Nyang v G4S Care & Justice Services Ltd & Ors

Detention-centre staff owe detainees a duty to take reasonable care to prevent self-harm, assessed in the context of the centre’s statutory powers, operational limits and the safety of others. Medical staff must exercise the ordinary skill and care of reasonably competent practitioners. A mental-health assessment should address relevant symptoms and risk by appropriate questions, not observation alone. Cultural assumptions based on limited experience cannot properly displace clinical assessment. Negligence does not establish liability unless it caused the injury on the balance of probabilities. The material negligence in this case did not cause the claimant’s catastrophic self-harm injuries.

The claimant, detained at an immigration removal centre pending removal to Gambia, suffered catastrophic spinal injuries after running head first into a concrete wall. He alleged negligence by detention staff and healthcare professionals in failing to identify and manage a developing depressive illness, failing to commence an ACDT process promptly, conducting a random room search, and failing to provide or act on relevant information.

The court tried preliminary issues concerning liability and causation. The central questions were whether any defendant had breached the applicable duty of care and, if so, whether the breach would probably have prevented the events of 30 January 2008.

1. Applicable duties. Detention staff owed a duty to take reasonable care to prevent self-harm, having regard to the statutory detention framework, the limits on their powers and the safety of others. Healthcare professionals were required to meet the standard of the ordinary skilled practitioner. The first defendant also accepted a non-delegable duty to provide appropriate physical and mental healthcare.
2. Mental-health assessment. A proper assessment of possible depression, psychosis and self-harm risk required more than observation. It ordinarily involved consideration of appearance and behaviour, speech, mood, thought content, perception, intellectual function and insight, together with brief pertinent questions. On 23 January 2008 the healthcare defendants failed to ask about suicidal or self-harm intent and mood, and relied materially on an inadequate cultural explanation for unusual behaviour. That fell below the required standard.
3. Detention staff. Mr Macdonald was negligent in failing to commence an ACDT process on 29 January and on the morning of 30 January, and in failing to consider postponing the random search of the claimant’s room. The remaining allegations of negligence were not established.
4. Causation. By 16 January the claimant had developed a depressive illness, which deteriorated into a psychiatric emergency by 30 January. Nevertheless, earlier assessment, ACDT involvement, monitoring, removal from association, referral or medication would not, on the balance of probabilities, have prevented the final act. The case did not involve uncertainty arising from the limits of medical science, so the material-contribution approach in Bailey v Ministry of Defence [2009] 1 W.L.R. 1052 did not apply.
5. The acts of negligence found were not causative of the injuries. The preliminary issues were therefore determined without establishing liability for the claimant’s harm.