![FD25C40130 - [2025] EWHC 1690 (Fam)](https://backend.juristeca.com/files/emisores/logo_0FrGysm.png){kind=logo}
The History of the Proceedings
The History of the Proceedings
The application first came before me at 3pm on 11 February 2025. During that hearing, I was told that the hospital was currently assessing N’s mental health but were likely to discharge her that day. However, there was no placement to which she could be discharged as the local authority had no safe space to accommodate her. Accordingly, I adjourned the hearing to 4.30pm the same day to enable the hospital to complete its mental health assessment and the local authority to hopefully find a placement for her. That hope did not come to fruition. Paragraph 10 of my order of 11 February 2025 stated: “In the event a solution could not be found overnight, the matter would need to be dealt with by an out of hours judge”. There was no solution found, and no hearing was pursued by the local authority or any hospital Trust.
N was aware of the expiry of the s.136 order. She left the hospital around 6.35pm on 11th February 2025. On 12th February 2025, in the early hours of the morning, N was located in a town centre intoxicated and indicating that she intended to end her life. N was again made the subject of Police Powers of Protection, and she was taken to a safe place. The only safe place that could be found was a police station. With the agreement of the local authority, the police took N to a family member’s home from where she absconded. At about 7.30am the next morning, the police found her. There were concerns for her mental state and the police again detained her under s.136 of the Mental Health Act 1983. They took her to hospital for an urgent mental health assessment.
On 14 February 2025 the application for a Deprivation of Liberty order came before me again. I was told N had agreed to be admitted to hospital as a voluntary patient. She had been taken there earlier in the day for that purpose but before the arrangements could be finalised, she had left the hospital. Hence the police had exercised their protective powers to take her into custody. Whilst no one before me considered that was a suitable place for N to be held, the hospital insisted N had to go through the admission process again. I was told that would mean a 19-hour wait for N in A&E until her mental health could be assessed. The police and social services were waiting for a clear indication from the hospital that N would be seen before transporting her there. They considered that she could not be kept safe in the waiting area of the hospital.
On 14 February 2025, I expressed my dissatisfaction about the way the case was being managed. I recorded on the face of my order that the Court expected senior management from both Tameside MBC and Manchester University NHS Foundation Trust/North Manchester General Hospital (the relevant hospital Trusts) to engage in constructive discussions to ensure N spends the minimum time possible in police custody. I considered it unconscionable that those responsible for her health and social care could contemplate her remaining in custody for 3 days while she awaited assessment in hospital. The police powers of protection were due to expire on Monday morning. I made arrangements for the case to return before me on Monday if an agreement between Tameside MBC and the NHS Foundation Trust could not be reached. I joined Manchester University NHS Foundation as a party and directed that should a hearing be necessary, it would be an attended hearing in London where I was sitting. I required a member of senior management from both Tameside MBC and the NHS Foundation Trust to attend that hearing.
Later, on 14 February 2025, a Multi-Disciplinary Team meeting was held to discuss N. By 7pm N was re-admitted to hospital under s.5(2) of the Mental Health Act 1983.
On 17 February 2025, the local authority made an urgent application within the proceedings before me. I was told that the s.5(2) order would expire at 3:03am and N was stating she would leave the hospital the minute it expired. The local authority, however, did not have a suitable placement for her. Accordingly, I made space within my list and heard the application. By the time the application came before me, the NHS Foundation trust was content to provide N with a bed for as long as reasonably required on condition that the local authority provided the staff to enable N to be kept safely on the ward whilst the local authority looked for a secure placement for her. To enable N to be kept safe on the ward, I permitted the local authority to invoke the inherent jurisdiction and exercised that jurisdiction to deprive N of her liberty. The deprivations of liberty I authorised were significant. They included: -
Using up to 2:1 monitoring/staffing should N’s behaviour require it
Preventing N from leaving the placement at North Manchester General Hospital without adult supervision at a level of up to 2:1 staffing, unless that had been prearranged and agreed it would be safe to do so. Such staffing ratio of up to 2:1 may also be in place within the hospital at North Manchester General Hospital.
When transporting N out into the community permitting up to a 2:1 ratio in the vehicle, excluding the driver. The doors and windows of the vehicle may be locked.
