Reid v. Secretary of State for Scotland and Another

The House of Lords allowed the Secretary of State's appeal and restored the interlocutor of the Lord Ordinary. The court held that, where a restricted patient suffers from a persistent disorder manifested only by abnormally aggressive or seriously irresponsible conduct (a psychopathic disorder), the sheriff, in determining an appeal under section 64(1) of the Mental Health (Scotland) Act 1984, must consider whether medical treatment in hospital is likely to alleviate or prevent a deterioration of the patient's condition (the "treatability" inquiry derived from section 17(1)(a)(i)). The Lords emphasised that the statutory phrase in section 64(1)(a) referring to liability to be detained "in a hospital for medical treatment" links to the admission criteria in section 17(1)(a), so that treatability is part of the enquiry for those disorders to which section 17(1)(a)(i) applies.

The court also held that the sheriff's factual finding, on evidence including the responsible medical officer's report, that the respondent's symptoms were being alleviated by treatment (broadly defined to include nursing and care under medical supervision) was supported by evidence and not vitiated as a matter of judicial review. The House concluded that the Inner House had erred in substituting its view of the evidence for the sheriff's and in construing section 64(1) so as to exclude the treatability element.

The respondent, convicted in 1967 of culpable homicide, was made subject to a hospital order and a restriction order. In 1994 he applied under section 63/64 of the Mental Health (Scotland) Act 1984 for discharge. Sheriff Reeves refused the application, finding a high risk of re-offending if the respondent were released and accepting the responsible medical officer's evidence that the structured, supervised hospital environment improved the respondent's anger management.

The respondent sought judicial review of the sheriff's refusal. The Lord Ordinary dismissed the petition. The Inner House allowed a reclaiming motion and reduced the sheriff's interlocutor, treating the fact that current psychiatric opinion might regard the disorder as untreatable as decisive for discharge. The Secretary of State appealed to the House of Lords.

Issues for decision included (i) the proper construction of section 64(1) of the 1984 Act: whether the sheriff, when considering discharge of a restricted patient with psychopathic disorder, must take into account the "treatability" requirement in section 17(1)(a)(i), and (ii) whether the Inner House was entitled, on judicial review, to overturn the sheriff's factual findings about the effect of medical treatment.

The House reasoned that the phrase in section 64(1)(a) referring to liability to be detained "in a hospital for medical treatment" imports the admission criteria found in section 17(1)(a), including the special qualification in section 17(1)(a)(i) for persistent disorders manifested by aggressive or irresponsible conduct. The court explained that "medical treatment" is defined widely (including nursing, care and training under medical supervision) so that measures which alleviate symptoms in a supervised hospital environment may count as treatment for the purposes of section 17(1)(a)(i). On the second issue the House held that the sheriff's findings — based on oral evidence and the responsible medical officer's report — were within the range of reasonable conclusions and should not have been displaced on judicial review. The appeal was therefore allowed and the Lord Ordinary's interlocutor restored.

The judgment noted the broader implications for other restricted patients and for precedent in England and Scotland (including the Court of Appeal's decision in Reg. v. Canons Park Mental Health Review Tribunal, Ex parte A), and emphasised the difference between the procedures under Part V (civil admissions) and Part VI (criminally restricted patients).

Appeal allowed. The House held that section 64(1)(a) must be read with the admission criteria in section 17(1)(a) so that, for psychopathic disorders, the sheriff must consider whether medical treatment is likely to alleviate or prevent deterioration (the "treatability" element). The House also held that the sheriff's factual finding that treatment was alleviating the respondent's condition was supported by evidence and should not have been overturned on judicial review.

Sheriff Reeves refused the respondent's discharge application (Sheriff's interlocutor, 19 July 1994). The respondent's petition for judicial review to the Lord Ordinary (Rodger) was dismissed: 1995 S.L.T. 555. The Inner House allowed the reclaiming motion and granted a decree of reduction: 1997 S.L.T. 162. The Secretary of State appealed to the House of Lords: [1998] UKHL 43 (this decision).