A.X. -v- The Mental Health Tribunal & Anr.

This is a case about the applicant challenging an order from Mental Health Tribunal (“the Tribunal”) that demanded her involuntary admission to St. John of God’s Hospital (“the Hospital”) for treatment of a mental disorder. On April 28th, 2014, a member of An Garda Síochána detained the applicant because there were sufficient grounds to believe that the applicant was suffering from a mental disorder which would cause harm to herself and others.

The member requested a registered medical practitioner’s opinion on whether the applicant should be involuntarily admitted to a hospital for treatment of mental disorder, as required by s. 12 of the Mental Health Act 2001 (“the 2001 Act”),. After examination, the medical practitioner recommended the applicant being admitted and treated by the Elm Mount Unit of St. Vincent’s University Hospital in Elm Park, Dublin 4. The applicant was examined again by a consultant psychiatrist in this hospital before her admission, who described the applicant as “thin, unkempt, thought disorder, persecutory delusions, erratic unpredictable behavior, and non compliance with medications” and from which the psychiatrist suggested “the reception, detention and treatment of the applicant” based on Section 3 of the 2001 Act. The clinical director of the Elm Mount Unit transferred the applicant to the hospital because “the applicant would be under the care of her previous consultant psychiatrist, and in a secure setting, there.”

The tribunal reviewed this detention shortly after the hearing on May 15th, 2014, and affirmed the admission order on April 27th 2014 because it was satisfied that the applicant suffered a mental disorder as defined in Section 3 of the 2001 Act. The consultant responsible for the treatment of the applicant renewed and extended the applicant’s detention on May 16th 2014. On June 5th 2014, another tribunal reviewed the detention on the ground of renewal order and upheld it. The applicant sought for judicial review of the second tribunal decision because she claimed both the detention and the renewed order were illegal.

The relevant provisions are as stated below:

Section 3 of the 2001 Act states:

“In this Act “mental disorder” means mental illness, severe dementia or significant intellectual disability where-

(a) because of the illness, disability or dementia, there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or other persons, or

(b) (i) because of the severity of the illness, disability or dementia, the judgment of the person concerned is so impaired that failure to admit the person to an approved centre would be likely to lead to a serious deterioration in his or her condition or would prevent the administration of appropriate treatment that could be given only by such admission and, and

(ii) the reception, detention and treatment of the person concerned would be likely to benefit or alleviate the condition of that person to a material extent.”

Section 17 of the 2001 Act has the following options for a Tribunal reviewing the detention of a person subject to an admission or renewal order:

“ (a) if satisfied that the patient is suffering from a mental disorder and

(i) that the provisions of sections 9, 10, 12, 14, 15 and 16, where applicable, have been complied with, or

(ii) if there has been a failure to comply with any such provision, that the failure does not affect the substance of the order and does not cause an injustice,

affirm the order, or

(b) if not so satisfied, revoke the order and direct that the patient be discharged from the approved centre concerned.”

The Court held that the detention and the renewed order were valid both in substance and in form. First, the tribunal is entitled to have an independent conclusion and may only give a general description of the reasoning. Second, unlike alleged by the applicant, the Court found that the tribunal’s review process did follow the criterion set out by s. 3(1)(b) of the Act. The Court noted that the Tribunal’s findings that the severity of the illness impaired the applicant’s judgment, that failure to detain the applicant would result in a deterioration in her condition or would prevent the administration of appropriate treatment, that detention would likely alleviate her condition, were consistent with the evidence.

“It follows that the task of the tribunal was not to review the correctness of the consultant psychiatrist’s opinion that the applicant was suffering from a mental disorder when an admission order was made on the 27th April 2014, but rather to form its own view concerning whether the applicant was suffering from a mental disorder when the review occurred on the 15th May 2014.” (Para 67)

“Under s. 19 of the 2001 Act, that court is entitled to reach its own conclusion on that issue, regardless of what conclusions had been reached earlier…the same must be said about the tribunal’s entitlement (indeed, obligation) to come to a conclusion on the same issue independent of any prior conclusion reached on that issue in the context of the making of an admission order.” (Para 68)