Judges rule that hospitals have a duty to protect voluntary psychiatric patients

BMJ 2012; 344 doi: (Published 10 February 2012) Cite this as: BMJ 2012;344:e1025
  1. Clare Dyer
  1. 1BMJ

Public institutions, including NHS hospitals, have a positive duty to safeguard the right to life of voluntary psychiatric patients as well as patients who are formally detained, the UK Supreme Court has ruled in a landmark judgment.

Five judges ruled that Pennine Care NHS Trust breached Melanie Rabone’s right to life under article 2 of the European Convention on Human Rights when she was allowed to leave Stepping Hill Hospital in Stockport in April 2005 for two days’ home leave with her parents. She had been admitted to hospital as a voluntary patient after a second suicide attempt, and a day after going home she went for a walk and hanged herself from a tree.

The Supreme Court’s judgment overturned rulings from the High Court and Court of Appeal, which held that the article 2 duty applied only to detained patients. The appeal court noted that NHS bodies would be laid open to considerable additional liabilities if the courts were to hold that these bodies were under a positive duty to protect the lives of informal patients as well as those detained under the Mental Health Act.

Ms Rabone, 24, had a history of depression. She was assessed as a “moderate to high suicide” risk in hospital and kept on a 15 minute watch. A doctor noted on her admission that if she attempted or demanded to leave she would be assessed for detention under the Mental Health Act, but despite this a consultant psychiatrist agreed that she could have home leave for two days and nights.

The trust eventually admitted negligence and agreed to pay £7500 (€8900; $11 600) damages to Melanie’s estate, but her parents, Richard and Gillian, launched proceedings on their own behalf as victims of the trust’s breach of article 2. The High Court and Court of Appeal ruled that there was no claim under article 2 because voluntary patients were crucially different from those who were detained: like patients having physical treatment in hospital, they were free to refuse treatment and leave.

But the Supreme Court disagreed. Lord Dyson said the difference was one of form, not substance. If Ms Rabone insisted on leaving the hospital, the authorities could and should have exercised their powers to prevent her from doing so.

Because the decision to allow home leave was “one that no reasonable psychiatric practitioner would have made, the trust failed to do all that could reasonably have been expected to prevent the real and immediate risk of Melanie’s suicide,” the judgment said. The court awarded Mr and Mrs Rabone £5000 each.

Emma Norton, legal officer of the human rights group Liberty, said: “This landmark human rights judgment means that voluntary patients in psychiatric care will finally get the same legal protection as sectioned patients. Hospitals rightly acknowledge their serious duties to detained people. Why should those who have asked for help be any different?”


Cite this as: BMJ 2012;344:e1025

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