I.F. v. Mental Health Tribunal and Ors.

[2018] IECA 101
Download Judgment: English
Country: Ireland
Year: 2018
Court: Court of Appeal
Tags: Informed consent, Mental health, Right to Liberty and Security of Person

The applicant, Ms. F, a woman in her early 60’s had a history of mental illness, was recommended by Ireland’s National Police and Security Service for an approved center (Mental Health Center), when it came to the fore that she has allegedly threatened her neighbor with a knife. The recommendation was made by a general practitioner pursuant to sec. 10 of the Mental Health Act, 2001 (hereinafter ‘the Act’), which provides for making of recommendation for involuntary admission.

Later an admission order was made by a psychiatrist pursuant to sec. 14, for her, stay still 28th October 2015. The admission order was affirmed by the Mental Health Tribunal (hereinafter ‘the Tribunal’) pursuant to sec 18(1)(a) which provides an authority to review admission order and renewal order. Ms. F filed an appeal against the affirmation of the Tribunal in the Circuit Court and the first hearing was fixed for Nov 10. In the meantime, a renewal order was made pursuant to sec. 15(2) of the Act extending period till 27th December. When the matter came before the Circuit Court on Nov 10, the issue before it was whether the appeal initially filed under sec.19( as per this section, an applicant can make an appeal against the decision of the Tribunal to the Circuit Court on the ground that he/she is not suffering from a mental illness) was now spent on the basis that the initial admission order has been overtaken by the subsequent renewal order, owing to which the Circuit Court ruled that the appeal has become moot and refused to entertain the substance of the appeal. The applicant went against the ruling of the Circuit Court in the High Court, which somewhat adopted a similar route. She contended that the Circuit Court has failed to adjudicate the appeal on its merit. The High Court upheld the consistent view that the admission order was replaced by a renewal order, therefore the Circuit Court was right in ruling that the appeal has become moot as the Court could neither revoke it nor affirm it. It could not rule upon the renewal order because it was at the premature stage. Finally, the applicant made an appeal before the present Court of Appeal. The legal issue arose before the Court of Appeal was whether the Circuit Court was confined by the language of s. 19 to consider only if a patient “is suffering” from a mental disorder at the time the appeal is heard, or if it may also consider the patient’s history as of the date of the admission or renewal order.

The Court of Appeal held that s.19 should be read as giving the Circuit Court the jurisdiction to determine if a patient “is or was” suffering from a mental disorder at the time of the Tribunal’s decision from which the appeal stemmed. This meant that the Circuit Court had jurisdiction to determine not only if Ms. F was suffering from a mental disorder at the exact time of the appeal, but also to historically review if she was suffering from one at the time of the original Tribunal decision.
The court reached this decision having regard for the legislature’s plain intention, and having regard for the 2001 Act as a whole, in particular, Section 28(5) which allowed for a patient who was no longer suffering from mental illness to appeal a decision of the Mental Health Tribunal. The Court observed that the detention of Ms. F was, at all times, based on the original admission order and had merely been prolonged by the renewal order. Therefore, the renewal order does not replace the original order with respect to her detention.
The Court held that while the Constitution of Ireland did not require there to be a right of appeal for the decisions of every administrative tribunal, the decisions of a Mental Health Tribunal under the 2001 Act had consequences for the patient’s constitutional rights, namely their liberty, protection of the person, and their reputation. The court observed that, in the involuntary detention of persons with mental disorders, statutory safeguards, such as appellate remedies, implement these constitutional guarantees.
Therefore, the Court of Appeal found that the Circuit Court had jurisdiction to hear Ms. F’s appeal against the affirmation of an admission order despite that order having been replaced by a renewal order.

“…for my part I think that the Oireachtas must have thereby intended that the Circuit Court should have an appellate jurisdiction to determine whether a particular patient not only is suffering from a mental disorder but also was suffering from such a disorder and that this was intended as a further protection for persons who had been involuntarily detained under the 2001 Act, even if they had either since been released under s. 28…or if that order providing for such detention had been overtaken in the meantime by another order for involuntary detention (which is the case here). The provisions of s. 28(5) therefore constitute the clearest possible legislative signal that the words ‘is suffering from a mental disorder’ in s. 19(1) should not be construed entirely literally.” Para 30.

“It is, of course, true that as Charleton J. pointed out in Han., the Oireachtas is not obliged by the Constitution to provide for an appellate remedy in the case of decisions of every administrative tribunal. But a decision of a Mental Health Tribunal under the 2001 Act affirming an admission order or a renewal order has far-reaching consequences for the constitutional rights of the detained person, including liberty (Article 40.4.1 [of the Constitution of Ireland]), the protection of the person and his or her good name (Article 40.3.2). As Henchy J. put it…in O’Dowd v. North Western Health Board [1983] I.L.R.M. 186, 205 many of the statutory safeguards attending the involuntary detention of persons with the mental disorder must be deemed to be the ‘implementation of these constitutional guarantees’…
Section 19 of the 2001 Act must also be construed in that light and this is another reason why the Oireachtas must be taken to have provided a real and effective appellate remedy for persons detained under the 2001 Act, even where the order against which they are appealing has been subsequently replaced by a subsequent renewal order.” Para 39-40.

Mental Health Act 2001 Section 10: Making of recommendation for involuntary admission. (1) Where a registered medical practitioner is satisfied following an examination of the person the subject of the application that the person is suffering from a mental disorder, he or she shall make a recommendation (in this Act referred to as “a recommendation”) in a form specified by the Commission that the person be involuntarily admitted to an approved center (other than the Central Mental Hospital) specified by him or her in the recommendation. (2) An examination of the person the subject of an application shall be carried out within 24 hours of the receipt of the application and the registered medical practitioner concerned shall inform the person of the purpose of the examination unless in his or her view the provision of such information might be prejudicial to the person's mental health, well-being or emotional condition. (3) A registered medical practitioner shall, for the purposes of this section, be disqualified for making a recommendation in relation to a person the subject of an application— (a) if he or she has an interest in the payments (if any) to be made in respect of the care of the person in the approved center concerned, (b) if he or she is a member of the staff of the approved center to which the person is to be admitted, (c) if he or she is a spouse or a relative of the person, or (d) if he or she is the applicant. (4) A recommendation under subsection (1) shall be sent by the registered medical practitioner concerned to the clinical director of the approved center concerned and a copy of the recommendation shall be given to the applicant concerned. (5) A recommendation under this section shall remain in force for a period of 7 days from the date of its making and shall then expire. Section 19 (1): “A patient may appeal to the Circuit Court against a decision of a tribunal to affirm an order made in respect of him or her on the grounds that he or she is not suffering from a mental disorder” Section 28 (5): “Where a patient is discharged under this section: (a) if a review under section 18 has then commenced, it shall be discontinued unless the patient requests by notice in writing addressed to the Commission within 14 days of his or her discharge that it be completed, or (b) if such a review has not then commenced, it shall not be held unless the patient indicates by notice in writing addressed to the Commission within 14 days of his or her discharge that he or she wishes such a review to be held, and, if he or she requests that a review under section 18 be completed or held, as the case may be, the provisions of sections 17 to 19 shall apply in relation to the review with any necessary modifications.”