Recent judgment sets important precedent for informal mental health patients

Rabone and another (Appellants) v Pennine Care NHS Foundation Trust (Respondent)

Judgment was given on the case of Rabone and another v Pennine Care NHS Foundation [2012] UKSC 2 in the Supreme Court on 8 February 2012.

Overturning the decision of the Court of Appeal, this case sets an important precedent in relation to the duties owed to informal mental health patients (i.e. not detained, or “sectioned” under the Mental Health Act 1983) by the hospital trust. Whilst the case mainly addresses Article 2 issues, it may have wider impact upon the mental health system.

Melanie Rabone was diagnosed with recurrent depressive disorder in March 2005 and admitted to Stepping Hill Hospital, Stockport in April 2005 following several suicide attempts. She voluntarily agreed to hospital admission.

During her stay at Stepping Hill, Ms Rabone’s family expressed concerns about “her impulsiveness and the risk of self harm”. Despite her parents’ anxieties, Ms Rabone’s doctor agreed that Ms Rabone could go on home leave for two days. Whilst on home leave, Ms Rabone committed suicide.

Ms Rabone’s family claimed damages against the hospital trust in negligence and for breach of Article 2 of the European Convention on Human Rights; the right to life. The negligence claim was settled in 2008, but the human rights claim has been considered at the High Court, Court of Appeal, and subsequently by the Supreme Court.

The European Court of Human Rights has interpreted the Article 2 duty to include “a positive duty to protect life in certain circumstances”. The courts have considered when this “operational duty” arises.

The High Court and Court of Appeal had found that the operational duty did not apply to Ms Rabone, as she had not been detained in hospital under the Mental Health Act 1983. In the Supreme Court, the legal representatives for the hospital trust argued that there was no such duty because there had been no “assumption of responsibility by the state for the individual’s welfare and safety.”

The Supreme Court found that, “By reason of her mental state, she was extremely vulnerable. The trust had assumed responsibility for her… Although she was not a detained patient, it is clear that, if she had insisted on leaving the hospital, the authorities could and should have exercised their powers under the MHA to prevent her from doing so… These factors… lead me to conclude that the European Court of Human Rights would hold that the operational duty existed in this case.”

It was held in the case of Osman v UK (2000) 29 EHRR 245 that there will be a breach of the operational duty where “the authorities knew or ought to have known at the time of the existence of a real and immediate risk to the life of an identified individual or individuals…”.

The Court of Appeal found that “if there was an operational duty, the trust failed to comply with it”. The trust appealed against this, and submitted that “the risk was neither real nor immediate”.

The Supreme Court found that “the decision to allow Melanie two days home leave was one that no reasonable psychiatric practitioner would have made… The trust failed to do all that could reasonably have been expected to prevent the real and immediate risk of Melanie’s suicide.”

The effect of this judgment is to provide a greater obligation on hospital trusts to manage the risk of suicide posed by informal patients, and could potentially have an impact upon the way in which informal patients are admitted into hospital.If you want to discuss this issues raised in this case, or any mental health law issues, please contact one of our Mental Health Team on 020 7426 0400.

The contents of this article are for the purposes of general awareness only. They do not purport to constitute legal or professional advice. The law may have changed since this article was published. Readers should not act on the basis of the information included and should take appropriate professional advice upon their own particular circumstances.