The Case of Keenan v. the United Kingdom (Application no. 27229/95)
Petition alleging Mark Keenan and his mother Susan Keenan, rights to life, not to be tortured and to have access to effective remedies under the European Convention on Human Rights were violated. No adequate remedy for the violation of Mark Keenan’s rights under the Convention; right to psychiatric treatment; Right to adequate medical treatment; lack of access to psychiatric/medical treatment as inhuman and degrading treatment; right to protection from self harm; Lack of effective domestic remedy for violations of the ECHR; States’ positive obligations to protection from self harm.
Mark Keenan received intermittent psychiatric treatment since the age of 21. At 28, Keenan was admitted to prison, initially to the prison health center. Several attempts were made to transfer him to the general population, but his mental health worsened each time. Following a transfer attempt, he assaulted two guards and his sentence was increased by twenty-eight days. The next day Keenan hung himself. His mother alleged violations of the European Convention on Human Rights, including failure to protect his right to life under Article 2, inhuman and degrading treatment under Article 3, and lack effective remedy to these violations under Article 13..
Under article 2 the Court stated that States’ positive obligations may include preventing self-harm. To determine a state’s obligations, the Court asks whether, in light of available information, authorities should have recognized an immediate risk of self-harm. If, given the risk, they took all reasonable measures, there is no violation. The Court found that because Keenan’s record contained no formal diagnosis of schizophrenia, authorities could not have known he was an immediate suicide risk. Therefore, their response to the known risk was reasonable and the claim under article 2 was dismissed.
With regard to article 3, States are obligated to protect prisoners’ mental health and inadequate mental-health treatment may be found to be a violation. In assessing adequacy of treatment the Court considers mentally ill persons’ vulnerability, and does not require them to articulate specific ill effects. In Keenan’s case, inadequate record keeping, monitoring, and psychiatric input showed significant defects in treatment. Extending his sentence some time after the assault, and nine days before his scheduled release, was not compatible with standard treatment for a mentally ill person.
The Court found available remedies inadequate under Article 13. No available remedy would allow Keenan to challenge his punishment within the additional prison time. For his mother, an inquest was not adequate because it would not determine authorities’ liability, or provide compensation. An action in negligence was inadequate because it might not consider Keenan’s mental suffering, or provide adequate compensation. No available remedy would allocate responsibility for Keenan’s death, an essential element of a remedy for a bereaved parent.
Susan Keenan was awarded £10,000 in damages; £7,000 for Keenan’s suffering, to be held by his estate and £3,000 for his mother’s suffering. She was awarded £21,000 for legal expenses.
The Court’s decision was important as it made clear inadequate medical care, including mental health care can rise to the level of inhuman and degrading punishment under the ECHR. States may have breached their ECHR duties where medical care falls below a certain standard. It is not necessary that a mentally ill person identify specific ill effects of treatment for a violation to be found. This decision has implications beyond prisons, to hospitals and other state institutions providing medical care. The case may also be significant as it may imply that negligence damages in the U.K. routinely fail to provide an adequate remedy where the complainant is not a dependent of the victim or where the injury to the victim was psychological, not physical.