FD24F00084 - [2025] EWHC 920 (Fam)

By an application dated 27^th November 2024, Nottinghamshire Healthcare NHS Foundation Trust (hereinafter ‘the Trust’) applies under the inherent jurisdiction for declaratory relief concerning the medical care and treatment of the respondent. The respondent, is a 53 year old man. The Trust seek a declaration under the inherent jurisdiction that the decision of MC's responsible clinician, Dr A, not to impose treatment pursuant to section 63 of the Mental Health Act 1983 (“MHA”), without MC's consent, is lawful, even if that leads to suboptimal treatment, a continued decline in his physical health, and a risk of death. This hearing has been held in public, subject to a reporting restrictions order dated 10 December 2024 and later amended. Time did not permit delivery of a judgment on the same day.

The applicant Trust has been represented by Ms Sutton KC, MC by Ms Kelly and the interested parties by Ms Gardner. I express my gratitude to Counsel for the skill and care with which each has advanced their respective case and for the very high quality of the detailed skeleton arguments submitted in advance of the hearing from which the arguments have been developed orally.

On 20^th January 2025 by an order listing the matter for a final hearing, 3 issues were identified for determination i) Whether treatment for MC's physical health needs is medical treatment under section 63 MHA; his refusal for such treatment being said to be a manifestation of his severe personality disorder ii) Whether MC has capacity to make decisions regarding his physical health needs within the meaning of the Mental Capacity Act 2005 (MCA) and iii) (in either event) Whether it is lawful and/or in MC's best interests for his treating clinicians not to use force to provide MC with medical treatment for his physical health needs (including through physical, chemical or mechanical restraint), even if this leads to MC's premature death.

MC has been detained under section 37/41 MHA in Rampton High Security Hospital (“Rampton”), operated by the Trust, since January 2005. This means that MC is detained at Rampton pursuant to a hospital order made by the Crown Court for treatment for his mental disorder as an alternative to prison, and that it was also considered necessary to make a restriction order to protect the public from serious harm. MC has engaged in very little risk reduction work due to the manifestations of his mental disorder. MC is a “restricted patient” so cannot be discharged by his responsible clinician without the consent of the Secretary of State for Justice. MC has a significant forensic history. Rampton patients meet the criteria of posing a grave danger to themselves or the public. MC has spent the greater part of his adult life in custody and/or detained. The fact that he is so detained has a relevance to the medication he may (in fact may not) have access to and keep/administer for himself in the way that a capacitous adult might otherwise have.