*Independent investigation into the care and treatment of Mr R: May 2012

Commissioners of services must ensure the early involvement of clinical teams with patients when the first steps of planning movement between services are proposed and to monitor attendance of the appropriate staff at any planning meetings. Early dissent on the appropriateness of moves should be aired and resolved. Commissioners must be cognisant of the time assessment of such patients takes and make budgetary adjustments to accommodate this.

Patients with a diagnosis of personality disorder admitted to secure units from HSH care on six months Section 17 leave should have this amount of time allowed to pass before accepting the full legal responsibility for them. In the case of R, this was Trust 1

The Guidance for Social Supervisors and Guidance for Clinical Supervisors (Ministry of Justice, 2009) should inform good practice and be adopted by all clinical staff and operational managers in secure units when discharging all patients to community settings.

Trust 2 should undertake a review of services for offenders with a personality disorder. This should be conducted taking into consideration the policy guidance of the ‘Consultation on the Offender Personality Disorder Pathway Implementation Plan’ Department of Health and Ministry of Justice (NOMS), February 2011. The Trust, within this review, should work with other agencies to agree and describe improved pathways out of healthcare and prison units. Commissioners of such services and stakeholder agencies should form part of the review. In further consideration of the change the governments wish to make in forensic services, the review should include in their considerations the government’s response to Lord Bradley’s, ‘Report on people with mental health problems or learning disabilities in the Criminal Justice System’.

Local MAPPA should be given as much notice as possible and information of returning offenders from secure care and recommend a minimum of six months prior to discharge is adopted in all cases.

Trust 1 should record the source of information regarding the detail of offences committed by patients, checking the detail of the offence(s).

Trust 1 should closely examine offences and offending behaviour described by the patient, making appropriate enquiries to verify the patient’s account.

Trust 1 should consider peer review of patients with personality disorders who are to be discharged into the community without statutory supervision.

Trust 1 should always consider if a Community Treatment Order would be appropriate in all cases of patients being discharged from secure hospital care who are not subject to supervision on a restriction order.

Commissioners of forensic services should acknowledge the time-consuming nature of this work and plan to commission services accordingly. An audit of the time taken in planning for the support and assessing ongoing risk factors of patients returning to the community from secure psychiatric care should be undertaken to help demonstrate the complexity they pose and the re-evaluation of the allocation of resources and identification of gaps in provision.

Trust 1 and 2 should reacquaint themselves with the guidance ‘Information Sharing and Mental Health’, Department of Health, September, 2009.