“… some of his behaviours to date particularly in the community would render him vulnerable to retaliatory behaviour. He is also likely vulnerable to exploitation were he to encounter unscrupulous others. His vulnerability does not… deprive him of the capacity to conduct the proceedings or to make decisions as to his care and residence.”
“When DN is in ‘meltdown’ he displays high levels of agitation, uses extremely threatening and violent language, intimidating behaviour, throwing furniture, displays a confrontational aggressive stance, running away from the scene into the road with no awareness of danger. DN does not always target specific individuals, he threatens whom he comes across; …. DN has assaulted his mother, friends and wider family historically. DN has assaulted police officers in response to feeling cornered and out of control.”
“[DN] requires immediate psychiatric intervention… he has multiple issues affecting his day-to-day functioning which are namely his anxiety, somatic complaints and mood…”. “The best scenario for [DN] would be a setting where he would be monitored in a residential setting without him feeling locked up and his freedom is removed. Thus, residential care might be the best option for [DN] where he can live in a communal setting but where staff are available 24 hours a day.”
“… the court being invited to approve a plan that [DN] may, lawfully, move to reside at [Stamford House], on the basis that [DN] may not have capacity to make decisions as to his residence and care, and may be unable to give lawful consent, freely and effectively, although does wish to move to live at [Stamford House] and the court approves of the placement move, and authorises any deprivation of liberty arising from the placement, under its inherent jurisdiction, pending final determination of the applications in these proceedings.”
“He spoke about his feeling “like I don’t have a choice… I don’t really have a choice” …. This was driven by his sense of frustration that is not likely to return home in the immediate future. The reality is he understands he has choices but that choices can bring adverse consequences”
“It is very clear from his comments that he does not wish to be “confined”
“(1) In this Part, “mental health treatment requirement”, in relation to a community order or suspended sentence order, means a requirement that the offender must submit, during aperiod or periods specified in the order, to treatment by orunder the direction of a registered medical practitioner or a[registered psychologist] (or both, for different periods) with a view to the improvement of the offender's mental condition. (2) The treatment required must be such one of the following kinds of treatment as may be specified in the relevant order— (a) treatment as a resident patient in [a] care home . . . [, an independent hospital] or a hospital within the meaning of theMental Health Act 1983 (c 20), but not in hospital premises where high security psychiatric services within the meaning of that Act are provided; (b) treatment as a non-resident patient at such institution or place as may be specified in the order; (c) treatment by orunder the direction of such registered medical practitioneror [registered psychologist] (or both) as may be sospecified; but the nature of the treatment is not to be specified in the order except as mentioned in paragraph (a), (b) or (c). (3) A court may not by virtue of this section include a mental health treatment requirement in a relevant order unless— (a) the court is satisfied. . . that the mental condition of the offender— (i) is such as requires and may be susceptible to treatment, but (ii) is not such as to warrant the making of a hospital order or guardianship order within the meaning of [theMental Health Act 1983 ]; (b) the court is also satisfied that arrangements have been or can be made for the treatment intended to be specified in the order (including arrangements for the reception of the offender where he is to be required to submit to treatment as a resident patient); and (c) the offender has expressed hiswillingness to comply with such a requirement. (4) While the offender is under treatment as a resident patient in pursuance of a mental health requirement of a relevant order, his responsible officer shall carry out the supervision of the offender to such extent only as may be necessary for the purpose of the revocation or amendment of the order.”
“In the context of the inherent jurisdiction I would treat as a vulnerable adult someone who, whether or not mentally incapacitated, and whether or not suffering from any mental illness or mental disorder, is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation, or who is deaf, blind or dumb, or who is substantially handicapped by illness, injury or congenital deformity. This, I emphasise, is not and is not intended to be a definition. It is descriptive, not definitive;indicative rather than prescriptive. The inherent jurisdiction is not confined to those who are vulnerable adults, however that expression is understood, nor is a vulnerable adult amenable as such to the jurisdiction. The significance in this context of the concept of a vulnerable adult is pragmatic and evidential: it is simply that an adult who is vulnerable is more likely to fall into the category of the incapacitated in relation to whom the inherent jurisdiction is exercisable than an adult who is not vulnerable. So it is likely to be easier to persuade the court that there is a case calling for investigation where the adult is apparently vulnerable than where the adult is not on the face of it vulnerable. That is all.”
