England and Wales Court of Appeal (Civil Division) Decisions
You are here:
BAILII >>
Databases >>
England and Wales Court of Appeal (Civil Division) Decisions >>
Barker v Barking Havering & Brentwood Community Healthcare Nhs Trust (Warley Hospital) & Anor [1998] EWCA Civ 1347 (30 July 1998)
URL: http://www.bailii.org/ew/cases/EWCA/Civ/1998/1347.html
Cite as:
(1999) 2 CCL Rep 5,
[1998] EWCA Civ 1347,
[1999] Lloyd's Rep Med 101,
[1999] Lloyds Rep Med 101,
(1999) 47 BMLR 112,
[1999] 1 FLR 106
[
New search]
[
Printable RTF version]
[
Help]
IN
THE SUPREME COURT OF JUDICATURE
LTA
98/6128/4
IN
THE COURT OF APPEAL (CIVIL DIVISION)
ON
APPEAL FROM THE QUEEN'S BENCH DIVISION (CROWN OFFICE LIST)
(MR
JUSTICE RICHARDS
)
Royal
Courts of Justice
Strand
London
WC2A 2LL
Thursday
30 July 1998
B
e f o r e:
THE
MASTER OF THE ROLLS
(LORD
WOOLF)
LORD
JUSTICE HOBHOUSE
LORD
JUSTICE THORPE
-
- - - - -
MELANIE
BARKER
Plaintiff/Appellant
-
v -
BARKING
HAVERING & BRENTWOOD COMMUNITY HEALTHCARE NHS TRUST
(Warley
Hospital)
DR
JASON TAYLOR
Defendants/Respondents
-
- - - - -
(Transcript
of the Handed Down Judgment of
Smith
Bernal Reporting Limited, 180 Fleet Street,
London
EC4A 2HD
Tel:
0171 421 4040
Official
Shorthand Writers to the Court)
-
- - - - -
MR
K GLEDHILL
(Instructed by Messrs Glabraith Branley, London, N12 9QD) appeared on behalf of
the Appellant
MR
J GRACE QC
and
MR
H LLOYD
(Instructed by Messrs Scrivenger Seabrook, Cambridge, PE19 1AJ) appeared on
behalf of the Respondent
-
- - - - -
J
U D G M E N T
(As
approved by the Court)
-
- - - - -
©Crown
Copyright
Thursday
30 July 1998
JUDGMENT
LORD
WOOLF, MR: On 11 May 1998 Mr Justice Richards dismissed Miss Barker’s
applications for habeas corpus and judicial review in relation to her continued
detention at the Warley Hospital under the provisions of the Mental Health Act
1983. This judgment deals with her appeal against the judge’s decision
on both her applications. The merits of her application for habeas corpus and
judicial review are the same. However leave is required to appeal to this
court from a decision on an application for judicial review but not from a
decision on an application for habeas corpus. In the circumstances we give her
leave to appeal against the decision on her application for judicial review and
deal with the substance which is the subject of both appeals.
Miss
Barker wants to challenge the renewal of her detention under the Mental Health
Act 1983. Mr Kris Gledhill repeats his submissions which he made on her behalf
before the judge. Mr John Grace QC appears on behalf of the Health Trust
responsible for the Warley Hospital where she was detained and on behalf of Dr
Jason Taylor a Consultant Psychiatrist at that hospital who has been the
appellant’s responsible medical officer for the purposes of the Act from
time to time since 1994.
The
appeal raises points of importance as to the general approach which should be
adopted as to the interpretation of the Act. It also raises questions as to
what is the procedure which should be adopted in order to test the issues which
the appellant seeks to have determined in her favour. Should they be raised on
an application for habeas corpus or an application for judicial review or are
both procedures appropriate? If they can be raised on either, then can the
choice of procedure affect the outcome?
