A.M., a proposed Ward of Court

• Jurisdiction: Ireland
• Judge: Mr. Justice Kelly
• Judgment Date: 27 March 2017
• Neutral Citation: [2017] IEHC 184
• Court: High Court
• Docket Number: [WOC No. 9013]
• Date: 27 March 2017

[2017] IEHC 184

THE HIGH COURT

WARDS OF COURT

Kelly P.

[WOC No. 9013]

IN THE MATTER OF A.M.

A PROPOSED WARD OF COURT

BETWEEN

HEALTH SERVICE EXECUTIVE

APPLICANT

AND

A.M.

RESPONDENT

Health – Mental Health Act 2001 – Wardship of mentally unsound person – Level of mental health – Discretion of Court – Public benefit

Facts: The applicant sought an order for making the respondent as ward of the Court on the basis that the respondent was of unsound mind. The applicant had produced extensive evidence in support of the present application including history of charges, convictions, detentions of the respondent both in prison and mental hospital. The applicant argued that given the nature of assaults such as manslaughter, murder, the respondent should be detained in a mental health facility as his release would be a danger to the public. The respondent contended the Court should not exercise its discretion in admitting the respondent into wardship but let the statutory provisions of the Mental Health Act 2001 prevail.

Mr. Justice Kelly granted the desired relief to the applicant. The Court held that the respondent would be detained in Central Mental Hospital pending further orders. The Court held that transfer of a patient from one approved centre to another was allowed under the 2001 Act; however, transfer from the mental health facility under one legal regime to another was not provided under that Act. The Court held that entitlements of a ward of court subject to a detention order were superior to those of persons detained under the 2001 Act as the ward of Court had immediate access to the High Court for making appropriate arrangements in case of any change of circumstances.

JUDGMENT of Mr. Justice Kelly , President of the High Court delivered on the 27th day of March, 2017

Introduction

1 The applicant (HSE) seeks to have the respondent (A.M.) made a ward of court. The application is opposed by A.M. on legal grounds. He does not challenge the medical evidence which has been put before the court which is to the effect that he is a person of unsound mind and is unable to manage his affairs. Such is his state of mental health that he needs to be detained in the only hospital suitable for his condition namely, the high secure unit of the Central Mental Hospital.

History

2 Extensive affidavit evidence has been placed before the court setting out A.M.'s long history of charges, convictions and detentions both in prisons and mental hospitals since the beginning of this century. It is not necessary to set them out in detail; a summary is sufficient.

3 The most serious offence that A.M. was charged with was murder by stabbing. He was found guilty of manslaughter and in February 2004 was sentenced to ten years imprisonment. That was reduced to seven years on appeal.

4 In January 2008 A.M. committed serious assaults on his treating consultant psychiatrist and his treating clinical psychologist.

5 A.M. was transferred to the Central Mental Hospital in January 2008 and has been there ever since. He has been under the care of Dr. Damian Mohan, Consultant Forensic Psychiatrist at that institution. He was due to be released at the conclusion of his sentence on 11th November, 2016.

6 In the light of his medical condition as attested to by Dr. Mohan, Professor Henry G. Kennedy, the Clinical Director of the Central Mental Hospital and Dr. John O'Mahony, Consultant Psychiatrist, it was clear that there could be no question of A.M. being released because of the risk that his mental illness posed to the public and to himself.

7 Accordingly, on 7th November, 2016 an application was made to me for a temporary detention order. The application was made in the context of an intended petition to have A.M. taken into wardship. I made such an order on that date. I also directed that one of the Court's medical visitors assess A.M. and report to the court on his findings.

8 The matter was made returnable before me three days later and on that occasion A.M. was represented. I continued the detention order, gave directions for the exchange of affidavit evidence and submissions and listed the case for hearing in January, 2017. This is my reserved judgment on foot of that hearing. In the meantime I directed the continued detention of A.M. at the Central Mental Hospital.

Mental condition

9 Dr. Damian Mohan, A.M.'s treating psychiatrist, has placed extensive affidavit evidence before the court. It sets out the entire history of A.M. with the psychiatric services of the State over many years. Much of his hospitalisation has been in the Central Mental Hospital and he has been there continuously since 2008.

