Rabone v Pennine Care NHS Trust

Facts

Melanie Rabone, aged 24, suffered from depression and had attempted to take her own life. She was admitted to a hospital run by the Trust as a voluntary patient after expressing suicidal intentions. The hospital allowed her to go home on leave for two nights, and during that leave she hanged herself from a tree. There was expert evidence that she remained at real risk of suicide when the decision was made.

History

The Trust admitted negligence, and the parents settled claims on behalf of the estate. They also brought a claim in their own right under the Human Rights Act 1998 alleging breach of article 2. The High Court and the Court of Appeal held that no operational duty arose in the case of a voluntary patient. The parents appealed to the Supreme Court.

Issue

Whether the Trust owed a voluntary psychiatric patient the operational duty to protect life under article 2, whether it had breached that duty, and whether the parents could claim as victims despite the settlement of the estate's claim in negligence.

Held

The appeal was allowed. The Trust owed Melanie an operational duty under article 2 to take reasonable steps to protect her against a real and immediate risk of suicide, it breached that duty by allowing her to go on home leave, and her parents were entitled to claim as victims.

Ratio

• The operational duty under article 2 to take reasonable steps to prevent a real and immediate risk to life arises where the state has assumed responsibility for a particularly vulnerable person, such as a mentally ill patient who is at risk of suicide, even where the patient is not formally detained.
• A breach of the duty is established where the authority fails to take reasonable measures that might have avoided the risk, as by allowing a patient at real and immediate risk of suicide to leave the hospital.

The judgments

Key reasoning

• The Strasbourg decisions show that the operational duty is not confined to those in detention but applies where the state has assumed responsibility for a vulnerable individual, so the duty can arise for mentally ill patients.
• Melanie's status as a voluntary patient could not defeat the duty, since she was admitted because she was at risk, she was under the control of the hospital, and the hospital could have prevented her leaving by using its powers under mental health legislation.
• The parents were victims because the claim concerned the deprivation of their daughter's life and the settlement of the negligence claim did not deprive them of the right to claim for the breach of article 2.

Where it fits in the module

Rabone belongs in the study of the Human Rights Act because it shows how the courts take account of Strasbourg case law to develop positive obligations on public authorities. It illustrates the claim that article 2 imposes more than a negative duty not to kill, and the relationship between a claim under the Act and ordinary negligence law. It is also useful on who counts as a victim under section 7 of the Act.

Criticisms

• Expanding the operational duty to voluntary patients risks pushing hospitals towards more detention and restriction of liberty, contrary to the policy of treating patients with the least restriction.
• The test of real and immediate risk is difficult to apply to mental illness, where the risk is often long-term, and clinicians may face liability by hindsight.
• The decision duplicates much of the law of negligence, and the award of damages for breach of article 2 alongside a settled negligence claim may be criticised as double recovery in substance.