The
Facts
The
evidence which is before this Court and was before the judge is limited. The
appellant’s medical history is contained in an affidavit of Dr Taylor
prepared for these proceedings and a report prepared by him in January 1998 for
a hearing before a Mental Health Review Tribunal. The evidence indicates that
the appellant has a long history of personality problems and she has repeatedly
been admitted to hospital because she was in an amphetamine induced psychotic
state. On 28 May 1997 she was again admitted to Warley Hospital suffering from
a drug-induced psychosis after she had set fire to her home causing extensive
damage. From the 3 June 1997 on an application of an approved social worker
supported by the recommendation of two medical officers, one of whom was Dr
Taylor, she was formally detained under section 3 of the Act for treatment of
what was said to be a psychopathic disorder. The authority for detention under
section 3 expires after six months unless it is continued under section 20 of
the Act. Her detention was therefore due to expire at the latest on 2 December
1997. From 21 October 1997 she was granted a succession of weekly periods of
leave by Dr Taylor under the Act. The periods of leave allowed her to be away
from the hospital from Thursday to Monday. In addition she was allowed to be
away from her ward for a number of hours each day. On 11 November 1997 Dr
Taylor completed Form 30 under section 20 of the Act in order to continue her
detention. The form states that in his opinion the appellant is suffering from:
"
Psychopathic disorder and [her] mental disorder is of a nature or degree which
makes it appropriate for [her] to receive medical treatment in a hospital and
such treatment is likely to alleviate or prevent a deterioration of [her]
condition."
Form
30 also states that Dr Taylor is of the opinion that it is necessary :
"(i) in
the interest of the patient’s own health
(ii) in
the interests of the patient’s own safety
(iii)
with a view to the protection of other persons
that
this patient should receive treatment and it cannot be provided unless [she]
continues to be detained under the Act, for the following reasons:
She
remains at high risk of relapse of drug induced psychosis. She will need a 24
hour staffed residential unit on discharge from hospital. She requires further
inpatient care and would not comply on an informal basis."
On
9 December 1997, Dr Taylor completed a certificate of consent to treatment in
which he certified that the appellant understood the effects of the medication
she was receiving and consented to the treatment. It was on 10 December that
the managers of the hospital sent a letter to the appellant indicating that
they had considered the reports relating to the renewal of her detention and
had decided not to discharge her. On 30 December 1997, her leave was made
seven days a week to be renewed weekly.
After
she had been granted leave to make her application for judicial review and her
application for habeas corpus had been adjourned on 17 March 1998, on 23 March
1998 she took amphetamines and returned to hospital suffering from a
drug-induced psychosis and was then reclassified as suffering from mental
illness as well as a psychopathic disorder. At the end of May 1998 she
inflicted serious injuries upon herself and since that time she has remained as
an inpatient of the hospital.
Mr
Gledhill accepts that at the present time, if an application was to be made to
detain her under section 3 of the Act, it would not be possible to show that
the order was without lawful foundation. He disputes that this was the position
on 11 November 1997, when Doctor Taylor completed Form 30, and on 2 December
1997, when the section 3 order was due to come to an end if not renewed.
However even if Mr Gledhill is correct in his submissions, in reality, there is
no question of the appellant being released. From the practical point of view
the significance to her of the outcome of this appeal is the difference in the
length of the period which can elapse before the authority for her detention
has to be renewed (6 months in the first instance and 12 months thereafter) and
when the question of her release can be referred to a Mental Health Review
Tribunal.
In
his affidavit, Dr Taylor, in addition to confirming the correctness of the
statements contained in Form 30 of 11 November 1997, states that the appellant
consented to her treatment by medication throughout, she underwent screening of
her urine for illicit drugs, and she attended as an inpatient occupational
therapy service and an art therapy group. He indicates that she was involved
in a “care programme approach” which involved seeking to
reintroduce her into the community gradually under supervision, given the
potential risks she represented to the community and the long term nature of
her condition. He states that he considers she requires this treatment until
such time as he is satisfied that she is able to return to live in the
community with the degree of support which he considers she requires to avoid
damage to her own health and to protect the safety of other persons.
The
Statutory Framework
In
order to determine whether the appellant is lawfully detained, the respondents
have first to establish that she was lawfully detained under section 3 of the
Act on 3 June 1997. Section 3 provides :
"(1) A
patient may be admitted to a hospital and detained there for the period allowed
by the following provisions of this Act in pursuance of an application (in this
Act referred to as “an application for admission for treatment”)
made in accordance with this section.
