Care Principles Ltd, R (on the application of) v The Mental Health Review Tribunal

A Mental Health Review Tribunal considering detention under section 2 of the Mental Health Act 1983 must assess whether detention is justified when it makes its decision. The hospital bears the burden of proving that continued detention is warranted on the balance of probabilities. Judicial review does not permit the High Court to reweigh evidence or act as an appellate tribunal on fact.

A stay preventing discharge ordinarily requires a strong case of unlawfulness and cogent evidence of danger. A fresh detention cannot simply nullify a tribunal’s discharge decision. It requires new information, including material previously unavailable to the tribunal, and hospital managers must critically consider whether detention is justified.

Two conjoined judicial review claims concerned AL, who had been detained under section 2 of the Mental Health Act 1983 for assessment. The Mental Health Review Tribunal ordered his discharge, briefly deferring it to allow community support arrangements.

Care Principles Ltd challenged the tribunal’s decision and obtained an interim order preventing discharge. AL separately challenged his subsequent admission under section 3 after the section 2 period expired. The issues were whether the tribunal had erred in law, whether the interim stay was properly granted, and whether the later detention unlawfully circumvented the tribunal’s decision.

1. Care Principles Ltd’s claim dismissed. The tribunal accepted that AL suffered from mental disorder but was not satisfied that its nature or degree warranted continued detention for assessment. It was entitled to evaluate the evidence, including his conduct in hospital, the effect of alcohol, the absence of medication, the nursing evidence and the absence of a satisfactory link between the disorder and the relevant conduct. Its conclusion was legally open to it. The High Court could intervene only for an error of law and could not reweigh the facts.
2. The tribunal’s power under section 72(3) to defer discharge did not make its decision irrational. There was no sufficient evidence that a support package could not be arranged within the period allowed.
3. A stay suspending a discharge order engages the patient’s liberty. Applying R(H) v Ashworth Hospital Authority [2003] 1 WLR 127, an arguable case is ordinarily insufficient. There should generally be a strong case of unlawfulness and cogent evidence that release would create danger. The patient’s representatives and the tribunal should normally receive notice, and the challenge should be determined with the greatest possible speed.
4. AL’s claim allowed. Applying R(von Brandenburg) v East London and City NHS Trust [2003] 3 WLR 1265, a fresh application inconsistent with a tribunal’s discharge decision requires new information. This may include material not taken into account by the tribunal. Hospital managers aware of the earlier decision must critically consider whether fresh detention is objectively justified.
5. Section 6(3) did not permit the managers simply to rely on the formal validity of the application or the social worker’s consideration. The section 3 admission was unlawful, was quashed, and AL was to be discharged in accordance with the tribunal’s decision, without prejudice to any later fresh application based on subsequent developments.

The judgment describes two conjoined judicial reviews. Lloyd Jones J made an interim order preventing discharge, and Sullivan J directed a rolled-up hearing. The Administrative Court dismissed Care Principles Ltd’s claim and allowed AL’s claim.