R(P) v Secretary of State for Justice
| Jurisdiction | England & Wales |
| Judge | MR JUSTICE MITTING |
| Judgment Date | 30 June 2008 |
| Neutral Citation | [2008] EWHC 1656 (Admin) |
| Court | Queen's Bench Division (Administrative Court) |
| Date | 30 June 2008 |
| Docket Number | CO/4303/2008 |
[2008] EWHC 1656 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Royal Courts of Justice
The Str and
London
WC2A 2LL
Mr Justice Mitting
CO/4303/2008
Mr Ian Wise (instructed by The Howard League for Penal Reform,
London N1 4HS) appeared on behalf of the Claimant
Mrs W Outhwaite (instructed by the Treasury Solicitor)
appeared on behalf of The Defendant
J U D G M E N T
( As Approved)
Monday 30 June 2008
The claimant has just turned 21. He has had a life of astonishing disadvantage. He was born to a mother who was a drug addict. He asserts (although on what basis it is not wholly clear) that when aged only eleven months he was injected with heroin by his mother. He also asserts that when aged 14 or 15, his natural father injected him with heroin too. Whatever the origin of his intermittent drug dependency has been, it has undoubtedly existed since his very early teens. Indeed there is evidence that he started to use cannabis when he was 9 and crack cocaine and heroin in his early teens.
Unsurprisingly, given that background, the claimant has been in repeated trouble with the criminal law. He was first convicted when aged 13 of theft. When aged 14 he had four appearances in courts for criminal damage and vehicle interference. By the age of 15 he had begun to commit more serious offences, including burglary and handling, and to receive short detention and training orders. By the time he was 17 the sentences became detention in a young offender institution. In August 2005, aged 18, he received a sentence of two years' detention for a series of offences, including aggravated vehicle taking. He told Professor Coid, Consultant Psychiatrist, in October 2006 that, since he was first sent to detention aged 15, the longest period he had been out of custody was nine months.
The claimant's offending resulted in his detention in an ordinary detention centre, but when serving the sentence imposed for the offences committed in 2005 it was realised that he had personality problems of a very severe kind which were capable of being categorised as psychopathic disorder. That was Professor Coid's conclusion in October 2006. It was also noted that whilst at the detention centre he was repeatedly causing harm to himself.
However, by then end of 2006 and the beginning of 2007 there was no agreement between the psychiatrists as to diagnosis or treatment. At that time it was thought, almost certainly correctly, that if he were to receive treatment in a psychiatric hospital it would be in Wales. Accordingly, he was examined by Dr Tegwyn Williams who prepared a report dated 23 January 2007. Dr Williams was the Director of Mental Health Services for the relevant NHS Trust which covered South Wales. His view was that, although he had antisocial and borderline personality traits, the claimant was not suffering from psychiatric disorder. He also was of the view that there was no evidence that he would benefit from hospital treatment and did not accept that any improvement would thereby result. Accordingly, as at 23 January 2007 the statutory grounds for a transfer under section 47 of the Mental Health Act 1983 to a mental hospital in Wales did not exist.
On 25 January 2007 the claimant was released on licence. On 24 February 2007, having befriended a man called Weaver, the claimant visited his home in the early hours of the morning in possession of a knife. He ordered Weaver to wrap brown parcel tape around his ankles and ordered him to sit on a chair where his arms were pulled behind his back and his hands taped, using parcel tape. The claimant then wrapped lighting cable across his stomach and arms so as to prevent Weaver from moving. He then pushed a cloth into his mouth and tied a “lead” around him and around the back of his head. The motive was robbery. He demanded that Weaver say where his sister kept money in a bedroom in the house. In the event all he took was a bracelet.
On 28 February 2007, having taken a Ford Escort motor car, he drove along the M4 motorway at speeds estimated at 110 to 115mph. He attempted to crash into the nearside of a marked police car. He was arrested and was charged with appropriate offences. On 4 July 2007 he pleaded guilty to dangerous driving and false imprisonment.
