Antoniou, R (on the application of) v Central and North West London NHS Foundation Trust & Ors

The court considered the scope of the procedural obligation under Article 2 ECHR where a patient detained under the Mental Health Act 1983 died by self-harm while in hospital care. The court held that, in England and Wales, the existing "staged" system of investigation into deaths — which commonly culminates in an inquest (and in appropriate cases a Middleton-type inquest) — will generally satisfy Article 2. The court rejected the claim that Article 2 requires an immediate, independent pre-inquest investigation in every Mental Health Act death and found no obligation on the defendants to commission a separate independent investigation prior to the inquest.

On the facts the court examined the internal Serious Untoward Incident (SUI) process, the conduct of the hospital and the subsequent inquest. It concluded that, taken overall, the investigatory process was independent, prompt and effective and therefore complied with Article 2. The court also rejected claims of unlawful discrimination under Article 14 ECHR and the Equality Act 2010 and declined to characterise the Department of Health and NPSA guidance as mis-stating the law in any material respect.

Background and parties: The claim arises from the suicide of Mrs Jane Antoniou while detained under section 3 of the Mental Health Act 1983 at an NHS hospital. The claimant, her husband, sought judicial review challenging the adequacy and independence of the investigations conducted by the NHS Trust and national bodies and contended that Article 2 ECHR required an independent investigation prior to any inquest. Defendants were the NHS Trust, the Secretary of State for Health and NHS England.

Relief sought: Declarations that the Trust and national defendants breached Article 2 by failing to commission an independent pre-inquest investigation; damages; and declarations of unlawful discrimination under Article 14 ECHR and the Equality Act 2010.

Issues framed: (i) the scope of the Article 2 procedural obligation in the context of a detained psychiatric patient’s suicide; (ii) whether Article 2 requires an independent investigation from the outset or before an inquest; (iii) whether any failure can be cured by a later inquest; (iv) which public body (if any) bears the duty; (v) whether Department of Health and NPSA guidance mis-stated the law; and (vi) whether the investigation process in this case complied with Article 2 and equality obligations.

Facts and procedural posture: The judgment summarises the clinical chronology, the hospital’s SUI policy and the SUI panel investigation, the police involvement, disclosure disputes, multiple pre-inquest reviews and a full jury inquest which returned a narrative verdict. The claimant issued judicial review proceedings which were stayed pending the inquest and later pursued again.

Court’s reasoning and conclusions: The court reviewed domestic and Strasbourg authorities (including Middleton, Smith, L, Amin, Ramsahai, Silih and others) and identified that English law operates a "staged" investigatory system which often culminates in an inquest able to discharge Article 2 procedural requirements. The court held that those detained under the MHA do attract substantive Article 2 protections and that Article 2 procedural obligations will be triggered where the substantive duty may have been violated; however, existing authorities do not establish a requirement for a separate, immediate, independent pre-inquest investigation in every MHA suicide case. The court found that the SUI process, although internal, together with the powers and independence of the coroner and the thorough jury inquest, meant the investigation process taken as a whole was independent, prompt and effective and complied with Article 2. The court rejected the discrimination and public-sector-equality-duty arguments and concluded the DoH/NPSA guidance did not materially mis-state the law.

The claim is dismissed. The court held that Article 2 does not, as a matter of existing domestic and Strasbourg jurisprudence, require an immediate independent investigation separate from an inquest in every case of suicide by a detained patient under the Mental Health Act. On the facts the investigation process (including the SUI investigation and the inquest) was, taken as a whole, independent, prompt and effective and complied with Article 2; there was no unlawful discrimination and the guidance relied on did not materially misstate the law.