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The Royal College of Psychiatrists Improving the lives of people with mental illness

Rabone and another (Appellants) v Pennine Care NHS Foundation Trust (Respondent)


What does this judgement mean for psychiatrists? Rabone and another (Appellants) v Pennine Care NHS Foundation Trust (Respondent)

At the heart of this tragic case are familiar challenges that clinicians face on a daily basis irrespective of whether a patient is detained or not or is in the hospital or community. This case once illustrates:

 

  • The need to undertake a careful assessment of risk
  • The need to formulate a clear risk management plan
  • The need to take all information into account including the views of other staff and of the family particularly when they will be relied upon to provide support outside hospital
  • The need for clear and detailed documentation outlining how decisions were made and the reasoning behind over-ruling any strong objections to the proposed plan.

 

The following statement is reproduced with the permission of the Medical Director of the Pennine Care NHS Foundation Trust, the trust involved in this case.

 

Background

On 20 April 2005, Melanie Rabone aged 24 hanged herself from a tree in Lyme Park, Cheshire. At the time, she was on two days’ home leave as she was undergoing treatment for a depressive disorder as an informal patient; she was not detained under the Mental Health Act 1983. 

 

Melanie had been admitted in to the care of Pennine Care NHS Foundation Trust as an emergency following a suicide attempt. Mr and Mrs Rabone maintained that the trust should not have allowed her home leave and that the trust was responsible for their daughter’s death. Mr and Mrs Rabone started proceedings against the trust alleging negligence and breach of the right to life protected by article 2 of the European Convention for the Protection of Human Rights and Fundamental Freedoms. The trust admitted negligence, but did not admit liability for breach of article 2. 

 

Supreme Court judgment

The matter proceeded eventually to the Supreme Court on a number of issues; the judgment of the Supreme Court on those issues is set out below.

 

  • The NHS owed an operational duty to protect Melanie Rabone’s life under Article 2 of the Convention. The NHS had a positive duty to protect against the risk of suicide of mental health patients (“the operational duty”). There was no practical or legal distinction between informal and detained patients. A distinction could be drawn between mental health patients and those attending hospital for physical care as the latter had accepted risk through a process of informed consent and were autonomous.
  • The test for the operational duty was higher than that of the common law test for negligence but was satisfied in this case as Melanie was in “real and immediate” risk of committing suicide.
  • Her parents were victims within the meaning of the European Convention on Human Rights.
  • Their victim status was not lost as a result of the settlement of the clinical negligence claim as there had been no explicit reference to any human rights action and the Fatal Accident Act 1976 did not provide bereavement damages for the parents of an adult child and consequently, their claim under Article 2 had not been satisfied.
  • The claim was not time barred as it was appropriate to exercise the Court’s discretion under Section 33 of the Limitation Act 1980 given the particular circumstances of the case.

 

Comment

So, how does this affect us, and what are the broader ramifications?

 

I am sure there will be considered opinion from Royal College etc as this clearly affects all clinicians, but my own take is that in day to day practice, this merely re-inforces the need for a proper documented assessment. The issue is not that somebody committed suicide whilst on leave, but that this occurred due to failings in care that allowed that leave to be granted. So this is not saying that we are entirely responsible for any action of a patient whilst on leave, but that we need to have made sound judgement (and for this to be documented), as to why leave was granted. You’ll notice key phrases throughout such as “real and immediate risk”, that her capacity was likely to be diminished by reason of her being in hospital in the first place, so more onus is put on us as providers of care.

 

A big impact I think potentially is in relation to Coroners inquests. Essentially we will face, where Article 2 is invoked, longer, more detailed inquests with families legally represented. They will be pressing Coroners to make findings of real and immediate risk to assist future claims under Article 2.

   

Lady Hale’s summary (para 91) is the most telling.

 

 

 

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