“(1) The following have a priority need for accommodation— … (c) a person who is vulnerable as a result of old age, mental illness or handicap or physical disability or other special reason, or with whom such a person resides or might reasonably be expected to reside; …”
“This is to confirm that Troy has hypoparathyroidism, a condition which he will have for the rest of his life. In this condition too little parathyroid hormone is released by the parathyroid glands, and this leads to low levels of calcium in the blood. This low level of calcium caused Troy to have a convulsion which led to the diagnosis of this condition. Hypoparathyroidism is treated with calcium and vitamin D supplements taken by mouth. Treatment is usually lifelong. These are not dietary supplements which can be bought overthe-counter, but prescription only medicines that require careful monitoring by a doctor. If hypoparathyroidism is adequately treated with calcium and vitamin D, the prognosis is good. However, this relies on taking medication daily for life and regular blood tests so that the dose of your medication can be carefully adjusted as needed. Domestic circumstances for safe and proper storage of the medication are absolutely essential. Appropriate accommodation for good engagement with a lifelong therapeutic regimen is going to be essential as the complications of poor adherence with therapy include kidney stones, muscle cramps, numbness and even recurrence of the convulsions that brought Troy’s condition to light in the first place.”
“Mr Guiste reports symptoms including depression, anxiety, auditory and visual hallucinations, which have told him to harm himself, leading him to cut his fingers and try to hang himself. He also describes flashbacks to the death of his favourite aunt and a lack of self-confidence and self-esteem, which he relates to the death of his father when Mr Guiste was age 9. He has smoked cannabis since age 11. Various diagnoses have been considered for him, including severe depression and Posttraumatic Stress Disorder (PTSD). In addition, he is genetically predisposed to schizophrenia, as his father apparently had paranoid schizophrenia; his father was said to have murdered someone and then was murdered himself in prison. Mr Guiste’s mental health presentation is complicated by him suffering from hypoparathyroidism. He is not fully compliant with taking his medication, which puts him at risk for seizures and other complications of low calcium. His doctor has wondered if some of his mental health difficulties, particularly depression and hallucinations, might be related to hypocalcaemia. Equally, depression and hallucinations, together with the paranoid thinking that Mr Guiste has expressed at times, could be associated with his chronic cannabis use, from a young age. Given these different possibilities, it is difficult to make a firm diagnosis. Certainly, he suffers from depression and anxiety, and he is at risk for harming or even killing himself by responding to command hallucinations… He is genetically vulnerable to schizophrenia, which might emerge as he reaches his late twenties or early thirties. In addition to these possibilities, I think it likely that Mr Guiste’s cognitive functioning is impaired. He told me that he cannot remember his own mobile number. He has poor understanding of his medical condition, both its aetiology and the importance of him taking his medication regularly. He needs help from his mother to manage his finances. She took him out of school at secondary school level, and we do not know why. It is possible that she recognised that he had special educational needs that were not being addressed. Apart from the medication that he is taking – inconsistently – for his low calcium level, he is not taking any psycho-active medications. His GP was asked to consider antidepressant medication, but he has not prescribed it, possibly in recognition of Mr Guiste’s inconsistency in taking medication. His prognosis for improvement is limited. To the extent that he may have low cognitive ability and may be prone to a schizophrenic illness, he will not improve. However, he clearly states that his mental condition has worsened when he has been threatened with eviction. His capacity is limited, and it is likely that he feels panicked and has little awareness of how to help himself, in the face of the proposed eviction.”
“I asked about his physical health. He said that he is stressed at present with overthinking about housing. He has a low calcium level, for which he has to take medication. His bones start to hurt when it is cold. He told the GP, and he increased his dose to two tablets of calcium twice per day and Vitamin D once per day. I asked if he remembers to take it. He said, “I do”
“It is entirely right that local authority officers, themselves without any medical expertise, should not be expected to make their own critical evaluation of applicants' medical evidence and should have access to specialist advice about it.”
“It is not the doctor but the local authority who has the duty of deciding whether the statutory tests of priority need are met.”
“There is no rule that a doctor cannot advise on the implications of other doctors' reports without examining the patient; but if he or she does so, the decision-maker needs to take the absence of an examination into account. Local authorities who rely on such advice, and doctors who give it, may therefore need to consider – as many already do - whether to ask the applicant to consent to their having their own examination. Between these two poles, however, there is a third possibility – that the local authority's medical adviser, again with the patient's consent, may speak to the applicant's medical adviser about matters which need discussion.”
