Informal mental health patients, suicide and the right to life
Supreme Court Judgment: Rabone v. Pennine Care NHS Trust
Melanie Rabone was a 24 year old woman who suffered from severe depression. She had a previous history of suicide attempts and agreed to be admitted to a Psychiatric Hospital as a voluntary patient following a suicide attempt on 11 April 2005. She was not detained under the Mental Health Act 1983 (MHA). Following her admission she was assessed as being a moderate to high risk of suicide, commenced on anti-depressant medication and was placed on 15 minutes observations. After 8 days in hospital Melanie Rabone’s Consultant Psychiatrist decided it was appropriate to allow her home on 2 days leave. Sadly she committed suicide the day after leaving hospital by hanging herself in the woods near her home.
Melanie Rabone’s parents brought a case in negligence on behalf of her Estate and also under the Human Rights Act 1998 (HRA) alleging that the Trust had failed to protect her right to life and had therefore acted in contravention of the obligation claimed to be owed to her under Article 2 of the European Convention of Human Rights (ECHR). As Melanie Rabone was over 18 when she died parents were unable to bring a claim for a bereavement award under the Fatal Accidents Act 1976 (FAA) which was at the time £10,000.
During the course of the proceedings Melanie Rabone’s parents settled the case in negligence on behalf of her Estate in the sum of £7,500. The NHS Trust admitted that it had been negligent in allowing the patient on home leave and the Chief Executive apologised for this. Mr and Mrs Rabone chose to carry on with their claims under the HRA as they argued that notwithstanding the settlement of the negligence claim the State had not compensated them for its failure to protect their daughter’s life under Article 2 of the ECHR. The parents were unsuccessful in the High Court and the Court of Appeal. The case therefore proceeded to the Supreme Court and judgment was handed down in February 2012.
The Supreme Court decision
The Supreme Court reversed the previous decisions of the High Court and the Court of Appeal and it found that the NHS Trust had failed to protect Melanie Rabone’s right to life under Article 2 as there had been a real and immediate risk of suicide from the point she was negligently allowed home from hospital. This meant that her parents were entitled to an award of damages under the HRA in addition to the £7,500 which had already been paid in respect of the negligence claim on behalf of the Estate. The Supreme Court ordered each parent be awarded £5,000.
Implications for future cases
The Rabone decision is likely to lead to a significant increase in the number of cases being brought under the HRA where it is alleged NHS Trusts have failed to protect the life of informal mental health patients who have committed suicide. We anticipate that there will also be an increase in the amount of damages being paid in this type of case, especially where Claimants are unable to claim for bereavement or financial dependency under the FAA. It should however be remembered that the decision does not apply to ordinary hospital or NHS patients who have died as a resulted of alleged medical negligence.
Prior to the decision in Rabone it had been assumed that the obligation to protect the lives of mental health patients who pose a real and immediate risk of suicide only applied if the patient had been detained under the MHA as detained patients are directly under the control of the State. Melanie Rabone had not been detained under the MHA and had been admitted to the hospital on an informal basis with her consent. The vast majority of mental health patients in England and Wales are not detained under the MHA so the decision in Rabone is likely to have a major impact on the number of civil claims for damages being successfully brought under the HRA in these circumstances.
The decision will also have a significant influence on the way Inquests are conducted where informal mental health patients have committed suicide. This is because in a case where it is arguable that the State (through the NHS) has failed to protect an individual’s right to life under Article 2 of the ECHR the Coroner must conduct an enhanced investigation into the circumstances of the individuals death. This is known as a Middleton Inquest and it is important distinction for practical reasons. In a Middleton Inquest there is the potential availability of Public Funding (formerly Legal Aid) for the bereaved family in order for them to be legally represented at the Inquest where such funding would not be available for an ordinary Inquest.
If you have any queries in relation to the above you should not hesitate to contact a member of the Clarke Willmott clinical negligence team.
Author: John Boyle