"Local towns and villages -- within an approximate 15-20 mile radius of the hospital . . . known in the hospital's policy as 'locality'."
"Initially an hour or so in the community, with possible extension to several hours"
"Exploration of issues related to risk assessment; community reintegration; assessment of reaction to this"
"1. Evidence of verbal/physical aggression since admission (plus details and action taken). There has been no verbal or physical aggression since admission. At times [X] has been mildly irritable or assertive, but not causing concern. 2. History of self-harm. Since admission, there has been no history of self-harm. 3. Evidence of sexually inappropriate behaviour since admission (plus details and therapeutic intervention). There has been none. 4. Fantasies and assessed risk of acting these out. There is no evidence of violent or otherwise concerning fantasy . . . 5. History and current assessment of risk of absconding. This has been assessed as low. 6. Concerns about substance abuse on leave. [X] does not have a particularly significant substance use history. 7. Therapeutic interventions and evidence of change, including development of insight (into offending behaviour, victim(s) need for medication et cetera). In his previous hospital setting, [X] has engaged in significant amounts of therapeutic activity . . . The nature of [X's] attitude about his offending is complex, in that he clearly articulates victim empathy, accepts and recognises his difficulties, but remains preoccupied with other aspects of his case, such as the male victim's mother's publicity, and the Minister's decision not to allow him to step down for care . . . 8. Is patient's mental state stable (how long for?). [X's] mental state has been stable apparently for some years . . . 9. Key issues from risk assessment and mental disorder that the leave(s) will test. [X's] risk profile involves a single high impact incident in the unusual context (for him) of having engaged in a relationship, also in the context of a major change of life situation -- namely his admission to hospital following long term self isolation. Escorted leave into the community will not involve the recreation of those aspects of the constellation of issues that led to his index event -- other than that this will be significant for him in terms of his emergence from a care setting into the community (a component of the index event circumstances) albeit in a very controlled way. The main risk assessment aim would be to begin to assess [X's] reaction to re-integration in the community after a long period of isolation in care and custodial settings. 10. Assessment of risk to individual(s) or public (bearing in mind index offence). In the context of [X's] current stability; with a degree of supervision and in the context of his current presentation, the risks are probably low. 11. Special sensitivities about destination (eg, area of index offence, chance of meeting victim(s)/family, adverse publicity). [X's] case has attracted considerable publicity in the past, driven in part by the mother of the male victim . . . The risk of adverse publicity is much reduced over the period of [X's] first steps to reintegration into the community . . . by the lack of general awareness of his whereabouts. In the context of an index event that took place in . . . and with one of the victim's families there, and the other victim's mother living in . . . there is a low risk of chance meeting in the local towns. 12. Is this request supported by all members of the MDT? Yes. Within the MDT there are a variety of views regarding the degree of [X's] therapeutic engagement, and the meaning of this, but consensus that for specific leaves into the community escorted by staff, the risks are low currently."
"I see [X] on a weekly basis for dynamic psychotherapy. It would appear [X] creates 'smoke and mirrors' to avoid feeling mainly anger and rejection. There is also a sense that if this young man were to lose control it would have a devastational result."
"Thank you for your recent consideration of our request for [X's] escorted community leave. With greatest respect, however, I am writing to appeal this decision in the hope that some markers may emerge about how progressing his care might proceed in the future. My understanding of the situation is that alongside the fact of huge historical risk that [X] presents on the basis of his index offence . . . his case has become something of a touchstone in relation to the issue of secondary victimhood, making his management more complex. On our side, as his clinical team, the dilemma that we are faced with is how to develop a strategy of care or a care pathway in this context. Our clinical view currently is that having stepped down from a high secure placement and having stabilised here, in addition to providing PD treatment, our central task is to begin the process of rehabilitation -- part of which is section 17 leave into the community. What would be helpful to know is whether the recent decision not to grant section 17 leave escorted into the community is for the foreseeable future, or whether it is pending some other milestone or milestones that he might achieve. It may well be, given the constellation of issues that surround [X] that his progress needs to be much slower than we as a team had envisaged. If this is the case, then we would need to develop a new strategy for his care, and indeed it might be that we should review whether he might be more suitably managed in a custodial rather than a healthcare setting (he being a s47/49 transfer patient) until such time as the process of rehabilitation can commence. I am aware that [X] presents a complex set of difficulties, and that it might be easier to discuss on the telephone, so I shall try to contact the unit following this note."
