Jersey Unreported Judgments

Hearing (Criminal) - re approved establishment for treatment.

[2021]JRC141

Royal Court

(Samedi)

6 May 2021

The Attorney General

-v-

Robert John Ingram Moon

Crown Advocate R. C. L. Morley-Kirk.

Advocate A. M. Harrison for the Defendant.

extempore JUDGMENT

THE DEPUTY BAILIFF:

1.        This is an application under Article 63 of the Mental Health (Jersey) Law 2016 to remand the defendant to an approved establishment for treatment.  

2.        The background to this case is that earlier this year after a trial lasting five days the defendant was convicted by the jury on 12^th February 2021 of two offences of grave and criminal assault and an offence of affray and has been in custody since that date, and indeed has been in custody since June of last year.  

3.        The defendant has long standing mental health difficulties and there was evidence given during the trial in respect of those difficulties, as they were relevant to the defence that he put forward before the jury.  His mental health has significantly deteriorated in the course of the last month or so which has lead to this application being made today.  

4.        Under Article 60 of the Law the powers conferred on the court under Article 63:

"...may be exercised in relation to a defendant who is convicted by the court of an offence punishable with imprisonment."

5.        Under Article 63 (1):

"A court may remand a defendant to a specified approved establishment for the purpose of treatment."

6.        The establishment that is the subject of this application is Brockfield House in Essex which is an approved establishment.  We have a letter from Dr David Ho, a consultant forensic psychiatrist at Brockfield House, to the effect that a bed is available at Brockfield House Secure Hospital for the defendant.  His treating consultant will be Dr Nicholas Hallett.  We are told from the community psychiatric nurse who assists the defendant, that the bed is not only available now but can be occupied from the 12^th May 2021 by this defendant. 

7.        The power conferred by Article 63(1) to remand the defendant to a specified approved establishment may not be exercised unless the court is satisfied on the written or oral evidence of two registered medical practitioners, at least one of whom is an approved practitioner, that there a reason to suspect the defendant is suffering from mental disorder of a nature or degree which makes it appropriate for the defendant to be detained in an approved establishment for treatment and on the written or oral evidence of a responsible medical officer or some other person representing the managers of the approved establishment in question.  Arrangements have been made for the admission of the defendant to that establishment within 7 days of the date of the order.

8.        The latter condition we have already considered in the shape of the evidence from Dr Ho.  As to the evidence of the two registered medical practitioners, at least one of whom is an approved practitioner, we have heard today from two approved practitioners who have not only given written evidence but have given oral evidence on oath to us.  

9.        The first was Dr Krysztofiak a consultant psychiatrist who saw the defendant in custody on the 4^th May 2021 which is two days ago, at the request of the defendant's psychiatric nurse.  He says that the defendant suffers from a number of mental disorders including Bipolar Affective Disorder, Antisocial and Paranoid Personality Disorders and Mental and Behavioural Disorder due to the use of psychoactive substances.

10.      The defendant was prescribed medication to deal in particular with his mood, and Dr Krysztofiak lists in his report various medicines that he has been prescribed.  Two in particular, Quetiapine and Lamotrigine, which are mood stabilising drugs that the defendant stopped taking in November 2020 and March 2021.  He has also more recently been prescribed a third drug Clonazepam by Dr Sani in April 2021 which has refused to take. 

11.      A consequence of this is that the defendant is now displaying the symptoms and signs of the manic phase of Bipolar Disorder, evidenced by elevated mood, irritability, grandiosity, unpredictability, destruction of property, being loud and expansive and in summary, presenting a risk to himself and those around him.  Accordingly, he has been placed, in effect, in isolation in the prison care and control unit.  The defendant feels he does not need treatment and can sort himself out by exercise and diet. 

12.      In the opinion of Dr Krysztofiak, Mr Moon's mental health disorder now warrants urgent treatment that he is refusing.  It is recommended that takes place in an in-patient's psychiatric unit.  In evidence to us Dr Krysztofiak said that it is essential that Mr Moon takes the drugs that he is prescribed.  He needs aggressive treatment which he is currently refusing and he will have to be treated against his will.  That simply cannot be done in custody at the prison. 

13.      As to Orchard House, the only available local facility, the defendant has now been kept in isolation since March and Orchard House cannot provide the level of security that is warranted.  It would be necessary to block out the whole of the intensive care unit at Orchard House (if that was to be available) which simply would not be practical or really possible.

14.      Brockfield House will provide the treatment the defendant needs, and the treatment is urgent.  Not simply to treat the symptoms of mania the defendant is currently exhibiting, but also because in the opinion of both psychiatrists the longer the defendants remains in a manic state the less likely he is that will retain his base level of function that he enjoyed before he became seriously unwell. 

15.      Accordingly, the longer that treatment is delayed the more likely it is that his recovery will be impaired.  So, it is important that treatment takes place soon because, in the view of Dr Krysztofiak, to spend over a month in a manic state is a very long time.  

16.      We also heard from Dr Sani in evidence, who gave evidence to the same effect as his colleague.  He has seen Mr Moon on two occasions, both in April and in May, 2021 and he said that Mr Moon's presentation is of a nature and degree that warrants immediate admission into a specialised care unit where his mental health care needs can be met.

17.      Dr Sani said that there is a possibility of significant self-injury, including death, to Mr Moon and that he poses a significant risk to others in his current state.  Dr Sani attempted to prescribe long acting medication to the defendant when he saw him on 16^th April, but the defendant refused to take it.  He said that his presentation will continue to deteriorate without mood stabilising drugs and the longer he remains untreated there is the risk that he will be unable to return to his previous level of functioning.  Dr Sani says that he needs to be treated in Brockfield House and thereafter assessed after such a lengthy period of being chronically unwell.  There will be a need to review the level of functioning which exists after that recovery has taken place.

18.      It is helpful that the defendant is determined to adopt a healthy diet and an exercise regime but that in itself will not lead to recovery - only the intervention of intervention drugs will do that, and it will be possible for the defendant, even at Brockfield House, to maintain remote contact with his family members, all of whom live in Jersey. 

19.      Advocate Harrison, on behalf of the defendant, accepts that the statutory tests under Article 63 are met.  He says on behalf of Mr Moon that he would much prefer to stay in Jersey.  He regards Brockfield House as a frivolous and pointless diversion and he is concerned about the separation from his family that being sent to this unit will involve, although in any event currently in the secure unit at the prison he is unable to see members of his family.  

20.      We are satisfied that the test under Article 63 is met.  We give directions that the defendant is conveyed on or about the 10^th March to Orchard House a place of safety, in order for him to be sedated there and thereafter on or about 12^th May that he be conveyed to Brockfield House Hospital in the way described by Mr Swain in his evidence by way of email, which indicates that the defendant will be conveyed to the United Kingdom by private plane attended by prison officers, mental health nurses and a doctor and thereafter we understand met by Brockfield House staff who will take him to that unit.

21.      We also note that the duration of this order in the first instance pursuant to Article 62(4) of the Law may be for no more than 28 days at which stage it will need to be reviewed. 

Authorities

Mental Health (Jersey) Law 2016