Lancashire County Council v Claire X

A court exercising the inherent jurisdiction cannot compel clinicians or public authorities to detain a child under the Mental Health Act 1983. However, the availability of suitable social care is relevant to whether psychiatric treatment is necessary. A less restrictive alternative must be genuinely available and capable of providing appropriate care. If no suitable placement exists within a reasonable timescale, hospital treatment may be necessary notwithstanding the absence of a preferred community placement. The court may authorise deprivation of liberty and direct best-interests treatment, but it cannot substitute its own decision for the statutory detention assessment.

The local authority sought authorisation under the inherent jurisdiction for the deprivation of liberty of a 15-year-old child in hospital. The child had a history of severe and repeated self-harm, suicidal behaviour, absconding and ingestion of dangerous objects. Multiple CAMHS and psychiatric assessments concluded that she did not meet the criteria for Tier 4 detention under the Mental Health Act 1983, characterising her needs as social and therapeutic rather than requiring acute psychiatric admission.

The central issues were whether the court could require detention under the Act, how the lack of secure accommodation affected the assessment of necessary treatment, and whether continued deprivation of liberty and therapeutic treatment in hospital were in the child’s best interests.

1. The court could not compel detention under the Mental Health Act 1983. The statutory assessment was for the relevant clinicians and authorities. The inherent jurisdiction could not require Claire to be detained under the Act. The court nevertheless remained entitled to scrutinise the practical consequences of the detention decision and the care available to her.
2. The lack of suitable social provision was legally relevant. A child should not be detained in a secure psychiatric facility where a less restrictive option can achieve appropriate care. Conversely, hospital treatment is not unnecessary merely because a social placement is theoretically preferable. If suitable care is unavailable within a reasonable timescale, hospital treatment may be necessary. The court expressed concern that resource shortages were being allowed to separate the assessment of mental-health need from the availability of any safe and therapeutic alternative.
3. Therapeutic intervention should not be postponed. Claire required treatment for her underlying disorder, including dialectical behaviour therapy. Although a stable and secure placement was preferable, treatment could begin in hospital while a suitable placement was sought. The court regarded delay as potentially damaging to her development.
4. Orders. Since Claire was somewhat more settled and treatment was to commence, the court authorised her continued deprivation of liberty at the Midlands Hospital and declared that receiving the proposed treatment was in her best interests.