Community care – assessment – care programme approach – eligibility criteria
The claimant, P, brought judicial review proceedings against the local authority, alleging breaches of duty when assessing his need for community care services under s47 NHS and Community Care Act 1990.
P and his family were asylum-seekers from Kosovo who had been tortured. One of P’s sons was killed by Serbian troops, leaving P in a state of depression and misery. On arrival in the UK, P and his family were reunited with the other son, who had already been granted asylum.
There had been concerns about P’s mental health since February 2002. In August 2002 a formal mental health assessment was carried out by a consultant psychiatrist, who concluded that P was not psychotic but was suffering from reactive depression and possibly the early stages of dementia. The assessment further concluded that P was not sectionable under the Mental Health Act 1983.
Islington local authority then prepared a Health and Social Care Assessment and Care Programme Approach (CPA) Community Care plan for P, the outcome of which was that P did not meet the authority’s CPA eligibility criteria and that (with the exception of P’s housing needs which had since been met) all of P’s assessed needs were to be left to be dealt with by his family.
Letters of complaint about the assessments from the family’s solicitors were met with the response that “An assessment was completed and following that assessment the decision was made that community care services will not be provided as Mr P does not have a severe and enduring mental illness […]”.
A second consultant psychiatrist, Dr H, appointed by P’s family solicitors, was of the opinion that P was suffering from a severe and enduring mental illness as his depressive symptoms were of a psychotic intensity and that P had been unwell for over 2 years. The psychiatrist was of the view that P needed regular supervision by mental health services.
Islington’s reply to Dr H’s report was that the council was “holding to its decision that Mr P does not have a severe and enduring mental illness thus warranting Community Care provision”.
P challenged the local authority’s decision, alleging that its response to Dr H’s report was “wholly inadequate” and “irrational”; that in light of its finding of “no firm psychiatric diagnosis” the local authority could not lawfully determine that P had no need for community care services; that the local authority had misapplied its own CPA criteria; and that even if P did not meet the CPA criteria because he did not have a severe and enduring mental illness, that was not determinative of whether he nevertheless needed generic health or social services community care.
The judge rejected all but the last challenge. He found that there was a firm diagnosis (of reactive depression) but it was not a diagnosis that fell within Islington’s CPA eligibility criteria. Islington had reconsidered its assessment in light of the family’s further evidence and had a rational basis for preferring its own evidence to that of the family. There was no error of law in Islington’s finding that P did not meet its CPA eligibility criteria.
The error of law on Islington’s part was to treat the conclusion that P did not meet its CPA eligibility criteria as because he did not have a severe or enduring mental illness as determinative of the question whether P was in need of community care services. In the judge’s view, this meant that there had never been a proper and comprehensive community care assessment of P – as required by S47 of the 1990 Act – only a CPA assessment.
The judge directed that Islington re-start the community care assessment process.