M was 17 years old. On 24/06/08 at 20:00hrs he attended the Tooting Walk-In Health Centre in the grounds of St George's Hospital, Tooting, run by the Second Defendant. He said that he was depressed and wanted to commit suicide. He was seen by a nurse and described to her several methods of ending his own life that he had researched on the internet. She recorded: "Impression: Depression with suicidal ideation".
An on-call psychiatrist, from the First Defendant Trust, agreed to see M at the A&E Department of St George's Hospital. After a 6 hour wait M was assessed at 01:45hrs on 25/06/08. The psychiatrist was concerned by M's behaviour and his risk of suicide. M agreed to be admitted to hospital for further assessment.
Unfortunately no bed was available in a psychiatric unit and arrangements were made for M to wait on the Clinical Decisions Unit (CDU) in A&E until one was found.
At 11:00hrs on 25/06/08 M was seen by a clinical nurse specialist from the Child and Adolescent Mental Health Services (CAMHS) for assessment. The nurse was concerned about M's preoccupation with suicidal thoughts and found that M had a "strong intent" towards self harm. The medical records note "Acute suicidal ideation in the context of chronic personality disorder...". At that stage a bed had still not been found.
Between 11:00hrs on 25/06/08 and 13:00hrs on 26/06/08 M was not seen by anyone. During this time, despite his age and vulnerability, he remained waiting on the CDU.
On 26/06/08 at approximately 13:00hrs M was seen by a Consultant Psychiatrist and Clinical Nurse, in the employ of the Third Defendant, for assessment. They elicited a history from him about his suicidal thoughts but midway through the assessment M got up and left the hospital. There was no attempt to detain him or to alert the emergency services. No attempt was made for an urgent referral to either an Outreach Team or to Social Services.
At the time M left, he had been in hospital for nearly 2 full days waiting on the CDU for an admission to a psychiatric bed or other treatment.
The following day, 27/06/08, M committed suicide by one of the methods he had repeatedly described during the above assessments.
We were consulted by M's family and an application for Legal Aid was made and granted.
Limitation expired in June 2011 and proceedings were issued against all 3 Defendants as M had been seen by various staff employed by the different Trusts during his 2 day wait in hospital. An extension of time for service of the proceedings was granted so that evidence could be obtained.
A Letter of Claim was sent to the Defendants in December 2011, with the NHSLA agreeing to deal with the claim on behalf of all 3 Defendants. Allegations against the Defendants included delay in treatment, failure to conduct a Mental Health Act assessment, allowing a minor to be discharged without follow up, failing to consider powers to detain under the Mental Health Act, failing to contact the emergency services to take M into protective custody.
M was a vulnerable young man with emerging psychotic features. He had expressed clear and explicit plans about suicide. He required an assessment under the Mental Health Act 1983 and the failure to do so and to detain him when he attempted to leave the hospital was negligent.
It was contended that on the balance of probabilities his condition was capable of cure and, had he been detained under the Mental Health Act 1983, he would have been treated, his psychosis would have passed and he would have been prevented from committing suicide.
Proceedings were served on the Defendants on 30/01/12.
Discussions between the parties took place prior to service of a Defence and on 23/03/12 settlement was reached in the sum of £20,000 plus costs.
The claim can be broken down as follows:-
General Damages: for pain, suffering and loss of amenity - £3,309
Statutory Bereavement Award - £11,800
Funeral Expenses - £4,891
In addition the Defendant also agreed to pay the legal fees.
This was a difficult case in that M had not been formally admitted to hospital at the time of his departure. He was there voluntarily to seek help. He had been seen by a variety of staff from each of the three Defendants and had not been classified as needing to be sectioned under the Mental Health Act.
It was considered that had M received appropriate psychiatric treatment on the occasion of his first presentation at hospital on 24/06/08 he would have been put on appropriate medication and would have been spared 3 days of anguish and frustration, and the agonies of the actual suicide on 27/06/08. It seemed that on the balance of probabilities appropriate treatment would have resulted in a cure for M. The immediate risk of suicide would have passed as his psychosis resolved and, although he may have been at risk of future psychotic episodes, his GP and psychiatrist would have been alive to such possibility and he would have been promptly and appropriately treated.
At the time the Claim Form was issued Health Trusts did not have an obligation to take special preventive measures to protect voluntary mental patients from the risk of suicide, even where that risk was "real and immediate". The obligation only existed in the case of persons for whom the state had assumed responsibility by their detention under the Mental Health Act 1983. However, following appeal in the case of Rabone v Pennine Care NHS Foundation Trust (2012) the Supreme Court unanimously decided that no distinction was to be drawn between those who are mentally ill and detained under the MHA and those who are not. It was following this judgment that the case settled and it was considered to be an influencing factor.
Claimant's legal team
Solicitor: Sarah Towler, Partner at Russell-Cooke
Counsel: Adam Korn of 7 Bedford Row
Defendant's legal team
Solicitor: Capsticks LLP