Thursday, 19 February 2015

CTO’s and a dreadful case of unlawful imprisonment

Mistakes in law can come back to haunt you, even many years later.
A recent Court of Appeal  judgment on 10th February 2015 ([2015] EWCA Civ 79) considered a request for compensation for unlawful imprisonment arising as a result of illegally imposing, then revoking, a Community Treatment Order which went as far back as 2009.
This related to a man called Lee Bostridge. He was lawfully detained under Sec.3 MHA in July 2008. In April 2009 a mental health tribunal reviewed his case and ordered his discharge, suggesting in the process that he should be discharged on a CTO.
But by so doing, the tribunal had committed an error in law. A CTO can only be imposed on a person who is "liable to be detained in a hospital in pursuance of an application for admission for treatment", but as the tribunal in their judgment no longer considered that that applied to Mr Bostridge, the subsequent CTO was by definition unlawful. (In essence, anyone on a CTO continues to be subject to detention under Sec.3, and when a CTO is revoked, the underlying Sec.3 detention comes back into force.)
After Mr Bostridge was discharged on this erroneous CTO in April 2009, he remained in the community until August, at which point his Responsible Clinician recalled him to hospital, under his powers of recall, and then revoked the CTO.
Despite having had two tribunals during this period of detention, it was not until 3rd November 2010, when he attended another mental health tribunal, that it was realised that his initial discharge on a CTO back in 2009 was unlawful, and that he had therefore been unlawfully imprisoned for a grand total of 442 days!
As soon as this was discovered, Mr Bostridge was immediately released. However, I don’t think he can have enjoyed much time out of hospital, as he was assessed and lawfully detained under Sec.3 on the same day. This period of (lawful) detention lasted until 13th September 2011.
Mr Bostridge received compensation for the 442 days that he was illegally deprived of his liberty. However, he appealed to the higher court on the basis that he ought to be entitled to a greater, and perhaps exemplary, compensation payment.
The Court of Appeal disagreed with the less than fortunate Mr Bostridge, concluding that “had the appellant been detained lawfully, he would have suffered the same unhappiness and distress that he suffered anyway”. He had therefore suffered no significant loss, and was not therefore entitled to any more than a nominal payment.
This sort of mistake was not unknown in the period following the introduction of CTO’s, which came into force as a result of the amendments to the MHA 1983 in the MHA 2007.
As well as having the power to discharge patients from detention under the MHA (generally Sec.2 & Sec.3), tribunals are allowed to make suggestions as to the disposal and aftercare of a detained patient and frequently do.

The tribunal regulations state that tribunals must discharge if certain things are concluded. One of these is if the tribunal is “not satisfied that the patient is then suffering from mental disorder of a nature or degree which makes it appropriate for the patient to be liable to be detained in hospital for medical treatment”.

Since Mr Bostridge’s tribunal had come to this conclusion, even though they were merely trying to be helpful in guiding the hospital towards a decision to use a CTO, the consequence of their decision was to make it illegal for the hospital to follow their suggestion.

Isn’t the law a wonderful thing?

Sunday, 1 February 2015

Who Should Sign the Section Forms: the AMHP or the Nearest Relative?

Yes, I know that in practice a patient’s nearest relative never makes an application for detention under Sec.2, Sec.3 or for guardianship. But the Mental Health Act and the guidance could never really seem to make their minds up about this point.

The NR has had this power since the 1959 Mental Health Act, and I am aware of one or two cases of the NR making the application under the old Act, often assisted by a psychiatrist who did not want a lay person meddling in his affairs.

Given that the whole point of the existence of Approved Social Workers (and AMHP’S) was to provide a professional with extensive knowledge and expertise in mental health and the law relating to mental health who wasn’t a doctor, it was something of a surprise to me, and to others, when the 1983 Act did not abolish the right of the NR to make an application.

And it was even more of a surprise when the 2007 Act, which amended the 1983 Act and created AMHP’s, did not take the opportunity to abolish this right, especially as in the meantime, the Mental Health (Care and Treatment) (Scotland) Act 2003 had done away with the right of the NR to make an application north of the border.

In fact, while the Scottish mental health legislation recognises the existence of the nearest relative, patients are allowed to nominate a "named person" who may or may not be their nearest relative, and it is this "named person" who has to be consulted and has the functions of the NR.

I personally think this is a good idea, and one which should have been adopted when Parliament had the chance.

Meanwhile, in England and Wales the Reference Guide states:
“AMHPs must make an application if they think that an application ought to be made and, taking into account the views of the relatives and any other relevant circumstances, they think that it is “necessary and proper” for them to make the application, rather than the nearest relative” (2.36)
This almost seems to imply that an AMHP has to make a specific reasoned decision to make the application themselves, rather than letting the NR do it as the default.

However, the Code of Practice seems to have a much firmer view on the use or otherwise of the NR in these circumstances. Para4.28. states:

“An AMHP is usually a more appropriate applicant than a patient’s nearest relative, given an AMHP’s professional training and knowledge of the legislation and local resources, together with the potential adverse effect that an application by the nearest relative might have on their relationship with the patient.”
I wrote about the powers and functions of the nearest relative on the blog a few months ago. But the reason I’m revisiting this now is because of the new Code of Practice.

You see, there's been a subtle, but I think significant, change in the advice given relating to the nearest relative making an application rather than an AMHP.
The old Code of Practice said (4.30):
“Doctors who are approached directly by a nearest relative about making an application should advise the nearest relative that it is preferable for an AMHP to consider the need for a patient to be admitted under the Act and for the AMHP to make any consequent application… Doctors should never advise a nearest relative to make an application themselves in order to avoid involving an AMHP in an assessment.”
However, the new Code of Practice, which comes into effect on 1st April 2015, has a much briefer equivalent paragraph:
"Doctors who are approached directly by a nearest relative about the possibility of an application being made should advise the nearest relative of their right to require a local authority to arrange for an AMHP to consider the patient’s case." (14.32)
It's quite different, isn't it? Gone is the bit about the doctor advising that it is preferable that an AMHP should undertake the assessment and make a decision.
Gone is the instruction that doctors should never advise the NR to do it themselves to avoid using an AMHP.
A conscious decision has clearly been made to amend this paragraph, removing the bits that suggest an AMHP should always be the best person to conduct an assessment.
But why?

Is it now the intention that NR's should be encouraged to undertake more assessments under the MHA?

I'm frankly perplexed.