The High Court has refused all relief sought by a patient who challenged being kept in a locked unit at St Patrick’s University Hospital after an order detaining him under mental health legislation was revoked.
In a judgment delivered on 24 January 2012, Mr Justice Michael Peart held that the patient remained a “voluntary patient” under the Mental Health Act 2001 after his renewal order was revoked on 12 October 2011. The court found that staff could respond to his wishes to leave by speaking with him and seeking his agreement to continue treatment, where he then agreed to remain. It did not declare the restrictions unlawful detention.
The applicant, identified as P. L., had entered the hospital voluntarily in August 2011. A detention order was made in September and later affirmed by a Mental Health Tribunal. The responsible consultant psychiatrist revoked the renewal order the day after the Tribunal affirmed it, having concluded the patient’s condition had improved and that he would remain voluntarily in the Special Care Unit and take medication.
The patient later asked to leave the unit or move to another ward, and on 21 November made attempts to leave, including trying to get over a garden wall. Hospital staff restrained him for seven minutes during one episode. The treating psychiatrist began a procedure to detain him for assessment, but a second psychiatrist, Dr Power, concluded the following day that the criteria for detention were not met. The patient agreed to remain in the unit and continue treatment.
The applicant argued that keeping him in a locked unit while treating him as voluntary left him without the statutory safeguards available to detained patients, despite his attempts to leave. The respondents maintained that staff acted in his best interests and that he had agreed to the care plan after being reassured. The judgment records differing clinical opinions about his capacity to decide whether to remain voluntarily.
The court said the Act defines a voluntary patient by the absence of an admission or renewal order, and does not provide that a patient’s withdrawal of consent alone changes that status. It accepted that staff could use clinical judgment to discuss a patient’s expressed wish to leave and seek renewed cooperation, and found that the patient had agreed to stay on the occasions at issue. The judge stressed that this did not mean a voluntary patient’s wish to leave could always be ignored.
The court also declined to make a declaration over the failure to give the patient’s legal representative a copy of the revocation order, finding no prejudice or injustice had been shown. It rejected the claim that delay in a forensic assessment breached the patient’s rights. No declarations or damages were granted.