B F v Clinical Director of Our Lady's Hospital and Others
| Jurisdiction | Ireland |
| Judge | Mr. Justice Michael Peart |
| Judgment Date | 04 June 2010 |
| Neutral Citation | [2010] IEHC 243 |
| Docket Number | Record Number: 1069 JR/2009 |
| Court | High Court |
| Date | 04 June 2010 |
Between:
And
[2010] IEHC 243
THE HIGH COURT
MENTAL HEALTH LAW
Detention
Admission order - Mental disorder - Voluntary patient released and readmitted as involuntary patient -Lawfulness of admission order - Lawfulness of admission requirements of Central Mental Hospital -Capacity of applicant - Treatment resistant schizophrenia - Whether admission order unlawful - Whether admission requirements of hospital lawful - Whether applicant had capacity - Whether mental disorder - McN v Health Service Executive [2009] IEHC (Unrep, Peart J, 15/5/2009 ), Re a Ward of Court (No 2) [1996] 2 IR 79 and EH v Clinical Director of St Vincents Hospital [2009] IESC 46 (Unrep, SC, 28/5/2009) considered - Mental Health Act 2001 (No 25), ss 3,8, 14, 18, 19, 21, 23 and 24 - Relief refused (2009/1069JR - Peart J - 4/6/2010) [2010] IEHC 243
F(B) v Clinical Director of Our Lady's Hospital Navan
Facts The applicant had a serious mental disorder, treatment-resistant Schizophrenia and was a voluntary patient at a hospital. The medical view appeared to be that in order to administer the necessary medical treatment at the Central Mental Hospital (CMH) the applicant was required to be an involuntary patient and not a voluntary one. On behalf of the applicant it was contended that the change of the applicant's status from voluntary to involuntary was not necessary as he was willing to undergo any recommended and necessary treatment. In these proceedings the most recent admission order and renewal order made in respect of the applicant were sought to be quashed. It was contended that the procedure by which the applicant was discharged and then made subject to an admission order under the Mental Health Act, 2001 was unlawful. Issue was also taken with the requirement that a patient was required to be an involuntary one before admission to the CMH and whether this requirement was lawful. The respondents disputed the assertions of the applicants and contended as a preliminary point that the applicant had not appealed the decisions of the Mental Health Tribunal to the Circuit Court under s. 19 of the 2001 Act. In addition it was contended that the Oireachtas had not provided that the admission of a patient was dependent upon the patient's own view of the need to detain him, and that this was not affected by an applicant's wish to remain as a voluntary patient. It was further contended that the applicant was a person in need of medical care and treatment which was available only at the CMH and that this care and treatment was only capable of being administered and provided under conditions of involuntary detention.
Held by Peart J in refusing to grant the relief sought. It was an obvious feature of the 2001 Act that its focus was very clearly on persons suffering from a mental illness and who need to be involuntarily admitted to an approved centre. A view by the relevant professionals was taken that the applicant's illness was such as to require treatment, available only at the CMH and only if he was transferred there as an involuntary patient. The decision to discharge the applicant and then immediately have him made the subject of an admission order was a decision which the first named respondent was entitled to make. It could not be the case that a person suffering from a mental disorder must having first admitted himself/herself as a voluntary patient, always be allowed to remain on a voluntary basis for as long as he/she expressed a wish so to do. The treating consultant psychiatrist must be entitled to make a decision in a patient's best interests in order to facilitate access to recommended required treatment. The applicant's right to remain as a voluntary patient was not an absolute right and his discharge in order for him to be admitted as an involuntary patient, did not constitute a violation of his rights to dignity, bodily integrity, privacy or autonomy. The criteria for mental disorder as set out in the 2001 Act were fulfilled and the relevant statutory provisions regarding admission had been complied with. The evidence adduced in this case made it clear that the reason why a voluntary patient could not access treatment at the CMH was that a patient receiving this treatment must, if necessary, be prevented from leaving the CMH. There was nothing irrational or arbitrary about having a requirement that such patients accessing this particular treatment at the CMH be there on an involuntary basis.
Reporter: R.F.
