Law Report: Court may order anorexic to be detained for treatment

Re C (a minor) (Detention for medical treatment); Family Division (Mr Justice Wall) 5 March 1997

The court had power, when exercising its inherent parens patriae jurisdiction in relation to a 16-year-old child, to authorise and direct the detention of the child in a specified institution for the purposes of medical treatment.

Mr Justice Wall, granting an application by the plaintiff local authority, ruled that the first defendant, referred to only as "C", should be detained at a private clinic specialising in the treatment of eating disorders in young people and that she should undergo medical treatment for anorexia whether or not she consented.

Alison Ball QC (Christopher Hinde, Hackney) for the local authority; Roderic Wood QC (Bindman & Partners) for C; David G.P. Turner (Goodman Ray) for the parents; James Munby QC (Official Solicitor) as amicus curiae.

Mr Justice Wall said C, who was 16, suffered from anorexia nervosa. The clinic where she was being treated was run on boarding-school lines. Its medical director regarded C's enforced presence in the clinic under an order of the court as an essential component of her treatment. If C was not in the clinic, she would not eat.

C disputed the need for an order, saying she agreed with the treatment she was receiving and was content to stay at the clinic on a voluntary basis.

C's parents supported the clinic's approach. Though they were married and lived together, the family was severely dysfunctional. None of the other four children apart from C lived at home. Her elder brother had sexually abused her over a substantial period.

But although C came from a dysfunctional family, she had never been taken into care or accommodated by the local authority, although she had previously been detained in another hospital under the Mental Health Act. The clinic was not a mental hospital and its philosophy was inimical to the compulsory admission of children under the Mental Health Act.

C's eating disorders began in October 1994 and she was diagnosed as suffering from anorexia in July 1995. She had been admitted and discharged from the clinic a number of times since then and had frequently absconded. In December 1996 the consultant psychiatrist and the medical director of the clinic made it clear they would not readmit her without an order of the court.

In Re W (a minor) (Medical treatment: Court's jurisdiction) [1993] Fam 64 and 81, the Court of Appeal upheld a decision, under the court's inherent parens patriae jurisdiction, to authorise the medical treatment of an anorectic 16-year-old girl without her consent. The judgments in that case did not deal specifically with the power to detain the minor in a specialist unit, though the existence of such a power could readily be inferred from the fact that the judge authorised W's removal to and her treatment at the clinic.

It was argued for C that since she consented to the treatment, her detention was not an essential part of it, and accordingly the inherent jurisdiction was being used solely for the purpose of deprivation of liberty.

His Lordship disagreed. On the evidence, C's detention at the clinic was an essential component of her treatment and without it she would not be treated. If C were free to leave the clinic, she would probably do so.

It was therefore clear that his Lordship, in exercising the court's inherent jurisdiction, had power to direct that C remain as an in-patient at the clinic until discharged by its medical director or until further order of the court. That power included the authorisation of her detention in the clinic for the purposes of treatment. Moreover, since her adherence to the clinic's regime was an integral part of her treatment programme, his Lordship had no doubt that the court also had power to authorise the use of reasonable force, if necessary, to detain C at the clinic.

In exercising the court's jurisdiction, section 1 of the Children Act 1989 applied and the welfare of C was the paramount consideration. In his Lordship's judgment, having regard to all the circumstances, the treatment proposed was in C's best interests and the order sought by the local authority should be granted.

Paul Magrath, Barrister