Woman wins court declarations against mental hospital

A woman diagnosed with schizophrenia who was found not guilty by reason of insanity of violent crimes has won Supreme Court declarations over the Central Mental Hospital’s handling of her bid to vary her living arrangements when she was on conditional release from the hospital.

The five-judge court said the clinical director of the CMH was wrong to refuse to put in place arrangements to give practical effect to a conditional order proposed by the Mental Health Review Board in the woman’s case. It found the woman, who was released unconditionally from the CMH in 2012 before her case was heard, is not entitled to damages for breach of her constitutional rights but said it will decide later if she is entitled to damages for breach of the obligations of public bodies under the European Convention on Human Rights Act 2003.

The woman, who cannot be identified, was detained in the CMH arising from her conviction relating to events which occurred almost 20 years ago.

Following the enactment of the 2006 Criminal Law Insanity Act, she was reclassified as a person found not guilty of the crimes by reason of insanity. Following her initial conditional release from the CMH, her place of residence outside it was determined by her treating psychiatrist. As her mental health improved, she was permitted to return home to live with her husband and children. When on conditional release, her husband, who has a history of being violent towards her, verbally abused her.

Fearing a setback in her mental health the CMH advised her to live with another relative and not be alone with her husband.

After living with other relatives, she gradually returned to live with her husband and their children. She sought a variation of the terms and conditions of her release so she alone could determine where she would reside.

The Mental Health (Criminal Law) Review Board, which reviews detention of patients in the CMH, directed the clinical director to assess and confirm the making of certain arrangements to facilitate the variation, and to supervise and enforce the revised conditions. The director declined to do so.

The court heard the CHM believed the conditions it had in place were necessary given the risk posed to the woman’s mental health by the husband’s behaviour.

In High Court judicial review proceedings against the director, with the board as a notice party, the woman sought orders directing the respondent to make such arrangements. She also sought declarations, including that the refusal to make the arrangements to facilitate the variation breached her rights, was unreasonable, unlawful and an unwarranted interference with the board’s functions.

By the time her case was heard in the High Court, the board had unconditionally discharged her from the CMH, allowing her to reside where she wanted with the effect she no longer needed to pursue much of her claim.

She sought certain declarations and damages on grounds including her rights under the Constitution and ECHR Act had been been breached.

The High Court dismissed her action as moot (pointless) and the Court of Appeal agreed.

The Supreme Court agreed to hear a further appeal and, in its unanimous judgment on Thursday, made certain findings in the woman’s favour. Giving the court’s decision, Ms Justice Marie Baker said the director was wrong to refuse to put in place the necessary arrangements to give practical effect to the conditional order the board proposed in the woman’s case. The board is an independent body which balances clinical decisions, patient rights and the public interest, and whose decisions are final, subject only to challenge by judicial review, she said.

The board had made a decision that has legal effect and must be put into being, she said. In the circumstances, the court would declare the legislation requires the director to put arrangements relating to the woman in place and the director failed to perform that statutory duty.

The director’s decision was not an appropriate response and the determination of how the different interests in the woman’s case are to be protected and enhanced lay with the Mental Health Review Board, the judge said. She stressed it was not argued the director had acted negligently and said it was accepted the director acted with the best interests of the woman and the wider public in mind.

The woman is not entitled to damages for breach of her constitutional rights but the court would hear submissions on whether she is entitled to damages under section 3 of the ECHR Act, which requires public bodies to perform their functions in a manner compatible with the ECHR, she said.