“A tendency to act impulsively and without consideration for the consequences. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflict with others, especially when impulsive acts are thwarted or censored and to self-destructive behaviour, including suicide gestures and attempts.”
“The patient’s time at St Andrew’s hospital has been marked by acts of self-harming and numerous, albeit increasingly infrequent, acts of aggression, mainly verbal, but including physical assaults on others and attempts at causing damage … the most recent assaults occurred in January 2011; in June 2011 when the patient assaulted staff members … and in September 2011 when the patient, together with another, took a member of staff hostage and later assaulted her … the patient has lost her temper on three occasions since September 2011. On each occasion there was no assault and the incident was de-escalated by a staff member, interventions which increasingly the patient is willing to accept.”
“would greatly benefit further from having her personality disorder addressed in an environment where she could be safely managed and adequate support can be given to facilitate her gradual integration back into the community.”
“Further detention there on any but a provisional basis pending the identification of a step-down placement, whether a low security or unlocked unit or an appropriately staff hospital, would risk therapeutic regression. Although the [Claimant], by reason of her emotional lability, continues to present a diminishing risk to her own health and safety and to the safety of others, the Tribunal is not convinced that this necessarily requires her continued detention in a hospital…. The Tribunal unreservedly accepts the evidence of the clinical team that to return the patient to prison to continue serving her sentence would be [to] put at risk all the progress she has made since her admission to St Andrew’s.”
“The issue is whether the [Claimant’s] therapeutic needs require continued detention in a low secure unlocked unit; or whether they can be met in an appropriately staffed hostel. In the judgment of the Tribunal, it is for [the Claimant’s care co-ordinator] to investigate what is available and if and when he has identified a hospital placement, it will be for that establishment, together with members of the clinical team who will then be responsible for the care of the patient, to assess her and the level of risk she continues to present; and to decide whether it can be managed in that environment; and whether it can adequately test out the [Claimant’s] ability to cope with time spent on her own outside the environment of the placement. If and when such an establishment agrees to receive her, it will be for the Secretary of State, depending upon his decision under Section 74(2)(b) of the Act, to authorise overnight leave there. If it be the case that he gives notice to the Tribunal that the patient may be discharged, the Tribunal will re-convene to consider the case further and if necessary, as it would be empowered to do under Section 74(6) and 73(7) of the Act, defer her discharge until the conditions set out above have been met.”
“The patient shall: 1. Reside where directed by his (sic) responsible clinician for the time being and abide by the rules of the placement; 2. Attend all appointments arranged for him with his responsible clinician for the time being; 3. Be compliant with all treatment, both pharmacological and psychological, as may be prescribed for him by his responsible clinician for the time being; 4. Attend all appointments with and allow reasonable access to him by his social supervisor for the time being; 5. …. 6. ….”
“…regrettably, I do not believe this document was known to most caseworkers in the Public Protection Casework Section or Mental Health Casework Section, including those who were dealing with [LV’s]’ referral following notification from the First Tier Tribunal.”
“15.18 Preparation of Parole Board dossier following discharge recommendation In cases where the lifer/IPP is tariff expired/about to become tariff expired and MHCS has informed PPCS the Tribunal has recently recommended that the prisoner is ready for conditional discharge but if not discharged s/he should remain in hospital, PPCS must arrange for the case to be referred to the Parole Board for listing for a hearing undersection 28 of the Crime (Sentences) Act 1997 , as soon as possible, to consider suitability for release direct from hospital. 15.19 MHCS should provide PPCS with the papers considered by the Tribunal which, along with its decision and reasons, should be attached in the ‘Relevant Papers’ section. The RC report should normally provide a summary of progress in hospital. 15.20 The Tribunal papers will normally include a: • statement by the Secretary of State setting out the circumstances of the offence, the events leading to admission to hospital and observations on the patient’s suitability for discharge. • list of previous convictions • clinical reports, and • a social work report. 15.21 PPCS will commission a report from the Offender Manager (IPP)/Home Probation Officer (Lifers), who has 28 days in which to complete and return the report. PPCS will also prepare the skeleton dossier for the Parole Board review and will send it together with the Offender Manager (IPP)/Home Probation Officer (Lifers) report, to the RC at the hospital within 7 days of receiving the Report. PPCS will also forward a copy of the dossier to the Parole Board. It is the responsibility of the RC/hospital managers to ensure that the dossier is disclosed to the lifer/IPP and that s/he submits any representations to the Parole Board within 28 days. 15.22 In cases where an Offender Manager/HPO has not been allocated to the case, PPCS will contact the Probation Area involved at the time of the sentencing to request that a Supervising Probation Officer be allocated to the case. In cases of difficulty, the NOMS Offender Management and Assessment Unit must be contacted for assistance. 15.23 Consideration by the Parole Board Cases where the prisoner is detained in hospital and a Tribunal recommendation for discharge has recently been received are normally considered at an oral hearing by the Parole Board using a reduced timetable of 13 weeks. The oral hearing will take place at the hospital in which the prisoner is being detained.”
