Savage v South Essex Partnership NHS Foundation Trust

Article 2 imposes an operational obligation on a hospital authority where staff knew or ought to have known that a detained mental-health patient faced a real and immediate risk of suicide. The threshold is high and more stringent than ordinary clinical negligence. Once engaged, the authority must take all measures reasonably expected in the circumstances, giving priority to preventing suicide while the danger persists. Causation does not require proof that death would probably have been avoided. It is sufficient to show that appropriate action would have provided a substantial chance of survival.

Carol Savage, a patient detained under section 3 of the Mental Health Act 1983, died after leaving an open psychiatric ward and being struck by a train. Her daughter brought proceedings under section 7 of the Human Rights Act 1998, alleging breach of Article 2.

The House of Lords had previously determined the applicable Article 2 operational duty in the same litigation, reported at [2009] 1 AC 681. The issues at trial were whether the Trust knew or ought to have known that Mrs Savage faced a real and immediate risk of suicide, whether it took all reasonably expected measures to prevent that risk, whether the claimant was a victim, and what just satisfaction should be awarded.

1. Article 2 duty. The court applied the two-stage test established in the preliminary decision. First, it had to determine whether the Trust knew or ought to have known of a real and immediate risk to Mrs Savage’s life. Secondly, it had to determine whether the Trust did all that could reasonably have been expected to avoid or prevent that risk. The threshold was high and required assessment without hindsight.
2. Knowledge of risk. The Trust had actual or constructive knowledge of significant risk indicators, including the previous suicide risk and absconding history, attempts to escape through windows in response to hallucinations, repeated expressions of self-harm, repeated attempts to abscond, and continuing severe psychotic symptoms. The assumption that Mrs Savage merely wished to return home was superficial and unsupported by adequate assessment.
3. Failure to take reasonable measures. The Trust failed to carry out or document proper risk assessments, risk reviews, care planning and observation decisions. Although inadequate records were not themselves decisive, the evidence showed that the staff failed to identify and respond to the risk. Level-two observations at intervals of 15 or 30 minutes would have given a real prospect or substantial chance of preventing the unnoticed departure. Her safety would have taken priority if a more restrictive regime had been necessary.
4. Causation and outcome. The applicable causation test was less demanding than the domestic but-for test. The claimant established a substantial chance of survival and therefore established a breach of Article 2.
5. Victim status and relief. The claimant, as the deceased’s close daughter, was entitled to bring the claim as an indirect victim. The court made a declaration that the Trust had violated its positive obligation to protect Mrs Savage’s life and awarded £10,000 for just satisfaction.

The judgment states that the House of Lords had determined a preliminary issue in the same litigation, reported at [2009] 1 AC 681. This judgment determined the remaining factual, liability, victim-status and relief issues at first instance.