Patient remains detained as Mental Health Tribunal publishes ruling for the first time

The first-ever Mental Health Tribunal to sit in public has ruled that the patient concerned should not be discharged.

In what also represents the first time a determination has been published, the First-tier Tribunal today (26 October) revealed that the detention of Albert Laszlo Haines, 51, was still necessary for his own health and safety and for the protection of others.

Haines has been detained under s. 37/41 of the Mental Health Act 1983 since October 1986. He was initially at Broadmoor Hospital, then between 1992 and 2008 at Three Bridges, and from early 2008 at Broadmoor again. The responsible authority is West London Mental Health Trust.

The index offences were of attempted wounding, which occurred when Haines tried to attack a doctor and nurse at the Maudsley Hospital with a machete and a knife. He was returned to Broadmoor in 2008 after an incident at Three Bridges when having been placed in seclusion after arming himself with a fire extinguisher as a weapon he climbed into a roof space.

The patient had been found to be suffering from both mental illness and psychopathic disorder. However, in 2008 under the law as it then stood, he was reclassified as suffering only from psychopathic disorder. More recently it was suggested that he did suffer from a mental illness, as well as from a personality disorder, but that was the subject of dispute.

Haines, who had successfully waged a lengthy legal battle to have the hearing in public, asked the Tribunal for an absolute discharge. It was also submitted on his behalf that in the alternative the Tribunal should grant a conditional discharge, which would have to be deferred. Mr Haines asked to be discharged to his brother’s house or failing that to a hostel.

In his “detailed and very articulate” statement Mr Haines said he did not want a conditional discharge because he would find it very difficult to comply. However, he said he would comply if that were the only alternative to remaining in detention. He did not accept that he had either a personality disorder or a mental illness.

Rejecting Haines’ application for discharge, the Tribunal found that:

• Haines was suffering from a mental disorder, namely a personality disorder. “This was the unanimous evidence of all the psychiatrists whose written or oral evidence we considered, and their conclusions were based on the very extensive and detailed history of physical and verbal aggression”. The index offences, although 25 years ago, were correctly described as a very violent and dangerous event, albeit one that did not lead to serious injury. There had been numerous incidents since
• There was insufficient evidence at this stage from which it could be safely concluded that Haines also suffered from a mental illness. There had been a divergence of views among the witnesses
• The unanimous evidence – which the Tribunal accepted – was that Haines’ mental disorder was of a nature that made it appropriate for him to remain liable to detention in hospital for treatment. “The frequency and intensity of the incidents of irrational, hostile, abusive and aggressive behaviour cannot simply be explained by understandable frustration at the length of detention or by a reaction to ward moves.” Haines could plainly be settled and pleasant, but this was almost invariably with those whom he sees as being on his side and doing what he wants
• Detention in hospital remained necessary for Haines’ own health and safety. “It is correct to say that any suicidal threats are now historic, but we noted that they occurred while he was in a less structured environment, including at a time when he was having a considerable amount of leave,” the Tribunal said. “We also concluded that outside hospital there would be a considerable indirect risk to his own safety due to retaliation by others caused by Haines’ behaviour towards them.” The provocation of others was so much a current feature of his presentation that it would inevitably be repeated outside hospital
• Unless Haines was detained in hospital for treatment he would be unable to contain his anger or aggression. Detention in hospital was therefore necessary for the protection of others.
• Appropriate medical treatment was available for Mr Haines in Broadmoor. This included medication and therapy.

The Tribunal said: “Mr Haines has not progressed enough in being able to control his anger and aggression not to require detention, and he is unable to recognise the need for continuing treatment.

“In the community there would in addition be a clear risk of a misuse of alcohol and drugs. He is incapable of coping with anyone perceived to be in authority. In his own evidence Mr Haines very frankly acknowledged that he would have great difficulty in complying with conditions, and would be likely to fail: we are satisfied that in his current presentation he would be unable to comply.”

The Tribunal added that it was “in nobody’s interest” that Haines be detained – whether in high or medium security – for a day longer than absolutely necessary.

“In our judgment detention does remain necessary, and we conclude by observing that it is likely to remain so unless the treating team are able to find a way of engaging Mr Haines, and that this will require an equal commitment by Mr Haines himself.”

A copy of the determination can be downloaded here.

The hearing took place on 27-28 September 2011.