Recommendation
C3 Division of the Home Office should act as a repository of information about the patient's index offence(s);
Recommendation
The procedures and practices of C3 Division could usefully be compared with Home Office practice in relation to Discretionary Lifer Panels;
Recommendation
The notes for the Guidance of Social Supervisors should be reviewed and revised to take account of potential conflicts in the roles of social workers arising from changes in the Community Care, Mental Health and Criminal Justice legislation;
Recommendation
The Case Worker Guide should be updated to require information not just from the RMO but from others who will bear responsibility for the after-care of the patient.
Recommendation
Suffolk Health invites the members of the Inquiry Panel to reconvene, in private, within six months of publication of this report, to consider the responses, both official and unofficial, to the recommendations; and to report activity to Suffolk Health early …
Read more
Suffolk Health invites the members of the Inquiry Panel to reconvene, in private, within six months of publication of this report, to consider the responses, both official and unofficial, to the recommendations; and to report activity to Suffolk Health early in 1997.
Show less
Recommendation
Case conferences should be recorded more fully.
Recommendation
Where a breakdown in a community placement occurs, the existing review systems should be implemented.
Recommendation
Health and Social Service Purchasers should review the balance of expenditure to see if a more specialised focus could be developed within the range of community-based residential services in order to provide a locally-based therapeutic service.
Recommendation
The Purchasing Authority should consider developing quality standards applicable to the care of patients with histories of violent offending. Such standards might include requiring Providers to ensure that a full range of assessment approaches, including access to forensic psychiatry services, …
Read more
The Purchasing Authority should consider developing quality standards applicable to the care of patients with histories of violent offending. Such standards might include requiring Providers to ensure that a full range of assessment approaches, including access to forensic psychiatry services, is available to such patients.
Show less
Recommendation
An externally facilitated multi-disciplinary review should be undertaken of the balance between behavioural and psychodynamic approaches at Easton House and the skills available to develop a greater degree of flexibility.
Recommendation
External, peer group audit should be incorporated into the Trust's quality assurance programme; and the Purchasers, perhaps in concert with the Department of Health, should develop contract monitoring measures more finely tuned to the needs of services for people with …
Read more
External, peer group audit should be incorporated into the Trust's quality assurance programme; and the Purchasers, perhaps in concert with the Department of Health, should develop contract monitoring measures more finely tuned to the needs of services for people with mental health problems.
Show less
Recommendation
Purchasers should ensure that there is clinical audit of hospital psychiatric teams to examine multi-disciplinary working and the representation of varied and possibly contradictory perspectives in clinical records.
Recommendation
Purchasers of social care should ensure that an adequate supply of forensic social work is available in their area.
Recommendation
The new Suffolk Health Authority should review whether the availability of forensic psychiatry services is sufficient.
Recommendation
Significant contributions to clinical assessments by professional staff in disciplines other than psychiatry and nursing should be captured systematically, e.g. in the compilation of reports for case conferences, other reviews and hospital transfers.
Recommendation
Social Services Departments which transfer case responsibility for restricted patients should also transfer the case records.
Recommendation
In any case where the criminal event involving a mentally disordered person is serious or dangerous, it should be the responsibility of the Crown Prosecution Service to prepare a full account of the criminal event before criminal proceedings have been …
Read more
In any case where the criminal event involving a mentally disordered person is serious or dangerous, it should be the responsibility of the Crown Prosecution Service to prepare a full account of the criminal event before criminal proceedings have been finalised. The CPS should also ensure that this account is transmitted, after the criminal process has run its course, to all those involved in the criminal proceedings, to clinicians subsequently responsible for the care of the patient, and to C3 Division of the Home Office in respect of restricted cases. The account should become an established part of the patient's clinical record.
Show less
Recommendation
The Crown Prosecution Service should review its procedures in relation to the prosecution of mentally disordered offenders destined to be routed into the mental health system through a Hospital Order.
