R (HP and KP) and London Borough of ISLINGTON
| Jurisdiction | England & Wales |
| Judge | Mr Justice Munby |
| Judgment Date | 08 January 2004 |
| Neutral Citation | [2004] EWHC 7 (Admin) |
| Docket Number | Case No: CO/1382/2003 |
| Court | Queen's Bench Division (Administrative Court) |
| Date | 08 January 2004 |
[2004] EWHC 7 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEENS BENCH DIVISION
ADMINISTRATIVE COURT
Royal Courts of Justice
Strand, London, WC2A 2LL
THE HONOURABLE MR JUSTICE MUNBY
Case No: CO/1382/2003
Mr Bryan McGuire (instructed by the Director of Law & Public Services) for the local authority
Ms Kate Markus (instructed by Bindman & Partners) for the claimants
The P family commenced judicial proceedings against the local authority ("Islington") on 12 March 2003 alleging breaches by Islington of its duties under section 47 of the National Health Service and Community Care Act 1990. Their application for permission was adjourned into court by Davis J on 13 March 2003 and came on for hearing before me on 26 March 2003 and again on 30 April 2003, 24 June 2003 and 23 July 2003. On the latter occasion I gave the claimants permission to apply on the basis of an amended claim form. By the time the substantive hearing began before me on 15 December 2003 all issues save one had been resolved. The one remaining issue relates to the adequacy of the community care assessment of Mr P prepared by Islington and dated 18 March 2003.
Before proceeding any further it is convenient to draw attention to the distinction between two different types of assessment: one a Care Programme Approach ("CPA") assessment relating to the care in the community of those with mental health problems, the other a generic Community Care assessment relating to the provision of community care for those who do not fall within the ambit of the CPA. I should also refer at this point to Islington's published 'Mental Health Assessment Priorities & Entitlement Criteria' policy. Appropriately this policy distinguishes between, although it provides procedures for co-ordinating the preparation of, CPA assessments and Community Care assessments. Thus it states that:
"For community Care Assessments a judgement must be made about the level of need, Higher, Medium or Lower. These do not necessarily relate to the CPA levels."
A diagram illustrates how, if there are severe and enduring mental health needs, it will be the adult mental services which will be responsible for future care, whilst otherwise the responsibility will be that of generic health or social services. Eligibility for Community Mental Health Team services is dealt with as follows:
"CMHTs must concentrate on working with people with severe and enduring MH problems …
1 Clients diagnosed as suffering from Schizophrenia, Manic Depressive Illness or any other persistent Psychotic Illness unless a high degree of stability has been achieved with their symptoms …
2 Depressive Illness, Anxiety Disorders and Obsessive Compulsive Disorders where the risk of self-harm or harm to others has been sufficiently serious to consider a hospital admission within the past two years.
3 …"
No challenge of any kind is made to the lawfulness or propriety of this policy.
The background is complex but I can summarise it comparatively briefly. The P family are Albanian asylum-seekers from Kosovo. They seem to have suffered gravely in Kosovo: their 6-year old son was shot dead by Serbian troops, another son A (who is now 18 years old) was tortured by Serbian troops. They arrived in this country in February 2001 where they were reunited with another son, B, who had already been granted asylum. The accommodation they obtained here was sub-standard: Islington described the conditions as squalid. The many accounts of Mr P's presentation since February 2002 (when the present story begins) show a picture of someone who, putting the point in layman's terms, appears in many respects to be sunk in depression and misery and almost to have lost the will to live. Certainly all the evidence suggests that without the constant assistance of his family, and in particularly of his son B, Mr P will not get out of bed, attend to his personal hygiene or take his medication. He does not initiate any activity and appears not to participate in family life. The evidence suggests that, hardly surprisingly, he has been deeply affected by the killing of his small boy and by the other traumas his family suffered in Kosovo. Prior to all that he had apparently been quite normal, albeit not functioning to a high level, and had worked and been able to support his wife and family.
