A HIGH Court judge has highlighted the absence of protections in the Mental Health Act for voluntary patients in psychiatric hospitals who, despite their status, may not be permitted leave hospital when they seek to do so.
Such patients lacked the safeguards applying to people involuntarily detained.
The issue arose in a case where a man with paranoid schizophrenia, with the status of a voluntary patient since an order for his involuntary admission under the Mental Health Act 2001 was discharged on October 12th, has not been permitted to leave a locked unit in a psychiatric hospital despite asking several times to do so.
In circumstances where the 2001 Act did not regulate treatment of voluntary patients, Mr Justice Michael Peart indicated yesterday this “very important” issue might benefit from being addressed by the Supreme Court.
He made the observation after refusing to declare that the man was detained unlawfully as a result of doctors refusing his request to be allowed to leave that hospital despite a discharge order on October 12th, 2011. That order revoked the man’s detention under the Act.
Over a 24-hour period on last November 21st-22nd, psychiatrists differed whether the man should be admitted as an involuntary patient under the Act.
He continues to have voluntary status.
The man had sought to leave the unit a number of times but had been often persuaded to remain by doctors and staff after, on some occasions, being restrained and sedated. His solicitor said clinical notes indicated that although a voluntary patient, he was forcibly restrained about 30 times.
His requests to leave were refused on grounds including that doctors believed immediate discharge was not in his best interests, that he required further care and that he could also represent a danger to himself and others.
Mr Justice Peart yesterday rejected arguments by the man’s lawyers that the regime at the hospital to which he, a voluntary patient, was subject and which he was not permitted to leave, had no lawful basis in circumstances where the man was not detained under sections 23 and 24 of the Mental Health Act 2001 and therefore had none of the safeguards provided to persons detained under the Act.
A wide discretion must be allowed to treating doctors in considering how the best interests of a patient would be served and he considered the regime in this case fell within the margin allowed, the judge said.
Just because a patient expressed a desire to leave did not mean doctors had to immediately discharge them. In circumstances where a duty of care was owed by doctors, not just to the patient but also to the public generally, and an immediate discharge may not be in a patient’s best interests, a wide discretion appeared to be given to the consulting psychiatrist.
No one was arguing it was in this man’s best interests to be discharged on to the street and it could not be so argued, he believed. It was also relevant this man was a voluntary patient, not because he decided to be but because of the revocation of the order for his detention under the Act.
He was satisfied the man, on the relevant occasions, had expressed a desire to remain and be treated in the hospital after expressing just hours earlier a desire to leave. He was also satisfied it was appropriate for staff to handle the situations which arose as they had.
A forensic psychiatrist concluded on November 21st that the man did not have the necessary capacity to make a decision to remain as a voluntary patient.
His treating psychiatrist also concluded on November 21st that given the man’s attempts to abscond, he should be detained as an involuntary patient under the Act. For that to happen, a second examining psychiatrist had to take the same view, but a psychiatrist who examined him on November 22nd concluded he did not meet the criteria for involuntary detention as he was saying he would remain in the locked unit and take his medication. This meant he remained a voluntary patient.
The judge has allowed lawyers until February 10th to consider his judgment, noting that it “may well benefit” from the views of others.
