Case Presentation

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Case Presentation

• KAREN WORKMAN
• South Lanarkshire Council
• SANDY WATT
• North Lanarkshire Council

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• Conditional Discharge for patient Mr A, on
  Compulsion Order and Restriction Order(CORO)
• Presentation for Personality Disorder Network
• 2010

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• Age 9
• Childhood History. Mr A second in family of 6
  children. No known significant early health
  problems. Had contact with the Children's Hearing
  System from age of 9 following concerns of lack
  of parental control and neglect. Both parents
  were dependant on alcohol. In addition he was
  involved in antisocial and offending behaviour
  (shoplifting to buy essentials for himself) as he
  had no family support from his parents and
  siblings.
• Age 10
• He was removed from the family home for his own
  safety and welfare and placed in a childrens
  home. Mr A subsequently became involved in
  alcohol and solvent misuse whilst in care.

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• Age 14-16 (Teenage years )
• Admitted to Residential Schools in Scotland due
  to
• ongoing family issues and Mr As involvement in
• offending behaviour.
• Whilst approaching his late teens he began to
• abuse a variety of substances that included LSD,
• cannabis, amphetamines, and
• prescribed medication

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• Age 16-21
• From aged 16 the offending behaviour continued
• and he remained involved with criminal justice
• system, including lengthy periods in custody for
• drink/substance related offences.
• Estimated Mr A spent approx only 4 months in
• total of his adult life living in the community.

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Age 21 -26

• Mr A continued to commit crimes including
  offences of a
• violent nature. He was detained in psychiatric
  care for
• assessment under the Criminal Procedure
  (Scotland) Act
• 1975. He was diagnosed then with borderline
  personality
• disorder with propensity to decompensate into
  frank
• psychosis following drug and alcohol abuse.
• He absconded twice during this period. On one
  occasion
• he assaulted a member of the public by holding
  them
• hostage with a knife held to their throat. He was
  discharged
• in his absence following the second absconsion.

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• During a brief period in the community subject to
  Probation in 1994, Mr A was charged with
  attempted murder and assault. From Court he was
  transferred to the State Hospital for further
  assessment. Mr A presented as paranoid with other
  psychotic symptoms.
• The original charges were reduced on conviction
  to assault to severe injury and permanent
  disfigurement and Mr A was detained in the State
  Hospital on a Hospital Order under the Criminal
  Procedure (Scotland) Act 1975 and the Mental
  Health Act (Scotland)1984.

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• Age 27 onwards
• During his first year in the State Hospital Mr A
  was nursed in seclusion
• due to his aggressive/ assaultive behaviour
  towards staff and patients.
• In the following years attempts were made to
  progress Mr A from the
• State Hospital to less secure hospital care.
  These were unsuccessful
• due to various incidents including the following
  significant events
• positive tests for drug abuse
• assaults against staff
• rooftop protest lasting several days attracting
  significant media attention.
• absconsion whilst on suspension of detention
• long term partner convicted of attempting to
  supply heroin to Mr A in hospital.

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• Age 36
• Throughout his detention in the State Hospital
• Mr A lodged appeals at Court regarding his
• Hospital Order disposal. Mr A continually felt
• aggrieved he was detained in hospital
• indefinitely as opposed to serving fixed
• sentence in prison.

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• 2007
• Sheriff grants deferred conditional discharge
• as no lower secure step down placement
• available and decision that risk can be
• managed safely in the community with
• access to 24 hour support/supervision.

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• 2007-2009
• Arrangements advanced to facilitate conditional
• discharge to community.
• Key components-
• Risk assessment (HCR 20 and RAMAS)
• Comprehensive Phased Rehabilitation Plan
• Person Centred Plan to detail support and
  supervision needs
• Commission service provider

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• 2009
• Mr A was eventually successful in his appeal
• and was granted a Conditional Discharge at
• Court under the 1975 and 1984 Acts.
• 13 conditions were applied to the license
• including absence from drugs and alcohol and
• no contact with his long term partner.
• See handout for final overview of process

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• Potential Issues for debate
• Resources for meeting needs of mentally
  disordered offenders moving from State Hospital
• Risk assessment tools
• Conflict resolution
• Communication/information sharing