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

Article 2 does not generally require a separate independent investigation from the outset into the suicide of a patient detained under the Mental Health Act 1983 where a properly conducted Middleton-type inquest is available. The Article 2 obligation is assessed by examining the staged investigation process as a whole. Defects in an earlier internal investigation may be remedied at a later stage, provided the overall process is independent, prompt and effective. A State is not required by law to adopt the independent-investigator arrangements used for deaths in prisons or police custody. Differences between psychiatric detention and penal detention are not, without more, discrimination based on disability. The Equality Act 2010 provisions on indirect discrimination and the public sector equality duty apply to living persons and do not govern the manner of investigating deaths.

The claim concerned the suicide of JA, who was detained under sections 3 and 5 of the Mental Health Act 1983 at a mental health unit. The claimant, JA’s widower, challenged the adequacy and independence of the investigations conducted by the NHS Trust, the health authorities and the subsequent inquest.

The principal issue was whether Article 2 of the European Convention on Human Rights required an immediate, independent investigation before or in addition to the inquest. Related issues concerned responsibility for any breach, whether the Department of Health and National Patient Safety Agency guidance misstated the law, whether defects could be cured by the inquest, and whether the arrangements unlawfully discriminated on grounds of disability.

Claim dismissed. The court held that no separate independent investigation was required from the outset, or at any later point apart from the inquest.

1. Article 2’s procedural obligation is triggered where a substantive Article 2 obligation has been, or may have been, violated and State agents may be implicated. The court followed the approach in R (Middleton) v West Somerset Coroner [2004] 2 AC 182 and R (Smith) v Oxfordshire Assistant Deputy Coroner [2011] 1 AC 1.
2. The domestic system is staged. An internal investigation may precede an independent coroner’s investigation. A properly constituted Middleton-type inquest will generally satisfy the Article 2 procedural obligation. The reasoning in R (Amin) v Secretary of State for the Home Department [2004] 1 AC 653 did not require an additional independent inquiry where the inquest itself discharged the obligation.
3. R (L (A Patient)) v Secretary of State for Justice [2009] 1 AC 588 concerned an attempted suicide causing serious injury, where no inquest was available. It identified the characteristics of an Article 2-compliant investigation but did not establish an automatic independent preliminary investigation for every detained-patient death.
4. The Trust’s internal investigation lacked independence, and there were shortcomings concerning the lost ligature, delayed evidence, disclosure and the depth of the internal report. Those defects were not fundamental. The coroner was independent, had extensive powers, and conducted seven pre-inquest reviews followed by a thorough jury inquest. The process as a whole was independent, effective and prompt.
5. The Department of Health guidance stated the correct general trigger. The NPSA guidance was imprecise in using the word “well”, but its correct test was that Article 2 had been, or might have been, violated and State agents might be implicated.
6. There was no unlawful discrimination under Article 14. The difference between psychiatric and penal detention arose from the circumstances and purpose of detention, not disability. Sections 19 and 149 of the Equality Act 2010 applied to living persons and could not regulate investigation arrangements after death.