“Miss Yaa Appiah presents with paranoid delusions and disturbed affect. She has no insight into being mentally ill and refuses all treatment. She will not accept treatment or hospital admissions willingly and would leave hospital if she could. She believes that she has property and wealth that is being misappropriated by the government. Such ideas have caused her distress and have led to hostile and aggressive behaviour. Treatment is at an early stage, can only be delivered in depot form and needs to continue. She will not stay in hospital unless detained and treatment cannot be delivered in the community as she will disengage and not accept it.”
“Yaa suffers from a psychosis not presently fully described, though likely to be a persistent encapsulated delusional disorder. Following prison assessments - she has committed a series of minor offences - she has been transferred to a forensic facility within which she continues to express her long held unusual beliefs, though perhaps with lesser force, at a time she is unwillingly certainly having antipsychotic depot medication. Staff report her as ‘guarded’, and she is essentially separate from those around her. She has objected - once violently - to such medication though is otherwise nonconfrontational. When seen, from the outset she made it clear even from her gestures that there was no question of her experiencing any mental illness, and that we were mistaken and/or liars for stating this. She dismissed the notion of others exploiting her financially - I thought in the past tense, and no longer talked of owning multiple properties. I judge her incapacitious regarding the location and nature of her required care in that she cannot ‘weigh in the balance’ any complex decisions relating to her care. Community based care would fail, at present, as she would inevitably immediately disengage. Only hospital based care will provide the safe and expertly [illegible] she requires, to which she cannot give consent, it therefore must be imposed. This still represent least restriction.”
“I am writing this letter to lodge a complaint about the way I am dehumanly treated forcing medication on me by injection every two weeks. Usually between 7 to 10 staff come around me and if I resisted violently throw me to the floor flat from my wheelchair in a degrading way and inject me with medication by throwing the syringe at me with my hands held back in a dehumanising manner after which they disappear and I have to crawl back to my wheelchair in pain and sorrow (with no one to help me) in a degrading way. I suffer from the side effects of the medication such as feeling jittery, regular shaking of both hands, liquid flowing from mouth and dizziness (symptoms I did not have before). I ask that you investigate this matter with the help of CCTV footage that covers the incident. I also ask that you give me a copy of the CCTV footage as soon as possible. I did not complain about the incidents to you from the beginning because I thought by telling those people by word of mouth that I did not like the way the (sic) handled and treated me they would stop but they haven't so I am now making this complaint for investigation.”
“We heard in medical and nursing evidence that there has been no sign of grandiosity or delusional beliefs since transfer but that she remains guarded, suspicious and lacking in insight. She is said to have made ‘considerable improvement’ as a result of anti-psychotic depot medication. Although there remains uncertainty about diagnosis, we were told that the patient probably has a schizo-affective disorder or schizophrenia. It is feared that if discharged the patient would not accept treatment and her symptoms would return, with risks of deterioration and self-neglect to herself and of aggression towards others, although the RC conceded that there is no evidence to link past aggressive behaviour to the patient’s perceived mental disorder. The RC also conceded that in the absence of a significant medical history it is not possible to predict how quickly the patient would relapse. She did accept that, since the patient is currently receiving depot medication, anti-psychotic medication would stay in her system for some time, even if she were to be discharged and become non-compliant. Nevertheless, and notwithstanding the fact that she does not rely upon the degree of the patient’s mental disorder for detention, the RC, supported by the other professional witnesses, suggested that the patient needs to stay in hospital until a suitable discharge plan has been devised and arrangements made for the engagement of the community team. We heard that the Intensive Support Service could in fact be engaged with the patient’s care in the community within 24 hours of discharge, although it was conceded that this may be to little avail if, as is clearly the case, the patient has no intention of accepting such support. It was also accepted that such arrangements would need to be revised if the patient moves to London in the next few days, as she has said she will. Although there was some discussion of a CTO, it was accepted that this too would serve little purpose if the patient did not agree to its terms. The patient and her husband, the nearest relative, told us very clearly and coherently that the patient has never suffered from a mental disorder and has no need of medication or other treatment. They made no attempt to pretend that the patient