The Supreme Court’s decision this week in Lewis-Ranwell v G4S Health Services (UK) Ltd and others raises stark questions about the intersection of mental health law, negligence, and public policy.
At its heart is a deeply tragic sequence of events. But the judgment is not about apportioning moral blame. It asks whether the civil law should permit a claimant to recover compensation for losses flowing directly from acts of extreme violence, even where those acts were committed during a psychotic episode and attracted no criminal responsibility.
For healthcare bodies and those working in mental health and criminal justice settings, the case is likely to be pertinent.
Background
Mr Lewis-Ranwell, a 34-year-old male, was diagnosed with schizophrenia in his mid-twenties and had periods in psychiatric intensive care in 2016 and 2017.
On 8 and 9 February 2019, he was arrested twice for burglary and GBH. On both occasions he behaved erratically and violently whilst in custody, appearing acutely mentally very unwell.
He was seen or spoken to by mental health professionals employed by G4S and Devon Partnership NHS Trust (the Trust) following both arrests.
After the second arrest the need for a Mental Health Act assessment was discussed with an approved mental health professional (AMHP) but was not arranged.
He was released on bail on 10 February. Later the same day, during a serious psychotic episode, he attacked and killed three elderly men in their own homes. Lewis-Ranwell was under the psychotic delusion that these men were paedophiles.
At trial, he was found not guilty of murder by reason of insanity, meaning the jury accepted that Lewis-Ranwell carried out the killings but was not criminally responsible. He was made subject to a hospital order with restrictions, and remains detained at Broadmoor Hospital.
In February 2020, Lewis-Ranwell brought civil proceedings against G4S, the Trust and Devon County Council, alleging that all four defendants had been negligent in failing to provide him with adequate care and mental health assessment, thereby causing him to be released into the community in a psychotic state. He also alleged that by their acts or omissions all four defendants had violated his rights under Articles 3 and 8 of the European Convention for the Protection of Human Rights and Fundamental Freedoms. He claimed that, but for those failures, he would have been admitted to hospital, and the killings would not have occurred.
He, therefore, sought damages for the consequences of the killings, including his compulsory detention, and an indemnity against potential claims by the victims’ families.
G4S, the Trust and the Council applied to strike out the claim on the ground that it was barred by the doctrine of illegality. They lost at both first instance and at the Court of Appeal. The Supreme Court unanimously allowed that appeal.
Ringing bells?
Some readers might be old enough to recall the case of Clunis v Camden and Islington Health Authority from 1998. This related to a patient receiving section 117 after care who failed to attend appointments and subsequently killed Mr Jonathan Zito at Finsbury Park tube station. He pleaded guilty to manslaughter on the grounds of diminished responsibility and was detained under Hospital Order and a Restriction Order under section 37/41 Mental Health Act. He too then brought a civil claim alleging he had suffered injury loss and damage. There the Court of Appeal said that
“ …public policy would preclude the court from entertaining the plaintiff’s claim unless it could be said that he did not know the nature and quality of his act or that what he was doing was wrong…. A plea of diminished responsibility accepts that the accused’s mental responsibility is substantially impaired but it does not removed liability for his criminal act”.
About twenty years later Henderson v Dorset Healthcare related to another patient who this time killed their mother during a psychotic episode whilst under the care of a community mental health team. She pleaded guilty to manslaughter on the grounds of diminished responsibility and again a Hospital Order and a Restriction Order were imposed. In her civil claim, she alleged but for the Trust’s breach of duty in failing to return her to hospital when her condition deteriorated, she would not have killed her mother. In rejecting her claim, the Supreme Court considered three tests which the Supreme Court in Lewis-Ranwell then also followed.
The Court’s decision
The judgment is fascinating for us lawyers and goes right back to case law from 1775 which said “No court will lend its aid to a man who founds his cause of action on an immoral or illegal act”.
Readers will have noticed a difference between this case and earlier ones above. This one did not involve criminal offences: here the claimant was found not guilty by reason of insanity (rather than guilty of manslaughter due to diminished responsibility). However, the jury established that he did the acts – killed three men. The psychiatric evidence before the court in the criminal trial was not that the claimant did not understand the nature and quality of his acts, but that he did not appreciate that it was wrong. The evidence was that he knew he was attacking the victims and was acting intentionally, albeit under the delusion they were paedophiles.
The case, therefore, required the Supreme Court to address an issue it had not previously decided directly: can the doctrine of illegality bar a civil claim where the claimant was not criminally responsible for the acts in question?