10 In anticipation of the possibility of A.M.'s release at the conclusion of his latest sentence of 10 years imprisonment imposed in 2009, Dr. Mohan conducted a capacity assessment which he avers to in his affidavit of 8th November, 2016. This is what he says:-

‘… A.M. continues to present with evidence of chronic paranoid schizophrenia which is characterised by prominent negative symptoms and limited insight. He lacks insight into the risk of violence associated with the relapse of his mental illness and regarding his functional impairments. He holds unrealistic expectations regarding his future ability to live independently. Furthermore, his condition is associated with significant cognitive deficits which have been identified by various assessments.

43. I say and believe that A.M.'s performance during his most recent psychological assessment in October 2016 was consistent with that of a man with a moderate intellectual disability. Psychological and occupational assessments have also highlighted the concerns regarding the impact of A.M.'s mental illness on his daily functioning. Neuropsychological testing has revealed that A.M. has severely impaired executive functioning. These findings were also reflected in the assessments of the occupational therapist.

44. I say and believe that it is my clinical opinion that A.M. lacks capacity to make decisions regarding his care and treatment.’

11 Dr. Mohan then set forth in detail a risk assessment of the factors faced by A.M. if he were to continue in a secure setting and those which he would face if he did not continue placement in a secure therapeutic setting. He states his conclusion concerning A.M.'s position as follows:-

‘47. I say and believe that A.M. lacks the capacity to manage his financial affairs or live independently in the community. He has a low level of executive functioning and it is such that he would not have the requisite ability to budget or plan his activities of daily living. He would be at serious risk of neglect.

48. A.M. will require a highly supported and highly structured placement to ensure even the most minimal response to treatment. I say and believe that the Central Mental Hospital is the only facility in the State that can safely and adequately meet the needs presented by A.M.'s paranoid schizophrenia.

49. If A.M. does not remain within the secure setting of the Central Mental Hospital it is likely that he would not comply with treatment and would deteriorate rapidly. This would put his health, safety and welfare at immediate and serious risk. In such circumstances A.M. would also pose a significant risk to others.

50. I say and believe that A.M. meets the criteria for wardship. However, it is the unequivocal view of his treating team that it is vital that A.M. remain in the Central Mental Hospital pending the conclusion of same. If A.M. was to be discharged it is my clinical opinion that he would disengage with therapeutic services causing a rapid deterioration in his mental health placing his life at risk.

51. I say and believe that the HSE have exhausted all efforts to come up with an alternative solution in order to secure A.M.'s safety and welfare in the event of his release. In light of his complex presentation, the importance of continuity of care is central to any such plan. The option of placing him in alternative approved units with extra staff and input from the clinicians already involved in his care was explored. However, the clinicians with responsibility for the said unit do not believe it is appropriate or possible to manage A.M. safely in such a setting. This is particularly so in light of the fact that none of the consultant psychiatrists involved in his care to date, who would have in-depth knowledge of his significant care needs from a clinical perspective, are attached to the said unit.’

12 Dr. Mohan's view is shared by Dr. John O'Mahony, a consultant psychiatrist who also swore an affidavit. He confirmed that A.M. has a diagnosis of paranoid schizophrenia, with clear cognitive impairment and functional disability. He carried out an assessment of A.M. on 19th October, 2016. He found A.M. to lack a useful degree of insight into his condition and the need for treatment. His recommendation was that A.M. will require a highly supported and highly structured placement such as the Central Mental Hospital to ensure even the most minimal response to treatment. The deficits identified by Dr. O'Mahony seriously impair the capacity of A.M. to live outside such a highly structured and secure setting. If A.M. is not able to avail himself of that facility it is likely that he will not comply with treatment and the potential outcome of non-compliance will place his safety, health and possibly that of others in peril. Dr. O'Mahony further expressed the view that the Central Mental Hospital is the only facility in the State that can safely and adequately meet the needs presented by A.M.'s paranoid schizophrenia. He likewise expressed the view that the HSE has exhausted all efforts to come up with an alternative solution in order to secure A.M.'s safety and welfare in the event of his release. He said as follows:-

‘In light of his complex...