Taylor, R (on the application of) v Haydn-Smith & Anor

Compulsory medication under the Mental Health Act 1983 requires convincing medical evidence that treatment is necessary according to generally accepted psychiatric principles. On a human-rights challenge, the court must reach its own conclusion on the evidence, although oral evidence and cross-examination will be appropriate only in rare cases. A patient’s lack of insight does not itself determine capacity. Where refusal of treatment rests on an irrational objection, treatment may properly proceed despite the absence of consent. The court may rely on detailed medical records, reasoned professional opinions and evidence of deterioration after medication is stopped.

The claimant was detained at Ashen Hill Hospital under sections 37 and 41 of the Mental Health Act 1983. He challenged the proposed administration of antipsychotic medication without his consent under section 58. A responsible medical officer and a second-opinion appointed doctor considered that he suffered from persistent delusional disorder and required medication. The claimant relied principally on contrary evidence from an independent psychiatrist.

The issues were whether medical necessity had been established, whether the court should hear oral evidence from the doctors, and whether the claimant had capacity to refuse treatment.

1. Medical necessity and standard of review. The defendants had to establish convincingly, according to generally accepted psychiatric principles, that the treatment was medically necessary. Because the claim engaged Articles 3 and 8 of the Convention, the court was required to reach its own conclusion on the evidence, in accordance with Wilkinson v Broadmoor Special Hospital [2002] 1 WLR 419.
2. Oral evidence. Following R(N) v M [2003] 1 WLR 562, oral evidence should not ordinarily be required. Where the court has the medical records, reasoned decisions, professional statements and responses to opposing views, cross-examination will be appropriate only in rare cases. The application to call the doctors was therefore refused.
3. Evidence of disorder and necessity. The claimant’s persistent persecutory beliefs, deterioration after stopping medication, neglect of himself and suicidal concerns supported the diagnosis and the need for treatment. The court rejected the contrary psychiatrist’s reports as selective, insufficiently informed by the history and inadequately reasoned. The responsible medical officer and second-opinion doctor had provided detailed and persuasive evidence, and the earlier improvement on medication was significant.
4. Capacity and consent. The relevant question under section 58 is whether the patient is capable of understanding the nature, purpose and likely effects of treatment, rather than whether he actually understands them. The claimant’s lack of insight did not resolve the issue. In any event, his refusal was based on the irrational belief that he was not mentally ill and was being unlawfully detained. Whether analysed as incapacity or as a sufficient reason to override consent, compulsory treatment was justified.
5. The claim was dismissed. The first defendant was awarded costs, subject to detailed assessment because the claimant was publicly funded. The claimant was permitted to apply in writing for leave to appeal within seven days of receiving the transcript.

This was a first-instance judicial review claim. The judgment records that an earlier injunction preventing medication was discharged by Hodge J on 10 March 2005 when permission was refused.