SL v Ludlow Street Healthcare
| Jurisdiction | UK Non-devolved |
| Judge | UTJ Jacobs |
| Judgment Date | 16 July 2015 |
| Neutral Citation | [2015] UKUT 398 (AAC) |
| Court | Upper Tribunal (Administrative Appeals Chamber) |
| Docket Number | HMW/0615/2015 |
| Date | 16 July 2015 |
Neutral Citation: [2015] UKUT 0398 (AAC)
Court and Reference: Upper Tribunal (AAC),
Judge: UTJ Jacobs
HMW/0615/2015
Issue: Whether there was sufficient treatment in hospital to justify ongoing detention under s3 Mental Health Act 1983.
Facts: SL had a lengthy engagement with psychiatric services; he had a mild learning disability and hyperkinetic disorder, which was associated with seriously irresponsible conduct. He had been placed under s3 Mental Health Act 1983 in January 2010; as was the normal course of events, his condition improved and he was allowed leave and then placed on a Community Treatment Order in April 2012. After a deterioration, he was placed on s3 again in January 2014 but soon allowed outside to live outside hospital on s17 leave in accommodation where he received 1:1 support and rehabilitation; he attended the hospital fortnightly for psychology sessions and monthly for review at the ward round. In September 2014, he made an application to a Tribunal, seeking discharge or a recommendation that he be placed on a CTO. The Tribunal found that the nature of SL's disorder was such as to make the s3 order appropriate as there was care that prevented conduct escalating and boundaries that prevented disengagement from the care process; that this was necessary for his own safety in light of his vulnerability to exploitation and retaliation for his impulsive conduct; and that there was still significant treatment in hospital and so he should remain liable to detention in hospital under s3. It did not recommend a CTO because the clinical team was working towards such an outcome. SL appealed on the basis that there was insufficient in-patient treatment for a s3 order to be lawful.
Save for the cover sheet, this decision may be made public (r14(7) of the Tribunal Procedure (Upper Tribunal) Rules 2008 (SI No 2698)). That sheet is not formally part of the decision and identifies the patient by name.
This decision is given under s11 of the Tribunals, Courts and Enforcement Act 2007:
The decision of the Welsh tribunal dated 18 November 2014 did not involve the making of an error on a point of law.
1. The issue that arises in this case is this: when will a patient who is living and receiving treatment outside hospital, remain liable to be detained in a hospital for treatment?
2. The patient has diagnoses of mild learning disability and hyperkinetic disorder, associated with seriously irresponsible conduct. He was born in 1975. He has been involved with mental health services for the last 20 years, half his life. At the time of the hearing before the Welsh tribunal, he was liable to be detained under s3 of the Mental Health Act 1983, but was living away from hospital pursuant to leave under s17. His history showed a cyclical pattern: he would improve and be given greater freedom, only to become resistant to the support he was receiving and want more independence. Picking up his history in January 2010, he was detained under s3. He improved to the point where he was allowed leave under s17. By August 2011, he was allowed to live outside the hospital and in April 2012 became subject to a community treatment order. Following deterioration, he was again detained under s3 in January 2014, but was in due course allowed to live outside the hospital under s17.
3. By the time of his application to the tribunal, his clinical team considered that he was improving, despite daily abusive outbursts. He received 1:1 support in his accommodation, which is not a hospital. He was allowed both escorted and unescorted leave away from the premises. The latter had caused no problems, although he avoided potential conflicts with authority that can lead to confrontations. He received rehabilitation and care on the premises where he lived. He was required to attend hospital for fortnightly psychology sessions and the monthly ward round. This is but a bare outline of what was involved.
4. The patient applied to the tribunal on 19 September 2014 seeking for a discharge or, failing that, a recommendation for a community treatment order. He was prepared in any event to remain in his present accommodation until a suitable long-term placement could be found.
5. The tribunal accepted that the patient had a mental disorder; this was not in issue. It is manifested by impulsive and aggressive outbursts, which it characterises as seriously irresponsible conduct.
6. As to the nature of the disorder, the tribunal found that the professionals who care for him were able to prevent...
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(1) Cumbria, Northumberland and Tyne & Wear NHS Foundation Trust, (2) Secretary of State for Justice v EG
...to EG could not satisfy the requirements of s72(1)(b)(i); and (c) It was not bound by the decision in SL v Ludlow Street Healthcare[2015] UKUT 398 (AAC), [2015] MHLR 390 which did not address the application of s72(1)(b)(i) in the context of a restricted patient in EG's position. 27. Permis......