R (CS) v Mental Health Review Tribunal & Another [2004] EWHC 2958 (Admin)

The claimant, (C), sought judicial review of a decision by the Mental Health Review Tribunal not to discharge her from detention under section 3 of the Mental Health Act 1983.

 

C had a long history of mental illness and had been diagnosed with paranoid schizophrenia.  C had attempted to manage her illness in the community with the support of friends but had been unsuccessful and regularly attended hospital.  Due to a marked deterioration in her condition and her reluctance to take her prescribed medication, C was admitted into hospital under section 3 of the Act.  C’s treatment plan included a careful and gradual discharge from hospital which included a full time leave of absence from the hospital under section 17 of the Act.  C was unco-operative in relation to the taking of her anti-psychotic medication and lacked insight into the impact of the failure to continue to take it on a regular basis.  It was felt by the RMO that she would not comply with her treatment regime if she became a voluntary patient and that her condition would rapidly deteriorate and thus she would pose a risk to herself if her continued detention under section 3 was not authorised.  C’s detention had been reviewed under section 72(1) and the MHRT concluded that given C’s non-compliance with previous measures in the community, it was not the right time to discharge her from detention under section 3.  C argued that it could be seen by her treatment plan that she was not receiving any hospital treatment and therefore the criteria for the exercise of the Tribunal’s powers under section 72 (1) did not arise.  The Tribunal submitted that leave of absence from hospital under section 17 was not in any way inconsistent with continuing detention and that a patient could still be liable to be detained in hospital even if that part of the treatment was minimal and following the decision in R v Barking Havering & Brentwood Community Health NHS Trust in the Court of Appeal, detention under section 3 did not necessarily mean residence in a hospital.

 

The High Court held that the continued detention of C was necessary to enable the health professionals to rehabilitate her into successful community living from hospital living.   It would not have been appropriate to have abruptly discharged C only for her to have been re-admitted within a short period of time.  By C’s continued detention under section 3 and bringing her back from leave at the earliest sign of deterioration, a significant descent into the most severe symptoms was prevented as well as unnecessarily long periods of detention spent on the ward.  The Tribunal had acted rationally and lawfully in its decision.  It was not bound to direct C’s discharge because at the time of the hearing she was on section 17 leave.  Periods of absence were in no way inconsistent with continuing detention under section 3 of the Act.  R v Mersey Care NHS Trust ex parte DR (2002) applied.

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