N, R (on the application of) v Mental Health Review Tribunal & Anor

Section 1(3) of the Mental Health Act 1983 prevents detention for psychopathic disorder where the relevant conduct is attributable solely to sexual deviancy. It does not exclude consideration of aggressive or seriously irresponsible conduct occurring while a person pursues sexual deviancy. The tribunal must identify a persistent disorder or disability of mind producing such conduct, then ask whether the finding rests solely on sexual deviancy. A tribunal may consider the manner in which sexual offences are committed, together with other symptoms outside the sexual conduct. An adjournment to obtain oral expert evidence is discretionary. Judicial review is unavailable where the written evidence sufficiently presents the issue, the parties can address the evidence, and no injustice results.

The claimant sought judicial review of the Mental Health Review Tribunal’s decision of 1 March 2006 maintaining his detention under sections 47 and 49 of the Mental Health Act 1983. He argued that the tribunal had misdirected itself on the meaning of psychopathic disorder and should have adjourned to hear oral evidence from his expert, Dr Reeves.

The central issue was whether section 1(3) excluded conduct occurring in the course of sexual deviancy, and whether the tribunal had acted unlawfully in proceeding on the written medical evidence.

1. The application for judicial review was dismissed. The tribunal had lawfully maintained the claimant’s detention, and its refusal to adjourn did not cause injustice.
2. Sections 72 to 74 and section 49 of the Mental Health Act 1983 required the tribunal to consider whether the claimant suffered from psychopathic disorder making detention for medical treatment appropriate. Section 1(2) defines that disorder as a persistent disorder or disability of mind resulting in abnormally aggressive or seriously irresponsible conduct.
3. Section 1(3) excludes detention where the diagnosis rests solely on sexual deviancy. Consistently with R v Mental Health Review Tribunal ex p Clatworthy [1985] 3 All ER 699 and W v Secretary of State for Scotland 1999 SC 412, sexual deviancy means sexually deviant conduct rather than a mere tendency.
4. The exclusion is not engaged merely because aggressive or seriously irresponsible conduct occurs during sexual offending. Such conduct may be considered as part of the overall diagnosis, provided the diagnosis is not based solely on sexual deviancy. Other symptoms, including personality disorder, serious lying, manipulation, lack of empathy and aggressive behaviour, may be relevant.
5. The tribunal’s reasons showed that it considered both the claimant’s conduct during sexual offending and symptoms outside that conduct. Its conclusion was therefore legally justified.
6. The tribunal had a discretion under rule 16 of the Mental Health Tribunal Rules 1983 to adjourn. Dr Reeves’s written report addressed the central issue, the factual and medical material was available, the claimant could question members of the clinical team, and nothing emerged at the hearing requiring reconsideration. The refusal to adjourn was consequently within the tribunal’s lawful discretion.

The application was made at first instance to the Administrative Court for judicial review of the Mental Health Review Tribunal’s decision dated 1 March 2006.