(2) An
application for admission for treatment may be made in respect of a patient on
the grounds that -
(a) he
is suffering from mental illness, severe mental impairment, psychopathic
disorder or mental impairment and his mental disorder is of a nature or degree
which makes it appropriate for him to receive medical treatment in a hospital;
and
(b) in
the case of psychopathic disorder or mental impairment, such treatment is
likely to alleviate or prevent a deterioration of his condition; and
(c) it
is necessary for the health or safety of the patient or for the protection of
other persons that he should receive such treatment and it cannot be provided
unless he is detained under this section.
(3) An
application for admission for treatment shall be founded on the written
recommendations in the prescribed form of two registered medical practitioners,
including in each case a statement that in the opinion of the practitioner the
conditions set out in subsection (2) above are complied with; and each such
recommendation shall include -
(a) such
particulars as may be prescribed on the grounds for that opinion so far as it
relates to the conditions set out in paragraphs (a) and (b) of that subsection;
and
(b) a
statement of the reasons for that opinion so far as it relates to the
conditions set out in paragraph (c) of that subsection, specifying whether
other methods of dealing with the patient are available and, if so, why they
are not appropriate."
In
the appellant’s case she was suffering from psychopathic disorder and so
the treatment had to meet the requirement of section 3(2)(b) that it was
“likely to alleviate or prevent a deterioration” of her condition.
In addition it was a requirement that the treatment was necessary and that it
could not be provided unless the appellant was detained under the section. It
is not disputed that in June 1997 those requirements of section 3 were met.
Section
17 gives the responsible medical officer wide powers to grant a patient leave
from the hospital. The leave can be for a specified or indefinite period and
it is subject to the responsible medical officer being able to revoke the leave
if, it is necessary to do so “in the interests of the patient’s
health or safety or for the protection of other persons”. However a
patient cannot be recalled if “he has ceased to be liable to be detained
under this Part of this Act”.
It
is on section 20 that most of the argument on this appeal has focused. Section
20(1) places the limit on the period of detention for those admitted to
hospital under section 3 to “a period not exceeding six months beginning
with the day on which he was so admitted .... unless the authority for his
detention .... is renewed under this section”.
Section
20(2) provides that the initial renewal shall be for a further period of six
months and subsequent renewals are to be for a further period of a year.
The
manner in which a renewal is achieved and the conditions which have to be
complied with are set out in section 20(3) and (4). These provisions are
important and are in the following terms:
"(3) Within
the period of two months ending on the day on which a patient who is
liable
to be detained
in pursuance of an application for admission for treatment would cease under
this section to be so liable in default of the renewal of the authority for his
detention, it shall be the duty of the responsible medical officer -
(a) to
examine the patient; and
(b) if
it appears to him that the conditions set out in subsection (4) below are
satisfied, to furnish to the managers of the hospital where the patient is
detained
a report to that effect in the prescribed form; and where such a report is
furnished in respect of a patient the managers shall, unless they discharge the
patient, cause him to be informed. (emphasis added)
(4) The
conditions referred to in subsection (3) above are that -
(a) the
patient is suffering from mental illness, severe mental impairment,
psychopathic disorder or mental impairment, and his mental disorder is of a
nature or degree which makes it appropriate for him to receive medical
treatment in a hospital; and
(b) such
treatment is likely to alleviate or prevent a deterioration of his condition; and
(c) it
is necessary for the health or safety of the patient or for the protection of
other persons that he should receive such treatment and that it cannot be
provided
unless
he continues to be detained
;
but
in the case of mental illness or severe mental impairment, it shall be an
alternative to the condition specified in paragraph (b) above that the patient,
if discharged, is unlikely to be able to care for himself, to obtain the care
which he needs or to guard himself against serious exploitation. (emphasis
added)”
Section
20(8) is also relevant to the argument advanced on behalf of the appellant. It
provides:
"(8) Where
a report is duly furnished under subsection (3) ... above, the authority for
the detention ... of the patient shall be thereby renewed for the period
prescribed in that case by subsection (2) above."
