R (B) v Haddock

Non-consensual treatment under the Mental Health Act 1983 requires a single, convincingly demonstrated medical necessity. The court must be satisfied that the patient suffers from a mental disorder for which the treatment is needed and that the treatment is likely to alleviate the patient’s condition. Exact diagnostic classification is not decisive where the patient suffers from mental disorder and the treatment is necessary for the relevant statutory purposes.

A patient’s mental disorder does not itself establish incapacity. Capacity must be assessed by reference to the ability to understand, retain, use and weigh the material information. A SOAD must make an independent decision and give reasons. Judicial review remains essentially a review exercise, although the court must address the human-rights issues at the required high level.

The claimant was detained at Ashworth Hospital under a hospital order and restriction order made under the Mental Health Act 1983. His RMO proposed forcible administration of depot antipsychotic medication. A SOAD certified the treatment, subject to restrictions on its type and amount.

The claimant challenged the treatment on human-rights grounds, arguing that he did not suffer from the relevant mental disorder, had capacity to refuse treatment, and that the treatment was neither necessary nor likely to be effective. He also relied on the Court of Appeal decision in R(B) v Ashworth Hospital Authority, but abandoned that ground after the House of Lords reversed that decision. The central issues were whether the statutory safeguards were satisfied and whether the proposed treatment was convincingly medically necessary.

The claim was dismissed.

1. The court held that the relevant question under the Mental Health Act 1983 and the European Convention was a single question of convincing medical necessity. The RMO and SOAD had to be persuaded that the claimant suffered from a mental disorder for which the proposed treatment was needed and that the treatment would alleviate his condition. Precise diagnosis was not always possible, and the statutory classification of the disorder was not decisive.

2. The claimant lacked capacity within section 58. Capacity is presumed, and mental disorder does not of itself establish incapacity. The claimant’s fixed beliefs about medication prevented him from properly weighing the advantages and disadvantages of treatment.

3. The court was bound by R(Wilkinson) v Broadmoor Special Hospital to adopt the required high-level human-rights review. However, oral evidence and cross-examination would not ordinarily be necessary. The court’s role remained essentially one of review, although it had to consider the evidence sufficiently to resolve the issues before it.

4. The SOAD had to make an independent decision and give reasons. The third defendant had provided full and detailed reasons, and the statutory consultation requirements had been satisfied.

5. The evidence showed that earlier depot medication had alleviated the claimant’s condition and that his condition deteriorated after medication ceased. That evidence provided a convincing basis for concluding that the proposed treatment was likely to alleviate his condition. The opposing medical opinions did not outweigh the evidence supporting treatment.

6. The court added that a SOAD should generally be treated as an interested party analogous to a tribunal whose decision is challenged. Representation is not ordinarily required unless a specific error of law is alleged, although the SOAD must provide the certificate and reasons and must give evidence if required.

First-instance judicial review claim. No appellate history was stated.