“Troy and mum desperate for urgent help as feel he is at significant risk of hurting himself or ending his own life and this risk is likely to increase if evicted tomorrow. I feel needs urgent review by a psychiatrist today – mum will take him to A & E now and Troy happy to go.” & E now and Troy happy to go.”
“Self-harm – previous self-harm at time of stress, ongoing thoughts of self-harm, no intent.”
“Presentation in the context of likely ongoing low mood and depression in conjunction with drug use and very difficult social circumstances and traumatic childhood. Would like benefit from therapy, reduced drug use, youth inclusion and a low dose antidepressant to support resilience. Troy is able to guarantee his safety; his mum is very supportive at the detriment of her own health.”
“He denied any active plans/intent of committing suicide, or of harming himself or others.”
“There is no indication that he has any severe or enduring mental illness such that would significantly affect his cognition or rational thought. He does not appear to require treatment with any mental health related medication. … No other new relevant medical information has been presented to us. In summary, based on the information available and for the reasons given, I don’t think the specific medical issues in this case are of particular significance compared to an ordinary person.”
“Further to our previous advice, I note further correspondence in this case. The applicant is a 22 year old man who had presented to emergency services on one occasion with suicidal thoughts. He does not present with active risk related behaviours. The facts in this case are that he was not picked up by psychiatric services, nor admitted to a psychiatric facility and he was not prescribed any psychotropic medication. The applicant does not suffer from a psychotic disorder; having hallucinations does not necessarily mean that it is psychosis. He is not subject to an enhanced care programme approach. Moreover, there is no evidence of significant impairment in functioning as a result of his mental health. In summary, I am unable to find evidence of a severe and enduring mental disorder. I therefore cannot find that the issues raised in this case have a particular significance compared to any ordinary person. I make no housing recommendations based on psychiatric grounds.”
“There is a general theme throughout the minded to letter of considering our client’s mental and physical health at this stage, as opposed to how he would suffer if made homeless. Our client is currently accommodated pending review and has never actually been homeless. Dr Freedman on the other hand focuses her mind on how homelessness would affect our client. She considers in particular whether he would continue to take medication for hypoparathyroidism (she considers that he would not and specifically explains why), how not taking the medication would affect him (passive suicide), how homelessness would affect his mental health (worsening of symptoms and risk of self-harm and suicide in response to his auditory hallucinations). It is not as if our client has not selfharmed before and indeed the previous incident occurred when faced with the prospect of homelessness…”
“The applicant is stated to have a history of low mood and symptoms of anxiety as well as substance misuse. He has possible features of post-traumatic stress disorder and reports auditory hallucinations. However, there is no evidence of a severe or enduring psychotic illness and his auditory hallucinations appear intermittent only and probably related to substance misuse including alcohol and cannabis. The applicant presented to a local A & E department in Sept 17 and at that stage he was not under the care of secondary mental health services and it was felt that his presentation was consistent with social difficulties rather than a significant mental illness as well as in the context of ongoing substance misuse. The applicant reports intermittent self harm in times of acute stress, although there is no evidence of active suicidal intent or planning. I note the new representations by the applicant’s legal advisers. I cannot find anything in these submissions that would change my view. I acknowledge that the applicant reports occasional suicidal thinking and has a history of self harm and auditory hallucinations, although these appear related to social circumstances and substance misuse. My view would therefore be that the applicant does not have psychiatric issues of particular significance when compared to an ordinary person if homeless. On this basis, I would not make any housing recommendations.”
“24. … It is to focus on the individual applicant, whether he or she is vulnerable. Whether a person is considered to be vulnerable requires comparison between the ordinary person who is homeless, not the ordinary homeless person. The test connotes being “significantly more vulnerable than ordinarily vulnerable as a result of being rendered homeless” as per Lord Neuberger in Hotak at [53]. 25. The assessment should be based on whether when compared to an ordinary person if made homeless, the applicant would suffer or be at risk of suffering harm or detriment which the ordinary person would not suffer or be at risk of suffering such that the harm or detriment would make a noticeable difference to his ability to deal with the consequences of homelessness.”
“Although, this might be inconvenient and may sometimes be difficult to remember, it does not appear to involve a great deal of effort to adhere to.”
