Restricted Patients, CPA and MAPPA

1. Restricted Patients, CPA and MAPPA Rosie Toal Fiona Tyrrell Team Leader Branch Head Restricted Patients Casework Mental Health Law Rosemary.Toal@scotland.gsi.gov.uk Fiona.Tyrrell@scotland.gsi.gov.uk

2. Introduction • Statutory background • Statistics • Role of Scottish Ministers • CPA • MAPPA and restricted patients

3. Definition of Mental Disorder • Under the Mental Health (Care and Treatment) (Scotland) Act 2003 “mental disorder” means any mental illness, personality disorder or learning disability however caused or manifested. • Definition is wide to ensure the services provided under the 2003 Act are available to anyone who needs them.

4. Restricted Patient • Section 59 of the Criminal Procedure (Scotland) Act 1995 in conjunction with a Compulsion Order • Is made when it appears to the court: • Having regard to the nature of the offence • The antecedents of the person; and • The risk that as a result of his mental disorder he would commit offences if set at large That it is necessary for the protection of the public from serious harm • A restriction order is without limit of time

5. STATISTICS AS AT MARCH 2008 • 187 Compulsion Order/Restriction Order • 46 Conditionally Discharged • 43 Transferred prisoners • 2 Hospital Directions • 31 Remand

6. Role of Scottish Ministers • Transfers between hospitals • Transfer from hospital to prison • Cross border transfers • Suspension of detention outwith hospital grounds • Recall from conditional discharge S202 • Variation of conditions of discharge • Provision of Position Statements to MHT reflecting Scottish Ministers’ position in relation to risk

7. SMs expectations of care team • multi-disciplinary team working • detailed risk assessment and management plan in place and updated at key stages in rehabilitation process • comprehensive care plan • appropriate testing • CPA from admission • Referral and notification of cases to MAPPA • on-going monitoring following CD - reports by RMOs, MHOs and CPNs • Immediate notification of incidents whilst on CD

8. Patients on Conditional Discharge by Health Board Ayrshire & Arran 3 Dumfries & Galloway 4 Lanarkshire Health Board 5 Lothian Health Board 5 Grampian Health Board 6 Greater Glasgow & Clyde Health Board 13 Highland Health Board 2 Fife Health Board 1 Tayside Health Board 7

9. Conditional Discharge • Subject to conditions ie residence, supervision, structure, drug/alcohol testing, • Can have condition must not enter specific area (ie if victim concerns) • Ministers may recommend conditions to MHT but ultimately decision for MHT • Ministers may vary conditions of discharge whilst patient is on CD ie either relax or strengthen

10. Care Programme Approach • Management of Offenders Legislation provided the statutory basis for administrative arrangements for assessing and managing risk (CPA) • Mechanism for regular review of all CORO patients • Puts protection of the public at the core of decision making • Will require that all engaged have an understanding of the risks and factors which suggest a relapse • Guidance as issued (NHS CEL 13 2007)

11. CPA (cntd) • Complying with CPA Boards will meet many MAPPA requirements • Section 8 of CPA Report accepted as Policy • Scope • Initial CPA meeting 4-10 weeks after admission • Review meetings at least every 6 months • RMO continued overall responsibility • Care Co-ordinator role (not RMO or MHO) • Two states of CPA meeting • Pre meeting (third party information, no patient) • CPA meeting (includes patient or representative) • Advice on running the meeting and competencies for chair

12. MAPPA GUIDANCE - CEL 19 2008 • Extension of Management of Offenders etc (Scotland) 2005 to restricted patients • Health Service guidance

13. CEL 19 2008 • Duty to co-operate for all offenders • Health Board responsible authority for restricted patients • CORO, HD, TTD, ICO • Clinical governance • CPA

14. ROLES • RMO • MHO • Health Board as responsible authority • Medical records • Police • MAPPA co-ordinator

15. Clinical Governance • NHS Boards: • Accountable for quality of care and treatment provides • Responsible for effective clinical governance • Required to collate statistical data required for inclusion in annual report

16. KEY STAGES • Admission • Transfer • Escorted suspension of detention • Unescorted suspension of detention • Conditional discharge • Absolute discharge

17. ADMISSION • Involve police from start of CPA process through MAPPA coordinator • Notification to MAPPA coordinator • Identification of police link • Involve in pre-CPA where necessary • Making relevant information available • Role when moving towards community • Involvement of MAPPA Health representative

18. SUSPENSION OF DETENTION • All cases to be referred at MAPPA level 2 • Uncommon high profile/high risk cases can be referred before unescorted SUS • MHD need to know case reviewed and any issues addressed before will authorise

19. CONDITIONAL DISCHARGE • Refer all cases at Level 2 when accommodation identified • Refer before recommending CD • Scottish Ministers will include MAPPA views in any submissions to Tribunal

20. ABSOLUTE DISCHARGE • Similar to de-registration for RSOs • Refer all cases at level 2 when accommodation identified and before recommending AD • If absolutely discharged by Tribunal, Health no longer Responsible Authority – but still has duty to co-operate • Scottish Ministers will include MAPPA views in any submissions to Tribunal

21. MAPPA notification • Transitional arrangements • All patients to be notified to MAPPA co-ordinator • New restricted patients • Notification to MAPPA co-ordinator asap after restriction order made • Notification form is only one page • Notification leads to identification of police link • Not a referral

22. MAPPA referral • Referral made when level 2 or 3 review is necessary • Longer form – but most of it should come from CPA documentation • May need to append risk assessment and management summary • Following referral MAPPA level 2 meeting should take place within 20 days • MAPPA level 3 meeting should take place within 5 days.

23. Role of MAPPA meeting • NOT • Case management • Doing risk assessment • Making risk management plan • Primary vehicle for inter-agency working • BUT • Review • Scrutiny • Ratification

24. UNEXPECTED DISCHARGE • Tribunal may discharge despite RMO recommendation • Early Discharge Protocol • Contingency plans • Emergency or pre-emptive CPS meeting • Refer at MAPPA Level 2 or 3 as appropriate

25. Useful web links • MOP: Working version is available on www.scotland.gov.uk/health/mentalhealthdivision • Forensic Managed Care Network www.forensicnetwork.scot.nhs.uk • Risk Management Authority Report on Risk Assessment and Management of RPs at www.RMAscotland.gov.uk • Version 4 of MAPPA guidance http://www.scotland.gov.uk/Publications/2008/04/18144823/0