The experts’ estimates, the more conservative of which was accepted by the court, 1 were between 40 and 600 times that figure. Since Ms Rabone's admission lasted 10 days, it is hard to see how a realistic estimation of her risk of suicide on any particular day could have been much beyond one tenth of that – 0.12%. Such a calculation, even with an extremely pessimistic base-rate assumption, reveals that the likelihood of a ‘high-risk’ patient dying by suicide while an in-patient is probably no more than 1.2%. It is possible, using these empirical data and making an assumption of the base-rate of suicide among all in-patients, to calculate the probability of such a ‘high-risk’ patient's admission ending in suicide. Reference Large, Ryan and Nielssen3 Its results suggest that Ms Rabone's depressed mood and previous suicide attempts would have meant that she was more likely to die by suicide than another in-patient without those features. The suicide of psychiatric in-patients (including those on approved leave) was the subject of a systematic review and meta-analysis. 2 The written judgments do not record how these figures were arrived at, but it is hard to see how they could have been based on what is actually known about the likelihood of suicide by psychiatric in-patients on approved leave.

He expressed the view that ‘the risk was approximately 5% on 19 April (after leaving hospital) increasing to 10% on 20 April and 20% on 21 April’. 2 The Trust's expert was more conservative. The expert psychiatrist engaged by the claimants estimated that Ms Rabone's ‘immediate risk’ of suicide on 19 April was ‘of the order of 70%’.

The court sought expert evidence as to whether there was a ‘real and immediate’ risk to the life of Ms Rabone on the day she was granted leave. She hanged herself from a tree in a local park sometime after 5 pm. She spent most of the next day with her mother, but in the afternoon said she was going to see a friend. She requested leave and, following a meeting with her psychiatrist and mother where she agreed not to self-harm, 2 days’ leave was granted. By 19 April Ms Rabone had again shown some signs of improvement. On 11 April she was readmitted voluntarily after tying lamp flex around her neck. By 14 March she ‘had shown sufficient signs of recovery’ to be allowed overnight leave, and on 18 March she was discharged to accompany her family on a week-long trip to Egypt. Melanie Rabone was 24 when on 4 March 2005 she attempted suicide by tying a pillowcase around her neck and was admitted to hospital diagnosed with ‘a severe episode of a recurrent depressive disorder’. 1 We have grave concerns about the quality of the expert evidence presented to court in this case.

Pennine Care NHS Foundation Trust the Supreme Court examined the duties that the European Convention for the Protection of Human Rights and Fundamental Freedoms might place on hospitals caring for informal psychiatric patients.

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