“in all the circumstances, Dr Levy concludes that your condition is not presently of a nature and degree (sic) that warrants treatment in hospital because the appropriate treatments for the disorder or disorders that you suffer from are readily available within the prison environment, if the court favours a custodial sentence, as it does”
‘394. In my opinion it was obvious even at the time of sentencing that Jamie Jenkins suffered from a chronic mental illness, namely paranoid schizophrenia; that this was an illness that was relapsing in nature; that relapses of his mental illness were precipitated by non-compliance with medication and possibly by substance use; that non-compliance was inevitable given Mr Jenkins’ lack of insight into his mental illness; that he presented a considerable risk to others when he relapsed, far in excess of any threat he presented when mentally well; and that his mental illness amounted to a mental disorder within the meaning of theMental Health Act 1983 as amended in 2007. 395. Although I have not seen all the relevant records including the records of his outpatient care in the weeks and months prior to the index offence, the records of his police detention and his records from when he was initially remanded to prison, it seems highly likely that Jamie Jenkins had been suffering from a relapse of his mental illness at the time of his offence, as judged by the offence itself, the description of his behaviour following his arrest, the fact that the Forensic Medical Examiner had found him unfit for interview after his arrest; and his presentation in prison in the months after his arrest before he resumed taking antipsychotic medication. 396. At the precise time of sentencing his mental illness would have been at least of a nature if not degree that made it appropriate for him to be treated in hospital in the interests of his own health and the protection of others, if not his own safety. 397. It has become abundantly obvious since Mr Jenkins was given his IPP that this remained the case over a number of years, with at least five clear relapses requiring hospital admission from prison, often associated with very dangerous behaviour in prison, including significant violence and fire setting. 398. Even now this remains the case. Mr Jenkins is only compliant to a limited extent and for a limited period with prescribed medication, requiring considerable persuasion on my part and on the part of nursing staff at prison to continue with his injected antipsychotic medication. As a result he presents no immediate risk to others but this could change at any time. Even now, however, his health and safety are somewhat at risk; currently he is refusing all oral medication for his mental health and is perhaps less well mentally than he might be; he is also refusing all physical health medication and definitely at higher risk of cardiovascular disease as a result, given his physical obesity, high blood pressure, high serum cholesterol and Type II diabetes. 399. With the passage of time, it has become increasingly clear that an IPP was the wrong sentence in July 2009; Jamie Jenkins has spent far longer in prison than was originally envisaged to be necessary, judging by the minimum tariff he was given, with no real hope of progress; his mental health has not been as stable as it might have been, due to his lack of insight and tendency to stop taking medication in prison, because he cannot be compelled to take medication in prison. As Dr Taylor pointed out several Years ago, “it is difficult to see how he will ever progress with or complete his sentence plan in a prison environment.” (emphasis added) Concerning risk factors, Dr Kahtan detailed at paragraph 415 that: ‘He can only be safety discharged from hospital with the conditions of a Restriction Order and the financial resources that would enable him to be discharged to appropriate 24-hour hostel accommodation staffed by professionals used to working with mentally ill clients and liaising with the statutory mental health services that would supervise Mr Jenkins’ care in the community.’
“10. The optimal disposal for someone like [the appellant], with a chronic relapsing psychotic illness, convicted of an offence involving serious violence and/or a history of presenting a risk of serious harm to others (especially when unwell) is a Hospital Order undersection 37 of the Mental Health Act 1983 with a Restriction Order under section 41 11. A custodial sentence, particularly a lengthy or potentially lengthy one, is not suitable despite the standard advice given by psychiatrists to courts in relation to mentally ill defendants that they can be transferred to hospital, if necessary, under sections 47 and 49 of the Mental Health Act. This is perhaps legitimate advice in mentally stable, compliant defendants whose offences are not related to their mental illness, but not in patients who are actively symptomatic or likely to be non-compliant with medication and relapse, or indeed for patients who committed their offences whilst suffering a relapse. This is because it either ignores the essential connection between their illness and their offence, or the fact that they will inevitably become ill in prison and require repeated admission to hospital. 12. A lengthy sentence is particularly unsuitable for patients like [the appellant] because during relapses he has seriously assaulted prison and hospital staff as a direct result of his illness. To reduce the risks of serious harm to others (and to himself) the ideal disposal is one that takes into account mental health needs and results in long-term mental stability… 13. An IPP was particularly unsuitable for a prisoner like [the appellant] because it was inevitable or almost inevitable that he would never be or have been capable of satisfying a Parole Board that he could be released, partly because he is incapable of completing the necessary courses in prison and partly because release under probation supervision cannot guarantee to the same level as a s.37/41 disposal future compliance with follow-up and prescribed treatment.”
“The principles which should guide a court in determining whether to make a Hospital Order under the 1983 Act either at the time of sentence, or on appeal in substitution for a custodial sentence, were set out by the Court of Appeal at [51] to [54]. They are as follows. 1. The requirements as to the recommendations of two registered medical practitioners in Section 37(2)(a) must be met, but this alone is not sufficient. 2. Where the conditions in Section 37(2)(a) are met judges must then have regard to “all relevant circumstances” including the following four issues when deciding whether the condition in Section 37(2)(b) is (or would have been) met: a) The extent to which the offender needed the treatment for the mental disorder which he was suffering; b) the extent to which the offending was attributable to that disorder; c) the extent to which punishment was required; and d) the protection of the public, including the various regimes in determining release and post-release. In relation to this consideration, the court emphasised at [52] that judges “must now pay very careful attention to the different effect in each case of the conditions applicable to and after release.”