“Factors identified by the Panel as being linked to your offending and future risk of harm are complex. You suffered a disturbed and traumatic childhood; your father was physically and emotionally abusive and you report to have been sexually abused whilst in care. Your experiences adversely affected your emotional and psychological development and you presented with behavioural problems (aggression and self-harming) from childhood. You have a long-standing diagnosis of Emotionally Unstable Personality Disorder (Borderline Type) and have, on many occasions, been admitted to psychiatric hospital. In 2004 you absconded from hospital and jumped from a bridge; you sustained a traumatic brain injury and reports refer to significant impairment in your visual and short-term memory and language function. Over a period of many years your presentation has been characterised by disturbed and impulsive behaviour, emotional disregulation, a low tolerance of frustration, self-harming behaviour that on occasion could have life-threatening consequences, aggressive outbursts. Your previous convictions are also evidence that when your mental state is not stable, you have a propensity to commit serious offences.”
“… you have not undertaken any meaningful interventions to address your offending behaviour. However, you were clear in your evidence that you do not accept that you pose a risk to either yourself or others. Whilst you accept that the personality problems you did suffer from were associated with your aggressive and antisocial behaviour…. it is your view that these have not been present since you sustained the brain injury in 2004. You explained that its consequences were that you had to re-learn everything like a child; you said that at the time of the index offence you did not comprehend the implications of your actions but now are able to take responsibility and communicate effectively with others when you need help. You believed that with the right aftercare, you would be able to live pro-socially in the community…”
“… the very serious nature of the index offence, your long history of seriously disturbed and challenging behaviour that has put both yourself and others at serious risk. Crucially, there remains essential risk reduction work for you to complete… for your offending behaviour to be addressed and for the progress you appear to have started to make to be built upon and tested through increasing exposure to the community through a programme of leave. In summary, the Panel accepted the argument presented that your risks of aggression and fire-setting are intrinsically linked to your mental disorder and that those risks have not reduced to a level commensurate with their safe management in the community. The Panel was not persuaded by your personal view that your personality problems have not been relevant since your brain injury in 2004 as numerous mental health professionals, including consultant forensic psychiatrists, have confirmed the relevance of both your Personality Disorder and the effects of your brain injury to your current presentation and risk.”
“… 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, … further order that the offender shall be subject to the special restrictions set out in this section ...; and an order under this section shall be known as “a restriction order”.”
“49(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; and where the Secretary of State gives a transfer direction in respect of any such person … he shall also give a direction under this section applying those restrictions to him. (2) A direction under this section shall have the same effect as a restriction order made under section 41 above and shall be known as “a restriction direction”.”
