of forensic psychiatric care to treatment in a psychiatric department under supervision by both the Prison and Probation Service and the department following his discharge so that, in consultation with the consultant psychiatrist, the Prison and Probation Service could make a decision on readmission under Article 72 §   1 of the Penal Code. M.H.M.’s statement 35 .     A letter from M.H.M. dated 18 July 2013 stated, in particular, that on 5 February 2013, the applicant had been transferred to an open ward (R3) for substance abuse treatment. Around March he had claimed to have progressive symptoms, and his doses of antipsychotics had been increased, having been lowered some months before. Since the patient’s anger had been found to be increasing despite the increase in doses, it had been decided to transfer him to a closed ward on 5 April 2013; however, he had left the area and an alert had had to be circulated, but he had quickly returned again by himself. The applicant had absconded again briefly on 18   April 2013, but had returned and had not appeared to be under the influence of drugs. On 21 April 2013, the applicant had threatened a carer, whom he had then beaten in the head without any warning. The following day he had had to be immobilised with belts because of new threats. On 5   May 2013, he had attacked and beaten a carer without any warning, and he had been found in a severely psychotic state. Immobilisation with belts had been applied until 12 May 2013, and during that period his state had been severely fluctuating, being at times severely psychotic and aggressively threatening. He had willingly accepted a change in medication to Leponex tablets with the simultaneous scaling down of treatment with Cisordinol (antipsychotics). His condition had quickly improved, and he now appeared to have returned to his usual condition, being friendly, cooperative and motivated to continue therapy. The applicant’s drug abuse was very limited and he only used cannabis, although he was unable to refrain from continuing to use that substance. 36 .     In his written statement M.H.M. further pointed out that the applicant was highly motivated to undergo psychiatric treatment, including treatment with psychoactive drugs. However, the applicant had expressed strong doubts as to whether he would be able to continue this treatment to an adequate extent if he was deported from Denmark and was offered treatment that did not comprise a fairly intensive psychiatric element. The applicant clearly feared that he would not have the resources to continue the necessary psychiatric therapy, including pharmacotherapy, if deported from Denmark. In this connection, there was deemed to be a high risk of pharmaceutical failure and resumed abuse, and consequently a worsening of his psychotic symptoms and a risk of aggressive behaviour. His current medication in the form of Leponex tablets was an antipsychotic that had to be administered on a daily basis. It was the overall assessment that a potential interruption of the treatment would give rise to a significantly higher risk of offences against the person due to a worsening of his psychotic symptoms. 37.     In his letter M.H.M. stated lastly that the medication currently being administered to the applicant included 50   mg of Risperdal Consta (risperidone) every 2 weeks (prolonged-release antipsychotic suspension for injection), and 250   mg tablets of Leponex daily (antipsychotic medication with clozapine as the active pharmaceutical ingredient). P.L.’s statements 38 .     In a written statement of 13 January 2014, P.L., who had been responsible for the treatment of the applicant since mid-July 2013, pointed out, in particular, that the applicant was still in a closed ward and that, for the past six months, his condition had been stable; he had abstained for long periods from smoking cannabis. Consequently, the applicant had been allowed leave to an increasing extent in accordance with the rights granted by the relevant regulations. On one occasion in autumn 2013, the applicant had absconded while on leave; on all other occasions of leave he had observed the agreement made. 39 .     The applicant was cooperative and did not appear productively psychotic in any way. He was generally forthcoming, but as previously, his behaviour continued to be characterised by some impulsivity and immaturity. The applicant had relapsed into smoking cannabis although he understood the importance of abstaining from such abuse. He had made a great effort not to engage in substance abuse; he was still aware that he had to take care not to allow such abuse to develop out of control. 40 .     The applicant had indicated to P.L. on numerous occasions that he sincerely regretted having committed the crime for which he had been sentenced. The applicant also said that he was doing well with the current antipsychotic treatment regime, which he was completely prepared to continue when he was ready for discharge at some point. 41 .     The letter further stated that the applicant had responded well to the combination therapy with Risperdal and Leponex. He denied having any psychotic symptoms such as delusions and hallucinations. Except for one single incident in which the applicant had been seriously provoked by a fellow patient and had kicked that person, he had not exhibited any externalising behaviour for the past six months. 42 .     