In the recent case of MC v Clinical Director of the Central Mental Hospital, the Supreme Court has found that the Clinical Director of the Central Mental Hospital (Clinical Director) is required to put in place the necessary arrangements to give effect to decisions of the Mental Health (Criminal Law) Review Board (Review Board) notwithstanding that the Clinical Director might disagree with the decision of the Review Board or take the view that the decision is not in the best interests of the party in question.
The applicant in these proceedings had been detained in the Central Mental Hospital, having been found not guilty by reason of insanity of the unlawful killing of her child. In accordance with the Criminal Law (Insanity) Act 2006 (as amended) (the 2006 Act), the detention of a person found not guilty by reason of insanity in the Central Mental Hospital is required to be reviewed on an ongoing basis by the Review Board and the Review Board may make decisions inter alia discharging a person from the Central Mental Hospital absolutely or subject to conditions. However, under section 13A of the 2006 Act, the Review Board cannot make a final order in respect of a conditional discharge until the Clinical Director has confirmed that he has put in place the necessary arrangements for the order to take effect.
Following a number of reviews in accordance with the 2006 Act, the applicant was granted a conditional discharge by the Review Board and an application was subsequently made by the applicant to vary that order to enable the applicant to live in a different location to that specified in the initial order. The Review Board, following a hearing at which it heard evidence from the applicant, her treating consultant psychiatrist and the Clinical Director, indicated that it would amend the conditional discharge order to allow the applicant to reside in a different location. The Review Board notified the Clinical Director and requested that the Clinical Director put in place the relevant conditions to enable the Review Board to make a formal order. In correspondence with the Review Board, the Clinical Director indicated that he was unable to put the arrangements in place, noting inter alia that the proposed decision was contrary to the advice of the applicant's treating psychiatrist and expressing disagreement with the decision of the Review Board. In light of the refusal of the Clinical Director to put the necessary arrangements in place, the Review Board could not make a formal order under section 13A of the 2006 Act. The applicant subsequently challenged by way of judicial review proceedings the decision of the Clinical Director to refuse to put in place the necessary arrangements, seeking inter alia declarations that the Clinical Director had breached statutory duty in failing to comply with section 13A, damages for breach of constitutional and ECHR rights and orders compelling the Clinical Director to comply with section 13A. The Review Board was a notice party to this challenge.
The question for the Court's consideration was whether the Clinical Director was entitled to refuse to put in place the relevant arrangements in order to enable the Review Board to issue the formal order in circumstances where the Clinical Director maintained that the proposed decision of the Review Board was not in the applicant's best interests and required the Clinical Director to take steps contrary to his professional opinion.
(Following the issuing of the judicial review proceedings, the applicant was granted an unconditional discharge order by the Review Board. A question then arose as to whether the proceedings became moot. The Supreme Court ultimately determined that the proceedings were not moot as the applicant's claim for damages and declaratory relief remained live.)
The Supreme Court held that the correct construction of the 2006 Act was that the Clinical Director was required to put in place the necessary arrangements in order to give effect to the decision of the Review Board. Ms Justice Baker noted the purpose of the Review Board which was "to hear the evidence and determine, in its independent statutory function, whether a conditional release is to be granted and the nature of those conditions". Ms Justice Baker further noted that the Oireachtas had expressly left the decision to the Review Board, "which is independent of the detainer", and that section 13A placed a mandatory requirement on the Clinical Director to put the necessary arrangements in place. The Court rejected the arguments put forward by the Clinical Director to the effect that the Review Board decision required Clinical Director to act in a manner contrary to the best interests of the patient. Ms Justice Baker stated that, to oblige the Clinical Director to put arrangements in place to comply with the Review Board's decision does not put the Clinical Director in a position whereby he is obliged to alter his clinical view but the Clinical Director "must accept that the ultimate decision does not lie with him".
On that basis, the Court held that the Clinical Director had failed to comply with the provisions of section 13A of the 2006 Act and granted a declaration accordingly. The applicant's claim for damages will be considered at a further hearing.
This case is an important case in the context of the interaction between the Clinical Director and the Review Board and the detention of persons found not guilty by reason of insanity. It clarifies that the Review Board has overall responsibility in determining whether conditional or unconditional discharge should be granted under the 2006 Act to persons found not guilty by reason of insanity and that, whilst the Clinical Director is entitled to take a view in respect of such an application, the ultimate decision under the 2006 Act ultimately lies with the Review Board and the Clinical Director must make the necessary arrangements in accordance with that decision.