The High Court has found that T.M. had sufficient capacity to decide whether to accept treatment and accommodation, and said he could live at a Nua Healthcare facility in Ireland only voluntarily. T.M. had returned to Ireland on 24 October 2016, before the judgment was delivered on 27 October, and was no longer detained when the court considered the remaining issues.
The case concerned High Court orders under which T.M. had been detained at St. Andrew’s Hospital in Northampton, England, from 2012 for therapeutic and educational purposes. He was an Irish citizen, habitually resident and domiciled in Ireland. After he turned 18, the court had previously found that he could instruct a solicitor but lacked capacity to make certain decisions about treatment and accommodation.
The HSE sought to transition him to a Nua Healthcare placement in Ireland. T.M. said he wanted to return and was willing to go there. His mother opposed the move, believing he was making progress in England and that the proposed placement would be unsafe. The guardian ad litem supported a voluntary transition while acknowledging the risks.
The court heard differing medical opinions on T.M.’s capacity, treatment and risks. It accepted the evidence of Dr Larkin Feeney that T.M. could understand, retain and weigh information about his options and communicate a decision, though his capacity could be limited during periods of severe emotional distress. The judge also cited evidence that progress at St. Andrew’s had stagnated and that T.M. was no longer engaging with therapy.
The judge concluded that the therapeutic rationale for continuing detention in England no longer existed and that further detention would not be proportionate or justifiable. The court found T.M. was not detainable under Ireland’s Mental Health Act 2001. It stressed that risk alone could not justify detaining him and said the HSE and Child and Family Agency had obligations to support his transition and help mitigate risks.
The court considered the proposed Nua Healthcare placement the most suitable option, but held that T.M. could reside there only voluntarily because of its finding on his capacity. It was optimistic about the transition and said his welfare should continue to receive extensive support. The judgment did not determine whether the High Court has inherent jurisdiction to detain an adult lacking capacity: the judge said it was unnecessary to decide that question because T.M. was no longer detained.