The Rabone case
In 2005, in the UK, 24-year-old Melanie Rabone was admitted to hospital as an emergency following a suicide attempt. She was assessed as being at high risk of a further suicide attempt, but was not detained under the Mental Health Act 1983. She remained a voluntary or “informal” patient, so when she requested a brief period of home leave, her doctor agreed. The following day, while on leave, she killed herself.3
The Supreme Court held that the treating hospital had a duty to take reasonable steps to avert the risk to life in circumstances where they knew (or ought to have known) of a “real and immediate” threat to that individual. In the specific circumstances of the case, the court held that the hospital involved had violated the positive duty that it had, under Article 2 of the European Convention on Human Rights – the right to life – to protect a voluntary patient from the risk of suicide.
There are similar concerns that depressed patients who are at risk of suicide will be detained longer or not granted leave even when there is only a low likelihood of suicide
Professor Rix observed that this case has caused some anxiety amongst psychiatrists. He points out that the court defined a “real” risk as “a substantial or significant risk and not a remote or fanciful one”, which is a low threshold. The court defined “immediate” as meaning “present and continuing”. He says that there is an understandable concern that if a patient has an antisocial personality disorder and has a history of causing serious harm, a court will deem them as posing a “real and immediate” risk to the public, if allowed to be at large, and so psychiatrists will detain, or seek to detain, such patients longer, if not indefinitely.
Likewise he says that there are similar concerns that depressed patients who are at risk of suicide will be detained longer or not granted leave even when there is only a low likelihood of suicide. However, this duty should not persuade professionals to behave any more cautiously or defensively than they are already persuaded to do by the ordinary law of negligence.4