Clinical Director did not breach statutory duty in refusing to change conditions for release of mentally ill woman

About this case:

• Judgment:
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The applicant, referred to as M.C., had been found guilty but insane in 2006 of killing her infant son and attempting to kill her young daughter.

She had been classified as a person found not guilty by reason of insanity under the Criminal Law (Insanity) Act 2006, and had been committed to the Central Mental Hospital, where she underwent periodic reviews.

In 2012, the Review Board granted a conditional discharge to the applicant, on the grounds that she complied with a number of conditions.

These included that her home be determined by consultant psychiatrist Dr Helen O’Neill, with consultation with M.C.

She was also required to inform the treating team of any mental illness symptoms, and to allow members of the team to visit her at home.

Further, she was required to inform the court if her husband resumed drinking, and of any deterioration in their marital relationship.

In 2013 M.C. telephoned Westport Mental Health Centre to report that her husband was being verbally abusive and threatening to their teenage son.

She was therefore removed from the home and placed in her mother’s home.

In correspondence it was detailed that Dr O’Neill noted the risk of violence, the increasing marital tension, the fact that M.C. had a psychotic relapse in February that year, and also noted verbal abuse by M.C.’s husband in making her decision to remove M.C. from the family home.

In August, 2013 the applicant sought amendment of the conditions, in order for herself to become the primary decision maker in relation to her place of residence.

The Review Board considered the application in December 2013 and made a further conditional discharge order acceding to vary the conditions.

However, the Clinical Director of the Central Mental Hospital refused to make the necessary arrangements to facilitate this variation, finding that if M.C. was requesting to live with her husband as a result of impaired mental capacity, then it would be unsafe to comply with her request. If the Review Board believed M.C. was of intact mental capacity, then the Review Board ought to grant her an absolute discharge.

In February 2014, the Board again requested that the Director make the necessary arrangements, stating that they believed he was under a duty to do so and under the relevant statutes should reconsider.

However, the Director again refused, noting that due to the risk of relapse posed by exposing M.C. to marital/domestic disharmony and violence, it remained Dr O’Neill’s position that she should retain the authority to determine M.C’s place of residence.

He noted that the current conditions allowed M.C. to spend substantial periods at home as she wished and urged the Review Board to leave the conditions as they were, as to vary them might mean that she could relapse and leave doctors without the power to protect her by moving her.

The Review Board acknowledged that there was a fundamental and legitimate disagreement in relation to the management of risk in this case, but pointed to the wording of s. 13A (2) of the Criminal Law (Insanity) Act 2006, which stated that the Clinical Director shall make arrangements as necessary.

The Review Board did not give any reasons for rejecting the concerns raised by Dr O’Neill and the Clinical Director.

The Court noted that despite the finding of the applicant as guilty but insane, and her subsequent reclassification as a person not guilty by reason of insanity, M.C. had only spent three and a half years as a patient in her local psychiatric hospital in Castlebar after the drowning incident, and was admitted to the Central Mental Hospital on the verdict of the jury.

Dr O’Neill in a comprehensive report given to the Review Board set out in full the background issues with regard to M.C. She also gave a report in 2013, detailing the various issues of which she had concerns.

The Court did not have before it any material that indicated that the Review Board considered or addressed these concerns.

In 2014 the applicant commenced judicial review proceedings. However, later in 2014 she also applied for an unconditional discharge order, which was granted.

This made certain reliefs, such as the request for orders of certiorari and mandamus, moot.

However, the applicant maintained that there had been a breach of statute, her rights had been breached resulting from this breach of statute, and that she deserved damages.

One question for the Court was whether or not the reliefs sought were moot or whether they were live issues still to be determined.

The Court noted the case J.B. v. Mental Health (Criminal Law) Review Board 2 I.R. 15, which refused reliefs on the grounds that the respondents had acted in the interests of the applicant and the public at large.

It also noted G. v. Collins 1 I.L.R.M. 1, which defined the doctrine of mootness as being: “proceedings may be said to be moot where there is no longer any legal dispute between the parties.”

The Court then considered whether to issue declarations that the respondent’s refusal to make necessary arrangements was unlawful, unreasonable and in breach of provisions of the Criminal Law (Insanity) Act, 2006; and in breach of the applicant’s Constitutional and Convention rights.

It also considered whether she was therefore entitled to damages for those breaches.

It found that there had been no breach of statutory duty or the applicant’s rights, as there was a duty on the Review Board to respond to the concerns raised by the Director and Dr O’Neill.

In relation to the issue of damages, the Court was of the view that having regard to the background issues, of which little had been explained by counsel for the applicant, regarding the drowning of her infant son and the attempted drowning of her daughter, the Court would not grant damages where the respondent had acted in the interest of the applicant and the public at large.