There have been concerns about Mr P's mental health since at least February 2002, when his GP reported on his physical and mental health. His condition has been monitored and assessed from time to time by a wide range of social work and mental health professionals. I need not go through the evidence in detail, save to record that the many documents I have been taken through record that he was seen on 4 April 2002 by a community mental health nurse and thereafter on a number of occasions by the Crisis Resolution Team. The visit on 4 April 2002 is recorded as follows in a report dated 5 April 2002:
"He was generally unwilling to be interviewed and much of the history therefore, was from the wife and son. Mr P had expressed his concern that he was not happy to be seen by a Doctor, because he believed he was going to be killed. He however volunteered a history of hearing voices, which he did not elaborate upon, before deciding he was not interested in being interviewed …
He sat on the bed with his head down most of the time. He had poor eye contact and [was] generally uncooperative and unwilling to be interviewed. He believed we had come to kill him. He was tearful when discussing his six-year son who was killed in Kosovo. His speech was retarded and he was depressed and irritable in his mood, but not suicidal. He had persecutory delusions as previously mentioned. It was impracticable to elicit any abnormality in his perception, or cognition, in view of his lack of co-operation he seems to have poor insight into his condition.
The impression is that he has presented with symptoms suggestive of a depressive episode, with psychotic symptoms, with a background of chronic grief reaction and unpleasant life experiences in Kosovo. It may well be that he has had symptoms suggestive of Post Traumatic Stress Disorder in addition."
On 31 July 2002 he was seen by a community psychiatric nurse and an approved mental health social worker who formed the view that he was psychotic and that a formal mental health assessment by a consultant psychiatrist was necessary. He was examined at home on 6 August 2002 by Dr McK, a consultant psychiatrist, who was accompanied by Mr P's social worker, JP. Dr McK reported as follows on 12 August 2002:
"Mr P speaks no English and it was necessary to work with an interpreter. Mr P was unwilling to answer questions other than to say he was all right. According to his family he has always been "slow" and apparently never functioned at a very high level. He had occasional, casual labouring jobs whilst living in Kosovo and only ever had 2 years formal education and is unable to read a newspaper. However, his family felt that his condition had deteriorated since coming to the UK and following the death of one of his sons in Kosovo. He had appeared low in mood and forgetful. However, on questioning, there appears to be no suicidal ideation and no psychotic symptoms.
My assessment was that he was suffering from reactive depression and possible the early stages of dementia, although this was very hard to assess properly in the circumstances. As noted above, it would appear at best that he has only a fairly low level of function. His family were of the view that the housing situation exacerbated his condition and we will obviously do what we can to help with this, although in view of his current indeterminate immigration status, there may not be a great deal that can be done in the short term. I note he is currently on Paroxetine 40mgs daily and Amisulpride 200mgs mane, 400 mgs nocte. I would recommend continuing with the Paroxetine but the Amisulpride should be tailed off over the next few months."
The same day (12 August 2002) Islington wrote to Mr P's solicitors, Bindman & Partners ("B&P"), saying that it had been concluded that Mr P "is not sectionable under the Mental Health Act 1983" and that the social worker – JP – would be returning to see Mr P to complete a comprehensive assessment of him. In the event JP made further visits to Mr P on 21 August 2002, xx September 2002, 30 October 2002, 19 November 2002 and 14 December 2002. Her notes record little observed change in Mr P's attitude and behaviour.
A draft 'Health & Social Care Assessment' of Mr P was prepared – when precisely is not clear – and sent by Islington to B&P on 21 January 2003.
On 18 March 2003 Mr P was visited by Dr B, Dr McK's specialist registrar. Her report, contained in a letter the same day, contains the following:
"I completed a home visit with Jackie Social Worker, a translator and Mr P's social worker. I visited Mr P at home with his wife and found him resting in bed upstairs. Initially Mr P did not respond to any questions at all and lay on his side staring at the wall. Most of the initial history was taken from his wife who was still also lying on the bed but was not asleep. His wife mentioned that her husband had always been "slow" and had never functioned cognitively at a high level.
She described how Mr P had been taking his medication but she had been giving her husband Paroxetine 60 mgs a day and Amisulpride 200 mgs once a day for the last year. He had been compliant with this and an improvement in his medical symptoms of aggression, suicidal thoughts and paranoid ideation...
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