Recommendation
The Royal College of Psychiatrists, the Royal College of Nursing and other relevant professional bodies, should issue guidance to their respective members not to rest content with information about the 'index offence' but to inquire thoroughly into the criminal events.
Read more
The Royal College of Psychiatrists, the Royal College of Nursing and other relevant professional bodies, should issue guidance to their respective members not to rest content with information about the 'index offence' but to inquire thoroughly into the criminal events.
Show less
Recommendation
Efforts should be made to ensure that the medical members of tribunals dealing with restricted patients are forensic psychiatrists.
Recommendation
The third category member of the Mental Health Review Tribunal should be named 'other relevant discipline' and the Lord Chancellor's list should include a number of psychologists.
Recommendation
The medical member of the tribunal should expect the hospital to provide a set of summary documents with reports from the professionals involved in the multi-disciplinary teams responsible for the patient's care and treatment.
Recommendation
The House of Lords' decision in Secretary of State for the Home Department v. Oxford Regional Mental Health Review Tribunal [1988] A.C. 120 should be reversed by law so as to allow a tribunal to adjourn an application in order …
Read more
The House of Lords' decision in Secretary of State for the Home Department v. Oxford Regional Mental Health Review Tribunal [1988] A.C. 120 should be reversed by law so as to allow a tribunal to adjourn an application in order to give time for a further examination of the patient's mental health before any decision to discharge is made.
Show less
Recommendation
Four general measures in respect of restricted patients should be considered by the Home Office: 1. C3 Division of the Home Office should act as a repository of information about the patient's index offence(s); 2. The procedures and practices of …
Read more
Four general measures in respect of restricted patients should be considered by the Home Office: 1. C3 Division of the Home Office should act as a repository of information about the patient's index offence(s); 2. The procedures and practices of C3 Division could usefully be compared with Home Office practice in relation to Discretionary Lifer Panels; 3. The notes for the Guidance of Social Supervisors should be reviewed and revised to take account of potential conflicts in the roles of social workers arising from changes in the Community Care, Mental Health and Criminal Justice legislation; 4. The Case Worker Guide should be updated to require information not just from the RMO but from others who will bear responsibility for the after-care of the patient.
Show less
Recommendation
The Department of Health should draw together the existing fragmented policy guidance on the role of Local Authority and Health Services staff in the care and after-care of mentally ill people in an integrated document of guidance.
Recommendation
Internal reviews of practice following major untoward events should be conducted by a manager with no direct line management responsibility for the case in question.
Recommendation
Given the need for close networking between many agencies and the establishment of supervision registers, some thought should be given by the Department of Health and the professional bodies to drawing on the best practice from child protection in developing …
Read more
Given the need for close networking between many agencies and the establishment of supervision registers, some thought should be given by the Department of Health and the professional bodies to drawing on the best practice from child protection in developing an interagency approach to case management for mentally ill patients who are discharged into the community.
Show less
Recommendation
In-patient units whose patients include offenders with disturbed personalities should have access to specialist psychodynamic expertise.
Recommendation
In respect of behaviour modification programmes and particularly in the absence of valid patient consent, a locally agreed procedure should be adopted in which the RMO should seek the advice of a suitably qualified person who is not a member …
Read more
In respect of behaviour modification programmes and particularly in the absence of valid patient consent, a locally agreed procedure should be adopted in which the RMO should seek the advice of a suitably qualified person who is not a member of the clinical team responsible for the patient. This will normally be a psychologist, although some medical staff, social workers and nurses have received special training that equips them to supervise psychological procedures.
Show less
Recommendation
RMOs and clinicians managing offender patients should afford such patients regular interviews in private.
Recommendation
All Police Forces should have formal Missing Patients Procedures agreed with local hospitals and Social Services, and within these a system for inquiring into the circumstances of repeated absconding by detained patients, particularly those subject to restriction orders.
Read more
All Police Forces should have formal Missing Patients Procedures agreed with local hospitals and Social Services, and within these a system for inquiring into the circumstances of repeated absconding by detained patients, particularly those subject to restriction orders.
