The Court of Appeal has dismissed an appeal by LW and RL over mental health care for LW, affirming a High Court declaration that the Health Service Executive (HSE) has a continuing duty to provide LW with appropriate treatment and services in accordance with section 7 of the Health Act 2004.
The court did not order the HSE to provide cognitive behavioural therapy or other psychological supports at the Central Mental Hospital. It also did not decide whether the care provided after the High Court declaration complied with that order. The judgment said compliance would need to be addressed in separate proceedings if it remained in dispute.
LW has diagnoses including schizophrenia and a personality disorder, and a history of serious violence and substance abuse. Before his release from prison in August 2019, he received antipsychotic injections and psychological support. Referrals to a community mental health team were rejected because clinicians considered the risk to staff and service users too high. A forensic psychiatrist continued injections informally after LW’s release, but that arrangement was interrupted and later resumed. The psychiatrist died in September 2022.
The High Court refused the principal reliefs sought, including orders aimed at securing community mental health services, but declared that the HSE had a continuing duty to provide appropriate care under section 7. The Court of Appeal noted that the HSE had arranged ad hoc injections at the Central Mental Hospital during the High Court proceedings and that some care continued afterward.
On appeal, the appellants sought declarations concerning equality and bodily integrity, and argued for a fuller package of treatment. The Court of Appeal held that the request for services at the Central Mental Hospital went beyond the case pleaded and argued in the High Court, which concerned community-based care. It said an appeal in judicial review proceedings was not the place to decide that new issue or assess compliance with the High Court order.
The court also rejected the constitutional equality claim, finding no suitable comparator and concluding that the different treatment was justified by the risk LW was considered to pose and by the different legal conditions applying to prisoners. It found no breach of the right to bodily integrity, which it said did not create an absolute entitlement to the treatment sought. The court affirmed the High Court order, describing LW’s entitlement as appropriate health care within the constraints of section 7. The appeal was dismissed. The court invited the appellants to file a short submission on costs within 14 days; the HSE could respond within a further 14 days.