|Judgments - Regina v. East London and the City Mental Health NHS Trust and another (Respondents) ex parte von Brandenburg (aka Hanley) (FC) (Appellant)
HOUSE OF LORDS
OF THE LORDS OF APPEAL
FOR JUDGMENT IN THE CAUSE
Regina v. East London and the City Mental Health NHS Trust and another (Respondents) ex parte von Brandenburg
(aka Hanley) (FC) (Appellant)
THURSDAY 13 NOVEMBER 2003
The Appellate Committee comprised:
Lord Bingham of Cornhill
Lord Hobhouse of Woodborough
Lord Scott of Foscote
Lord Rodger of Earlsferry
LORD BINGHAM OF CORNHILL
The Master of the Rolls, with whom Buxton LJ agreed, gave an affirmative, although qualified, answer to that question. So also did Sedley LJ, although he gave his own, slightly different, reasons. Mr Gordon QC for the appellant contends that a negative answer should have been given, save where the situation in question is one of emergency.
Sedley LJ expressed his conclusions in paragraphs 38-43 of his judgment:
The governing principles
By subsection (3) the tribunal was empowered, as it did in this case, to direct the discharge of a patient on a future date specified in the direction.
(1) The issue at the tribunal is whether the patient, if discharged, might cause harm to himself. The tribunal, on the evidence presented, discounts that possibility and directs the discharge of the patient. After the hearing, the ASW learns of a fact previously unknown to him, the doctors attending the patient and the tribunal: that the patient had at an earlier date made a determined attempt on his life. Having taken medical advice, the ASW judges that this information significantly alters the risk as assessed by the tribunal.
(2) At the tribunal hearing the patient's mental condition is said to have been stabilised by the taking of appropriate medication. The continuing stability of the patient's mental condition is said to depend on his continuing to take that medication. The patient assures the tribunal of his willingness to continue to take medication and, on the basis of that assurance, the tribunal directs the discharge of the patient. Before or after discharge the patient refuses to take the medication or communicates his intention to refuse. Having taken medical advice, the ASW perceives a real risk to the patient or others if the medication is not taken.
(3) After the tribunal hearing, and whether before or after discharge, the patient's mental condition significantly deteriorates so as to present a degree of risk or require treatment or supervision not evident at the hearing.
In cases such as these the ASW may properly apply for the admission of a patient, subject of course to obtaining the required medical support, notwithstanding a tribunal decision directing discharge. The position of the patient's nearest relative, in those cases where he or she makes the application with knowledge of the tribunal decision, does not differ in principle from that of the ASW, although the nearest relative could not in many cases be expected to be familiar with the evidence or appreciate the grounds on which the tribunal had based its decision.
LORD HOBHOUSE OF WOODBOROUGH
LORD SCOTT OF FOSCOTE
LORD RODGER OF EARLSFERRY