The Court of Appeal has allowed an appeal by an anonymised patient who was physically restrained from leaving St. Patrick’s University Hospital while classified as a voluntary patient. It held that such a patient may be prevented from leaving only through the short-term detention procedure in section 23 of the Mental Health Act 2001.
The ruling, delivered by Mr Justice Gerard Hogan on 14 February 2018, concerned events after the patient’s renewal order was revoked on 12 October 2011. The judgment said he remained in the hospital’s locked Special Care Unit and was not allowed to leave, despite being a voluntary patient. On 21 November, after he sought to leave, he was restrained. The court noted that section 23 was not invoked that day.
The hospital’s consultant psychiatrist considered that the patient’s condition had deteriorated after he stopped taking medication. The patient had tried three times to climb over the unit’s garden wall and had behaved aggressively, according to the judgment. The consultant believed treatment in the unit was needed for safety. A second psychiatrist did not consider that the patient required admission under section 24. The patient agreed to resume medication and remain in the unit voluntarily, but later again said he wished to leave. The consultant then made an order under section 23 to allow an assessment. The judgment’s account does not say that this order was made before the earlier restraint on 21 November.
The hospital argued that staff could temporarily prevent a voluntary patient from leaving while they assessed whether section 23 should be used. The applicant argued that the restraint had no lawful basis. The Court of Appeal rejected the hospital’s interpretation: section 23 authorises detention for up to 24 hours when a staff member covered by the section is of the opinion that the patient has a mental disorder. Section 24 provides for a subsequent psychiatric examination and possible admission order.
The court said staff could try to persuade a patient to stay and could use reasonable restraints to prevent an unsafe exit, such as climbing over a garden wall. But, without using section 23, they could not prevent a voluntary patient from leaving at an appropriate time and by an appropriate means. It also rejected the broader reading of section 28 adopted by the High Court, while declining to decide the proper interpretation of that provision in full.
The High Court had refused the patient’s application for relief. The Court of Appeal allowed the appeal and said it would hear further submissions on the precise form of order. The judgment addressed only the appeal from the High Court’s first judgment; a separate appeal concerning a European Convention on Human Rights declaration was to arise only if this appeal failed.