In
setting out the provisions of section 20 I have omitted the references to
patients placed under guardianship which is also dealt with by the section but
which are not directly relevant.
Section
23 contains the powers of the responsible medical officer, the managers of the
hospital, or the nearest relative of the patient to discharge the patient.
Section
145 contains a wide definition of medical treatment which is in the following
terms :
"includes
nursing, and also includes care, habilitation and rehabilitation under medical
supervision."
The
only other section of the Act to which I should refer at this stage is section
58. Section 58 is relevant because of the certificate of consent to treatment
which Dr Taylor completed on 9 December 1997 on which Mr Gledhill relies. The
consent has a formal role under the Act. A patient cannot be given any form of
treatment to which that section applies unless he has consented to that
treatment and this is certified in writing or a second opinion is obtained from
another medical practitioner.
THE
ARGUMENT FOR THE APPELLANT
In very clear and concise submissions Mr Gledhill explains why he contends that
on the facts which I have set out Dr Taylor was not in a position to lawfully
continue the appellant’s detention. He accepts that the critical dates
for judging the issues are when Dr Taylor furnished his report and the date on
which the previous detention would if not renewed expire. As the managers have
the power to discharge and are required to inform the patient of a report it
might have been expected that the renewal was dependent on the patient being
informed or at least considered by the managers, but that is not the position.
This was made clear by this court in
R
v
Managers
of Warlingham Park Hospital, ex parte B
(1994) 22 BMLR 1.
Mr
Gledhill contends that on the proper interpretation of the Act Dr Taylor could
not properly come to the conclusion that the appellant fulfilled the criteria
set out in section 20. He submits that the appellant was spending more and
more time away from the hospital and her ward. By 2 December she was spending
5 days away from the hospital and she was soon to spend the whole week away.
She was compliant with medication (as demonstrated by the certificate of
consent signed by Dr Taylor) and she was only going back to the hospital for a
brief assessment. Mr Gledhill submits that section 20(4)
“mirrors” section 3 and under section 3 a patient cannot be
detained purely for assessment. If this is the situation there has to be an
admission for assessment under section 2. Assessment is not treatment. Section
20 (4) cannot be used if it is not necessary for the patient to be treated as
an inpatient for the reasons set out in the section 20. He submits that as the
Act affects the liberty of the subject its terms must be construed in favour of
the subject . He relies strongly on the judgment of McCullough J. in
R
v Hallstrom, ex p W, R v Gardner, ex p. L
[1986] QB 1090.
In
Hallstrom
both
W and L had a long history of medical treatment for mental illness, but they
would not accept the medication which their doctors considered they needed
voluntarily. W was therefore detained by the doctors implementing the
provisions of section 3 and L’s detention was renewed by the doctors
under section 20. In both cases the action was challenged on the basis they
were not liable to be detained. It is important to note that in both cases it
was accepted that they did not require treatment as inpatients and the real
reason for the doctors’ action was L and W’s refusal to take the
medication, which could have been taken as outpatients if they had taken it
voluntarily. On the facts the decision of McCullough J. that their detention
was unlawful is perfectly justified. However McCullough J. in a very careful
judgment analysed the interaction between sections 3, 17 and 20 and it is his
reasoning when doing this which gives rise to difficulty.
The
judge contrasts the use in the sections of the words “detained” in
a hospital and “liable to be detained” in a hospital. He also
compares sections 26, 39 and 43 of the Mental Health Act 1959, which is the Act
which preceded the 1983 Act, with sections 3,17 and 20 of the Act 1983 and he
states:
"Each
term appears many times in the Act. In a very few places it may be that the
less apt term has been used but, reading the Act as a whole, the distinction
between them and their meaning are clear and, unless there are strong
indications to the contrary, Parliament must be taken to have been deliberate
in its choice of the one term rather than the other."
