Mental Health Act 2001: Themes from Recent Case-Law


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  • Mental Health Act 2001: Themes from Recent Case-Law

    1. 1. <ul><li>Themes from Recent </li></ul><ul><li>Mental Health </li></ul><ul><li>Case-Law </li></ul>Darius Whelan UCC Mental Health Law Conference 26 Feb. 2010
    2. 2. <ul><li>Legal challenges only to be made if in patient’s best interests? </li></ul><ul><li>Voluntary Patients </li></ul><ul><li>Removals to Approved Centres </li></ul><ul><li>Power of Garda </li></ul><ul><li>Lack of interview by independent psychiatrist of responsible psychiatrist </li></ul><ul><li>Burden of Proof </li></ul><ul><li>Appeals to Circuit Court </li></ul><ul><li>Reviews if Order already revoked </li></ul><ul><li>Re-admission soon after discharge by MHT </li></ul>
    3. 3. Mental Health Commission Summary <ul><li>Summary of Judgments delivered by the Superior Courts on the Interpretation of the Mental Health Act 2001 </li></ul><ul><ul><li> </li></ul></ul>
    4. 4. Legal challenges only to be made if in patient’s best interests? <ul><li>The fact that s.17 of the 2001 Act provides for the assignment …of a legal representative for a patient …should not give rise to an assumption that a legal challenge to that patient’s detention is warranted unless the best interests of the patient so demand </li></ul><ul><ul><li>E.H. v Clinical Director of St. Vincent's Hospital (2009) Kearns J. </li></ul></ul>
    5. 5. Voluntary Patients
    6. 6. E.H. v St. Vincent’s (2009) <ul><li>Patient initially admitted on involuntary basis, then remained in centre after involuntary detention ended </li></ul><ul><li>12 days of detention in issue (Dec. 10-22) </li></ul><ul><li>Supreme Court – Patient was “voluntary” within meaning of s.2 of 2001 Act during that period </li></ul><ul><li>Act merely requires that person be receiving care and treatment in the approved centre </li></ul><ul><li>Kearns J.: H.L. v UK not relevant as in that case the patient was voluntary at the outset </li></ul>
    7. 7. M.McN. V Health Service Executive (2009) <ul><li>Very similar to E.H. Case </li></ul><ul><li>Peart J. also emphasised hospital’s duty of care: </li></ul><ul><li>It would be grossly negligent for the hospital to bring patients to front door of hospital and say “off you go” </li></ul><ul><li>Doors could be locked for safety of patients </li></ul><ul><li>H.L. v UK was different as L. had been admitted on voluntary basis at outset </li></ul>
    8. 8. Removals to Approved Centres <ul><li>S.13 </li></ul><ul><li>If applicant unable to arrange person’s removal to approved centre, doctor may request clinical director to arrange for removal by approved centre staff [or by authorised persons] </li></ul><ul><ul><li>Reference to authorised persons added by s.63 Health (Miscellaneous Provisions) Act 2009 </li></ul></ul><ul><li>Known as “assisted admission” </li></ul>
    9. 9. <ul><li>R.L. v St. Brendan’s (2008) Supreme Court </li></ul><ul><ul><li>Application under Art.40.4 of Constitution </li></ul></ul><ul><ul><li>If s.13 had been breached by use of independent contractors, later detention would still be lawful. </li></ul></ul>
    10. 10. <ul><li>E.F. v St. Ita’s (2009) O’Keeffe J. </li></ul><ul><ul><li>Judicial Review </li></ul></ul><ul><ul><li>Judgment 2 years after removal </li></ul></ul><ul><ul><li>Removal was effected by independent contractors – Nationwide Health Solutions Ltd. </li></ul></ul><ul><ul><li>O’Keeffe J. declared that 2001 Act had been breached </li></ul></ul><ul><ul><li>Led to 2009 amendment of Act (see previous slide) </li></ul></ul>
    11. 11. Power of Garda <ul><li>S.12 – Garda may take person into custody if has reasonable grounds for believing person has Mental Disorder and there is serious likelihood of serious harm to self/others </li></ul><ul><ul><li>(Note harm ground only – “need for treatment” ground cannot be used) </li></ul></ul><ul><li>He/she or another Garda must apply forthwith to a doctor for a recommendation </li></ul>
    12. 12. <ul><li>M.Z. v Khattak (2008) Peart J. </li></ul><ul><ul><li>Applicant had been taken into custody by Garda under s.12 but application for admission made by brother </li></ul></ul><ul><ul><li>Held lawful. Application commenced fresh procedure under s.9. </li></ul></ul><ul><li>F.W. v James Connolly Hospital (2008) Hedigan J. </li></ul><ul><ul><li>Detention by Gardaí made on being phoned by psychiatrist </li></ul></ul><ul><ul><li>Held lawful </li></ul></ul>
    13. 13. <ul><li>S.C. v St. Brigid’s (2009) Dunne J. </li></ul><ul><ul><li>Gardaí took applicant into custody under s.12 </li></ul></ul><ul><ul><li>Psychiatrist later detained under “need for treatment” ground rather than “harm ground” </li></ul></ul><ul><ul><li>Detention held lawful. Gardai had reasonable grounds. </li></ul></ul>
