Rabone v Pennine Care NHS Trust [2012] 2 AC 72 (SC)

Facts

• Rabone v Pennine Care NHS Trust concerned the right to life under Article 2 of the European Convention on Human Rights (ECHR).
• The claimant was a voluntary psychiatric patient under the care of a mental health service.
• The Supreme Court examined whether the state’s positive operational obligations under Article 2 extended to voluntary psychiatric patients, not only to those formally detained.
• The patient was vulnerable due to impaired decision-making associated with their mental health condition.
• Mental health staff were found to have accepted responsibility for the patient’s safety.
• The claim focused on whether the NHS Trust failed to identify and respond to a clear and present risk of suicide.

Issues

1. Does the state have a positive operational duty under Article 2 ECHR to protect the life of voluntary psychiatric patients?
2. Is this duty triggered only for detained patients, or does it also apply when the state accepts responsibility through a care relationship?
3. How should the courts determine whether the risk to life was “clear and present” and whether the authorities knew or ought reasonably to have known of the risk?
4. Did the NHS Trust take sufficient steps to assess and respond to suicide risk in the context of Article 2 obligations?

Decision

• The Supreme Court held that the operational duty under Article 2 ECHR applies to voluntary psychiatric patients when mental health services assume responsibility for their safety.
• The duty is not limited to situations where patients are legally detained; it can arise from the nature of the care provided.
• The operational duty is triggered only by a “clear and present” risk, requiring objective evaluation of all information known to health staff at the time.
• The Court determined that the NHS Trust had not taken all necessary steps to protect the patient from a known suicide risk.
• The application of the Osman test (from Osman v United Kingdom) was affirmed to assess whether the risk to life was sufficiently specific and foreseeable, and whether the authorities responded adequately.

Legal Principles

• Article 2 ECHR imposes a positive obligation on the state to take preventive operational measures to protect life in certain circumstances.
• This operational duty extends to voluntary psychiatric patients when the state takes charge of care and is, or should be, aware of a specific risk to life.
• The “Osman test” establishes that authorities must know, or ought reasonably to know, of a real and immediate risk to life, and must take measures within their powers to address that risk.
• The existence of a care relationship and the vulnerability of voluntary psychiatric patients increase the scope of the operational duty.
• Preventive steps in mental health care must be proportionate and specifically tailored to identified suicide risks.

Conclusion

The Supreme Court in Rabone v Pennine Care NHS Trust confirmed that Article 2 ECHR’s operational duty encompasses voluntary psychiatric patients when the state, through medical staff, assumes responsibility and is aware or should be aware of a clear and immediate risk to life, requiring proactive and sufficient protective measures.