In re L [1998] UKHL 24

Mr L, a profoundly mentally retarded autistic man, was informally admitted to a psychiatric hospital after a self-harming incident. The House of Lords held that his informal admission under section 131(1) of the Mental Health Act 1983 was lawful, and that treatment of compliant incapacitated patients could be justified under the common law doctrine of necessity.

Facts

Mr L was a 48-year-old man with autism and profound mental retardation who had been a long-term resident at Bournewood Hospital. In 1994, he was discharged on a trial basis to live with paid carers, Mr and Mrs E. On 22 July 1997, at a day centre, Mr L became severely agitated, hitting himself and banging his head against walls. He was sedated and taken by ambulance to Bournewood Hospital. His consultant psychiatrist, Dr Manjubhashini, assessed him as requiring in-patient treatment. As he appeared compliant and did not resist admission, he was admitted informally under section 131(1) of the Mental Health Act 1983 rather than being compulsorily detained.

Subsequent Events

Mr and Mrs E wished to have Mr L returned to their care, but the hospital maintained that his discharge depended on clinical assessment. Proceedings were commenced on behalf of Mr L seeking judicial review, habeas corpus, and damages for false imprisonment and assault.

Issues

The central legal issues were:

• Whether Mr L had been unlawfully detained by the hospital
• Whether section 131(1) of the Mental Health Act 1983 permitted informal admission of patients who lacked capacity to consent but did not object
• Whether the common law doctrine of necessity could justify the treatment and care of such patients

Judgment

Section 131(1) of the Mental Health Act 1983

The House of Lords held that section 131(1), which was identical to section 5(1) of the Mental Health Act 1959, applied not only to patients who consented to admission but also to compliant incapacitated patients who did not object. This interpretation was supported by the recommendations of the Percy Commission (1957), which had recommended that compulsory detention should only be used where necessary, and that care should be offered without deprivation of liberty to those who needed it and were not unwilling to receive it.

The Common Law Doctrine of Necessity

The House held that treatment and care of informal patients who lacked capacity could be justified under the common law doctrine of necessity, as established in In re F (Mental Patient: Sterilisation) [1990] 2 AC 1. Lord Goff noted that necessity has an important role across the law of obligations.

False Imprisonment

While Lord Nolan and Lord Steyn considered that Mr L had in fact been detained (in that the hospital would not have permitted him to leave), the House held that any restriction on his liberty was justified by necessity. Lord Goff emphasised that for false imprisonment there must be an actual, complete deprivation of liberty, not merely a potential one. The steps taken, including the ambulance journey and informal admission, were justified by necessity in Mr L’s best interests.

Concerns About Safeguards

Lord Steyn expressed concern that compliant incapacitated patients would not benefit from the statutory safeguards available to those compulsorily detained under the Act of 1983. He noted this was an unsatisfactory gap in mental health law, though statutory construction compelled the result reached.

Implications

This case confirmed that large numbers of mentally incapacitated patients could continue to be admitted informally to hospitals without the procedural safeguards applicable to compulsorily detained patients. The decision had significant practical implications, as the Court of Appeal’s contrary ruling would have required compulsory detention procedures for an estimated additional 22,000 resident patients and 48,000 admissions per year. The House acknowledged concerns about the lack of statutory safeguards for informal patients but held this was a matter for Parliament rather than the courts. The case remains an important authority on the scope of informal admission under mental health legislation and the application of the doctrine of necessity to the care of incapacitated patients.

Verdict: Appeal allowed. The House of Lords held that Mr L's informal admission and treatment at Bournewood Hospital was lawful under section 131(1) of the Mental Health Act 1983 and justified by the common law doctrine of necessity.

Source: In re L [1998] UKHL 24