“[78] I should elaborate this a little: (i) Constraint: it does not matter for this purpose whether the constraint amounts to actual incarceration. The jurisdiction is exercisable whenever a vulnerable adult is confined, controlled or under restraint, even if the restraint is only of the kind referred to by Eastham J in Re C. It is enough that there is some significant curtailment of the freedom to do those things which in this country free men and women are entitled to do. (ii) Coercion or undue influence: what I have in mind here are the kind of vitiating circumstances referred to by the Court of Appeal in Re T (an adult: medical treatment) [[1992] 4 All ER 649 ,[1993] Fam 95 ], where a vulnerable adult's capacity or will to decide has been sapped and overborne by the improper influence of another. In this connection I would only add, with reference to the observations of Sir James Hannen P in Wingrove v Wingrove (1885) 11 PD 81, of the Court of Appeal in Re T (an adult: medical treatment) [[1992] 4 All ER 649 ,[1993] Fam 95 ], and of Hedley J in Re Z [[2004] EWHC 2817 (Fam) ,[2005] 3 All ER 280 ,[2005] 1 WLR 959 ], that where the influence is that of a parent or other close and dominating relative, and where the arguments and persuasion are based upon personal affection or duty, religious beliefs, powerful social or cultural conventions, or asserted social, familial or domestic obligations, the influence may, as Butler-Sloss LJ put it, be subtle, insidious, pervasive and powerful. In such cases, moreover, very little pressure may suffice to bring about the desired result. (iii) Other disabling circumstances: what I have in mind here are the many other circumstances that may so reduce a vulnerable adult's understanding and reasoning powers as to prevent him forming or expressing a real and genuine consent, for example, the effects of deception, misinformation, physical disability, illness, weakness (physical, mental or moral), tiredness, shock, fatigue, depression, pain or drugs. No doubt there are others The Applicants rely specifically on this sub-paragraph. . [79] I am not suggesting that these are separate categories of case. They are not. Nor am I suggesting that the jurisdiction can only be invoked if the facts can be forced into one or other of these headings. Quite the contrary. Often, indeed, the facts of a particular case will exhibit a number of these features. There is, however, in my judgment, a common thread to all this. The inherent jurisdiction can be invokedwherever a vulnerable adult is, or is reasonably believed tobe, for some reason deprived of the capacity to make therelevant decision, or disabled from making a free choice, orincapacitated or disabled from giving or expressing a realand genuine consent. The cause may be, but is not for this purpose limited to, mental disorder or mental illness. A vulnerable adult who does not suffer from any kind of mental incapacity may nonetheless be entitled to the protection of the inherent jurisdiction if he is, or is reasonably believed to be, incapacitated from making therelevant decision by reason of such things as constraint,coercion, undue influence or other vitiating factors.”
“The evidence currently available to the court indicates that she lacks capacity”. ; she was in her late 80s, and the issue was whether she could or should be living at a residential care and elderly mentally infirm unit (T unit). While the comments atpara.[16] of that judgment at first blush may seem to give some support for the proposition that the inherent jurisdiction can be used to deprive an adult of their liberty, this paragraph must (I consider) be read together with [23] (ibid.) which significantly qualifies the earlier remarks: “[16] It is in my judgment quite clear that a judge exercising the inherent jurisdiction of the court (whether the inherent jurisdiction of the court with respect to children or the inherent jurisdiction with respect to incapacitated or vulnerable adults) has power to direct that the child or adult in question shall be placed at and remain in a specifiedinstitution such as, for example, a hospital, residential unit,care home or secure unit. It is equally clear that the court'spowers extend to authorising that person's detention in sucha place and the use of reasonable force (if necessary) todetain him and ensure that he remains there: see Norfolk and Norwich Healthcare (NHS) Trust v W[1996] 2 FLR 613 (adult), A Metropolitan Borough Council v DB[1997] 1 FLR 767 (child), Re MB (Medical Treatment)[1997] 2 FLR 426 at page 439 (adult) and Re C (Detention: Medical Treatment)[1997] 2 FLR 180 (child). [23] … if the inherent jurisdiction is to be invoked to justify the detention of someone like PS in somewhere like the T unit, the following minimum requirements must be satisfied in order to comply with Article 5: i) The detention must be authorised by the court on application made by the local authority and before the detention commences. ii) Subject to the exigencies of urgency or emergency the evidence must establish unsoundness of mind of a kind or degree warranting compulsory confinement. In other words, there must be evidence establishing atleast a prima facie case that the individual lackscapacity and that confinement of the natureproposed is appropriate. iii) …”
