Transcript MAPPA - RMA Scotland

Restricted Patients, CPA and MAPPA
Rosie Toal
Team Leader
Restricted Patients Casework
[email protected]
Fiona Tyrrell
Branch Head
Mental Health Law
[email protected]
Introduction
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Statutory background
Statistics
Role of Scottish Ministers
CPA
MAPPA and restricted patients
Definition of Mental Disorder
• Under the Mental Health (Care and Treatment)
(Scotland) Act 2003 “mental disorder” means
any mental illness, personality disorder or
learning disability however caused or
manifested.
• Definition is wide to ensure the services
provided under the 2003 Act are available to
anyone who needs them.
Restricted Patient
• Section 59 of the Criminal Procedure (Scotland) Act 1995 in
conjunction with a Compulsion Order
• Is made when it appears to the court:
– Having regard to the nature of the offence
– The antecedents of the person; and
– The risk that as a result of his mental disorder he would commit
offences if set at large
That it is necessary for the protection of the public from
serious harm
• A restriction order is without limit of time
STATISTICS AS AT MARCH 2008
• 187 Compulsion Order/Restriction
Order
• 46 Conditionally Discharged
• 43 Transferred prisoners
• 2 Hospital Directions
• 31 Remand
Role of Scottish Ministers
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Transfers between hospitals
Transfer from hospital to prison
Cross border transfers
Suspension of detention outwith hospital grounds
Recall from conditional discharge S202
Variation of conditions of discharge
Provision of Position Statements to MHT reflecting
Scottish Ministers’ position in relation to risk
SMs expectations of care team
– multi-disciplinary team working
– detailed risk assessment and management plan in place and
updated at key stages in rehabilitation process
– comprehensive care plan
– appropriate testing
– CPA from admission
– Referral and notification of cases to MAPPA
– on-going monitoring following CD - reports by RMOs, MHOs
and CPNs
– Immediate notification of incidents whilst on CD
Patients on Conditional Discharge
by Health Board
Ayrshire & Arran
Dumfries & Galloway
Lanarkshire Health Board
Lothian Health Board
Grampian Health Board
Greater Glasgow & Clyde Health Board
Highland Health Board
Fife Health Board
Tayside Health Board
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13
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Conditional Discharge
• Subject to conditions ie residence, supervision,
structure, drug/alcohol testing,
• Can have condition must not enter specific area
(ie if victim concerns)
• Ministers may recommend conditions to MHT
but ultimately decision for MHT
• Ministers may vary conditions of discharge whilst
patient is on CD ie either relax or strengthen
Care Programme Approach
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Management of Offenders Legislation provided the
statutory basis for administrative arrangements for
assessing and managing risk (CPA)
Mechanism for regular review of all CORO patients
Puts protection of the public at the core of decision making
Will require that all engaged have an understanding of the
risks and factors which suggest a relapse
Guidance as issued (NHS CEL 13 2007)
CPA (cntd)
• Complying with CPA Boards will meet many MAPPA requirements
• Section 8 of CPA Report accepted as Policy
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Scope
Initial CPA meeting 4-10 weeks after admission
Review meetings at least every 6 months
RMO continued overall responsibility
Care Co-ordinator role (not RMO or MHO)
Two states of CPA meeting
• Pre meeting (third party information, no patient)
• CPA meeting (includes patient or representative)
• Advice on running the meeting and competencies for chair
MAPPA GUIDANCE - CEL 19 2008
• Extension of Management of Offenders
etc (Scotland) 2005 to restricted patients
• Health Service guidance
CEL 19 2008
• Duty to co-operate for all offenders
• Health Board responsible authority for
restricted patients
– CORO, HD, TTD, ICO
• Clinical governance
• CPA
ROLES
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RMO
MHO
Health Board as responsible authority
Medical records
• Police
• MAPPA co-ordinator
Clinical Governance
• NHS Boards:
– Accountable for quality of care and treatment
provides
– Responsible for effective clinical governance
– Required to collate statistical data required for
inclusion in annual report
KEY STAGES
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Admission
Transfer
Escorted suspension of detention
Unescorted suspension of detention
Conditional discharge
Absolute discharge
ADMISSION
• Involve police from start of CPA process through
MAPPA coordinator
• Notification to MAPPA coordinator
• Identification of police link
– Involve in pre-CPA where necessary
– Making relevant information available
– Role when moving towards community
• Involvement of MAPPA Health representative
SUSPENSION OF DETENTION
• All cases to be referred at MAPPA level 2
• Uncommon high profile/high risk cases
can be referred before unescorted SUS
• MHD need to know case reviewed and
any issues addressed before will authorise
CONDITIONAL DISCHARGE
• Refer all cases at Level 2 when
accommodation identified
• Refer before recommending CD
• Scottish Ministers will include MAPPA
views in any submissions to Tribunal
ABSOLUTE DISCHARGE
• Similar to de-registration for RSOs
• Refer all cases at level 2 when accommodation
identified and before recommending AD
• If absolutely discharged by Tribunal, Health no
longer Responsible Authority – but still has duty
to co-operate
• Scottish Ministers will include MAPPA views in
any submissions to Tribunal
MAPPA notification
• Transitional arrangements
– All patients to be notified to MAPPA co-ordinator
• New restricted patients
– Notification to MAPPA co-ordinator asap after
restriction order made
• Notification form is only one page
• Notification leads to identification of police link
• Not a referral
MAPPA referral
• Referral made when level 2 or 3 review is
necessary
• Longer form – but most of it should come from
CPA documentation
• May need to append risk assessment and
management summary
• Following referral MAPPA level 2 meeting should
take place within 20 days
• MAPPA level 3 meeting should take place within
5 days.
Role of MAPPA meeting
• NOT
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Case management
Doing risk assessment
Making risk management plan
Primary vehicle for inter-agency working
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– Review
– Scrutiny
– Ratification
UNEXPECTED DISCHARGE
• Tribunal may discharge despite RMO
recommendation
• Early Discharge Protocol
• Contingency plans
• Emergency or pre-emptive CPS meeting
• Refer at MAPPA Level 2 or 3 as
appropriate
Useful web links
• MOP: Working version is available on
www.scotland.gov.uk/health/mentalhealthdivision
• Forensic Managed Care Network
www.forensicnetwork.scot.nhs.uk
• Risk Management Authority Report on Risk
Assessment and Management of RPs at
www.RMAscotland.gov.uk
• Version 4 of MAPPA guidance
http://www.scotland.gov.uk/Publications/2008/
04/18144823/0