Since 2 March 2007 he has been remanded in custody at Feltham Young Offender Institution. While there he has repeatedly harmed himself in an extreme way. The means of self-harm include inserting sharp objects into his urethra, some of which have found their way into his bladder; inserting sharp objects into his abdomen; rubbing excreta into surgical wounds; and severing the tendons of both feet, as well as less extreme means of harming himself. Unsurprisingly, as a result of these repeated acts of self-harm he has been admitted on a number of occasions to ordinary hospitals for appropriate emergency medical treatment.
In harming himself in this way, the claimant has without doubt put his long-term survival at grave risk. The potential consequences have been bleakly stated by Dr Bell, a Consultant in Intensive Care and Anaesthesia at Leeds General Infirmary, who prepared a report upon him at the request of the Howard League for Penal Reform dated April 2008, in which he says:
“9.2 His current injuries and their sequelae place him at risk of renal failure due to obstruction of the urinary tract and at constant risk of life-threatening infection from necrotizing fasciitis, urinary tract sepsis, bacterial endocarditis and deep-seated pelvic infection. The risk of these complications is enhanced not only with each new additional injury but also by the multiple retained foreign bodies within the tissues which create susceptibility to colonisation by bacteria and subsequent infection from any distant source of sepsis carried around the body by circulation.
9.3 It is noted that optimal future management of severe infection will be compromised because of penicillin allergy, because certain investigations such as magnetic resonance imaging [MRI scanning] will not be possible due to retained metal components within the body, or because surgical treatment options will no longer be feasible because of progression of his injuries, as referenced in communication from the attendant urology team.
9.4 He is also currently at risk of losing limbs through refractory infection and the use of his penis for normal urination and sexual function.
9.5 Matthew's life is also in jeopardy from exsanguination with either intentional or accidental arterial damage during further self-harm.
9.6 This pattern of self injury will predictably induce a state of chronic ill-health within a short time-frame and leave Matthew more vulnerable to the above complications of his injuries. The cycle will then become self-fuelling, inevitably culminating from one complication or another in Matthew's death.”
Dr Bell spoke of the need to place the claimant in a hospital environment but noted that the optimal management of his condition which might then be possible “depends very much on Matthew's compliance with advice and cares, which is predictably dependant upon resolving a longer term package of care, and provision of appropriate psychiatric and psychological support whilst within any conventional hospital setting”.
The diagnosis of the claimant's underlying psychiatric condition has remained substantially unchanged. In a report dated 8 November 2007, Professor Coid repeated his diagnosis of antisocial and borderline personality disorder with features suggestive of attention deficit hyperactivity disorder continuing into adulthood such that his condition amounts to mental illness and psychopathic disorder within the meaning of the 1983 Act. Professor Coid recommended that the Secretary of State should exercise his powers to transfer the claimant to a psychiatric hospital under section 48 of the 1983 Act.
By 1 April 2008 Dr Williams had provisionally relaxed his view about the claimant's condition and the prospects of treatment. In a letter of that date he stated that he felt that a trial of treatment would be worth considering, but raised the query about whether or not the claimant was in fact a patient for whom his primary care trust was responsible. That query was well-founded. Although the claimant had been born in South Wales and had spent much of his life there, on his release in January 2007 he had registered with a medical practice in Worthing within the geographical responsibility of the Sussex National Health Service Trust.
That Trust took a little time to establish for its own purposes the psychiatric diagnosis and the availability of facilities within its area. By 27 May 2008, when a report from Dr Richard Noon, a Consultant Forensic Psychiatrist, was obtained, he and the Trust accepted that the claimant suffered from a severely abnormal personality and reached a high diagnostic threshold for specific personality disorder types which suggested that he “may reach a threshold for psychopathic disorder classification” and “he could be classed as suffering from a psychopathic disorder within the meaning of the Mental Health Act 1983”. Accordingly, and against the background of the known frequency and severity of self-harm, Dr Noon concluded, and the Trust accepted, that it would be appropriate to admit the claimant for a period of in-patient assessment under section 28 of the Mental Health Act 1983. That section permits admission on an interim basis for the purpose of assessment for periods totalling at most twelve months.
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