" . . . It is clear that Dr Morris views community leave as an essential ingredient in the rehabilitation of [X]. It is clear that [X] has stepped down from a high secure environment and remains stable. What is not clear is the reason why the Ministry of Justice has not granted Dr Morris' request for community leave . . . It is our view that to not set out clearly reasons for a Ministerial decision not to grant is grossly unfair to both patient and treating team. As Dr Morris remarked in his5th December 2008 letter to yourselves he has appealed the decision not to grant community leave 'in the hope that some markers might emerge about how progressing his case might proceed in the future'. It is our view that not only is this situation an unfair one to [X], it is potentially unlawful and in violation of [X's] rights underArticle 5(1) of the European Convention of Human Rights . . . Quite clearly, it is impossible to investigate whether the treatment for [X] could be provided in the community safely and adequately without him being tested. The first test is, of course, escorted community leave. Accordingly, we request on behalf of [X] an urgent response to this letter setting out the reasons why [X] has been denied escorted community leave in response to his Responsible Clinician's23rd July 2008 request. In particular, we request from the Ministry of Justice clear indication as to the therapeutic interventions and events which are required to have taken place before a successful application for escorted community leave. It is also important to set timescales for the achievement of the interventions and events . . . "
" . . . I am aware of the problems you face and that [X's] progress is likely to be slow. As you know, the request was refused by the Minister who gave no reasons for his decision. This of course makes planning future care for [X] somewhat difficult. However, it is not our intention to let this continue indefinitely, but to put the case again before the minister. It is too soon to do so at present, but intend to make further recommendations in March or April and I would be grateful for a further request from you around this time. In the meantime if you need to discuss the case, please do not hesitate to telephone me on the number above."
"Thank you for your letter of 17th December regarding the previous refusal of escorted leave. Please accept my apologies for the delay in responding. A further recommendation to grant escorted leave has been submitted to the Minister. I am unable to estimate when a response will be given but I will advise you and Dr Morris as soon as I have any information."
"Further to my letter to you of 22nd December, a further submission was put before the Minister requesting escorted leave in the local area and clarifying the exclusion areas. However, the request was again refused. The Minister commented that due to the deeply disturbing nature of the crime and importantly, the perspective of the victim's family he would not allow escorted leave. As I have said previously, I am aware of the difficulties involved in rehabilitation when there can be no s17 leave, particularly when there is little guidance on what [X] can do to progress the issue. I can only suggest that the request is again submitted later in the year."
" . . . There is a power exercisable by the RMO under section 17 of the 1983 Act to grant a patient leave of absence from the hospital where he is detained. There is a power under section 19 as to the transfer of patients. In the case of a restricted patient the exercise of powers under sections 17 and 19 requires the consent of the Secretary of State . . . "
"25. In my judgment the central question in this case is whether the risk posed by the claimant is sufficiently low to make it appropriate for him to be accommodated in medium security rather than high security. If it is, then plainly there is a case for transfer; if it is not, his continued detention in conditions of high security is plainly a justifiable interference in his Article 8 rights. 26. Who is to decide that question of risk? That is really the stark issue raised by Mr Bowen's submissions. Is it the persons upon whom the statutory powers have been vested by Parliament? Is it the Tribunal or the court? In my judgment the answer is clear. The decision must lie with those in whom Parliament has vested the statutory powers and who are thereby made responsible for forming the necessary judgments upon which the exercise of the statutory powers is necessarily based. That applies in particular to the Secretary of State who has ultimate responsibility under all the relevant statutory provisions, either as the person with power to direct or as the person whose consent is a precondition to the exercise of the powers by others. The statutory scheme is clear. It is not for the court to substitute its judgment for the statutory decision-maker. 27. The process contemplated in Wilkinson in hearing expert evidence, including cross-examination, which is the process that the claimant invites the court to adopt in the present case, seems to me to relate to a very different context. This is a situation where the court can and should acknowledge that the statutory responsibility has been vested in others. It should afford to the decision-maker a margin of discretion, though of course it will look carefully at the basis of the decision and at the judgment reached and will examine in particular whether all relevant evidence has been taken into account and, where there has been a recommendation, albeit an extra-statutory recommendation by the Tribunal, whether that recommendation has been properly taken into account. The court's role is, however, the secondary one of determining whether the decision-making process has been a proper one and whether the judgment reached is one reasonably open on the evidence."