    14. 14. Lack of interview by independent psychiatrist of responsible psychiatrist <ul><li>S.17 – Independent psychiatrist must interview responsible consultant psychiatrist (RCP) </li></ul><ul><li>D. v HSE [2009] IEHC 488 </li></ul><ul><ul><li>Independent psychiatrist attempted to telephone psychiatrist at centre but got no answer; he was told that she was ill </li></ul></ul><ul><ul><li>MHT was informed of this but decided that, as it had no doubt as to patient’s mental disorder, detention would be affirmed </li></ul></ul><ul><ul><li>Peart J. - Failure to interview the RCP before submitting report to tribunal was not such as to render report invalid for purpose of s. 17 </li></ul></ul><ul><ul><li>Defect in report is not so fundamental as to invalidate report to extent that the tribunal could not be entitled to have regard to it. </li></ul></ul>
    15. 15. Burden of Proof <ul><li>Act does not deal specifically with question of burden of proof </li></ul><ul><li>Act state s Mental Health Tribunal must be satisfied of certain matters if it is to affirm order </li></ul><ul><li>Arguable s.18 effectively places burden of proof on approved centre to show that patient’s detention is justified. </li></ul><ul><li>If patient presented no evidence, his / her detention could not be continued unless evidence from hospital justifying detention </li></ul><ul><li>However, there will be an independent psychiatrist’s report, and so even if patient chose not to participate, MHT could detain him / her if psychiatrist’s report provided sufficient grounds </li></ul>
    16. 16. <ul><li>English legislation required patients seeking discharge to demonstrate to the tribunal that they did not meet the standard of confinement (s.72(1)(b) MHA ’83) </li></ul><ul><li>English courts held s.72(1)(b) was incompatible with the European Convention </li></ul><ul><ul><li>R v MHRT N & E London ex p H ( 2001 ) </li></ul></ul><ul><li>Mental Health Act 1983 (Remedial) Order 2001: It is for those opposing the discharge to prove, or the tribunal to be satisfied, that the patient is suffering from mental disorder. </li></ul>
    17. 17. <ul><li>On appeal to Circuit Court: Burden of proof on patient – s.19(4) </li></ul><ul><li>Unclear whether this complies with ECHR </li></ul><ul><ul><li>R v MHRT, N. & E. London, ex parte H. (2001) </li></ul></ul><ul><ul><li>Is an appeal stage different from first instance stage? </li></ul></ul><ul><ul><li>Reid v UK (2003) – Appeal courts should comply with Art.5(4) </li></ul></ul><ul><ul><ul><li>See also Toth v Austria (1991); Navarra v France (1994); Rutten v Netherlands (2001) </li></ul></ul></ul>
    18. 18. <ul><li>T.S. v Mental Health Tribunal (2008) O’Keeffe J. </li></ul><ul><ul><li>S.19(4) merely states that appellant must prove his/her case </li></ul></ul><ul><ul><li>However, this interpretation is questionable </li></ul></ul><ul><ul><li>Re ECHR case-law, O’Keeffe J. stated that all cases concerned first instance rather than appeals </li></ul></ul><ul><ul><li>However, once an appeal is available, the proceedings must ensure equality of arms </li></ul></ul>
    19. 19. Appeals to Circuit Court <ul><li>If patient has been released by time of hearing of appeal to Circuit Court, court cannot hear appeal </li></ul><ul><ul><li>Han v President of the Circuit Court (2008), Charleton J. </li></ul></ul><ul><ul><li>Legislative purpose behind s.19 is to allow those patients who are still detained to have the condition of their mental health reviewed before the Circuit Court </li></ul></ul><ul><ul><li>Purpose is not to engage in an historical analysis </li></ul></ul>
    20. 20. Reviews if Order already revoked <ul><li>If patient discharged before MHT hearing, psychiatrist must notify patient of right to continue review (s.28) </li></ul><ul><li>If patient wishes to continue review, he/she must indicate this within 14 days of discharge </li></ul><ul><ul><li>(16 patients did this in 2007) </li></ul></ul><ul><li>Otherwise review will be discontinued </li></ul>
    21. 21. <ul><li>Unclear what purpose of s.28(5) is </li></ul><ul><li>Charleton J., obiter, in Han case: </li></ul><ul><ul><li>Seems to involve historical review of whether patient had MD when admission order was made </li></ul></ul><ul><li>Another issue: how can a patient who lacks capacity decide to seek a review within 14 days? </li></ul><ul><ul><li>Referred to in passing by Peart J. in M.McN. v HSE </li></ul></ul>
    22. 22. Re-admission soon after discharge by MHT <ul><li>C.C. v Clinical Director St. Patrick’s (No.2) (2009) Hedigan J. </li></ul><ul><li>5 January – MHT revoked admission order </li></ul><ul><ul><li>(During tribunal hearing, patient indicated she would be willing to remain in centre on voluntary basis) </li></ul></ul><ul><li>Jan. 15 – Patient re-detained under re-grading procedure in ss.23 & 24. </li></ul><ul><li>Hedigan J: </li></ul><ul><ul><li>A MHT decision is not a bar for some indeterminate period to bona fide clinical judgements </li></ul></ul><ul><ul><li>Highly desirable that another tribunal should sit as soon as possible </li></ul></ul>
    23. 23. <ul><li>[email_address] </li></ul>