View/Open - Scholarly Commons Home

position of many other informally admitted patients in need of review, with significant
resource repercussions. The case went to the House of Lords who reversed the decision
of the Court of Appeal. They employed the best interest test and the principle of
‘necessity’ to justify Mr L’s hospitalisation and treatment, despite his inability to
consent, and without the protective mental health legislation.
From the outset, the House of Lords’ judgement appears to have been primarily
concerned with resource allocation and the judgements reflect this interpretation. The
case report begins with a summary of the “grave concern” caused by the Court of
Appeal’s decision among “those involved in the care and treatment of mentally
disordered persons” (Lord Goff, p. 3). A written submission from the Mental Health
Act Commission detailing the resource implications of the decision was referred to by
the House of Lords. The submission offered evidence suggesting that an additional
22,000 detained patients, plus 48,000 admissions per year would be affected by the law
change with a resulting “substantial impact on the available resources… the resource
implications were likely to be considerable” (Lord Goff, p. 4). The influence of the
resource implications over the best interests of Mr L (and other informally admitted
mental health patients) was made clear by Lord Steyn:
If considerations of financial resources are put to one side, there can be
no justification for not giving to compliant incapacitated patients the
same quality and degree of protection as is given to patients admitted
under the Act of 1983…I would have wished to uphold the judgement of
the Court of Appeal if that were possible… on a contextual
interpretation of the Act of 1983, this course was not open to the House.
Lord Steyn, R v Bournewood Community and Mental Health NHS Trust, Ex parte L
[1998] p. 4
Even though the agreed evidence was that Mr L would be prevented from leaving if he
attempted to do so, the Lords disagreed that he had been wrongfully hospitalised
without his consent. The focus between each court was quite different and the
subsequent interpretation and application resulted in an entirely different process and
outcome.
42