"(1) Where a hospital order is made in respect of an offender by the Crown Court, and it appears to the court, having regard to the nature of the offence, the antecedents of the offender and the risk of his committing further offences if set at large, that it is necessary for the protection of the public from serious harm so to do, the court may, subject to the provisions of this section, further order that the offender shall be subject to the special restrictions set out in this section . . . (3) The special restrictions applicable to a patient in respect of whom a restriction order is in force are as follows -- (c) the following powers shall be exercisable only with the consent of the Secretary of State, namely -- (i) power to grant leave of absence to the patient under section 17 above . . . "
"(1) Where a transfer direction is given in respect of any person, the Secretary of State, if he thinks fit, may by warrant further direct that that person shall be subject to the special restrictions set out in section 41 above . . . (2) A direction under this section shall have the same effect as a restriction order made under section 41 above . . . "
"(1) The responsible clinician may grant to any patient who is for the time being liable to be detained in a hospital under this Part of this Act leave to be absent from the hospital subject to such conditions (if any) as that clinician considers necessary in the interests of the patient or for the protection of other persons . . ."
"Decisions under the Act must be taken with a view to minimising the undesirable effects of mental disorder by maximising the safety and wellbeing (mental and physical) of patients, promoting their recovery, and protecting other people from harm."
"People taking action without a patient's consent must attempt to keep to a minimum the restrictions they impose on a person's liberty, having regard to the purpose for which the restrictions are imposed."
"21.6. Only the patient's responsible clinician can grant leave of absence to a patient detained under the Act. Responsible clinicians cannot delegate the decision to grant leave of absence to anyone else. . . . 21.8. Leave of absence can be an important part of a detained patient's care plan, but can also be a time of risk. When considering and planning leave of absence, responsible clinicians should: • consider the potential benefits and any risks to the patient’s health and safety of granting or refusing leave; • consider the potential benefits of granting leave for facilitating the patient’s recovery; • balance these benefits against any risks that the leave may pose in terms of the protection of other people (either generally or particular people); • consider any conditions which should be attached to the leave, eg, requiring the patient not to visit particular places or persons . . . • take account of the patient's wishes . . . • (in the case of mentally disordered offender patients) consider whether there are any issues relating to victims which impact on whether leave should be granted and the conditions to which it should be subject."
"3. The claimant does not engage in therapeutic interventions that involve groups of patients . . . Clinicians with the conduct of the claimant's care comment that his non-engagement removed one of the means of monitoring his mental state and hence assessing his risk . . . Similarly, the claimant's minimal levels of interaction with staff and patients and self-isolation within the hospital . . . mean that opportunities for monitoring his mental state and assessing his risk by observing interactions are similarly limited. 4. . . . Dr Morris acknowledged that whilst there was no evidence of the claimant harbouring violent fantasies, because he keeps his own counsel, such fantasies might well not be disclosed. . . Dr Morris subsequently commented at the November 2008 CPA meeting that the claimant ' . . . creates 'smoke and mirrors' to avoid anger and rejection. There is also a sense that if this young man were to lose control it would have a devastational result'. 5. The claimant has iterated frustrations at his detention and the lack of leave that he has been granted into the community . . . Dr Morris identified leave into the community as a part of the claimant's rehabilitation; but acknowledged that the claimant's case presents a 'complex set of difficulties . . . ' and that given the issues that surround him it may be that the claimant's progress needs to be slower than the clinical team had envisaged."
"9. In considering the application for escorted leave that was made on the patient's behalf, the defendant noted that the claimant's responsible clinician stated that escorted leave into the community would allow his risk to be assessed in a community setting and that it would comprise rehabilitative treatment. The claimant's responsible clinician stated that the risks associated with the escorted leave are 'probably low'. The [Secretary of State] however noted that the means by which the claimant's condition can be assessed are restricted by his non-engagement in group therapy . . . and that notwithstanding the claimant's engagement in individual therapy, there was evidence of evasiveness which made an assessment of the risk that he poses problematic . . . [The Secretary of State] noted that pressure had been placed on the responsible clinician by the claimant for an application for escorted leave to be made . . . and that the responsible clinician did appear to have some doubts as to whether escorted leave is suitable, acknowledging as he did that the case is complicated and that a slower route towards rehabilitation might be appropriate . . . Finally, the [Secretary of State] noted the strong parallels that arise between the index offences and the application for leave . . . the reports that indicate that the claimant has remained isolated in hospital . . . did not assuage the [Secretary of State's] concerns in this regard. In light of these matters the [Secretary of State] differed from the view that the responsible clinician had reached as to the level of risk that the claimant would pose were escorted leave to the community to be granted and refused to grant the request. The [Secretary of State] maintains that in all the circumstances this decision was lawful. 10. The reasons that have been provided in support of the [Secretary of State's] decision to refer to the nature of the claimant's index offences. The [Secretary of State's] reasons should be viewed in the context of the [Secretary of State's] decision-making power and the relevant considerations of risk and rehabilitation that arise. The reference to the nature of the claimant's index offence as a reason not to grant the leave means that he is aware that the level of risk that he is still perceived to pose outweighs the rehabilitative benefits to him of the leave being granted."