The High Court has found that K.W., an anonymised young adult, lacks capacity to make material decisions about her medical treatment and therapy. It ordered her involuntary detention in an adult psychiatric ward under the care of the Clinical Director of Ennis General Hospital, with a safe transition from St Andrew’s Healthcare in Northampton to Ireland over three months, or sooner if her treating medical teams agree.
In a judgment delivered on 12 March 2015, Ms Justice Bronagh O’Hanlon said the court was acting under its inherent jurisdiction to protect K.W.’s welfare and constitutional rights. She said K.W. remained at high risk of suicide or self-harm and was not in a position to protect herself. The court said the transition should allow her to receive treatment and medication advised by her treating psychiatrist at St Andrew’s.
The case followed K.W.’s 18th birthday on 25 January 2015. Earlier orders had authorised her detention in England while an adult forensic psychiatrist assessed her capacity. The issue before the court was whether she could make decisions about future care and treatment and, if not, whether the court could authorise further detention.
Professor Henry Kennedy, a consultant forensic psychiatrist, gave evidence that K.W. could understand and retain relevant information and reason about available options. However, he said her mood and decisions could fluctuate rapidly and unpredictably, and she could not consistently communicate decisions based on understanding, reasoning and appreciation of their importance. The judge accepted his evidence that K.W. did not appreciate the benefit of others making decisions for her or limiting her freedom to harm herself when she was in a “bad place”.
The judge applied the capacity principles set out in *Fitzpatrick v F.K.* and concluded that K.W. lacked capacity in relation to material decisions about her treatment and therapy. The court also accepted that she was an Irish citizen, domiciled in Ireland and remained habitually resident there while temporarily placed in England.
The Health Service Executive had asked the court to authorise continued detention at St Andrew’s. K.W.’s guardian ad litem supported that position, citing the absence of a suitable facility in Ireland. The judge rejected continued placement at St Andrew’s as disproportionate, saying the therapies there had not changed K.W.’s presentation. She instead ordered a transition back to Ireland in accordance with K.W.’s wish to return. The judgment grants the applicant’s suite of orders and says the court will hear further submissions on any additional orders required.
The court upheld K.W.’s privacy rights as an adult. At the discretion of the Clinical Director of Ennis General Hospital after her transition, a broad outline of her progress and treatment may be disclosed to her parents, but it must not include medical reports.