QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
B e f o r e :
|THE QUEEN ON THE APPLICATION OF MERSEY CARE NHS TRUST||(CLAIMANT)|
|MENTAL HEALTH REVIEW TRIBUNAL||(DEFENDANT)|
Smith Bernal Wordwave Limited
190 Fleet Street London EC4A 2AG
Tel No: 020 7404 1400 Fax No: 020 7831 8838
(Official Shorthand Writers to the Court)
MR STRACHAN (instructed by TREASURY SOLICITOR) appeared on behalf of the DEFENDANT
MR SOUTHEY (instructed by PETER EDWARDS) appeared on behalf of the INTERESTED PARTY
Crown Copyright ©
"The tribunal may conduct the hearing in such manner as it considers most suitable bearing in mind the health and interests of the patient and it shall, so far as appears to it appropriate, seek to avoid formality in its proceedings."
So far as representation is concerned, Rule 10(1) provides:
"Any party may be represented by any person whom he has authorised for that purpose not being a person liable to be detained or subject to guardianship or after-care under supervision under the Act or a person seeking treatment for mental disorder at the same hospital or mental nursing home as the patient.
"Any representative authorised in accordance with paragraph (1) shall notify the tribunal of his authorisation and postal address."
"The view remains that she no longer requires conditions of high security to manage her mental health problems."
So far as the social services' ability to make provision for D was concerned, he said this:
"My department could not, on its own, match her current or anticipated health care needs. She could return to her home address but this is not viable unless she has a robust care plan that provides intensive follow up to manage her complex health care needs. I have no real confidence that such arrangements ie a community care package, are feasible at the present time."
"The admission to Ashworth has managed to re-stabilise [D's] mental state, encouraged communication, education and understanding of her illness and subsequent behaviour which has offered insight and utilisation of suitable coping mechanisms. There is still a need for [D] to consolidate her progress and reduce the risks of further relapse. Consequently, I feel she will need a further period of inpatient treatment to ensure maintenance of stability and gradual rehabilitation back to the community."
"Given her current reported increased stability in presentation, and past pattern of entry and discharge from services such therapy could also be undertaken at lower levels of security."
1) "We considered carefully the written reports and the oral evidence. The patient presented extremely well at the Hearing with good insight into how ill she had been and to her current needs.
2) "At the time of her admission (brought about by the patient herself seeking help) she was acutely psychotic and disturbed and refusing medication. She was aggressive and violent and difficult to manage (a fault, which she now acknowledges and recognises was inappropriate).
3) "Following her transfer to Ashworth she was very quickly persuaded to restart Clozapine. This had a very rapid effect on her mental state. She has not been violent since 28 July 2002 (5 days after transfer to Ashworth).
4) "She has some residual symptoms but she is able to cope with them and has some strategies to manage them. She recognises she can be violent and has asked for Anger Management Therapy. She has made strong relationships with staff and some patients on the ward.
5) "In Autumn 2002 the team referred the patient back to Reaside as they felt a maximum security setting was not appropriate. Reaside have said that their current facilities are unsuitable. The women's services in Birmingham will be at a new facility (Ardenleigh) which it is anticipated will open in September 2003. The indication is that [D] will be transferred there. There is of course no guarantee that Ardenleigh will open on time or that [D] will be transferred there immediately.
6) "It is the Tribunal's view that [D] is as well as she can be in terms of her mental state. She is receiving no treatment at Ashworth save medication and nursing care. She is such a distance from home as to make family visits difficult and therefore rare.
7) "She has coped in the community in the past with a support package and did engage with the professional support workers.
8) "She has her own flat and her self care skills were reported to be good.
9) "The whole team are of the view that her current placement at Ashworth is not appropriate to her needs, but no other facility has been identified as available for rehabilitation.
10) "We are of the view that with the support of a CPN [Community Psychiatric Nurse], Social Worker and Doctor she can cope in the community. We do not of course presume to identify as suitable care package but hope that it can include appropriate therapies, in particular Anger Management.
11) "We are concerned that a continued lengthy detention in a special hospital will have an adverse affect on her mental state. She is unable to be tested out or enjoy graduated unaccompanied leave into the community.
12) "Therefore, we conclude that [D] has a mental illness, schizophrenia, which is not of a nature or degree which requires continuing detention in hospital. Furthermore, to detain her for an indeterminate period in conditions of maximum security represents a disproportionate breach of her Human Rights under article 8 ECHR.
13) "We would add that it is crucial for [D's] continued good health that she complies with medication and participates in any recommended therapeutic interventions.
14) "We are deferring this discharge for one month to allow an aftercare package to be put in place. In setting this deadline we are mindful of the importance of [D] retaining the tenancy of her flat."
"The patient had a good deal of insight into her illness, and had acknowledged herself that she would risk relapsing if she were to stop taking her medication. We had no reason to disbelieve her evidence on this issue.
"Furthermore, Ms Linton ... also gave evidence to the Tribunal that the patient was likely to continue taking her medication on this occasion. This was also consistent with the patient's conduct whilst at Ashworth Hospital, as confirmed by the evidence of her Ward Manager.
"In light of this, and with the support of a Community Psychiatric Nurse, Social Worker and Psychiatric supervision, I and the Tribunal reached the clear view that the patient would be able to cope in the community. Based upon the evidence of Ms Linton, the Tribunal had understood that an adequate care package could be put in place before the patient was discharged. Ms Linton did not know how long it would take, but we took the view that a month would be sufficient. We had in mind the importance of [D] being able to continue the tenancy of her property if she was released within this time frame."
"If the tribunal is in doubt as to whether suitable after-care arrangements will be made available, it is difficult to see how it can specify a particular date for discharge. In cases of doubt, the safer course is to adjourn. On the facts of the present case, the tribunal could not reasonably have assumed that the services would be provided as soon as H was discharged into the community."
The facts of that case were very different from the facts of the present case. H had a long history of violent conduct. He had been detained for six years in a special hospital and the Tribunal had ordered his immediate discharge from detention despite the fact that not merely were there no after-care arrangements in place, but he had no alternative accommodation. Indeed, H's position was so difficult that he had to remain in the hospital as a voluntary patient.
"No problems on visits out. Reaside a medium secure forensic unit. Should be able to put together a suitable support package.
"Potentially could do Anger Management in community.
"Reaside knows [D]. Don't know how long it would take to put together support package."
"It is crucial for [D's] continued good health that she complies with medication and participates in any recommended therapeutic interventions."
"First, as often happens, the tribunal was required to resolve a difference of opinion between experts as to whether the patient should be discharged. In such cases, it is important that the tribunal should state which expert evidence (if any) it accepts and which it rejects, giving reasons. This is as important in a case where the tribunal rejects evidence in favour of discharge as it is in a case where the tribunal rejects evidence which advocates continued detention. It is not enough for the tribunal simply to state that it prefers the evidence of A and B to that of C and D. It must give reasons. As the hand book states, these may be brief, but in some cases something more elaborate is required. It must at least indicate the reasoning process by which it decided to accept some and reject other evidence."