Noel Ruddle v Secretary of State for Scotland
| Jurisdiction | England & Wales |
| Judgment Date | 02 August 1999 |
| Date | 02 August 1999 |
| Court | Queen's Bench Division (Administrative Court) |
Court:Lanark Sheriff's Court
Sheriff JD Allan
GC Bell QC and SG Collins (instructed by Ms McKenna) for R; RA McCreadie (instructed by Ms Lyons) for the Secretary of State.
Whether a patient with a personality disorder should be discharged on the basis that he was not treatable; whether containment in a structured environment together with nursing care amounted to treatment.
R, who had a previous psychiatric history, and had for some time had a substantial problem of alcohol and drug abuse, had purchased a rifle in a public house, and used it to shoot a known drug dealer who visited his flat, and then began to shoot randomly from his balcony; he was arrested after a police siege. He was charged with various offences arising out of the incident and entered a guilty plea to offences of culpable homicide (on grounds of diminished responsibility) and various lesser offences. On the basis of medical evidence available to the court, he was made the subject of a Hospital Order under s. 175 Criminal Procedure (Scotland) Act 1975 (now s. 58 Criminal Procedure (Scotland) Act 1995; and the equivalent of s. 37 Mental Health Act 1983 in England and Wales) specifying the State Hospital (the Scottish equivalent of the Special Hospitals in England) as the place of detention; the court also made a Restriction Order without limit of time under s. 178 of the Act of 1975 (now s. 59 of the Act of 1995 and the equivalent of s. 41 Mental Health Act 1983). He was diagnosed as suffering from a mental disorder, namely paranoid schizophrenia.
His psychotic symptoms soon resolved, and the mental disorder from which he was diagnosed as suffering was changed to anti-social personality disorder. Various psychological interventions requested by his treating psychiatrist were not carried out. Doubts were raised as to whether R's disorder was "treatable" - ie whether what was offered alleviated or prevented a deterioration in his condition. He appealed to the sheriff to discharge him from detention under s. 64 Mental Health (Scotland) Act 1984 (the statutory equivalent of an application to a Mental Health Review Tribunal for discharge under s. 73 Mental Health Act 1983).
The Sheriff, having resumed consideration of the cause, and being satisfied that the applicant is not at the time of the hearing of this appeal suffering from mental disorder of a nature or degree which makes it appropriate for him to be liable to be detained in a hospital for medical treatment, Directs the absolute discharge of the applicant as from this date.
Finding:
1. The applicant, Noel Gerard Ruddle, who was born on 16 December 1954, is presently a patient in the State Hospital, Carstairs.
2. Case Records
2.1 The bulk of the medical, forensic, personal and family history of the applicant as set out in his State Hospital Medical Records has been obtained from him at interview since admission to the State Hospital.
2.2 Exceptions to this include, inter alia, (i) reports concerning his contact with English psychiatric services in Epsom in 1982 and 1989; (ii) information obtained from his family by Lisa Osborne, Social Worker, at the time of the index offences; and (iii) his record of previous convictions in Scotland.
2.3 There are discrepancies in the accounts which he has given since admission relating to a number of aspects of his personal and forensic history.
2.4 The likelihood is, however, that it will not now be possible to obtain further or additional, corroborative information to shed light on these discrepancies, since the applicant has had little contact with any of his family in the years leading up to admission, and also since he no longer has any contact with his girlfriend of the period 1985 to 1990.
2.5 There is also little likelihood of obtaining further information now surrounding the index offences of 30 November 1991 which was not available to the authorities at that time and could not have been obtained by State Hospital staff soon afterwards.
2.6 There is sufficient information presently available to enable diagnosis to be made of (i) the nature and degree of his mental disorder; (ii) whether that disorder is treatable, ie whether medical treatment in a hospital is likely to alleviate or prevent a deterioration of his condition, and (iii) whether it is necessary in the interests of the health and safety of the patient or for the protection of others that he receive such treatment. Although it is good practice to attempt to obtain more information, as a matter of practicality, decisions have to be made and patients have to be treated. Additional information is not likely to lead to any change in the diagnosis or the expectation that treatment would help the applicant.
3. Personal and Family History
3.1 It appears that the applicant was born in London and brought up in Epsom, Surrey; he has an elder sister and a younger brother; his parents were both psychiatric nurses; his mother is retired and lives in Epsom and his father died of cancer in 1991; he continues to have telephone contact with his mother and written contact with his brother and sister.
