“...the tribunal’s determining of the application without information on aftercare amounted in practical terms to an abdication of its role, because without that evidence it couldn’t know whether ongoing detention represented the least restrictive option for SS’s care and so it couldn’t properly answer the questions posed by section 72 MHA.”
“Is [the appellant]’s mental disorder of a nature or degree which makes it appropriate for him to be liable to be detained in a hospital for medical treatment? 39. The Tribunal was not satisfied that [the appellant]’s mental disorder is currently of a degree which makes it appropriate for him to be liable to be detained. Although [the appellant] remains regularly physically and verbally aggressive, there was clear evidence that the ward environment was causing much of [the appellant]’s dysregulated behaviour, and therefore it was not possible to establish to what extent these behaviours could be described as the degree of his mental disorder or rather as his reactions to the challenging environment. 40. The Tribunal noted the evidence of all professionals that [the appellant]’s current placement on an acute ward is exacerbating some of his behaviours and that discharge to a quiet individual accommodation with a high level of support would enable him to present as more settled and able to engage in the community. The Tribunal noted that [the appellant] was described as being at his baseline presentation and is ready for discharge once suitable accommodation is in place. 41. Taking this into account, the Tribunal was nevertheless satisfied that [the appellant]’s mental disorder is of a nature which makes it appropriate for him to be liable to be detained in hospital until the identified accommodation is in place: … Is it necessary for [the appellant]’s health or safety or the protection of other persons that he should receive such treatment? 42. The Tribunal was satisfied that detention is necessary in the interests of [the appellant]’s health. If [the appellant] were discharged without appropriate accommodation and aftercare support in place, it is highly likely that his mental and physical health would deteriorate. [the appellant] requires significant support in respect of self-care and nutrition, including monitoring of fluid intake. …”
“It not infrequently happens that [...] those who have apparently hopeless cases turn out after a full and fair hearing to be in the right.”
“32. This case was, therefore, a case that fell within the category identified by Dyson LJ in R (H) v Ashworth Hospital Authority & Ors[2002] EWCA Civ 923 at §69: “I would endorse the general observation of the judge at paragraph 69: "In general, in a case in which after-care is essential and satisfaction of the discharge criteria depends on the availability of suitable after-care and accommodation, as in H's case, a tribunal should not direct immediate discharge at a time when no after-care arrangements are in place and there is no time for them to be put in place. […] If […] there is uncertainty as to the putting in place of the after-care arrangements on which satisfaction of the discharge criteria depends, the tribunal should adjourn pursuant to rule 16 to enable them to be put in place, indicating their views and giving appropriate directions: c.f. Ex parte Hall[2000] 1 WLR 1323 , per Kennedy LJ at 1352D." … 45. However, when exercising its case management powers the tribunal had to seek to further the overriding objective (rule 2(3)). While "avoiding delay" is one aspect of dealing with cases fairly and justly (rule 2(2)(e)), that objective is qualified by the words "so far as compatible with proper consideration of the issues". If the step taken to avoid delay is liable to hamper proper consideration of the issues, then it does not further the overriding objective. 46. Other aspects of the overriding objective were also relevant to the decision not to adjourn. In particular, rule 2(2)(a) requires the tribunal to deal with the case in ways which are "proportionate to the importance of the case … and the resources of the parties". At stake was the applicant's liberty, which was clearly a weighty matter, and in the context of the "resources of the parties" it was relevant that SS was wholly reliant on the local authority for information on how it would exercise its discretion as to the particular package of care which it would make available to discharge its section 117 duty. 47. It was accepted that SS didn't need to be in hospital if an appropriate package of care were available to him in the community, and that this had been the case for some time. The RC's evidence, accepted by the panel, was that not only did SS not need to be in hospital, he needed not to be in hospital, because being there was "counter-therapeutic". The tribunal heard that SS was becoming institutionalised to the extent that he considered the PICU ward to be his home and the staff and patients on the ward to be his family. There was a clear risk that the longer he remained there, the more institutionalised he would be, and a successful discharge would become more difficult to achieve. 48. The only reasons not to adjourn for aftercare information would be either because it is not relevant because the patient had not reached the stage at which discharge was a realistic prospect, or because there was no realistic prospect of such aftercare information being produced. Clearly neither of those situations was applicable in SS's case.”
“…In his decision refusing permission to appeal Judge Jacobs’ decision in AM v West London to the Court of Appeal (reported as AM v West London Mental Health NHS Trust[2013] EWCA Civ 1010 ; [2013] MHLO 73) Richards LJ said that the key question in such a situation was whether information about discharge and aftercare was “incapable” of affecting the decision whether to adjourn…”
“48. The only reasons not to adjourn for aftercare information would be either because it is not relevant because the patient had not reached the stage at which discharge was a realistic prospect, or because there was no realistic prospect of such aftercare information being produced. Clearly neither of those situations was applicable in SS’s case.”
“107. The decision to continue to impose representation on KH had a significant impact on the way that the proceedings unfolded. Did it have a material impact on the outcome of the reference? That might seem unlikely, given what the reports before the tribunal said, but we can never know. As Lord Pearce observed in Rondel v Worsley[1969] 1 AC 191 (at §275): “It not infrequently happens that [...] those who have apparently hopeless cases turn out after a full and fair hearing to be in the right.””
“[29] There are at least two fundamental reasons why procedural fairness is important. The first is that it helps to improve the chances of reaching the right result. In John v Rees[1970] Ch 345 , at 402, Megarry J noted that there are some who would say that, when the outcome of a case is obvious, why force everybody to go through the tiresome waste of time involved in framing charges against a person and giving them an opportunity to be heard? Megarry J eloquently answered that question in the following way: “As everybody who has anything to do with the law well knows, the path of the law is strewn with examples of open and shut cases which, somehow, were not; of unanswerable charges which, in the event, were completely answered; of inexplicable conduct which was fully explained; of fixed and unalterable determinations that, by discussion, suffered a change. Nor are those with any knowledge of human nature who pause to think for a moment likely to underestimate the feelings of resentment of those who find that a decision against them has been made without their being afforded any opportunity to influence the course of events.” “[29] There are at least two fundamental reasons why procedural fairness is important. The first is that it helps to improve the chances of reaching the right result. In John v Rees[1970] Ch 345 , at 402, Megarry J noted that there are some who would say that, when the outcome of a case is obvious, why force everybody to go through the tiresome waste of time involved in framing charges against a person and giving them an opportunity to be heard? Megarry J eloquently answered that question in the following way: “As everybody who has anything to do with the law well knows, the path of the law is strewn with examples of open and shut cases which, somehow, were not; of unanswerable charges which, in the event, were completely answered; of inexplicable conduct which was fully explained; of fixed and unalterable determinations that, by discussion, suffered a change. Nor are those with any knowledge of human nature who pause to think for a moment likely to underestimate the feelings of resentment of those who find that a decision against them has been made without their being afforded any opportunity to influence the course of events.”