“Although I do not have a firm diagnosis for him, the array of symptoms I described above constitute a vulnerable state. He functions at a low cognitive level, and he would find it more challenging than an ordinary person made homeless to understand his options, how he might manage, and how to keep himself safe if made homeless. He also is at physical risk of failing to take his medication for hypocalcaemia, secondary to hypoparathyroidism. As his doctors have stressed to him, failure to take his medication regularly would place him at risk for significant physical harm, if not death. He told me that if he was made homeless, he would not keep track of his medication. He added, “What’s the point?”
“From the information [before] me, although you have advised of having suicidal thoughts, there is no intent to act on it and [you] have not required referral to secondary care services as a result. Neither is there any evidence that your mental health issues significantly impedes your day to day functioning. There is no indication that you are diagnosed with having a severe or enduring psychotic illness. It is thought that your hallucinations might be related to cannabis use, therefore was advised to abstain, in order to have a clear diagnosis.”
“74… You have informed of having suicidal thoughts and intermittent self-harm in times of acute stress, although there is no evidence of active suicidal intent or planning. According to the medical information before me, you have not presented with active risk related behaviours. 75. In summary, I do not think that your psychiatric issues are of particular significance when compared to an ordinary person if homeless. This is not to say, that further suicidality in response to various life stressors is unlikely. However, I do not think there is current evidence to indicate you would experience harm or deterioration as a result of homelessness.”
“60. I agree with Miss O’Brien that Ground 1 is not made out. There are matters arising in the medical material which give pause for thought, but nothing which cries out for a finding of vulnerability. The report of Dr Judith Freedman requires careful consideration and, with some assistance from NowMedical, the review officer thought it through and engages with it throughout the review decision. I fear that the Appellant’s legal advisers have set too much store by Dr Freedman’s report. Indeed it founds the third ground of appeal, that of irrationality. But the review officer was perfectly entitled to conclude that this report did not “prove vulnerability” either by itself or in conjunction with the other medical material. 61. Ground 2 raises the question, I am tempted to say perennial question, of the NowMedical “reports”
“Yet Lord Neuberger PSC clearly saw that phrase as expressing an approach consistently adopted by this court. One of the themes that runs through previous decisions of this court is that there must be a causal link between the particular characteristic (old age, physical disability etc) and the effect of homelessness: in other words some kind of functionality requirement. We now know that the functionality is not an ability to “fend for oneself” nor an ability “to cope with homelessness without harm”
“an applicant's vulnerability if he is not provided with accommodation”: the Hotak case, at para 37.”
“I agree that a person’s ability to find accommodation is not relevant to the question whether he is homeless. But I do not agree that it is irrelevant to the question whether he is vulnerable. First, it is contrary to a long line of cases in this court. Second, the exercise that must be carried out is to be both practical and contextual. Since one practical way of dealing with homelessness is to find accommodation, I cannot see that it makes sense to exclude a person’s future ability to find accommodation from consideration… the question whether someone is (now) in priority need is assessed, at least in part, by reference to the risks of what will or may happen to him in the future.”
“an impairment of a person’s ability to find accommodation or, if he cannot find it, to deal with the lack of it. The impairment may be an expectation that a person’s physical or mental health would deteriorate; or it may be exposure to some external risk such as the risk of exploitation by others.”
“64. I do not, therefore consider that Lord Neuberger PSC can have used “significantly” in such a way as to introduce for the first time a quantitative threshold, particularly in the light of his warning about glossing the statute. Rather, in my opinion, he was using the adverb in a qualitative sense. In other words, the question to be asked is whether, when compared to an ordinary person if made homeless, the applicant, in consequence of a characteristic within section 189(1)(c), would suffer or be at risk of suffering harm or detriment which the ordinary person would not suffer or be at risk of suffering such that the harm or detriment would make a noticeable difference to his ability to deal with the consequences of homelessness. To put it another way, what Lord Neuberger PSC must have meant was that an applicant would be vulnerable if he were at risk of more harm in a significant way. Whether the test is met in relation to any given set of facts is a question of evaluative judgment for the reviewer.”
“In the short term, I think that Mr Guiste would have increased depression and anxiety. He would be at risk for self-harm and suicide, particularly in response to his auditory hallucinations.”
“The High Court – (a) must refuse to grant relief on an application for judicial review, and (b) may not make an award under subsection (4) on such an application, if it appears to the court to be highly likely that the outcome for the applicant would not have been substantially different if the conduct complained of had not occurred.”