“74(1) Where an application to the appropriate tribunal is made by a restricted patient who is subject to…a restriction direction, … the tribunal— (a) shall notify the Secretary of State whether, in its opinion, the patient would, if subject to a restriction order, be entitled to be absolutely or conditionally discharged under section 73 above; and (b) if the tribunal notifies him that the patient would be entitled to be conditionally discharged, may recommend that in the event of his not being discharged under this section he should continue to be detained in hospital. (2) If in the case of a patient not falling within subsection (4) below— (a) the tribunal notifies the Secretary of State that the patient would be entitled to be absolutely or conditionally discharged; and (b) within the period of 90 days beginning with the date of that notification the Secretary of State gives notice to the tribunal that the patient may be so discharged, the tribunal shall direct the absolute or, as the case may be, the conditional discharge of the patient. (3) Where a patient continues to be liable to be detained in a hospital at the end of the period referred to in subsection (2)(b) above because the Secretary of State has not given the notice there mentioned, the managers of the hospital shall, unless the tribunal has made a recommendation under subsection (1)(b) above, transfer the patient to a prison or other institution in which he might have been detained if he had not been removed to hospital, there to be dealt with as if he had not been so removed. (4) If, in the case of a patient who is subject to a transfer direction under section 48 above, the tribunal notifies the Secretary of State that the patient would be entitled to be absolutely or conditionally discharged, the Secretary of State shall, unless the tribunal has made a recommendation under subsection (1)(b) above, by warrant direct that the patient be remitted to a prison (etc.) … (5A) Where the tribunal has made a recommendation under subsection (1)(b) above in the case of a patient who is subject to a restriction direction …— (a) the fact that the restriction direction … remains in force does not prevent the making of any application or reference to the Parole Board by or in respect of him or the exercise by him of any power to require the Secretary of State to refer his case to the Parole Board, and (b) if the Parole Board make a direction or recommendation by virtue of which the patient would become entitled to be released (whether unconditionally or on licence) from any prison or other institution in which he might have been detained if he had not been removed to hospital, the restriction direction or limitation direction shall cease to have effect at the time when he would become entitled to be so released.” (a) shall notify the Secretary of State whether, in its opinion, the patient would, if subject to a restriction order, be entitled to be absolutely or conditionally discharged under section 73 above; and (b) if the tribunal notifies him that the patient would be entitled to be conditionally discharged, may recommend that in the event of his not being discharged under this section he should continue to be detained in hospital. (a) the tribunal notifies the Secretary of State that the patient would be entitled to be absolutely or conditionally discharged; and (b) within the period of 90 days beginning with the date of that notification the Secretary of State gives notice to the tribunal that the patient may be so discharged, (a) the fact that the restriction direction … remains in force does not prevent the making of any application or reference to the Parole Board by or in respect of him or the exercise by him of any power to require the Secretary of State to refer his case to the Parole Board, and (b) if the Parole Board make a direction or recommendation by virtue of which the patient would become entitled to be released (whether unconditionally or on licence) from any prison or other institution in which he might have been detained if he had not been removed to hospital, the restriction direction or limitation direction shall cease to have effect at the time when he would become entitled to be so released.”
“Everyone who is deprived of his liberty by arrest or detention shall be entitled to take proceedings by which the lawfulness of his detention shall be decided speedily by a court and his release ordered if the detention is not lawful.”
“… it would not be difficult to arrange for the lawfulness of the Claimant’s continued detention under the 1983 Act and the penal legislation applicable to him [to be] determined by a single tribunal. Members of the Parole Board already include legal and psychiatric members of mental health review tribunals.”
“In my judgment, Mr Bowen’s submission, if correct, results in an unnecessary, unreasonable and impractical interpretation of Article 5(4). It is evident that the Member States might sensibly create different and differently qualified “courts” to determine the lawfulness of detention under different heads of Article 5(1). The effect of Mr Bowen’s submissions would be to render it at least difficult for Member States to have the various grounds for detention considered by specialist courts. I do not think that the Convention should be given such an unreasonable interpretation. Provided there is no undue delay in the review of the lawfulness of detention, or other infringement of a Convention right, there is no reason to require that the same court (whether nominally one court or a panel that sits as more than one court) determine each head of detention.”
“56. … The investigations and procedures necessary for the second court must take into account the fact that there had been investigations and a decision by the first court. It will also be relevant that the period before the first court (in the present context, the mental health review tribunal) hearing provided an opportunity for the Home Secretary to make investigations and obtain evidence for the purpose of the second court hearing. That is not to say, however, that the Home Secretary (or the Parole Board) is necessarily required to do so. If the investigations and procedures for the second court cannot sensibly be carried out before the first court makes it’s decision (because, for example, it has been impossible to assess the detained person in appropriate conditions), a delay before the second court makes it’s decision to enable those investigations to be carried out will not preclude it’s decision from being “speedy”, even if the start date for the assessment of the relevant period is the date of the application to the first court.”
“In order to determine whether the requirement that a decision be given “speedily” has been complied with, it is necessary to effect an overall assessment where the proceedings were conducted at more than one level of jurisdiction. The question whether the right to a speedy decision has been respected must – as is the case for the “reasonable time” stipulation in Articles 5(3) and 6(1) of the Convention – be determined in the light of the circumstances of each case, including the complexity of the proceedings, their conduct by the domestic authorities and by the applicant and what was at stake for the latter.”