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England and Wales High Court (Administrative Court) Decisions |
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You are here: BAILII >> Databases >> England and Wales High Court (Administrative Court) Decisions >> MM, R (on the application of) v The Secretary of State for the Home Department & Anor [2006] EWHC 3056 (Admin) (23 November 2006) URL: http://www.bailii.org/ew/cases/EWHC/Admin/2006/3056.html Cite as: [2006] EWHC 3056 (Admin) |
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QUEEN'S BENCH DIVISION
THE
ADMINISTRATIVE COURT
Strand London WC2 | ||
B e f o r e :
____________________
THE QUEEN ON THE APPLICATION OF MM | (CLAIMANT) | |
-v- | ||
THE SECRETARY OF STATE FOR THE HOME DEPARTMENT | (DEFENDANT) | |
FIVE BOROUGHS NHS TRUST | (INTERESTED PARTY) |
____________________
WordWave International Limited
A Merrill Communications Company
190
Fleet Street London EC4A 2AG
Tel No: 020 7404 1400 Fax No: 020 7831
8838
(Official Shorthand Writers to the Court)
MR M CHAMBERLAIN (instructed by Treasury Solicitor)
appeared on behalf of the DEFENDANT
____________________
Crown Copyright ©
"Many previous reports indicate that at times [MM] has presented with abnormal thoughts, including paranoid thinking, abnormal perceptions, including hallucinations, and a range of behaviours that gave concern, including threats to harm others, including his family."
"As Dr Kulupana points out, if he is going to relapse in the future, it will be due to the lack of compliance and the use of illicit substances."
"Given his impulsive personality, I would advise that the threshold for considering an assessment under the Mental Health Act is low should his mental state suggest psychotic relapse."
"In spite of the difficulties represented in this report, I would recommend at this time a conditional discharge in order to test his ability to more adequately manage his own mental health and illicit drug use."
"(f) Submits to random testing for the presence of illicit drugs by giving samples of urine/blood and/or hair."
"After reading and hearing the evidence as listed above, we are not satisfied that this patient's mental illness presently meets the statutory criteria for his lawful detention in hospital for treatment. We have heard that there has been an overall improvement in [MM's] mental state. He has not shown any psychotic symptoms. He has abstained from the use of illicit drugs. He has shown a certain degree of co-operation with his clinical team. There has been an apparent increase in the level of his insight into his mental illness and the affect drugs have had and are likely to have thereon."
"This patient's clinical team is of the opinion that further detention in hospital would be counter-productive to his continuing improvement. We recognise that [MM] has a history of non-compliance with his medication resulting in a deterioration of his mental health and recall to hospital on three occasions following his conditional discharge. We are satisfied that he needs to remain subject to recall in the event of a further relapse and a return of the symptoms of his paranoid schizophrenia."
"The problems are likely to be if he returns to illicit substance misuse, and to an extent this has commenced as he uses cannabis regularly. However, he dismisses this as having any affect on his mental health and insists he uses it purely for pain relief from his chronic shoulder pain. I have made him thoroughly aware that if I am aware this cannabis use is impacting on his mental health, then we will be taking steps to inform the Home Office and have him recalled."
"Phone call from Vincent Williams, saying that MM's father contacted him. MM admitted to his father that he had taken 'rock cocaine'. This was after initial denials and challenging behaviours. In addition to this, MM has continued to use cannabis and is suspected of selling mobile phones and a coat to purchase cocaine. Mr Williams saw MM two weeks ago and described his eyes as 'glazed'. He was asked in front of his mother whether he was using a class A drug. When he denied it, his mother left the room. Mr Williams took this to mean that MM was lying and his mother was unhappy about it.
MM has been associating with other drug users. His father, with whom he has a fragile relationship, went to one of their houses to retrieve his son. Mr Williams feels that MM is engaging on a very superficial level with supervision and has recently refused a drug test. Mr Williams stated that there is a 'clear relapse signature' and will submit a report ASAP."
"MM's illicit drug use precipitates a mental health relapse when he has, and may continue to present a threat of harm to others.
