Benjamin Ridge v Dorset Healthcare University NHS Foundation Trust

In a medical-negligence claim concerning psychiatric risk assessment, a clinician does not breach the Bolam standard merely because another competent practitioner would have reached a different assessment. The court must determine whether the impugned assessment fell outside the range reasonably to be expected of a competent practitioner. Under Bolitho, a clinical decision involving comparative risks must have a logical basis and reflect consideration of the competing risks and benefits. In assessing suicide risk, the clinician may weigh both high-risk conduct and countervailing matters, including resistance to suicidal impulses, engagement with services, future planning and other positive features. Referral to a specialist home-treatment team may be required even where the initial clinical assessment is reasonable. Causation must nevertheless be proved on the balance of probabilities, including the likely treatment decision and availability of a hospital bed.

The claimant suffered severe physical injuries after climbing an electricity pylon and receiving an electric shock. Shortly beforehand, he had received mental-health support from the defendant, including an assessment by a community mental-health consultant psychiatrist.

The claimant alleged that the psychiatrist negligently assessed his depression and risk of self-harm as moderate rather than severe, failed to refer him to the Home Treatment Team, and thereby failed to secure his admission to hospital before the incident. The defendant accepted that a referral to the Home Treatment Team should have been made, but disputed breach, the likelihood of inpatient admission and the availability of a suitable bed. The central issues were whether the psychiatric assessment was negligent and, if so, whether referral would probably have resulted in timely admission and prevented the injury.

1. Claim dismissed. The claimant failed to establish that the assessment of his depressive illness and risk of self-harm as moderate fell below the standard reasonably to be expected of a competent community mental-health consultant psychiatrist.
2. The court applied the principles in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. A difference of professional opinion does not itself establish negligence. The relevant question is whether the assessment was outside the range of reasonable and respectable psychiatric opinion.
3. The unusual and dangerous nature of climbing an electricity pylon could not be treated as determinative of either the severity of the underlying depression or the risk of actual self-harm. Those matters had to be assessed in the round. Relevant countervailing factors included the claimant’s repeated resistance to suicidal impulses, engagement with mental-health services, forward planning, range of mood and aspirations for the future.
4. The failure to obtain a corroborative account from the claimant’s parents was not, in the circumstances, a breach of duty. Such an account might often be desirable, but its absence was not of itself negligent, particularly where the claimant had not disclosed his suicidal thoughts or pylon visits to them.
5. Although the defendant accepted that referral to the Home Treatment Team should have occurred, the claim would independently have failed on causation. Applying Bolitho v Hackney HA [1998] AC 232, the Home Treatment Team would have considered the comparative risks and benefits of inpatient admission and community treatment and would have reached a defensible decision not to recommend immediate admission.
6. In any event, the claimant failed to prove that a suitable bed would probably have been available before the incident. The evidence showed limited bed availability, competing patients and a threshold of very high risk for immediate allocation. The possibility of a bed being allocated to the claimant fell short of proof on the balance of probabilities.