(at
p.1101)
So
far as his analysis causes McCullough J. to come to the conclusion that section
3 “only covers those whose mental condition is believed to require a
period of inpatient treatment” I have no reason to quarrel with his
reasoning. The overnight admission of W was not the inpatient treatment which
justifies section 3 being invoked. It is his reasoning as to the
interpretation of section 20 which I regard as being wrong and as leading to
results which cannot have been intended by Parliament. McCullough J having
noted that section 43 of the 1959 Act referred only to “liable to be
detained” came to the conclusion that as Parliament changed “liable
to be detained” to “detained” in section 20 (3) (b) and 4(c)
that Parliament must have intended the word detained “to mean what it
said” in section 20 (3) (b) and 4(c). He added bearing in mind the fact
that section 20 “is a provision which infringes the liberty of the
subject” and it becomes virtually impossible to construe “detained
in any other sense” (1108D\G) .
McCullough
J’s judgment has now been applied for many years by the medical
profession. They have accepted that a patient on leave under section 17 cannot
have his detention renewed under section 20. Consequently care is taken to
ensure that a patient is not on leave when the renewal process takes place.
The need to rearrange leave is an inconvenience but nothing more than an
unnecessary inconvenience. More serious is the indirect consequence that Mr
Gledhill contends follows from McCullough J’s reasoning. Mr
Gledhill’s argument depends on looking not at the appellants treatment as
a whole, that is both at what happens in hospital and when she is on leave,
but only that part of the treatment of the appellant when she is
“detained” as an inpatient. The treatment when she is detained he
categorises as being no more than “assessment” which would not be
sufficient for section 3 and therefore should not be sufficient for section 20
which mirrors section 3.
If
Mr Gledhill’s approach is right it creates considerable difficulties in
treating the many patients like the appellant who should be treated partly as
an inpatient and partly as an outpatient as described by Dr. Taylor in the case
of the appellant. In such cases the activities which take place as part of the
inpatient treatment may all individually be capable of being performed without
the treatment taking place in the hospital, yet for the treatment as a whole to
be successful there will often need to be an inpatient element to the treatment
which means it is in fact “appropriate for him to receive medical
treatment in a hospital” and “that it cannot be provided unless he
continues to be detained”. The requirement that the patient has to
return to hospital and be monitored and is liable to be recalled and from time
to time is subjected to the discipline of being treated in hospital as an
inpatient under direct supervision with urine and other tests is an essential
part of the treatments. They enable the patient to attempt the process of
rehabilitation in the wider community which would be more precarious otherwise.
This appears to be just the type of treatment contemplated by the second half
of the definition of treatment contained in section 145 of the Act. As the Code
of Practice states in paragraph 20.1, leave “can be an important part of
a patient’s treatment plan.”
The
approach of Mr Gledhill conflicts with that of Hoffmann LJ as to the meaning of
“treatment” in
R
v Croydon Health Authority
[1995] Fam. 133. Hoffmann LJ was not considering outpatient treatment but he
rejected an “atomistic” approach to what is treatment by looking at
treatment as a whole (at p.138/9). It is the treatment as a whole which must
be calculated to alleviate or prevent a deterioration of the mental disorder
from which the patient is suffering. As long as treatment viewed in that way
involves treatment as an inpatient the requirements of the section can be met.
Reading
McCullough J’s judgment as a whole I am by no means sure that he was
intending to say anything inconsistent with the approach to treatment indicated
above being adopted. However whether he intended to do so is perhaps of little
significance since I am satisfied that his interpretation of section 20 is
flawed. Mr Grace in a supplemental skeleton argument traces the background to
1983 Act. He refers to the White Paper, “Reform of Mental Health
Legislation” (Cmnd 8405), the intervening Act of 1982 and his
investigation of the lengthy Parliamentary debates in Hansard and he can find
nothing which throws light on the reason for the change of language of the
legislation since 1959 Act. His researches provide no support for McCullough
J’s interpretation.
Mrs
Justice Hale in “Mental Health Law” suggests the change in language
may be a draftsman’s slip. On my reading of the 1959 Act “liable to
be detained” is used both to cover a person who is detained and a person
who would be detained if he were not on leave. The opening words of section
20(3) require the responsible medical officer to examine those who are
“liable to be detained”. This literally applies to those on leave
but it must also refer to those who are “detained”. It is to the
managers of the hospital where the “patient is detained” that the
report is to be furnished. However I do not find it inappropriate to describe
the hospital of a patient who is on leave in this way. As Mr Grace submits the
detention does not have to be continuous, as section 17 makes clear, but even
when on leave the patient still has a hospital at which he is detained when not
on leave. Equally he will for the purpose of section 20(4) continue to be
detained whether when the report is furnished he is in hospital or liable to be
required to return to hospital.