would engage with mental health services or accept medication in future, but instead maintained their position that the patient does not have a mental disorder and so does not need any such interventions. They also offered explanations for what had been interpreted in the medical evidence as delusional beliefs and bizarre behaviour: it was, for example, explained that when the patient talked about the government taking away her most valuable possessions she was referring to the fact that her four children had in the past been taken into care; or, for example, when she flooded her cell it was because she had been secluded in unbearably hot conditions and simply needed to cool down. The patient’s husband told us that the patient is not habitually an aggressive person and that her detention in prison and then in hospital has been a terrible burden upon the family. He also told us, in agreement with the patient, that if discharged she would initially stay in Leeds for a few days with their son who is a student there, and after that she would return to London to be with her husband and live with her extended family. We heard that since the patient’s immigration status has now been resolved she will be entitled to receive welfare benefits and will in any event be in a much more secure position. In the light of the available evidence, we are not at all convinced that the case for mental disorder has been satisfactorily made out. Between 2013 and 2017 the patient had three mental health assessments, none of which elicited findings of mental disorder. The grounds for the patient’s current detention are stated to be grandiosity and incongruous affect, yet we heard from the patient and the nearest relative plausible, and indeed persuasive, alternative explanations for what had been taken to be grandiose beliefs and ‘bizarre behaviour’. We are also acutely conscious of the severely stressful circumstances in which the patient found herself when in prison, facing deportation after residence in the UK for so many years. Since the patient’s deportation notice has been rescinded she is reported to have shown signs of considerable improvement and to be less guarded, whilst, perhaps not surprisingly given the recent circumstances, remaining somewhat circumspect in the presence of medical and nursing staff. Whilst the medical evidence links that improvement to acceptance of anti-psychotic medication, it seems just as likely that the change in the patient’s circumstances has also played a significant part in her improvement. Indeed aspects of her reportedly bizarre behaviour, lack of insight and guarded presentation are as consistent with an understandable reaction of the patient’s adverse circumstances as with mental disorder. We note that even now there is no settled diagnosis of the patient’s putative mental disorder and since admission to the Becklin Centre there have been no signs whatsoever of psychotic symptoms, to the extent that the RC does not rely on degree and is understandably uncertain about the chronicity of the patient’s past presentation and its future prognosis. We are also mindful of the patient’s calm assurance that she has never had a mental disorder and of her husband’s spirited reinforcement of that view. In any event, it is accepted by the RC that if the patient does have a mental disorder it is responsive to treatment, that the patient is currently in remission and that it is entirely uncertain how quickly she will relapse, if at all, especially since her depot medication will remain in her system for some time. The RC is also unable firmly to associate the patient’s formerly aggressive behaviour with any form of mental disorder, and we note that most, if not all, such incidents have arisen in circumstances where the patient has been in conflict with restraining staff members or with the police: there is nothing to suggest that she is habitually aggressive when ‘unwell’ or indeed that her behaviour is subjectively or objectively ‘bizarre’ when judged against her social circumstances. We do not therefore find that the case is made out that the patient currently has a mental disorder whose nature or degree makes it appropriate for her to be liable to detention under s.3 MHA 1981. Furthermore, even if mental disorder, and its nature, were made out, we do not find that detention is in any event necessary in the interests of the patient’s own health and safety or for the protection of others. The patient has lived in the community for most of her adult life without apparent incident. On three occasions over a period of several years she has been found not to be suffering from mental disorder. There is considerable uncertainty about possible diagnosis and prognosis. There is no firm connection between the patient’s limited forensic history and any supposed mental disorder. The patient’s husband is impressive in his support and attests to the wider family support of the patient in the community. We do not as a result find that there is convincing evidence to uphold the view that there would be significant risk to the patient’s own health and safety or to the interests of others if she were to be discharged. Finally, since we cannot find that mental disorder, its nature or its degree are made out, it follows that we do not consider that the treatment which is available in the form of anti-psychotic medication and nursing care is ‘appropriate’ or indeed necessary.”
