The High Court said that patients who object to continued psychiatric treatment under section 60 of the Mental Health Act 2001 must have their choices recorded and considered through an assisted decision-making process, alongside independent review. The ruling did not require a court hearing for every treatment decision and the plaintiff was not granted the relief she sought.
In a judgment delivered on 23 November 2012, Mr Justice John MacMenamin considered a challenge brought by M.X. [APUM] to procedures governing her treatment at the Central Mental Hospital. She was receiving Clozapine and regular blood tests without giving consent. The court found that the treatment was governed by section 60, which concerns medicine administered continuously for three months or more, rather than section 57, as the plaintiff had argued.
The plaintiff challenged the procedures on constitutional and European human rights grounds. Her case included a claim that a finding that she lacked capacity should be independently reviewed and that her wishes should be supported in treatment decisions. The court heard evidence from treating and independent psychiatrists. It found that the required section 60 assessments had been carried out, including independent examinations and authorisations at three-month intervals. The judgment also noted that the Form 17 used to record those decisions did not ask for the patient’s views.
The judge held that section 60 was not unconstitutional. Instead, it should be applied in a constitutionally compliant manner. For future cases, the Form 17 process should be reviewed so that a patient’s decision or choice is recorded and given due regard. The court said a patient’s choice would not always determine the outcome, and that consultant psychiatrists would retain a pivotal role. It described assisted decision-making as potentially involving a suitably qualified person, such as a carer, social worker or family member.
The court said patients must have access to the courts independently of State agencies if the need arises. It did not find a right to mandatory, ongoing court involvement in every case, and rejected the request for a declaration that section 60 was incompatible with the European Convention on Human Rights. It also held that the UN Convention on the Rights of Persons with Disabilities did not have direct effect in Ireland at that time, although it could guide interpretation of care and review standards.
The judge concluded that the court proceedings had themselves provided review in this case, and that he had made the treatment decision after considering the plaintiff’s best interests and the need to limit interference with her rights. Although he found that she had standing to bring the case, he ruled that she was not entitled to relief under the claims advanced.