Show less
Recommendation
The 'Appropriate Adult' system in criminal justice should be re-examined with a view to extending its role.
Recommendation
Employers, their legal advisers and insurers should find ways of helping their staff make direct personal contact with bereaved families, unless the families do not wish for this.
Recommendation
All authorities mandated to set up inquiries under NHS Executive Guidance HSG(94)27 of 10 May 1994 should actively consider including in their Terms of Reference directions that families of victims should be given the opportunity to be present at any …
Read more
All authorities mandated to set up inquiries under NHS Executive Guidance HSG(94)27 of 10 May 1994 should actively consider including in their Terms of Reference directions that families of victims should be given the opportunity to be present at any Inquiry into homicide, whether the Inquiry is held in public or private.
Show less
Recommendation
A more direct, proactive and individual approach to the members of victims' families should be adopted by all agencies engaged in crisis support work following homicides and similar events.
Recommendation
The Secretary of State for Health should set in train a review of the Mental Health Review Tribunal system in the context of a review of the Mental Health Act 1983.
Recommendation
Police Forces nation-wide should commit themselves to adopting the training and policies for dealing with mentally ill people, as currently practised within the Metropolitan Police.
Recommendation
Any social services worker assigned the task of social supervisor of a restricted patient should be an Approved Social Worker.
Recommendation
The relevant Government departments should set a target date by which time all social supervisors of restricted patients will have acquired the competencies in forensic social work set out by CCETSW.
Recommendation
The Department of Health should ensure the funding of adequate numbers of training places for Clinical Psychologists.
Recommendation
All trainees in General Psychiatry should spend a period of training in a forensic psychiatric service under the supervision of a Forensic Psychiatrist.
Recommendation
General Psychiatrists taking up consultant posts with responsibility for secure beds should have had a period of training in forensic psychiatry.
Recommendation
Arrangements for psychiatric training both nationally and locally in Suffolk and in the Anglia and Oxford Region, should be reviewed and, if necessary, enhanced so as to ensure that all trainees in general psychiatry receive adequate clinical training, and experience …
Read more
Arrangements for psychiatric training both nationally and locally in Suffolk and in the Anglia and Oxford Region, should be reviewed and, if necessary, enhanced so as to ensure that all trainees in general psychiatry receive adequate clinical training, and experience in psychodynamic and forensic aspects of psychiatry.
Show less
Recommendation
Attention should be given to identifying and meeting more thoroughly the training needs of existing, as well as new Mental Health Review Tribunal members.
Recommendation
Tribunal members should be informed about the clinical outcomes for patients following discharge decisions, and confidential retrospective reviews should be held in cases where patients re-offend seriously after discharge.
Recommendation
There should be greater clarity and explicitness in the guidance concerning the disclosure of documents to public inquiries.
Recommendation
The Rules of the Supreme Court - Order 38, rule 19(1) - which authorise the Crown Office to issue a subpoena 'in aid of an inferior court or tribunal' should be reviewed by the Rules Committee to make it clear …
Read more
The Rules of the Supreme Court - Order 38, rule 19(1) - which authorise the Crown Office to issue a subpoena 'in aid of an inferior court or tribunal' should be reviewed by the Rules Committee to make it clear that non-statutory public inquiries, set up by central or local Government, qualify for subpoena powers.
Show less
Recommendation
The Prison Service should ensure, by the end of 1996, that it has in place a database and a fully effective system whereby prisoners' IMRs, including those of remand prisoners, follow them wherever they may be in the system. The …
Read more
The Prison Service should ensure, by the end of 1996, that it has in place a database and a fully effective system whereby prisoners' IMRs, including those of remand prisoners, follow them wherever they may be in the system. The provision should encompass access to the system for all those involved in the penal system.
Show less
Recommendation
The question of confidentiality of prison medical records should be fully reviewed. As a first step towards such review, the General Medical Council and other professional bodies should be asked for their views.
Recommendation
The Government should consider establishing an independent committee to review the subject of the supply and dissemination of information within the services dealing with people in need of treatment, care and control.