MM has admitted to continuing to use cannabis on a daily basis since his latest discharge and shows little insight into how illicit drug use might affect his mental health."
"Historically, MM's placement in the community fails due to his return to illicit drug use and resultant relapse of his mental illness. It has been brought to my attention by his Care Co-ordinator, Mr Vince Williams, and other members of the Assertive Outreach Team that there is a likelihood that MM has been using illicit drugs once more. This is based on reports from his father of belongings having disappeared for no convincing reason. It is suspected that they have been sold to make funds for drug purchase. More direct evidence to support this supposition is MM's manner was more abrasive than previously seen when visited last week. When asked to provide a urine sample for drug testing, he refused to do so."
"In view of the rapidity with which he can relapse and the danger he poses when unwell we felt it was important to bring this to your attention immediately."
"(b) to abstain from illicit drugs;
(c) to submit to regular drug screening."
"The patient was recalled to hospital on 8.6.06 for breaking one of the conditions attaching to his conditional discharge on 9.5.06, namely the taking of illicit drugs [he was in fact released as a result of the Tribunal's decision on 9 May, and recalled again by the Secretary of State].
That was triggered by the patient learning that the Home Office were intending to judicially review the discharge order of 9.5.06. The patient was noticed by his mother to have physical symptoms consistent with his having taken illicit drugs and she phoned the Mental Health Services to inform them.
Since his recall he has not exhibited any psychotic features which is confirmed by the clinical teams. He has been involved since his admission with a drug rehabilitation team which can continue three times a week in the community and which he has so far attended on six occasions.
We were impressed by the patient's mother and of the importance attached by her to drawing to the attention of the authorities any taking of illicit drugs by her son. We were satisfied that the parents are prepared to offer a stable home to the patient and that [the mother] will use her best endeavours to ensure that her son engages with the clinical team and the rehabilitation work proposed by them."
He was discharged on the same day.
"It is clear that MM is using illicit substances, and it is for such behaviour that we have recalled three time previously. I have spoken to Dr I and discussed the possibility of recall or a warning letter. He feels a warning letter would be best course as MM is very worried about possibility of recall."
He therefore directed that a strong and final warning be sent to MM.
"Unfortunately MM was adamant that he would continue to use drugs. However, Gary felt it unlikely the father would kick Michael out as he often takes this stance initially. Gary and I agree that we would not recall today as the mental state appears stable, but I advise that we will recall the next time MM tests positive."
"Use of illicit drugs is behaviour that is likely to lead to deterioration in your mental health, and you will doubtless recollect has led to your recall to hospital on a number of occasions in the past. It is, therefore, in your own best interests to comply with all the conditions on which you were discharged to avoid being recalled.
It must be clearly understood that this letter should be considered a final warning. Should you test positive for illicit substances in the future, we will have no option other than to immediately recall you to hospital."
"Gary McDonald rang to say that MM had had a drugs screen and had tested negative for cannabis and cocaine, but positive for amphetamines. This is despite our warning letter of 14.9.06. I said we would be likely to recall, but I wanted Dr Ibitoye's confirmation of this. Gary and I agreed that we would go ahead with arrangements to get MM assessed by the hospital in Blackpool where he would be admitted."
"Dr Ibitoye rang as promised. MM has been assessed and will be admitted to a low secure unit."
She determined to prepare a warrant for his recall, which was issued that day. He has been detained ever since. A Mental Health Review Tribunal is pending.
"(3) The Secretary of State may at any time during the continuance in force of a restriction order in respect of a patient who has been conditionally discharged under subsection (2) above by warrant recall the patient to such hospital as may be specified in the warrant."
"... the detention must be effected in accordance with the procedure prescribed by law, ie domestic law; except in emergency cases, the individual concerned must be clearly shown to be of unsound mind, ie a true mental disorder must be established before a competent authority on the basis of objective medical expertise; the mental disorder must be of a kind or degree warranting compulsory confinement; and the validity of continued confinement depends upon the persistence of such a disorder."