No
help is therefore available to Mr Gledhill from McCullough J’s judgment.
The same is true as to the distinction which he seeks to draw between
assessment and treatment. The fact that assessment by itself cannot amount to
treatment for section 3 does not mean that assessment cannot be a legitimate
treatment under sections 3 and 20. Often assessment or monitoring of progress
will be an important part of treatment. This will certainly be the case where
as here there is an evolving programme of treatment.
Having
clarified the legal position the question as to whether Dr Taylor was entitled
to furnish the report on 11 November 1997 continuing the appellant’s
detention can only be answered in the affirmative.
THE
APPROPRIATE PROCEDURE AND REMEDY
The
appellant cannot be criticised for making applications both for habeas corpus
and judicial review. However that this should be thought necessary can cause
inconvenience to the parties and the court and extra expense to the parties.
The procedural reforms to Order 53 RSC which streamlined the procedure on an
application for judicial review were not accompanied by reforms to the
procedure on an application for the writ of habeas corpus. There are probably
two reasons for the unwillingness of reformers to tackle habeas corpus. The
first is the relative rarity, until recently, of reliance on habeas corpus, a
position which is likely to change in the event of the European Human Rights
Convention becoming part of our domestic law. The second is the veneration
which is paid to habeas corpus because of its historic role in protecting the
liberty of the subject. This is a veneration which is probably no longer
justified in view of the ability of judicial review to provide a remedy equally
expeditiously whenever the liberty of the subject is threatened. (See
“Should we Abolish the Writ of Habeas Corpus?” Le Sueur [1992]
Public Law 13 but c.f. “In Defence of Habeas Corpus” [1993]
Shrimpton Public Law 24.)
On
the surface the differences between the two procedures is total. There are
different prescribed forms for initiating the applications(86, 86A for judicial
review and 89 for habeas corpus). There is no leave stage or discretionary bars
and no requirement of leave to appeal in the case of habeas corpus. Furthermore
the grant of habeas corpus is said to be as of right so unlike the prerogative
orders available on judicial review its grant is said not to be discretionary
(see Sharpe, The Law of Habeas Corpus, 2nd Edn. (1989) p.58/59). However in
reality the differences are less significant. The evidence will invariably be
the same whether the application is for judicial review or habeas corpus, there
is usually a two stage procedure on an application for habeas corpus (Order 54
r.1 and 2) and at the first stage if the application is without merit it will
be dismissed. If it has merit it will usually be adjourned for an inter partes
hearing and as in both cases there is power to grant interim relief the result
will be very much the same though in fact the variety of interim powers on an
application for judicial review are greater than on an application for habeas
corpus. On judicial review there is little scope for delay or discretion to
play any part if the applicant is being wrongfully detained and the application
for judicial review will be expedited if the liberty of the subject is at
stake. While there is the unrestricted right of appeal in the case of habeas
corpus, the Court of Appeal is now developing its case flow management so that
an obviously unmeritorious appeal will be struck out summarily so there will
increasingly be less advantage in being able to avoid the filter of leave.
It
is sometimes thought that habeas corpus has advantages over judicial review
because of the difference in the burden of proof. However in practice I suggest
this has no practical consequence. It is always for the custodian to show
there is some justification for detention. What is important is the nature of
the issue. On the other hand judicial review has undoubtedly advantages over
habeas corpus because of the range of remedies which are available. If a person
who has been wrongly detained is released prior to an order for habeas corpus
then technically that means there is no relief which the court can grant while
in the case of judicial review it can grant an injunction and in appropriate
case damages.