Permitting the internal and external doors and windows to the ward to be locked or restrictors to be used to prevent N from leaving or barricading herself in a room within the hospital.
Reasonable and proportionate physical restraint.
I directed the case to be returned to court by 3 March 2025. The authorisation for N’s deprivation of liberty would expire just before midnight on 3 March 2025. This was a far from perfect solution but one made in N’s best interests to keep her safe in an environment where her physical and medical needs could be met whilst a placement was found for her by the local authority.
The guardian visited and spoke to N whilst she remained in hospital. Within a report written for a review hearing, the Guardian stated that she was extremely concerned that the deprivations set out above were not being used appropriately and that the least restrictive provisions were not being utilised in respect of N.
On 3 March 2025 the local authority‘s application came before HHJ Jordan sitting as a s.9(1) judge in the Deprivation of Libert List. A placement had been found for N. It was a sole placement and was available for her to move into that day. On that occasion the court sanctioned, as being in N’s best interests, significant deprivations of her liberty to enable her to be kept safe at the new placement. They included: -
2:1 monitoring/staffing and, should N’s behaviour require it, for an initial period of 4 weeks upon discharge from hospital the supervision can be increased to 3:1.
Restraint of her person within the home or community for the purpose of preventing N from absconding or harming herself or others.
Prevention of N leaving the placement by a level of up to 2:1 staffing, unless this has been prearranged and agreed it would be safe to do so.
When transporting N out into the community permission for there to be a 2:1 ratio in the vehicle, excluding the driver. The doors and windows of the vehicle may be locked.
The internal and external doors and windows to the house may be locked or restrictors used to prevent N from leaving or barricading herself in a room.
Supervision and observations may take place to mitigate the risks to N using items to self-harm, the level of supervision and observations to be determined by the placement staff in response to N’s presentation and associated risks.
Items identified to pose a risk to N in being used for the purpose of self-harm or otherwise causing harm to others may be removed, subject to any items removed being recorded with reasons for removal identified.
Use of physical restraint to protect N from physical harm. Reasonable and proportionate physical restraint may be used by agents of Tameside MBC, who have undergone appropriate restraint training, when this is necessary to keep N or others safe. These provisions in place for N are necessary, the least restrictive and a proportionate response to the risk of harm which arise. The local authority and their agents are reminded that the declaration is a permissive one only and the restrictions should only be used if and when they are necessary and not otherwise.
The case was listed before me for further review on 7 March 2025. On that occasion I was told that there had been a series of significant incidents since 3 March 2025 including an incident of self-harming by cutting. She absconded on 6 March 2025. N was found in the early hours of 7 March 2025. She was taken to a police station where she was kept whilst the application was before me. I was told that she was refusing to eat and drink. The police intended to take N to hospital for further mental health assessment. They remained with her at the hospital until registered mental health nurses attended. The local authority had, I was told, made clear to the hospital that they must be notified forthwith of any plan for discharge and there must be a discharge planning process. In the meanwhile, the local authority told me they were taking immediate action to ensure N’s placement was now physically secure and that she had somewhere safe to go on discharge.
Such was the concern for N that I listed the application by the local authority before me on 12 March 2025. By then, N had been discharged back to her placement and was reported to be more settled. The level of supervision that it was necessary to authorise to keep her safe was reduced. Thereafter there were approximately monthly reviews before me to consider whether the deprivations of liberty previously sanctioned remained necessary and proportionate. In parallel a step-down plan was implemented; there was liaison between children’s social care and adult social care teams to ensure she had ongoing support post-18 and close interagency working between social care and mental health and therapeutic agencies. They all worked with N who engaged with the help and support that was offered to her. N’s stated aim was to be free of restrictions by her eighteenth birthday.
The last hearing before me was on 21 May 2025. I was informed that all were in agreement that N is now able to make better choices, be independent and to make positive decisions for her own welfare. There was a plan in place for her to move to a more appropriate property that will allow her to progress being fully independent. She will continue to be supported by Adult Social Care and the Leaving Care Team. N had been allocated a personal adviser from the Care Leaver Service and an Adult Social Worker with whom she has started to build positive relationships. I was told that the local authority no longer sought the court’s authorisation to deprive N of her liberty. The current application was no longer necessary, and the proceedings could conclude.