“the reality is that he understands he has choices, but his choices can bring adverse consequences”
“Article 14(1)(b) CRPD is a non-discrimination provision and provides that “the existence of a disability shall in no case justify a deprivation of liberty”
“13. Through all the reviews of State party reports, the Committee has established that it is contrary to article 14 to allow for the detention of persons with disabilities based on the perceived danger of persons to themselves or to others. The involuntary detentionof persons with disabilities based on risk ordangerousness, alleged need of care or treatment orother reasons tied to impairment or health diagnosis iscontrary to the right to liberty, and amounts toarbitrary deprivation of liberty.” “13. Through all the reviews of State party reports, the Committee has established that it is contrary to article 14 to allow for the detention of persons with disabilities based on the perceived danger of persons to themselves or to others. The involuntary detentionof persons with disabilities based on risk ordangerousness, alleged need of care or treatment orother reasons tied to impairment or health diagnosis iscontrary to the right to liberty, and amounts toarbitrary deprivation of liberty.”
“the analogy between the circumstances of AB’s case and those of DL was not so precise that I am satisfied that it would be appropriate to exercise the court’s existing inherent jurisdiction in respect of vulnerable adults”). But she felt that the inherent jurisdiction could be ‘extended’ (following Anderson v Spencer[2018] EWCA Civ 100 ,[2018] 2 FLR 547 ), given the very significant difficulties which would arise for AB otherwise. It may be that the Hertfordshire case and the situation of DN can simply be distinguished on their facts; Gwynneth Knowles J was keen to emphasise that she was prepared to make the order so as “to encompass the particular circumstances of AB’s case…where AB is subject to a plan which has been very carefully designed for his particular benefit and also to protect members of the public”
“AND UPON it being recorded that [DN] accepts, consistent with the oral evidence of Dr Quinn at the hearing on08 August 2019 , that when presenting in a state of heightened arousal and anxiety (a “meltdown”), he is unable to properly weigh and use information relevant to decisions as to his care and treatment, and at these times, lacks capacity to make these decisions IT IS DECLARED PURSUANT TO SECTIONS 15 AND 16 OF THE MENTAL CAPACITY ACT 2005 THAT: 1. [DN] has capacity to make decisions regarding his residence and care and treatment arrangements, except when presenting in a state of heightened arousal and anxiety (“a meltdown”) during which episodes it is declared that he lacks capacity to consent to care and treatment provided by the applicants, their staff and/or agents. 2. In circumstances where the applicants, their staff and/or agents reasonably believe that [DN] is experiencing a state of heightened arousal and anxiety / meltdown (the triggers for which are more fully described in the attached care plan), and as such [DN] lacks capacity to make decisions about his care and treatment arrangements, it shall be in [DN]’s best interests for the applicants, their staff and/or agents to deliver care and treatment to DN in accordance with the care plan annexed to this Order. 3. To the extent that the arrangements set out at paragraph 2 (above) and the care plan amount to an interference with [DN]’s rights and may amount to a restriction and/or deprivation of [DN]'s liberty, they are declared lawful and authorised, providing always that any measures used to facilitate or provide the arrangements shall be the minimum necessary to protect the safety and welfare of [DN] and those involved in his care and treatment, and that all reasonable and proportionate steps are taken to minimise distress to [DN] and to maintain his dignity.”
“Whatever the outcome of the case, this has already been a success story for [DN]. He has avoided incarceration, and the very deleterious consequences which would follow to his mental and physical well-being, and for a time, made incredible progress. It is hoped that a way is found to maintain [DN]’s placement, and that strategies are successful in getting on the path to his own, independent living in a straightforward community setting.”