I
would apply without limitation the words of Lord Wilberforce in
R
v Home Secretary, Ex p Khawaja
[1984] 1 AC 74 at p.99:
"These
remedies of judicial review and habeas corpus are, of course, historically
quite distinct and procedurally are governed by different statutory rules, but
I do not think that in the present context it is necessary to give them
distinct consideration. In practice, many applicants seek both remedies. The
court considers both any detention which may be in force and the order for
removal: the one is normally ancillary to the other. I do not think that it
would be appropriate unless unavoidable to make a distinction between the two
remedies and I propose to deal with both under a common principle. Each of the
present cases appears, in fact, to be of judicial review."
The
reason why in this case I indicated that the appellant could not be criticised
for making the two applications and appeals, although it in fact resulted in a
case which did not justify any special priority being granted priority and
caused extra expense, is the judgment of Sir Thomas Bingham MR in the case of
In
re S-C (Mental Patient) Habeas Corpus
[1996] QB 599. That was a case in which there was an application which
resulted in the detention of a patient under section 3 of the Act which was
defective because the social worker who made the application showed the mother
of the patient as the consenting nearest relative in the application when in
fact the father was the nearest relative and did not consent. In that
situation an attempt was made to defeat an application for habeas corpus by
suggesting that the application should have been made by judicial review and
therefore could not be by habeas corpus relying on section 6 of the Act.
Section 6 provides that a duly completed application is “sufficient
authority” for conveying a patient to hospital and detaining the patient.
The suggestion received short shrift from a court consisting in addition to the
Master of the Rolls, Neill and Hirst LJJ. As the Master of the Rolls said
“It is perfectly possible that the hospital managers were entitled to act
on an apparently valid application but the detention was in fact
unlawful”(at p.612 C). As Neill LJ said (at p.613) section 6 provided a
defence in
civil
proceedings. It did not affect the right to an order of habeas corpus. With
this I entirely agree. However the Master of the Rolls added (at p612 E)
“I am for my part, satisfied that on the present facts an application for
habeas corpus is an appropriate, and possibly even
the
appropriate,
course to pursue.”
From
the report of the argument in the report it is clear that the Master of the
Rolls did not have his attention drawn to the ramifications which follow if
there has to be an application for habeas corpus. For example, this could
result in a duplication of proceedings. I would respectfully disagree with the
suggestion that “possibly” an application for habeas corpus was
the only procedure which was appropriate. While accepting that in that case
that habeas corpus was an appropriate procedure I would suggest that judicial
review was equally appropriate and would even have advantages over habeas
corpus. I would discourage applications for habeas corpus unless it is clear
that no other relief will be required.
This
case is more obviously an appropriate candidate for judicial review proceedings
than
In
re S-C.
In the judgments in the case of
In
re S-C
the court considered the distinction between cases where what is in issue is
whether some precedent fact going to jurisdiction is in issue such as
R
v Secretary for State for the Home Department, ex p Khawaja
[1984] A.C.74 when an application for habeas corpus is appropriate and cases
where what is in issue is the propriety of some prior administrative act. In
the latter situation, as the court appears to .accept in
S-C,
there is authority for saying that habeas corpus is not the appropriate
procedure in the judgments of this court in
R
v Secretary of State for the Home Department, ex p. Muboyayi
[1992] QB 244 The distinction between the two categories of situations is not
always easy to distinguish and that is another reason why it is preferable to
usually to proceed by way of judicial review.
In
support of the use of habeas corpus here Mr Gledhill also relies on the case of
R
v Board of Control ex p Rutty
[1956] 2 QB 109. In this case it was held that habeas corpus is available when
there is no evidence to justify the decision to detain. In
Rutty
the
decision was judicial not administrative and it has been the subject of
criticism (Sharpe, The Law of Habeas Corpus
2nd
edn
(1989)
p.32-34). Nonetheless it does provide support for Mr Gledhill and I would
not go far as Mr Grace and say this is a case where habeas corpus cannot be
used. This is a case where judicial review is the more satisfactory procedure
and judicial review should be used in similar situations in the future. If it
is there would be no justification for also making an application for habeas
corpus.
I
hope in the future it will be possible to make an order of habeas corpus on an
application for judicial review. Until this is possible if both applications
are made again every effort should be made to harmonise the proceedings. The
same affidavits should be used for both sets of proceedings. At any
interlocutory and the final hearing both sets of proceedings should be before
the court. In the event of an appeal the same notice of appeal will suffice.