MENTAL HEALTH ACT 2001 S23
MENTAL HEALTH ACT 2001 S24
MENTAL HEALTH ACT 2001 S14
MENTAL HEALTH ACT 2001 S3B
MENTAL HEALTH ACT 2001 S9
MENTAL HEALTH ACT 2001 S3 (1)A
MENTAL HEALTH ACT 2001 S3 (1)B
MENTAL HEALTH ACT 2001 S18
MENTAL HEALTH ACT 2001 S19
MENTAL HEALTH ACT 2001 S2
MENTAL HEALTH ACT 2001 S16
MENTAL HEALTH ACT 2001 S16(2)(G)
MENTAL HEALTH ACT 2001 S21
MCN (M) & C (L) v HSE UNREP PEART 15.5.2009 2009 IEHC 236
H (E) v CLINICAL DIRECTOR OF ST VINCENTS HOSPITAL 28.5.2009 2009 IESC 46
EUROPEAN CONVENTION ON HUMAN RIGHTS ART 6
EUROPEAN CONVENTION ON HUMAN RIGHTS ART 8
WARD OF COURT (NO.2), IN RE 1996 2 IR 79
MENTAL HEALTH ACT 2001 S14(1)
MENTAL HEALTH ACT 2001 S29
MENTAL HEALTH ACT 2001 S28
MENTAL HEALTH ACT 2001 S15
MENTAL HEALTH ACT 2001 S22
The applicant is a 36-year-old man who, it is accepted by all concerned, suffers from a serious mental disorder, namely, treatment resistant schizophrenia with prominent positive and negative symptoms.
On 29th August 2007 he admitted himself as a voluntary patient to St Brigid's Hospital, Ardee, from where he was later transferred to our Lady's Hospital, Navan. For much of the time since that date, though not entirely, the applicant has remained at Our Lady's Hospital as a voluntary patient. He has never sought to leave that hospital or refused any treatment recommended, such that the provisions of sections 23 and 24 of the Mental Health Act 2001 were required to be invoked in order to admit him on an involuntary basis. In due course I will set out details of what orders have from time to time been made, renewed and on occasions revoked, because that history gives a valuable context for the present application.
However, what gives rise to the present application is that on the6th August 2009 the status of the applicant was changed from voluntary to involuntary, not by the invocation of sections 23 and 24 of the Act, but rather by his treating psychiatrist discharging him even though he had not recovered, and then immediately thereafter arranging that he be detained as an involuntary patient by way of an Admission Order under section 14 of the Act.
His consultant psychiatrist at the approved centre, Dr. Rutledge had, prior to the 6th August 2009, formed the view that the applicant was so seriously ill that he required psychiatric treatment in a specialist forensic hospital under conditions of medium security, such as exist at the Central Mental Hospital ("CMH"). It would appear that the medical view is that such treatment, in order to be appropriately administered, requires that the patient be an involuntary patient, and not a voluntary patient. That is the opinion of Dr. Rutledge, and it is a view which has been expressed also by certain responsible consultant psychiatrists whose evidence has been available to Mental Health Tribunals which have from time to time reviewed Admission Orders and Renewal Orders made in respect of the applicant as will appear hereunder.
There is a suggestion also made by the applicant that it is the policy of the CMH that only patients who are detained on an involuntary basis may, following a transfer to the CMH, avail of the specialist facilities and treatment there, which has been recommended for the applicant by, inter alios, Dr. Rutledge, and which he is willing to undergo there but on a voluntary basis.
It would be helpful at this stage to refer to a report by Dr. Rutledge on the applicant's mental state, which she prepared on 18th August 2008 (almost one year prior to the 6th August 2009). I do so in order to provide a context for consideration of the present application by way of judicial review, where the applicant is seeking to quash the Admission Order made on the 6th August 2009, and the Renewal Order made subsequently on 27th August 2009 and is seeking certain declaratory reliefs in relation to the alteration of his status from voluntary to involuntary.
In her report on the applicant's mental state on18th August 2008, Dr. Rutledge stated the following:
"[The applicant] was dishevelled. He remained isolated and withdrawn on the ward. He had prominent negative symptoms of schizophrenia with apathy, and amotivation and avolition. He displayed irritability at times. If he is stressed in any way he can become irritable and sensitive to personal slights.
His mood objectively and subjectively is euthymic with no ideas of suicide or suicidal intent.
His mental state was guarded. He denied the presence of auditory hallucinations. He continued to hold a fixed delusional system relating to the ultimate and absolute psychiatrist whom he would like to harm. He also held to the delusional belief of the significance of particular Euro Millions lottery numbers.
He discussed his fixed delusion of the ultimate psychiatrist being Daniel Wayne Ivory Rodriges. He told me that is just sort of clicked and came to him over a period of two weeks. When I asked had he thoughts of harming himself, this ultimate psychiatrist, he said "there is no point, he can't learn, it's...
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