High Court: Judge directs immediate release of woman from mental health centre

About this case:

• Citation:
  [2024] IEHC 408
• Judgment:
  External link
• Court:
  High Court
• Judge:
  Mr Justice Garrett Simons

Delivering an ex tempore judgment for the High Court, Mr Justice Garrett Simons stated: “The admission order must be right. It must display jurisdiction on its face and it must indicate that the consultant psychiatrist has understood and engaged with the statutory criteria. That is a minimum before a non-judicial person could be allowed to deprive somebody of their liberty for up to 21 days (and longer if further orders are made). Given that this is a basic, essential, and fundamental requirement, it is not open to correct the matter subsequently. It is not good enough to seek to mend a respondent’s hand once they are called on to explain the position in the court.”

Julia Fox BL appeared for the applicant instructed by Daly Lynch Crowe & Morris Solicitors LLP, and Donal McGuinness BL appeared for the respondent instructed by ByrneWallace LLP.

Background

On 30 June 2024, the applicant was taken by her husband to the emergency department of Beaumont Hospital. At 3pm, a nurse practitioner in the emergency department made an application for a recommendation for the involuntary admission of the applicant which stated “OBSERVED TO BE PARANOID AND PSYCHOTIC IN THE ED”.

A recommendation form was completed at 4pm by a medical practitioner in the same department which stated: “Presented with irrational and paranoid thoughts. Evidence of psychosis on a background of schizoaffective disorder”.

The applicant was conveyed to an approved centre at 8pm, with her admission order signed at 5.10pm the next day stating: “Grandiose & paranoid delusional beliefs, lacks insight into need for treatment”.

The applicant applied for an inquiry pursuant to Article 40.4.2° of the Constitution (habeas corpus) into the lawfulness of her detention.

The High Court

Mr Justice Simons considered the concept of a ‘mental disorder’ as set out in s.3 of the Mental Health Act 2001, and the procedure set out in s.9(1) for obtaining an admission order.

Noting that the application in respect of the applicant was made by an “other person” pursuant to s.9(1)(d), the judge highlighted s.9(5) of the 2001 Act which states:

The court highlighted that notwithstanding the provision of a “careful statutory scheme” in the 2001 Act providing for the review of admission orders by the Mental Health Tribunal within 21 days and for a statutory right of appeal, “the High Court’s jurisdiction under Article 40.4.2° is not displaced. It continues to remain available. It is open to an applicant — notwithstanding the fact that there is a statutory procedure — to make an application for an inquiry under Article 40.4.2°.”

Formally adopting the statements as to the limits and scope of the inquiry procedure set out in AB v. Clinical Director of St. Loman’s Hospital [2018] IECA 123, [2018] 3 I.R. 710 and Clinical Director of the Department of Psychiatry XY Hospital [2024] IEHC 169, Mr Justice Simons moved to consider the nature and extent of the duty to give reasons in cases such as the matter before him.

The court had regard to F.C. v. Mental Health Tribunal [2022] IECA 290, in which the Court of Appeal stated that “whether the reasons given by a decision-maker are adequate is not only context-specific (in the sense of the legal context in which the decision is being made), but also case-specific in the sense that the issue turns on the specific language used in communicating the particular decision in the context of the hearing which has gone before, including the evidence adduced and the submissions made”.

Mr Justice Simons considered that “these principles, which govern the giving of reasons by the Mental Health Tribunal, cannot simply be ‘read across’ to the duty to give reasons at an earlier stage in the decision-making process (including, in particular, the statutory duty to give reasons as required under section 9(5) of the Mental Health Act 2001). This is because the respective decisions (i) to apply for a recommendation for involuntary admission; (ii) to recommend a voluntary admission; and (iii) to make an admission order, are ones which are reached in a very different context.”

Nonetheless, the judge opined: “Whereas the reasons required need not reach the higher standard expected of the Mental Health Tribunal, they must nevertheless reach a minimal threshold. The reasons should indicate that the decision-maker has properly considered and applied the statutory criteria. It is not sufficient simply to recite the legislative provisions under the Mental Health Act 2001 without making some attempt to explain how the statutory criteria are met.”

The court scrutinized the admission order, highlighting that it was grounded upon the second limb of the statutory definition, implying inter alia that the applicant’s judgment was so impaired by her mental illness that a failure to admit her would likely cause a serious deterioration in her condition or would prevent treatment that could only be administered by her admission.

Finding it necessary for the consultant psychiatrist to diagnose the applicant with a mental illness “at least on a preliminary basis” and to identify whether her condition would deteriorate or that she would not receive appropriate treatment without admission, Mr Justice Simons determined: “The most that is done in the admission order is effectively to recite symptoms… It is not sufficient simply to tick a box to indicate that certain statutory criteria have been met without in any way seeking to engage with or to explain how those statutory criteria have been fulfilled.”

Noting that this detail was essential to allow a prospective applicant to consider their legal options, the court continued: “I want to emphasise that this court is not suggesting that very detailed reasons need to be given. In that regard, I draw attention to what the Court of Appeal said in relation to context. Context is all but there must be some explanation.”

Unconvinced that a respondent could “mend its hand” by producing evidence ex post facto, the court expressed that evidence nonetheless allowed de bene esse from the consultant psychiatrist was, in any event, “a cause of greater alarm” indicating that the applicant agreed to stay overnight in the approved centre as a voluntary patient, a fact not referenced in the admission order.

Observing that the psychiatrist “had to be satisfied, not merely that the Applicant could be diagnosed with a mental illness, but rather that the statutory criteria of ‘mental disorder’ had been met, a key component of which is whether involuntary admission is necessary”, Mr Justice Simons considered that the “failure to make reference to this at all in the admission order would be sufficient, in itself, to invalidate it”.

Indicating that he would be willing to direct the applicant’s release on the basis of the deficiency of the admission order alone, the court further considered that making of the initial application by a person ‘other’ than those identified in (a), (b) and (c) of s.9(1) imposed an additional obligation to state reasons, finding that the application form came “nowhere close to meeting the statutory requirement”.

Conclusion

Accordingly, the High Court directed the immediate release of the applicant.

A.A. v Clinical Director of the Ashlin Centre [2024] IEHC 408