WH v Llanarth Court Hospital (Partnerships in Care) [2015] UKUT 0695 (AAC)
| Jurisdiction | UK Non-devolved |
| Judge | HHJ Knowles |
| Judgment Date | 21 December 2015 |
| Neutral Citation | [2015] UKUT 695 (AAC) |
| Docket Number | HMW/1678/2015 |
| Court | Upper Tribunal (Administrative Appeals Chamber) |
| Date | 21 December 2015 |
Neutral Citation: [2015] UKUT 0695 (AAC)
Court and Reference: Upper Tribunal (AAC)
Judge: HHJ Knowles QC
HMW/1678/2015
Issues: Whether a Tribunal decision should be quashed on the basis that the appropriate treatment test was not met; which hospital had to be considered for the purposes of that test; the adequacy of the Tribunal's reasons.
Facts: WH had been admitted to hospital on several occasions; he had numerous criminal convictions and had made various suicide attempts; his diagnosis was of dissocial personality disorder. He had been in Llanarth Court Hospital since 2007, detained as though an order under s37 Mental Health Act 1983 had been made. At a hearing before the Mental Health Review Tribunal for Wales on 12 February 2015, the Responsible Clinician noted that no treatment offered at Llanarth Court or other locations going back to 1995 had been successful; and that nothing else was available in the hospital, a separate rehabilitation hospital, Aderyn, or the community. He supported transfer to another hospital, not yet identified. Two social work reports confirmed that WH could not be managed in the community in light of the risk he posed to himself and others and the lack of suitable input such as an Assertive Outreach Team, which was not available in his home area. The Tribunal concluded that the test for detention was made out, including that appropriate treatment was available at Aderyn, to which hospital WH said he was willing to go, without which treatment he would disengage and deteriorate. WH appealed, contending that the Tribunal erred in finding that appropriate treatment was available; erred in various other findings, including that psychological training could be reinstated if WH was more cooperative; and gave inadequate reasons. Before the appeal was heard, WH was transferred to a high secure hospital.
Save for the cover sheet, this decision may be made public [r14(7) of the Tribunal Procedure (Upper Tribunal) Rules 2008]. That sheet is not formally part of this decision and identifies the patient by name.
This decision is given under ss12(2)(a), 12(2)(b)(i) and 12(3) of the Tribunals, Courts and Enforcement Act 2007.
The decision of the Mental Health Review Tribunal for Wales [the tribunal] on 12 February 2015 involved the making of an error on a point of law and that decision is set aside. The matter is remitted to the Mental Health Review Tribunal for Wales for rehearing before a differently constituted tribunal.
I invite the tribunal to consider using its powers to transfer this case to the First-tier Tribunal (Mental Health) of the Health, Education and Social Care Chamber as the patient is presently detained in hospital in England.
In advance of the rehearing, updated reports from the patient's Responsible Clinician, the nursing staff and the patient's care co-ordinator are to be obtained. The new tribunal must consider all aspects of the case, both fact and law, afresh and in accordance with the guidance set out in this decision.
1. The issue in this appeal was whether the appropriate treatment test in s72(1)(b)(iia) of the Mental Health Act 1983 [the Act] was satisfied with respect to this patient at the time of his tribunal hearing on 12 February 2015. The patient was detained in hospital pursuant to a notional s37 of the Act and had been so detained in the same hospital since 28 December 2007.
2. I consider the content of reports to the Mental Health Review Tribunal in Wales and suggest that the Practice Direction dated 28 October 2013 issued by the Senior President of Tribunals entitled First-tier Tribunal: Health Education and Social Care Chamber: Statements and Reports in Mental Health Cases should be adopted by the Mental Health Review Tribunal for Wales. I allow the appeal for inadequacy of reasoning and because the tribunal materially erred in law by finding that the appropriate treatment test was satisfied by treatment at a hospital other than the one in which the patient was detained. I reject the patient's submission that, on the evidence available to it about the availability of appropriate treatment, the only course was for the tribunal to discharge the patient.
3. I allow the appeal and set aside the tribunal's decision. I remit the case for rehearing to the Mental Health Review Tribunal for Wales and invite it to consider transferring the case to the First-tier Tribunal (Health, Education and Social Care Chamber) as the patient is now detained in a hospital in England.
4. The patient has a diagnosis of dissocial personality disorder and has a long history of involvement with psychiatric services including a number of compulsory admissions to hospital under the Act. He had a substantial forensic history with 34 convictions for offences including theft, robbery, and assault and a long history of drug misuse. Whilst in the community, the patient was non-compliant with psychiatric services and made several attempts on his own life.
5. Since 28 December 2007, the patient had been detained in Llanarth Court Hospital under a notional s37 order. A tribunal on 14 March 2014 refused to discharge the patient in circumstances where he disputed that appropriate treatment was available to him in hospital.
6. The issue of appropriate treatment was once more central to the patient's case for discharge before the tribunal on 12 February 2015. The tribunal had lengthy reports from the patient's Responsible Clinician [RC] and from 2 social workers but no report from any nursing staff. The RC's report concluded that the patient had not benefited from psychiatric treatment, noting that (a) he had been in this hospital since 2007 and (b) that attempts to treat him had been made in a variety of settings since 1995. Various treatments had been tried but the patient had not improved. The RC stated that the patient did not wish to have further treatment and that the hospital had no treatment to offer him [p67]. The RC recommended transfer to another hospital as soon as possible as there is nothing further that can be offered at Llanarth Court but it is not possible to discharge him because a community package cannot be formulated to meet his needs. It may be that another clinical team at another hospital would have other ideas for his treatment and rehabilitation [p67]. Both social work reports were absolutely clear that the patient could not be managed in the community where he would be a risk to himself and to others. Neither of those 2 reports supported discharge from compulsory detention in hospital.
7. At the tribunal hearing the RC was clear that there was no appropriate treatment available for the patient either at Llanarth Court or at Aderyn, a rehabilitation hospital run by Llanarth Court but separate from it. A variety of treatments had been tried but nothing had worked. The ward environment was unsuitable and the RC stated that it could be argued that keeping the patient in hospital was detrimental to his mental state. He confirmed that the 2 other units to which the patient had been referred had both concluded that (a) there was no appropriate treatment available for the patient in hospital and (b) he ought to be discharged into the community. When asked about the options available, the RC confirmed that he would prefer the patient either to be discharged or moved to another hospital such as Aderyn. He stated that it would be irresponsible to discharge the patient into the community without a supportive after-care plan.
8. The nurse who gave evidence did not know the patient well but described the patient's fluctuating mental state and said he might manage in the community with a robust care package. The social worker said that, if discharged, there was nowhere for the patient to go. She thought he would be a good candidate for an Assertive Outreach Team but such a team was not available in his home area. She explained that a bespoke package in the community had been explored. Nothing had come of this as the patient had not moved from a medium secure setting to a low secure setting thereby demonstrating that he could/would co-operate with services in the community.
9. The patient told the tribunal that he would be willing to go to Aderyn and that medication had definitely helped him.
10. Through his solicitor, the patient sought discharge from hospital and the tribunal was referred to copies...
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