On the basis of the course of the applicant’s treatment, P.L. supported the recommendation of a variation of the sanction from a sentence of forensic psychiatric care to a sentence of forced psychiatric treatment. The health professional went on to note that the applicant’s prospect of recovery was good if, when released, he could be reintegrated into society by being offered a suitable home and intensive outpatient therapy in the following years. The applicant was aware of his disease and clearly acknowledged his need for therapy. On the other hand, the applicant’s prospect of recovery was bad if he were to be discharged without follow-up and supervision. P.L. agreed with M.H.M. (see paragraph   36 above) that the potential interruption of the treatment gave rise to a significantly higher risk of offences against the person because of the worsening of the applicant’s psychotic symptoms. 43 .     When heard by the City Court on 7 October 2014, P.L. stated that, during the period that had elapsed since his medical statement of 13 January 2014, the applicant had been doing well in the safe environment at the department. The applicant had kept to the agreements made, and he had been able to have a job. In P.L.’s assessment, the applicant would lose focus if he did not have a solid framework. The applicant’s personal history showed this. The applicant had demonstrated violent behaviour for a long time, including at school and while in forensic psychiatric care. The violent behaviour had diminished as a result of the treatment. 44 .     P.L. added that the medical treatment of the applicant was an expert task. He was being given complex treatment, and the treatment plan had to be carefully followed, including the taking of blood samples for somatic reasons on a weekly or monthly basis. The applicant needed to receive his medicine in order to avoid serious relapses. It was a condition for making a recommendation to amend the sanction that the applicant should be taken care of through a range of treatment initiatives, in addition to the correct administration of medicines and the necessary arrangements for blood sampling. Some of the other treatment initiatives consisted of a regular contact person for supervision of the applicant, a follow-up scheme to make sure that the applicant paid attention to the medical treatment administered, assistance from a social worker to deal with any dependence and other problems and assistance for making sure that he was in the right environment and was offered an occupation. These elements of his treatment were essential to prevent relapses. These initiatives were designed as an element of his treatment in Denmark. In P.L.’s assessment, the same offers of treatment would not be available to the applicant in Turkey. If he relapsed, this could have serious consequences for himself and his environment. 45 .     P.L. believed that the applicant could become very dangerous if he relapsed, which was likely to happen if he was not given the right medication and support, such as that which he was currently receiving. According to P.L., there were highly skilled psychiatrists in cities in Turkey, but probably not in the small village in which the applicant was likely to settle, with the result that the applicant would not be taken care of in the same way as in Denmark. Opinions of the Immigration Service 46 .     On 8 October 2013 the Immigration Service issued an opinion on the issue of the applicant’s expulsion under section 50a of the Aliens Act. It stated, in particular: “Against this background, the Copenhagen Police ( Københavns Politi ) has requested an opinion on the treatment options in Turkey, and for the purpose of this case, we have been informed that the following medicinal products are currently being administered to [the applicant]: Risperdal Consta, which contains the active pharmaceutical ingredient risperidone, and Clozapine, which contains the active pharmaceutical ingredient clozapine. According to data from MedCOI [Medical Community of Interest], a database financed by the European Commission to provide information on the availability of medical treatment, the medicinal products Risperdal [risperidone] and Clozapine are available in Turkey, but their prices are not given. As regards the treatment options in Turkey, it also appears from data from MedCOI that all primary healthcare services are free and are provided by general practitioners, but that patients have to pay themselves if they are tested at a hospital laboratory in connection with primary healthcare services and in connection with prescriptions. ... ... According to data from MedCOI, in 2010 in Turkey there were 2.20 psychiatrists per 100,000 inhabitants and 1.85 psychologists per 100,000 inhabitants, and this is the lowest rate among the countries in the European part of the World Health Organization ...” 47 .     On 4 July 2014 the Immigration Service issued a supplementary opinion which had been requested by the Copenhagen Police. The Immigration Service relied on a consultation response of 4 July 2014 from the Danish Ministry of Foreign Affairs, in which the latter had replied to the questions of the Immigration Service regarding treatment options in Konya, Turkey. 48 .     