Case Presentation KAREN WORKMAN South Lanarkshire Council SANDY WATT North Lanarkshire Council

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

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 children’s home. Mr A subsequently became involved in alcohol and solvent misuse whilst in care.

Age (Teenage years ) Admitted to Residential Schools in Scotland due to ongoing family issues and Mr A’s 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

Age 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.

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 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. Age

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.

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.

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.

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.

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

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

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