R (East London and the City Mental Health NHS Trust) v Mental HealthReview Tribunal (IH as Interested Party)
| Jurisdiction | England & Wales |
| Judgment Date | 26 August 2005 |
| Neutral Citation | [2005] EWHC 2329 (Admin) |
| Date | 26 August 2005 |
| Court | Queen's Bench Division (Administrative Court) |
[2005] EWHC 2329 (Admin)
Collins J
Appearances:V Sachdeva (instructed by Bevan Brittan) for the Claimant; the Defendant did not appear; K Gledhill (instructed by Kaim Todner) for IH.
Whether a discretionary discharge was rational and adequately reasoned.
IH suffered from paranoid schizophrenia; he had a history of assaults and arson, and had been an in-patient under s. 3 Mental Health Act 1983. He had lived in a hostel (Riverside) between 2002 and June 2004, but was readmitted to hospital following an assault on another resident and a nurse who intervened; he displayed psychotic symptoms at the time of this admission. He had absconded from hospital in August 2004 and was returned a week or so later after having been arrested following incidents of demanding money when pretending to have a gun. In June 2005 he was transferred to a medium secure hospital, though the reason for that was not clear; he had been compliant with medication and his condition was gradually improving.
A Mental Health Review Tribunal met on 19 July 2005. The Responsible Medical Officer, Dr H, supported ongoing detention, as did others involved in IH's care. Her plan included ongoing treatment and rehabilitation, leading to a gradual increase of leave, transfer to a less secure hospital and eventual discharge to a hostel. Reports were also provided by an independent psychiatrist and an independent social worker, both of whom supported discharge; there was also evidence from the nurse at Riverside who had been assaulted, who confirmed that IH would be accepted there, and noted that the other patient involved in the assault had moved on. Oral evidence was also given. The Tribunal decided to exercise its discretionary power to grant a discharge, noting that in light of the "excellent support he received and will receive at Riverside, we believe that his detention in conditions of medium security is disproportionate to the risk and is not warranted." Discharge was delayed until 9 August 2005 to allow an aftercare package to be arranged. The health trust responsible for the provision of aftercare challenged the decision, arguing that the Tribunal's reasons were inadequate and that its failure to ensure that a care package was in place meant that the decision was irrational. IH argued that the decision was rational and adequately reasoned.
1. This claim concerns a decision of the relevant Mental Health Review Tribunal to discharge a patient, who is to be called IH, from liability to be detained. The claimants are the Authority responsible for providing aftercare for IH following his discharge. They contend that the decision of the Tribunal was wrong in law. The Tribunal itself does not appear to defend its decision. It was asked to consent to an order quashing that decision but declined to do so. The reasons that it gave are set out in a letter of 22 August in which the Treasury Solicitor says this:
"I can confirm that my client would not, in principle, agree to a consent order that the MHRT's decision of 19 July 2005 be quashed. Firstly, it is clear that the Interested Party [that of course is IH] would not agree to such an order and secondly given that the Interested Party's liberty is at the heart of this matter, he should be allowed an opportunity to defend this claim. As I made clear in my letter to the court dated 19 August, my client is of the opinion that it is a waste of court time and public funds to defend this claim when it is already being defended by the Interested Party. I can also confirm that my client does not possess evidence that may assist the court in determining the claim, had he possessed such evidence it would have been filed on Thursday."
2. IH has been represented and Mr Gledhill has argued that the decision should stand. IH is now 39. He suffers from paranoid schizophrenia. He believes that he is the Messiah. The illness commenced to show itself in 1992 when he left home and went to live on the streets. He assaulted a verger in a church and in 1993 he stabbed his brother with a bread knife in the belief that God had required him to do so. When charged with grievous bodily harm, he was found not guilty by reason of insanity. But due, I was told, to the failure of the Home Office to process the necessary paperwork, he was not committed to hospital in pursuance of the court order. He was, however, detained in due course under s. 3 of the Mental Health Act 1983 until 1996. He was then discharged into the community and remained with no apparent problems until 1999, when he committed a serious offence of arson.
3. The circumstances appear to have been that he emptied his own flat of personal belongings and furniture and started a fire with rubbish collected outside. He expressed the intention of killing everybody in the hostel because he considered they were all sinful. For reasons of which I was not informed, he was not prosecuted but was committed again under s. 3 of the Mental Health Act. He remained in hospital until he was discharged in 2002 to a hostel, the Riverside Hostel. Again, it seems that all went reasonably well for some 2 years, but on 22 June of 2004 he committed a serious assault on a fellow resident. There was much evidence called before the Mental Health Review Tribunal about that assault. It was clear that he was provoked and had been bullied by the other resident whom he assaulted. The violence shown was undoubtedly excessive and he expressed a desire to kill his victim because he regarded him as the anti-Christ. It seems that he also assaulted a nurse who intervened in order to try to pull him away from the victim.
4. He was admitted to hospital as a result of this and displayed, at that stage, psychotic symptoms. The report of the nurse who was in charge of him when he was admitted to hospital records that he initially appeared suspicious, guarded, unwilling to discuss the assault incident and that other patients were sinners not worthy of him. He refused to sit or eat with them and he was displaying psychotic symptoms expressing bizarre grandiose religious ideation.
5. In July, he indicated that God had sent a message of deliverance to him but God had disappointed him during the past 15 years and he was anxious that God might disappoint him on his birthday, which was the following day, 16 July. A month later, in August, he was granted an escorted walk within the hospital grounds...
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