The Court of Appeal has recently considered whether there is a duty to hold an Article 2 compliant inquest following the death of a voluntary in-patient of a psychiatric rehabilitation unit due to an overdose of recreational drugs when at home in the community.
As is well-known, since the judgment in the Supreme Court case of Rabone, where an informal mental health patient is sufficiently vulnerable and is at real and immediate risk of suicide that the hospital knew or ought to have known about, it is obliged to take reasonable steps to prevent the suicide. Translated into the context of an inquest, this means that in such a case, Article 2 of the ECHR engages and the hearing must look into the broad circumstances of the death. It is common in inquests now for arguments to be aired over whether Article 2 applies.
Ms Morahan died of cocaine and morphine toxicity. At the time of her death, she was a voluntary in-patient at a psychiatric rehabilitation unit. She left the unit with agreement on 30 July 2018 but did not return. The Coroner determined the inquest should not be an Article 2 inquest; the Family challenged this Ruling which was considered by the Court of Appeal.
- The Article 2 operational duty does not automatically exist for all voluntary patients – each must be looked at on the individual facts, taking into account whether or not there are grounds for detention under the Mental Health Act 1983 for that patient. Some patients may be genuinely voluntary patients, with choices so unrestricted they are similar to those visiting hospitals as an outpatient, rather than those like Rabone who the Court found should have been involuntarily detained. There is a wide spectrum which must be treated on a case by case basis.
- The nature of the risk in question is a relevant consideration. Ms Morahan had no history suggesting a suicide risk nor a history of accidental overdose. Drug abstinence had been evidenced by urine tests. The risk must be real, avoiding the benefit of hindsight, and be a risk of death not merely a risk of harm or even serious harm.
- There is no justification for extending the automatic enhanced investigative duty to cases of accidental death of a voluntary psychiatric patient.
The full judgment is available here.