Court approves sedative PRN medication

By Maria Maier, 17th June 2026

As an Independent Advocate for individuals who lack mental capacity, I have seen at first-hand the vital role the Court of Protection plays in safeguarding some of the most vulnerable members of society. Despite its importance, the Court’s work is often overlooked and underreported. By observing and reporting on its cases, I hope to contribute to greater public understanding and informed discussion, helping to ensure that the Court protects our fundamental rights as effectively as possible.

As I had time available for court observation on 10th June 2026, I reviewed the court lists the evening before and found case COP 20031464. The matter was listed before Ms Justice Harris at 1:00 pm as a remote hearing in the Royal Courts of Justice. I sent an email (at 5:50pm 9th June) asking to observe, copying and pasting the updated template e-mail from the Open Justice Court of Protection website.  This updated template requests three court documents identified in the Court of Appeal judgment in Re Gardner as documents that can be made available to observers to assist transparency (see: A statement on the Court of Appeal’s judgment in Re Gardner (Deceased) (Court of Protection: Disclosure of Position Statements).  These are: a) the case summary, (b) a chronology of relevant events, and (c) the issues for determination at the hearing.

The following day, a Court Associate sent me the joining link for the hearing at 10:23am. Later, at 12:33pm, I received a Case Summary from Ms Justice Harris’s clerk, while the Transparency Order arrived just a few minutes before the hearing began.

The Case Summary was incredibly helpful. It made a significant difference to my ability to follow and understand the proceedings, providing essential context that would otherwise have been difficult to grasp. I am grateful to the legal teams for contributing to transparency in this way.

From the Case Summary, I learnt that the protected party at the centre of the case (“P”) is a 17-year-old male with childhood diagnoses of Mixed and Other Personality Disorders and Reactive Attachment Disorder. These conditions are said to result in high levels of impulsivity, profound mood swings and intense emotional dysregulation.

As a result, P has been assessed as lacking capacity to make decisions about his care and residence, including the level of supervision and restrictions required to meet his needs. He had previously been detained under section 3 of the Mental Health Act 1983 but has since been discharged to a suitable care placement.

Just over a week before the hearing (on 2nd June), a round-table meeting took place at which a draft order was agreed. The proposed order sought interim authorisation of P’s care arrangements and requested further evidence from the local authority regarding aspects of his care, particularly the use of PRN medication. (“PRN” stands for pro re nata, meaning medication administered only when required rather than according to a fixed schedule.)

The use of PRN medication became a particular focus because of its potential sedative effects. When the draft order was presented to the Tier 2 judge, HHJ Gillespie, concerns were raised about both P’s age and the possibility that the medication could amount to a form of chemical restraint. As a result, the matter was escalated to a more senior Tier 3 judge, Ms Justice Harris.

The parties in the hearing were:

  • The appellant Local Authority (Lincolnshire County Council) represented by Richard Borrett,
  • The first respondent, P, represented by Oliver Lewis,
  • The second respondent, Lincolnshire ICB, represented by Daniel Taylor.

When Ms Justice Harris joined the call, counsel for the appellant provided a summary of the case and updated the Court on P’s condition. Although P had been experiencing ‘improved episodes of dysregulation’ prior to the previous week, his presentation had deteriorated over the preceding seven days. This deterioration included several incidents of self-harm. Although there is no confirmed evidence of causation, Mr Borrett outlined that these changes have coincided with changes to P’s medications.

Mr Borrett then began his submission for an interim declaration from the Court that it was lawful and in P’s best interests to stay in his current placement, for physical restraint to be used when necessary, and to so far as the PRN medication amounted to chemical restraint – for its use to be authorised by the Court. Mr Borrett clarified that physical restraint is not used often and is very light. Mr Borrett also made it known that, while psychiatric PRN had been increased over the last few days, it is being reviewed by P’s doctors and has only been given at P’s request.

The groundbreaking Supreme Court judgment (AGNI) came up, as it must do in many hearings at present. Mr Borrett made clear that the Local Authority was still reflecting on its position as to P’s ‘deprivation of liberty’ stating, ‘we haven’t had, or anyone else for that matter, the chance to digest that judgment and decide what it means on an individual case basis’. The 24th July 2026 was agreed by all parties as a date by which the Local Authority should have considered the implications of this judgment for P’s case and decided on a way forward.

There were no disagreements between the parties at this hearing. Both barristers for the respondents were invited by Ms Justice Harris to present any arguments against the appellant, however neither did. Mr Lewis thanked the Local Authority, ICB and those caring for P for pulling together ‘quite impressively’ the information regarding P’s medications. Mr Taylor echoed that he had ‘no objections’ and that ‘the proposed way forward seems reasonable.

What struck me most about the hearing was that the Court considered this matter despite there being no dispute between the parties. The proposed arrangements had already been agreed, and neither respondent party opposed the local authority’s application. Nevertheless, HHJ Gillespie had recognised the significance of the issues involved and, given P’s age and vulnerabilities, considered that scrutiny by a more senior judge with specialist expertise was warranted.

This served as a useful reminder that the Court of Protection is not simply a forum for resolving disagreements. Even where there is consensus, the Court has an independent responsibility to ensure that restrictions imposed on a person who lacks capacity are lawful, proportionate and genuinely in that person’s best interests.

Although the hearing lasted only 37 minutes, it provided an opportunity for careful judicial consideration of arrangements involving close supervision, the possibility of physical restraint and the administration of sedative PRN medication. The application was not treated as a procedural formality. Instead, the Court ensured that the proposed restrictions were justified and accompanied by appropriate safeguards.

Ms Justice Harris ultimately approved the agreed draft order. She stated that she was “more than content” with the proposed arrangements and was “satisfied that the restrictions in place – the supervision, physical restraint when necessary and PRN, if it amounts to chemical restraint – were lawful and proportionate, and in P’s best interests.”

Mr Borrett then raised the issue of whether the case should remain at Tier 3 or be returned to HHJ Gillespie. Ms Justice Harris noted that the PRN medication was not being used regularly and was administered only when necessary and at P’s request. In those circumstances, she was satisfied that the level of intervention did not require ongoing oversight by a Tier 3 judge.

Maria Maier is an aspiring barrister with an interest in the Court of Protection. She is currently working as a Relevant Person’s Representative (RPR) and Rule 1.2 Representative for adults who lack mental capacity and are deprived of their liberty under the Mental Capacity Act (MCA).  She has previously blogged for the Project here: Five Practical Tips For Observing Your First Court of Protection Hearing  She will begin her Bar Course studies in September 2026. Her LinkedIn is here.

 

 

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