1. Workshop Managing maternal filicide John Crichton

2. Background An amalgam of four cases Similar management demands and challenges Your first task: please form multidisciplinary groups!

3. 5 th September 2013 On the radio on the way home it is disclosed a car has been found with two dead children. The badly injured mother has been taken to the local Royal Infirmary. The police are not looking for any other suspects

4. First tasks You are the forensic team responsible for female MDOs The next day the liaison psychiatry consultant and the Pf depute for the homicide team want to contact you. What initial advice might you give, what additional information would you like?

5. First rule The first rule of high profile cases is that you do what you would normally do – as far as you can. Ask for police summary, past convictions. Establish HB and LA, address, DoB, retrieve notes and photocopy them. Establish extent of injuries and immediate medical and mental health needs.

6. Initial info 45 year old American national In context of custody dispute No previous criminal record Local HB and LA Pneumothorax, L wrist tendons severed, burns. Appears confused, ? paranoid

7. Second task Consider initial management considerations and forensic team input whilst at royal infirmary

8. Whilst in general hospital Recovery from physical injuries Charged with homicides Police constantly present Considerable chaplain involvement Suicidal intent and attempt, anxious weepy, not sleeping Initial interview possible Paranoid themes to presentation No considered fit for police interview

9. Task 3 You decide to apply for section 52D What preparations do you make? Assume you are able to admit to a mixed gender medium secure admission ward with three intensive care suites

10. Admission considerations No 52D until physically ready for discharge with plan for physical care including f/u OPD and physio. Court in the hospital Preparation of staff Nursed on constant in secure area Communications, security, IT, senior management liaison, Scottish Gov.

11. Progress on ward Quickly settles VIP visitors Able to interview at length Two boxes of diaries and copious notes delivered. At end of assessment a diagnosis of paranoid personality disorder made.

12. Task 4 A patient is overheard telephoning the press how do you manage the situation? How will you manage an OP appointment? The local bishop want to visit how do you respond? The PM has horrific details what do you do with the information. How do you manage the mass of information.

13. No right or wrong answers Used an interpretation of the specified person regulations. OP appointment very carefully planned Low key visit Restricted access to PM Do not underestimate the work

14. Task 5 What do you do next 52M? Insanity, Diminished responsibility Fitness to plead Final disposal?

15. What did happen Depression: 52M DR CORO (1 victim) Mixed PD: 52M DR 5 year tariff (victim) Paranoid and narcissistic PD no 52M, DR 16 year tariff (3 victims) deportation Paranoid PD no 52D, murder 23 year minimum punishment part of life sentence

16. And what happened next Task 6 After 9 months in custody subject slashed across face Serious attempt at self harm Hunger strike three weeks What would you like to do?

17. How it went on Same inpatient management plan put in place Hunger strike resolved quickly Opinion from Rampton sought Appealed to MWC for tribunal Expected delay in tribunal thought to make transfer to CV unlikely to be successful Transferred to Rampton.