In the matter of an application by RM (a person under disability) by SM, his father and next friend (AP) for Judicial Review [2024] UKSC 7

RM, a restricted patient detained under the Mental Health (Northern Ireland) Order 1986, sought discharge from hospital. The Supreme Court addressed whether leave of absence under article 15 is inconsistent with continued detention for treatment. The Court held that article 15 leave can form part of treatment while a patient remains detained.

Facts

RM was born in 1988 with a significant intellectual disability and severe impairment of social functioning associated with abnormally aggressive behaviour. Following criminal proceedings where he was found unfit to be tried but a jury found he had committed unlawful acts (including sexual offences), he was admitted to Muckamore Abbey Hospital under article 50A of the Mental Health (Northern Ireland) Order 1986 with a restriction order without limit of time.

RM applied for discharge from detention. The review tribunal refused, accepting medical evidence that RM was at a stage where article 15 leave of absence was appropriate to test him in the community while remaining liable to detention. The High Court upheld this decision, but the Northern Ireland Court of Appeal allowed RM’s appeal, holding that article 15 leave should have no bearing on whether detention for treatment is warranted.

Issues

First Issue

Whether the differences in wording between the Mental Health (Northern Ireland) Order 1986 and the Mental Health Act 1983 support a conclusion that a lower threshold test for compulsory detention applies under the 1983 Act.

Second Issue

Whether the grant of leave of absence under article 15 is inconsistent with a conclusion that a patient still satisfies the test for detention in hospital for medical treatment.

Judgment

Lady Simler (with whom Lord Reed, Lord Sales, Lord Stephens and Lady Rose agreed) delivered the judgment allowing the appeal and restoring the review tribunal’s decision.

On the first issue, the Court held that the NICA was wrong to conclude that different threshold tests apply under the two legislative schemes:

The single compressed statutory condition for admission to detention in article 12(1)(a) of the 1986 Order is disaggregated in section 3(2) in subsections 3(2)(a) and 3(2)(c) of the 1983 Act… Accordingly, while different language is used in the parallel provisions of the two legislative schemes, the word ‘appropriate’, in context, plainly means that it will only ever be appropriate to compulsorily detain in hospital if it is necessary to do so. The test for compulsory detention under the 1983 Act is the same necessity test that applies under the 1986 Order.

On the second issue, the Court held that article 15 leave is not inconsistent with continued detention for treatment:

Importantly, the fact that article 15 leave is planned does not necessarily mean that the patient’s mental disorder no longer warrants detention in hospital for treatment. Treatment received in detention may have suppressed symptoms or behaviours deriving from the mental disorder. Article 15 leave is simply a means of managing risk and testing whether the treatment so far provided to the patient… has sufficiently alleviated the disorder and/or its symptoms so that the medical disorder no longer necessitates detention.

However, the Court rejected the ‘significant component’ test previously applied:

I do not regard the ‘significant component’ test as necessary, or indeed helpful, when deciding whether a patient’s ongoing treatment is treatment in a hospital. The test has no statutory basis and is a gloss on the statutory words… For these reasons, it should no longer be followed.

Implications

This judgment clarifies the relationship between detention for treatment and leave of absence provisions in mental health law. It establishes that article 15 leave can be viewed as part of a continuing responsive programme during which the need for treatment in hospital and on leave is reassessed. The decision preserves an important therapeutic tool for managing detained patients while maintaining appropriate safeguards. The rejection of the ‘significant component’ test removes an unnecessary gloss on statutory provisions that risked arbitrary outcomes.

Verdict: Appeal allowed. The decision of the review tribunal was restored. The Court held that the statutory test for detention in hospital for medical treatment was met notwithstanding that RM was to reside on a long-term basis in a community setting on article 15 leave.

Source: In the matter of an application by RM (a person under disability) by SM, his father and next friend (AP) for Judicial Review [2024] UKSC 7