The High Court ruled that regular blood-count tests could be treated as part of the psychiatric care of an involuntary patient identified in the judgment as M.X., where the tests were needed to monitor medication and protect her health. The court left wider questions about safeguards and the next procedural steps for later consideration.
In a judgment delivered on 29 July 2011, Mr Justice John MacMenamin considered the Health Service Executive’s judicial review application concerning whether the Mental Health Act 2001 permitted the proposed treatment regime. M.X. was detained at the Central Mental Hospital and had a diagnosis of paranoid schizophrenia and borderline personality disorder. The court said she lacked capacity to consent to or refuse the proposed blood tests, based on the treating psychiatrists’ evidence and the opinion of an independent psychiatrist.
The medical evidence was that anti-psychotic medication required regular blood tests because M.X. had previously experienced a potentially life-threatening fall in her white blood cell count in response to different drugs. The proposed tests involved taking blood from a vein. Because she objected, staff considered restraint necessary; sedation or anaesthetic supervision might be required if a safe sample could not otherwise be taken.
M.X.’s lawyers argued that “treatment” under the Act should be read narrowly because the legislation did not provide specific review safeguards for blood tests, despite safeguards for certain other procedures and continued medication. They warned that a broad interpretation could permit repeated invasive procedures without adequate protections. The judge said there was force in that concern.
The court nevertheless interpreted “treatment” broadly enough to include an invasive procedure that was ancillary to, and part of, the procedures necessary to treat or ameliorate the patient’s mental illness or its consequences. It held that the blood-count tests in this case were lawful under the Act and in M.X.’s best interests. The ruling was limited to the circumstances before the court: it did not extend “treatment” to measures unrelated to a patient’s mental illness, and the judge said the finding was not open-ended.
The judgment did not decide the defendant’s wider challenge concerning whether the Act provided adequate procedural safeguards or was compatible with constitutional and Convention rights. The judge noted that no constitutional challenge or application for a declaration of incompatibility had been brought, and that evidence about seclusion and whether other methods of restraint had been tried was limited. He directed that the parties consider the issues and next steps, ordered reports on the course and outcome of treatment to date, and said he would hear further submissions about procedure and representation of the relevant interests.