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Hospital breached duty of care to psychiatric patient, supreme court rules

NHS trust contravened 'operational obligation' under European law by allowing home release for patient who then killed herself.

An NHS trust breached its duty of care to a 20-year-old patient who killed herself while on home release from a psychiatric unit, the supreme court has ruled.

The decision was greeted by mental health charities and civil liberties groups as a significant extension to hospitals' responsibility for protecting all patients, both those detained and those admitted voluntarily.

Melanie Rabone, who chose to enter Stepping Hill hospital in Stockport, was found hanged from a tree in 2005 after being diagnosed with recurrent depressive disorder.

She had previously cut her wrists and been assessed as a moderate to high suicide risk who might need to be detained if she attempted to leave.

Pennine Care NHS Trust, the supreme court found, breached its "operational obligation" to look after her under Article 2 of the European convention on human rights, which states that "everyone's right to life shall be protected by law".

In allowing the family's appeal against the trust, the supreme court said her parents were the "victims" under the terms of the convention and confirmed that they should receive damages of £2,500 in addition to an earlier settlement.

"Melanie Rabone had a history of depression," the judgment said. In March 2005 "she cut both of her wrists with broken glass" and was eventually given informal admission to the hospital.

One doctor "noted that, if she attempted or demanded to leave, she should be assessed for detention under the Mental Health Act 1983". But on 19 April 2005, she was allowed home after requesting leave. Her mother "expressed concern about Melanie coming home for the weekend, but Melanie was keen to do so. On 20 April 2005, Melanie, aged 24, hanged herself from a tree."

Welcoming the decision, Paul Farmer, of the charity Mind, said the judgment recognised "that a positive duty is owed towards patients with mental health problems … whether or not a patient has been formally detained."

Deborah Coles, of Inquest, said the new duty "must go hand in hand with an investigation and inquest process that ensures deaths in psychiatric care are independently and robustly scrutinised. This would not only enable families to find out what happened to their relatives but also ensure lessons are learned to help prevent deaths in the future."

Emma Norton, Liberty's legal officer, said: "This landmark human rights judgment means that voluntary patients in psychiatric care will finally get the same legal protection as sectioned patients. Hospitals rightly acknowledge their serious duties to detained people – why should those who have asked for help be any different?"

Jodie Blackstock, of Justice, added: "With all the scepticism currently surrounding the European convention on human rights, this case demonstrates what a vital role it has in protecting the rights of the most vulnerable in society.

"In this case the supreme court has not only acknowledged that through the convention the state holds a responsibility for those in its care to which there is a real and immediate risk of death, but when it fails in that duty, parents should be entitled to vindicate their loss also".



Feb 13