QUEEN'S BENCH DIVISION
B e f o r e :
|on the application of|
|- v -|
|(1) MENTAL HEALTH REVIEW TRIBUNAL|
|(2) THE SECRETARY OF STATE FOR HEALTH|
Smith Bernal, 190 Fleet Street, London EC4
Telephone No: 020 7421 4040
(Official Shorthand Writers to the Court)
MISS LISA GIOVANETTI (instructed by the Treasury Solicitor) appeared on behalf of THE DEFENDANT
Crown Copyright ©
Tuesday 9 July 2002
"[H] suffers from the devastating combination of Asperger's Syndrome with a super-imposed psychosis. He undoubtedly fulfils the criteria for detention under the Mental Health Act under the criteria of Mental illness. If he were discharge he would be a danger to himself and to others as he is quite incapable of organising his own life and understanding the consequences of his actions. He is extremely vulnerable to stress and it would be too risky for anyone to try and cope with [H] within a family home. People with Asperger's Syndrome have great difficulty tolerating other people's strong emotions.
At his recent CPA meeting it was agreed that I would ask his local Health Authority for an up-to-date assessment of his needs with a view to referring him to a newly opened specialist unit which caters for people with Asperger's Syndrome who present a risk to themselves and others. He was assessed on 3 May 2000 by a clinician from the John Howard Centre on behalf of the East London and City Health Authority and depending upon the outcome of that assessment I will refer him to Dr Anna Thomas at Cefn Carnau. The Clinical Team agree that he does not require the high secure element of the treatment at Rampton, but because of his unpredictability and the vehemence of his aggression there is currently little in the way of provision nationally that could manage his assaultative behaviour."
"I believe that there is in these circumstances no evidence to justify the conclusion that [H] needs to be in Rampton Hospital. I believe that that conclusion is perverse, in view of the evidence that was given by [H's] RMO. I also believe that the conclusion that [H] is lawfully detained in terms of articles 3, 5(1) and 5(4) of the European Convention for Protection of Human Rights .... is inconsistent with both the instruments themselves and the manner in which those instruments have been interpreted by the European Court."
"A. With a view to facilitating discharge on a future date, does the Tribunal recommend that the patient be --
(i)granted leave of absence from the hospital?
(ii)transferred to another hospital?
(iii)transferred into guardianship?"
"You will see from the enclosed Tribunal report [that was a reference to a previous report] that he was admitted here from Kneesworth House Hospital after his behaviour became so challenging that they were unable to manage him. He has the sad combination of Asperger's Syndrome, coupled with the worst sort of psychotic disorder that came on in late teenage years. He has been seen by Lorna Wing in the past who agrees that the prognosis is appalling. He is not a serious management problem now but he is totally misplaced in an admission ward in a high secure setting.
I would very much like to be able to refer him to Dr Anna Thomas who works for an organisation that has recently opened a specialist medium secure unit near Cardiff which meets the needs of young people with Asperger's syndrome with unpredictable and risky behaviour."
(Lorna Wing, who is referred to in that letter, is an acknowledged expert in Asperger's Syndrome.) The specialist medium secure unit near Cardiff was the Welsh Unit to which I referred earlier.
"We have also considered the legal matters raised in the submissions to the tribunal."
"We are satisfied that the patient still suffers from a mental illness, namely autistic spectrum disorder and schizophrenia of a nature and degree which makes it appropriate for him to be liable to be detained in hospital for medical treatment and also that such treatment is necessary in the interests of the patient's health and safety and for the protection of others.
His capacity for appropriate social interactions is limited, as is his ability to understand the consequences of his actions. The frequency and extent of his aggressive outbursts have reduced since his admission to Rampton Hospital which is a measure of the success of his treatment.
Nevertheless there have been a number of incidents of aggression, some recent, and he has required seclusion on two occasions in the last two months. It was suggested to the tribunal that the projection of danger relies only upon a disputed episode of threat with a knife towards a woman. It does not. It includes assault in hospital which led to facial injuries and rib fracture in staff.
He responds adversely to high expressed emotion; the tribunal recognises the sincere view of his mother that he would be safely supported by extensive family contact. However, it concludes that unfortunately this is not wholly realistic nor, on the evidence, would it necessarily be beneficial to his overall treatment.
The unopposed professional evidence was that he requires a high level both of procedural and relational security, whilst the need for physical security is less paramount.
In total we conclude his treatment could only safely be delivered in high secure hospital.
We note that a recent assessment from Dr Thomas from a specialist medium secure unit with expertise in autism concluded that he could not be treated there since he is too dangerous.
We conclude that the detention in Rampton Hospital is not currently in excess of his requirements.
The tribunal is satisfied that the clinical team will take appropriate steps to obtain a placement elsewhere when this is feasible in the light of his complex treatment needs which are currently met at Rampton Hospital.
The tribunal find no breach of the provisions of the Human Rights Act."
"A tribunal may under subsection (1) above direct the discharge of a patient on a future date specified in the direction; and where a tribunal does not direct the discharge of a patient under that subsection the tribunal may --
(a) with a view to facilitating his discharge on a future date, recommend that he be granted leave of absence or transferred to another hospital or into guardianship; and
(b) further consider his case in the event of any such recommendation not being complied with."
"With a view to facilitating discharge on a future date, does the tribunal recommend that the patient be --
(ii) transferred to another hospital?"
MISS GIOVANETTI: My Lord, I am not instructed to make any application.
MR JAISRI: My Lord, the claimant is legally aided.
MR JUSTICE STANLEY BURNTON: You would like the usual certificate?
MR JAISRI: My Lord, yes.
MR JUSTICE STANLEY BURNTON: You may have the usual certificate. Thank you both very much.