3.2 The applicant is of above average intelligence; he probably left school at the age of 16 years, worked for a period, and then returned to full-time education; having obtained two 'A' levels he spent some years doing clerical work followed by a few years travelling around France and Spain, during which time he began to misuse a variety of illicit drugs.
3.3 The applicant appears not to have been in full-time employment since at least 1986, and he seems to have been unable to maintain stable employment over a substantial period of time.
3.4 It appears that in 1985, the applicant met Jane Livingston with whom he moved to Scotland, initially living in the Isle of Bute and then in Glasgow. She is said to have become depressed at her failure to conceive between 1986 and 1990 and took an overdose of medication, resulting in hospitalisation. She left the applicant about February 1990 due to fear of his violent behaviour and ongoing alcohol abuse. They have had no contact since then.
4. Admission History
4.1 Having appeared at Glasgow Sheriff Court on charges of murder, attempted murder, reckless discharge of a rifle to the danger of life and various Firearms Act matters, arising out of events of 30 November 1991, the applicant was admitted to the State Hospital on 10 December 1991 in terms of s. 25 of the Criminal Procedure (Scotland) Act 1975 in the light of the psychiatric reports prepared by Dr JA Baird and Dr R Antebi.
4.2 On 24 January 1992, Dr Baird reported that, after very thorough clinical assessment, no evidence had been found of a detainable mental illness.
4.3 In a second, supplementary psychiatric report, Dr Baird felt unable to offer any firm opinion as to why the mental state of the applicant had deteriorated at around 24 February 1992.
4.4 In a third, supplementary psychiatric report around 11 March 1992, Dr Baird by then considered that the applicant was suffering from a detainable mental illness and was of diminished responsibility; and this view was shared by Dr Martin Humphries on 18 March 1992.
4.5 On 20 March 1992, in respect of the 30 November 1991 charges, the applicant pled guilty at Glasgow High Court to 3 contraventions of the Firearms Act 1968, 2 charges of assault to danger of life, one charge of culpable and reckless discharge of a rifle to the danger of life, and a charge of culpable homicide.
4.6 The Court, having heard evidence from Dr Baird and Dr Humphries, and being satisfied that the applicant was suffering from a mental disorder within the meaning of the Mental Health (Scotland) Act 1984(hereinafter referred to as "the 1984 Act"), made a Hospital Order under s. 175 of the Criminal Procedure (Scotland) Act 1975 (now s. 58 of the Criminal Procedure (Scotland) Act 1995)specifying the State Hospital as the place of detention, and also made an Order restricting the discharge of the applicant from hospital without limit of time, all in terms of s. 178 of the said Act of 1975 (now s. 59 of the said Act of 1995).
4.7 The mental disorder from which the applicant was diagnosed as suffering was the psychotic disorder of paranoid schizophrenia. Personality disorder was not the basis of the recommendation for the Hospital Order.
4.8 The applicant has been continuously detained in the State Hospital since 20 March 1992, where he is presently detained in Forth Ward.
5. Psychiatric History Prior to 1992
5.1 The applicant describes a history of aggressive outbursts, depression and feelings of fear and anxiety since adolescence.
5.2 He was seen as an out-patient in Epsom in September 1982 following referral by his general practitioner because of anxiety and depression. He indicated that he coped with his problems by drinking alcohol, although he showed no evidence of alcohol addiction. He sought admission but this was not thought appropriate, as he was considered by the assessing doctor to suffer principally from a personality disorder of the psychopathic type and not from a psychosis.
5.3 He was admitted to hospital at Epsom on 3 October 1982 after an overdose of fluanxol and anti- depressant and in the context of drinking half a bottle of spirits daily, and arguments with his parents and siblings. He admitted at this time to a long-standing drink problem and to having taken cannabis, heroin and LSD. The discharge diagnosis was of a psychopathic personality disorder. There seemed to be no evidence of psychotic illness or significant depression of mood at this time.
5.4 He was admitted to hospital on 10 October 1989 complaining of withdrawal from temgesic, DF118 and diamorphine, which he claimed to have been taking for 3 months because of "depression". He also claimed to have been drinking a bottle of spirits and 5 pints of beer each day. He was again diagnosed as suffering from a personality...
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