The Court answered firmly in the affirmative. While insanity is a complete defence in criminal law, the absence of criminal responsibility doesn't prevent conduct from engaging the illegality defence in civil law.
The court emphasised “…killing another human being without lawful justification breaches a fundamental moral rule in our society – you shall not kill”, even where the individual bears no criminal responsibility.
Having found that the killings engaged the illegality doctrine, the Court applied the three stage test in Patel v Mirza [2016] UKSC 42, [2017] AC 467.
- The purpose of the prohibition breached
The prohibition against unlawful killing exists to preserve life, promote respect for the sanctity of life, protect the public, deter unlawful killing, condemn unlawful killing, punishment, and acknowledge the wrong done to victims. Allowing a civil claim which compensates a person for the consequences of having killed others would undermine that purpose. It would also be inconsistent for a criminal court to impose detention to protect the public, and for a civil court to award compensation for the consequences of that detention. The court talked of the law otherwise giving with the right hand what it took away with the left. - Other relevant public policies
While there is a public interest in courts examining alleged negligence, this can be examined in other arenas, including inquests and public inquiries. Maintaining confidence in the integrity of the legal system was given greater weight over permitting a claim. It was felt that inquests and inquiries were better suited arenas. - Proportionality
The acts in question were of the utmost seriousness and were central to every head of loss claimed. Denying the claim was, therefore, a proportionate response.
Was the Supreme Court right?
From a public body and healthcare perspective, the judgment provides welcome clarity. The court did not suggest that failures in mental health assessment or care are unimportant, nor that public bodies should be insulated from scrutiny. Rather, it drew a line around what civil liability can properly address.
Allowing the claim to proceed would have required the courts to assess loss flowing directly from three unlawful killings, including detention of the perpetrator, which was imposed to protect the public. The Supreme Court considered that outcome incompatible with legal coherence and public confidence.
Importantly, the decision doesn't mean that individuals with serious mental illness can never bring negligence claims, nor does it remove duties owed by healthcare providers. The ruling is closely tied to the exceptional facts: the gravity of the acts, their centrality to the losses claimed, and the nature of the relief sought.
What might they have decided if the defendant/claimant had not known what they were doing / did not act intentionally?
What if the claim had succeeded?
Had the claim been allowed, the ramifications would have been far-reaching. Healthcare providers, local authorities, and outsourced custody healthcare services could have faced liability for losses arising from the most serious violent acts, even where the claimant was the perpetrator.
Such an outcome would have blurred the boundary between civil negligence and the criminal justice system’s response to serious violence. As the court noted, mental illness exists on a spectrum, and drawing liability lines based on fine distinctions risks uncertainty and inconsistency.
What does this mean in practice?
For healthcare and public bodies, the decision reinforces several key points.
- Illegality remains a robust defence in exceptional cases involving serious unlawful acts, even without criminal conviction.
- Civil claims are not the only means of examining systemic failings; inquests and inquiries remain vital.
- Duties to assess and treat mentally unwell individuals remain critically important, but the law will not permit recovery where doing so would undermine fundamental legal principles.
- The case is a reminder of the limits of tort law when confronted with profound tragedy. Some questions are better answered through public scrutiny and learning, rather than compensation.
Key takeaways for mental health providers and NHS bodies
- Extreme violence and civil liability
Claims seeking damages that flow directly from acts of unlawful killing - including compensation for compulsory detention imposed to protect the public - are unlikely to succeed, even where serious mental illness is involved. - This decision does not ‘relax’ clinical duties
The decision certainly does not dilute the obligations on mental health services to assess, manage and treat patients presenting with acute psychiatric symptoms, particularly in custodial settings. Risk identification, risk ownership and risk management remain, as always, key. Communication, getting the right staff involved at the right point are often features in such cases. - Scrutiny of healthcare providers may still come via other routes.
If there has been an alleged care failure in the context of a serious incident (as in the present case), investigation is more likely to take place via PSIRF, inquests, safeguarding reviews, or public inquiries rather than civil claims by the perpetrator of the crime. - Clear documentation of decision making processes are critical
The case underlines the importance of robust assessment processes, clear decision-making, and documented escalation where patients present a potential risk to themselves or others, to ensure patient safety and public protection. - Coherence of the legal system
Had the claim succeeded, it could have significantly expanded the scope of liability for mental health providers. The judgment provides reassurance that the courts will not extend negligence claims into areas that would undermine the coherence of the legal system.
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