"The weight of medical evidence at the material time was in the applicant's favour, for the most recent decision of the Mental Health Review Tribunal in 1986 had found that there was no evidence that the applicant was then suffering from any psychopathic disorder."
"30. The nature of mental illness is such that the severity of the symptoms and the need for treatment will often fluctuate over time. A sequence of discharge, readmission, discharge and readmission is not uncommon. Normally a sensible period is likely to elapse between discharge and readmission. In such circumstances the implied statutory requirement of change of circumstances for which Mr Gordon contends is neither necessary nor sensible. If the professionals concerned are acting objectively and bona fide, the application for readmission is likely to be triggered by behaviour of the patient that is, at least in part, a reaction to life in the community. This will almost certainly constitute a change of circumstances when compared with the patient's reaction to the hospital regime that was prevailing when the tribunal discharged the patient. To require the professionals involved to investigate and attempt a comparison between the two sets of circumstances in order to decide whether or not there has been a relevant change of circumstances would not be helpful or even meaningful.
"31. The position is very different where an application for readmission is made within days of a tribunal's decision to discharge, which carries the necessary implication that the criteria for admission are not present — the more so if the patient has remained under the hospital regime because discharge has been deferred, so that there has been no change in the patient's environmental circumstances. In such a situation there is likely to have been, as Mr Gordon pointed out, a difference of view between the patient's responsible medical officer and the tribunal as to whether or not the criteria justifying detention were established. Under the statutory scheme, where such a conflict exists, it is the opinion of the tribunal that is to prevail."
"Fourthly, the rule of law requires that effect should be loyally given to the decisions of legally-constituted tribunals in accordance with what is decided. It was clearly established by the House in P v Liverpool Daily Post and Echo Newspapers plc [1991] 2 AC 370 that a mental health review tribunal is a court to which the law of contempt applies. It follows that no one may knowingly act in a way which has the object of nullifying or setting at nought the decision of such a tribunal. The regime prescribed by Part V of the 1983 Act would plainly be stultified if proper effect were not given to tribunal decisions for what they decide, so long as they remain in force, by those making application for the admission of a patient under the Act. It is not therefore open to the nearest relative of a patient or an ASW to apply for the admission of the patient, even with the support of the required medical recommendations, simply because he or she or they disagree with a tribunal's decision to discharge. That would make a mockery of the decision."
"As the Master of the Rolls pointed out in para 30 of his judgment quoted above, the condition of many of those suffering from mental disorder will not be static. Episodes of acute illness may be followed by episodes of remission. Thus it does not follow that a tribunal decision, however sound when made, will remain so. Other things being equal, the longer the period since the decision was made the greater the chance that the patient's mental condition may have altered, whether for better or worse."
"The tribunal will doubtless endeavour to assess a patient's condition in the round, and in considering issues of health, safety and public protection under sub-paragraphs (a)(ii) and (b)(ii) of section 72(1) it cannot ignore the foreseeable future consequences of discharge, but the temporal reference of 'then' is clear and the tribunal is not called upon to make an assessment which will remain accurate indefinitely or for any given period of time."
"Consistently with the principle identified in para 8 above, an ASW may not lawfully apply for the admission of a patient whose discharge has been ordered by the decision of a mental health review tribunal of which the ASW is aware unless the ASW has formed the reasonable and bona fide opinion that he has information not known to the tribunal which puts a significantly different complexion on the case as compared with that which was before the tribunal. It is impossible and undesirable to attempt to describe in advance the information which might justify such an opinion."
"At the tribunal hearing the patient's mental condition is said to have been stabilised by the taking of appropriate medication. The continuing stability of the patient's mental condition is said to depend on his continuing to take that medication. The patient assures the tribunal of his willingness to continue to take medication and, on the basis of that assurance, the tribunal directs the discharge of the patient. Before or after discharge the patient refuses to take the medication or communicates his intention to refuse. Having taken medical advice, the ASW perceives a real risk to the patient or others if the medication is not taken."