The court stated that hospitals risk breaching human rights law if they do not take action to protect the lives of voluntary patients, as well as those detained under the Mental Health Act 1983.
Twenty-four-year-old Melanie Rabone hanged herself from a tree in Cheshire shortly after being sent home on two-days leave by Stepping Hill Hospital, where she had been admitted as an emergency case following a suicide attempt.
In 2000 Rabone was diagnosed with depression and received medical treatment. On March 4, 2005 she tied a pillow case around her neck and was admitted to Stepping Hill Hospital following an emergency referral by her general practitioner. Three days later she was diagnosed as suffering from a severe episode of a recurrent depressive disorder. On March 18 it was felt she had recovered enough to be discharged. On March 31 she cut her wrists with broken glass but, because no beds were available, she was seen as an outpatient. On April 11 she tied lamp flex around her neck and agreed to be admitted to hospital.
Although she was assessed as a moderate to high suicide risk at that time and a doctor noted that if she attempted to leave she should be assessed for detention, she was given leave to go home on the nineteenth. The next day, after telling her mother she was going to visit a friend, she hanged herself in a park.
Melanie Rabone's parents, Richard and Gillian Rabone, went to court, claiming negligence on behalf of the estate and damages on their own behalf.
After a judge ruled that Pennine Care NHS Trust had no duty under the Human Rights Act to protect their daughter's life because she had not been detained, they took their case to the Supreme Court.
"As regards the differences between an informal psychiatric patient and one who is detained under the MHA, these are in many ways more apparent than real," stated Lord Dyson his his judgement
. "It is true that the paradigm of a detained patient is one who is locked up in a secure hospital environment. But a detained patient may be in an open hospital with freedom to come and go. By contrast, an informal patient may be treated in a secure environment in circumstances where she is suicidal, receiving medication for her mental disorder which may compromise her ability to make an informed choice to remain in hospital and she would, in any event, be detained if she tried to leave. Informal in-patients can be detained temporarily under the holding powers given by section 5 of the MHA to allow an application to be made for detention under section 2 or 3 of the MHA."
He stated that she had been admitted to hospital because she was a real suicide risk and the trust had assumed responsibility for her and should have exercised their powers under the MHA to prevent her from leaving.
"It's a relief but it's tinged with sadness that it doesn't help Melanie, the BBC
quoted Richard Rabone as saying.
"In all the past judgements, it was never clear whether somebody who was not detained by an authority - be it a prisoner or a hospital patient - was not subject to Article 2 in terms of protecting their life.
"The judgement that has been made today clears that distinction completely away and hopefully, hopefully it will mean hospitals will have to take far more notice in terms of the care... It is irrelevant whether a patient is sectioned or not."
Gillian Rabone stated that if Melanie were there she would be pleased with the ruling.
Compensation of £7,500 was paid to Melanie Rabone's estate in 2009, and the appeal awarded her parents £5,000 each.
Paul Farmer, CEO of Mind
, said: "Today, the Supreme Court's judgement has further strengthened the need for hospitals to treat people with dignity and respect. This case, following the tragic suicide of Melanie Rabone, now makes it clear that hospitals have a positive duty to protect the life of people who are voluntary patients by taking appropriate steps to prevent them taking their own lives."
In a press release, Inquest
co-director Deborah Coles said that organisation "welcomes the Supreme Court’s landmark ruling that psychiatric patients are owed a positive duty of protection under human rights law. This 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."