“The claimants place heavy reliance on the tribunal judgment. It is right to say that the tribunal found that the statutory criteria were not made out in August. It is also right to note that, historically, other assessments had found that the first claimant was not suffering from mental disorder. However, the tribunal were considering a different issue, namely whether the first claimant’s continuing detention could be authorised. No finding that the detention to date had been unlawful was or could have been made by the tribunal. The first claimant had, by then, received treatment and it is the first defendant’s case that she had improved as a result. Whether that is right or not is not a matter that needs to be determined at this stage.”
“Take notice that the claimants do not wish to rely on expert evidence for their claim. The claimants explain that the claim has never been a personal injury case and are not required to file and serve a personal injury expert evidence. The claimant also explained that they no longer wish to rely on clinical negligence claim due to time constraint, given the strict deadline within which to file and serve the expert psychiatric report by28th March 2025 and the court may not agree to further extension of date for filing and serving the expert evidence. This means that the claimants claim will now proceed only with the breach ofHuman Rights Act 1998 and European Convention on human rights relying on articles 5, 3 and 8 and false imprisonment under the MHA 1983, procedural breaches of hospital admission, stigma of being associated with mental disorder, and mental incapacity under the MCA 2005”
“As previously advised, there is no CCTV footage at either the Becklin Centre or Newsam Centre and there is, therefore, no CCTV footage to be disclosed. On behalf of the Trust, we have previously confirmed there is no CCTV on any of their wards. There has never been CCTV on the wards at Becklin Centre or Newsam Centre. Following the Order made by Deputy Master Marzec we have gone back to the Trust and they have confirmed again that this is the case. We note the reference in the notes from12 August 2019 to CCTV footage. In the record from12 August 2019 it says, “Nicky said that as per CCTV footage there is no direct evidence of Yaa assaulting anyone”
“I’ve read the entry that suggests I stated these things. It would seem this was typed by Dr. Das on the ward at the time. There is no entry written by me (sic) suggested I said there was any CCTV cameras at the Becklin Centre. This has either been misheard or mistyped by the Doctor writing those notes at the time. It’s not something I would ever say as there are no CCTV cameras at the Becklin centre. I cannot recall the exact event as it was many years ago, but I do recall the patient and their spouse being highly dissatisfied with being detained under the MHA on the ward. In response of the second part of paragraph 4(a)(ii) of that Order they were: 63. I have no idea. I suspect any conversation would have been a reassuring one to try and de-escalate the situation, but I would certainly never have lied about such a thing. I hope this helps to clarify the matter.”
“The MHT made a decision on23 August 2019 that the First Claimant should be discharged immediately. The Tribunal was not satisfied that the statutory criteria for her detention were met at that time. The First Claimant was therefore discharged on23 August 2019 . The finding of the Tribunal on23 August 2019 was not that her detention prior to this date had been unlawful it was an assessment that at that time detention was no longer required and the First Claimant was discharged accordingly. The Tribunal discharged the First Claimant on23 August 2019 as her detention under section 3 was no longer deemed necessary by the MHT. Prior to that date, however, and from26 April 2019 she had been detained lawfully at the trust pursuant to S.3 of the MHA. The paperwork and documentation shows there were no procedural breaches of the MHA. The First Claimant was lawfully detained under S3 MHA from26 April 2019 until her discharge on23 August 2019 .”
“False imprisonment is the unlawful imposition of constraint on another’s freedom of movement from a particular place. The tort is established on proof of (1) the fact of imprisonment; and (2) the absence of lawful authority to justify that imprisonment. For these purposes, imprisonment is complete deprivation of liberty for any time, however short, without lawful cause.”
“All that a claimant has to prove in order to establish false imprisonment is that he was directly and intentionally imprisoned by the defendant, whereupon the burden shifts to the defendant to show that there was lawful justification for doing so.”
“The tort of false imprisonment has two ingredients: the fact of imprisonment and the absence of lawful authority to justify it.”
“Next to personal security, the law of England regards, asserts, and preserves the personal liberty of individuals … it is a right strictly natural … the laws of England have never abridged it without sufficient cause and … in this kingdom it can never be abridged at the mere discretion of the magistrate, without the explicit permission of the laws.”
‘The Convention does not state what is to be understood by the words ‘persons of unsound mind’