In
these circumstances being in agreement with the judgment of Richards J, I
would dismiss this appeal.
LORD
JUSTICE HOBHOUSE: I agree that these appeals should be dismissed for the
reasons which have been given by the Master of the Rolls.
If
our decision upon the substantial question had been in favour of Miss Barker,
the appropriate remedy upon the facts of this case would clearly have been a
declaration pursuant to her application for judicial review. I venture to
doubt whether it was at any material time appropriate for her to seek relief by
way of an application for a writ of Habeas Corpus. I would like to endorse the
need for further consideration and guidance to be given to when an application
for the writ or for judicial review is appropriate. Whilst it is of the
greatest constitutional importance that the availability of the right to apply
for the writ should in no way be undermined, it may be thought that the present
procedural confusion and overlap is undesirable and requires reconsideration
and clarification. The present case has not in my judgment provided us with an
adequate opportunity definitively to undertake that task; meanwhile I support
all that the Master of the Rolls has said on this subject in the concluding
part of his judgment.
LORD
JUSTICE THORPE: I have had the advantage of reading in draft the judgment of
my Lord, the Master of the Rolls, with which I am in complete agreement.
In
my opinion it is important that any construction of section 20 of the Mental
Health Act should be as far as possible compatible with section 17. Medical
treatment as defined by section 145 includes rehabilitation under medical
supervision. Obviously a statutory power to grant leave of absence under
section 17 is an important power where the appropriate treatment for the
patient is rehabilitation under medical supervision. Mr Gledhill stresses that
the conditions expressed in section 20(4) are cumulative so that the
section’s application is limited to those patients requiring such
in-patient treatment as cannot be provided unless the patient continues to be
detained. However I see no necessity to adopt the narrow construction for
which he contends.
On
2nd December 1997 the primary treatment thought appropriate for Miss Barker was
rehabilitation under medical supervision. The endeavour to rehabilitate was
dependant upon her regular consumption of the prescribed drugs and her
abstinence from the illicit drugs which in the past had proved her undoing.
The stepping stones to the goal of rehabilitation were weekly leaves of absence
under section 17, gradually extended in duration so long as there were no
setbacks. But her home base remained the hospital despite the fact that she
slept many more nights out than in and despite the fact that she had a daily
leave of absence for four hours on each of the two days per week when she
returned to the hospital. It seems obvious to me that those two days of
detention each week were an essential ingredient of the treatment. If it were
to succeed structure and discipline were important ingredients. Indeed once
those elements were reduced to minimal levels the treatment soon failed.
Furthermore those periods of weekly detention were crucial to allow Dr Taylor
to assess Miss Barker’s state of mental and psychological well-being and
to monitor her progress. Mr Gledhill’s submission that medical treatment
cannot be construed to include general monitoring or urinalysis is in my
opinion plainly wrong. How can there be medical supervision of the
rehabilitation without monitoring and without the resident medical officer
having the power to carry out physical tests, such as urinalysis, to ascertain
the patients behaviour when not subject to direct detention?
I
found equally unconvincing the submission that Warley Hospital was no more than
a dormitory to Miss Barker during her 48 hours of weekly detention. The fact
that she did not receive any specific or additional treatment during those 48
hours does not justify the submission that she was receiving no treatment
during those 48 hours. Her presence in the hospital each Tuesday and Wednesday
was an essential part of the treatment package, it could only be provided in
the hospital and could only be effectively provided if Miss Barker continued to
be detained. She was throughout, and her disorder made it appropriate for her
to be, a detained patient enjoying generous weekly leaves of absence to put her
possible rehabilitation to the test. Were Mr Gledhill’s submissions
accepted it would be extremely difficult for the responsible medical officer to
provide the treatment of rehabilitation under medical supervision without
forfeiting essential ingredients namely structure, discipline, and monitoring.
Order:
Appeal dismissed. Section 18 costs order nisi of respondent's costs. Legal
Aid Taxation of appellant's costs. Leave to appeal to the House of Lords
refused.