Richard Ive represents an NHS Mental Health Trust at an inquest where the deceased had been detained under Section 136 of the Mental Health Act 1983

Richard Ive recently represented an NHS Mental Health Trust at a five-day inquest.

The inquest centred on the death of SM. SM died in 2020 at a hospital in London. He had been admitted following self-inflicted knife wounds. These were precipitated by recreational cannabis use. The previous day, SM had been detained under Section 136 of the Mental Health Act 1983 (‘the Mental Health Act’), and he had been taken to a Place of Safety. At the Place of Safety, he was assessed as not suffering from a mental disorder. The coroner heard from three of the Trust’s witnesses in relation to SM’s assessment under Section 136 of the Mental Health Act.

After being assessed under Section 136 of the Mental Health Act, SM was then subsequently released. In relation to SM’s release from the Place of Safety, the coroner carefully considered (i) the ambit of Section 136 Mental Health Act assessments, and (ii) the Mental Health Act 1983: Code of Practice.

Upon return to his home, SM inflicted harm to his neck, wrists and chest. He was taken to a hospital in London. Once there, he was assessed as being stable. He was sedated. And then he was eased off sedation. When SM eventually woke, he appeared delusional. He removed all of his devices and was restrained. SM suffered a cardiac arrest and could not be resuscitated. Expert evidence confirmed that that he suffered thrombosis. The coroner recorded that SM had suffered a large, bilateral pulmonary embolism from his leg veins which caused him to suffer a cardiac arrest. He died from this.

The coroner recorded that SM died of 1c: Stab wound; 1b: Cardiac rupture; and 1a: Pulmonary embolism.

Richard made closing submissions on behalf of the NHS Mental Health Trust. He submitted that, in all the circumstances, a short, narrative conclusion would be appropriate. He also submitted that, because this was not an Article 2 inquest, any conclusion – or finding – must be neutral. He reminded the coroner of the need to neutrally set out the facts surrounding SM’s death, and the coroner subsequently handed down a short, narrative conclusion. Finally, Richard submitted that there was no legal basis for issuing a Prevention of Future Deaths (PFD) report. The coroner agreed with Richard’s submissions. He concluded that, in all the circumstances, there was no statutory basis to issue a PFD report.

Richard accepts instructions to represent interested parties at inquests. Any such request should be made to the Farrar’s Building Clerking Team.

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