The opinion stated, in particular: “... It appears from the medical statement of 13 January 2014 that [the applicant’s] recovery prospects are good if, when released, he can be reintegrated into society by being offered a suitable home and intensive outpatient therapy in the following years. On the other hand, his recovery prospects are bad if he is discharged without follow ‑ up and supervision. [The applicant] has pointed out that he has no social network in the village in Turkey in which he was born and lived with his family for the first years of his life, that he will be far away from psychiatric assistance in that village, and that he understands only a little Turkish because he is Kurdish-speaking. Opinion ... By letter of 1 May 2014, which relates to the return of a Turkish national, the Immigration Service asked the Ministry of Foreign Affairs for assistance in obtaining information on treatment options in Konya, Turkey. The patient has been diagnosed with ‘ paranoid schizophrenia, sentenced to psychiatric placement, cannabis dependence syndrome, abstinent, overweight without specification ’ and receives Risperdal Consta injections and Clozapine tablets. The Immigration Service asked for a reply to the following questions. The Ministry of Foreign Affairs has obtained information from the SGK, the social security institution in Turkey, and a physician at a rehabilitation clinic in Konya under the auspices of the public hospital named ‘ Konya Egitim ve Arastirma Hastanesi ’. The public hospital in Konya named ‘ Numune Hastanesi ’ has also been contacted and asked [the following] questions: (1)     Is it possible for the patient to receive intensive care in a psychiatric hospital matching the needs of a person with the stated diagnosis in the province of Konya? Mentally ill patients are generally eligible for treatment at public hospitals and from private healthcare providers who have concluded an agreement with the Turkish Ministry of Health on an equal footing with other patients who apply to treatment facilities with a non-mental disease. Turkish nationals living in Turkey who are not covered by health insurance in another country will be covered by the general healthcare scheme in Turkey upon application. In order to be covered, the citizen must register with the Turkish Civil Registry and subsequently enquire at the District Governor’s office to lodge an application. The person has to pay a certain amount, depending on income, to be enrolled in the scheme. Examples of payment ... Monthly income of 0 to 357 [Turkish liras (TRY)]: No contribution is payable as the citizen’s contribution is paid by the Treasury Monthly income of TRY 358 to TRY 1,071: TRY 42 (approximately 105 [Danish kroner (DKK)]) Monthly income of TRY 1,072 to TRY 2,142: TRY 128 (approximately DKK 320) Monthly income exceeding TRY 2,143: TRY 257 (approximately DKK 645) (2)     Is the mentioned medication available in the province of Konya? The physician has confirmed that Risperdal Consta 50   mg (in packs containing solution for 1 injection, manufacturer Johnson & Johnson, retail price: TRY 352.52, corresponding to [approximately] DKK 925) is generally available at pharmacies in Konya and is used for the treatment of patients suffering from paranoid schizophrenia. If a specific medication is sold out by one pharmacy, it is possible to enquire at another pharmacy or order the medication for later pick-up. It is a prescription drug. Medication with clozapine as the active pharmaceutical ingredient is available in two forms: Leponex 100mg, packs containing 50 tablets, manufacturer Novartis, retail price TRY   25.27 (corresponding to approximately DKK 66). Active pharmaceutical ingredient: Clozapine. Is generally available at pharmacies in Turkey. It is a prescription drug. Clonex 100mg, packs containing 50 tablets. Manufacturer Adeka Ilac, retail price TRY 25.27 (corresponding to approximately DKK 66). Active pharmaceutical ingredient: Clozapine. Is generally available at pharmacies in Turkey. It is a prescription drug. a. if yes, what [are] the costs for the patient? As the relevant medicines are prescription drugs, the patient normally has to pay the full price unless he or she is covered by the general healthcare scheme. In that case, the patient has to pay 20% of the retail price, and the remaining 80% is covered by the general healthcare scheme. However, patients covered by the general healthcare scheme may be exempted from paying the 20% patient’s share if the physician writes a special committee report which has been approved and signed by several physicians. Such a report will be issued if, in the assessment of the physician, the patient has an existing and real need for long-term treatment and it is deemed unreasonable that the patient has to pay the costs himself or herself. This assessment does not take into account the patient’s financial situation. (3)     Do healthcare personnel in Konya speak Kurdish? According to the physician, the hospitals employ Kurdish-speaking staff, who can offer language assistance should the need arise. The public hospital in Konya named ‘ Numune Hastanesi ’ gave the same reply. Conclusion The medical report issued by the Mental Health Centre of the Hospital of Saint John does not give rise to any supplementary observations in addition to those made in our opinion of 8 October 2013 providing information on treatment options in Turkey. Accordingly, we refer to our opinion of 8 October 2013 in general. ...” The applicant’s statements 49 .     The applicant was heard by the City Court on 6 February and 7   October 2014. He stated that he had no family in Turkey, as all his family members were in Denmark. He confirmed that, when he had been young, he had lived in a small village near Konya, and that the distance from that village to Konya was about 100 km. The applicant also stated that his mother no longer owned real property there, as it had been demolished; if expelled to Turkey, he would not know where to stay, as he was not familiar with that country and was not able to find his way there. He could not speak Turkish, only Kurdish; he spoke better Danish than Turkish. 50.     The applicant was worried that he would not be abl