Restricted Patients, CPA and MAPPA

1
Restricted Patients, CPA and MAPPA

• Rosie Toal Innes Walsh
• Team Leader Implementation Manager
• Restricted Patients Casework Risk Management
  Authority
• Rosemary.Toal_at_scotland.gsi.gov.uk Innes.Walsh_at_scot
  land.gsi.gov.uk
• Tel [phone] Tel[phone]

2
Introduction

• New Memorandum of Procedure
• Support multi-disciplinary working
• Patient Journey
• New SUS arrangements
• New reporting formats including role for CPNs
• MHTs, CPA and MAPPA
• Statistical background
• Reflection on changes and issues arising
• General issues

3
New Memorandum of Procedure

• Taking account of new guidance
• Streamlining
• Supporting multi-disciplinary teams

4
RMA recommendations for the MoP

• Support for standard documentation for CPA.
• Specifically mapped out stages in the patient
  journey where formal risk assessment reviews are
  required.
• Describe a system of risk assessment and
  management planning which is
• practicable for local teams
• flexible enough to accommodate local protocols
  and
• congruent with RMA standards and guidelines and
  the Care Programme Approach.

5
Care Programme Approach

• Management of Offenders Legislation provided the
  statutory basis
• Mechanism for regular review of all CORO patients
• Puts protection of the public at the core of
  decision making
• Requires that all engaged have an understanding
  of the risks and factors which suggest a relapse

6
MAPPA

• CEL 2008 19
• Notification requirements
• Referral points
• CPA still the management system
• Data from CPA documentation

7
Overarching Principles

• Focus on risk assessment to support decision
  making
• CPA as core process and documentation
• Reference points for MAPPA

8
Patient Journey

• Process guidance structured around the patient
  journey
• Admission and assessment
• Management in hospital
• Suspension of detention
• Transfers
• Conditional Discharge

9
New SUS arrangements

• Uses CPA
• MAPPA notifications and referrals
• Feedback mechanisms
• Supporting programme of events

10
New reporting formats

• Templates offered whilst keeping scope for
  flexibility
• Linked to CPA
• Reporting role for the CPN

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STATISTICS AS AT SEPTEMBER 2008

• 183 Compulsion Order/Restriction Order
• 50 Conditionally Discharged
• 42 Transferred prisoners
• One on TTD and CORO
• 2 Hospital Directions
• One on HD and CORO
• 34 Remand

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RESTRICTED PATIENT CASELOAD
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IMPACT OF THE MENTAL HEALTH TRIBUNAL

• Scottish Ministers decisions in 3 years up to
  2003 Act
• Conditional Discharge 40
• Absolute Discharge 17
• Removal of Restriction Order 3
• Mental Health Tribunal decisions (Oct 05 Sept
  08)
• Conditional Discharge 42
• Revocation of Compulsion Order 17
• Revocation of Restriction Order 9
• Appeals against excessive security (since May
  2006) 56 (25 withdrawn)
• 2 year reviews (total to August 2008) 228

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• Appeals to Court of Session
• No appeals under S322 (excessive security)
• No appeals against revocation of compulsion order
  
• By Patient
• 1 against refusal of MHT to order CD
• 1 against recall from CD
• By Ministers
• 3 against decision of MHT to revoke RO
• 2 against decision of MHT to re CD patients

15
Tribunal issues

• S189 two year reviews
• Up-to-date information for hearings
• RMOs making recommendations prior to S189
  hearings
• RMO and MHOs not party to proceedings
• Representation at Tribunal and advance notice of
  unavailability
• Named Person role of MHOs
• (Guidance issued by Geoff Huggins, letter
  dated 2/10/08)

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CPA/MAPPA

• Police engagement
• Admission allows suitable police liaison
  officer to be identified and will assist with
  gathering of intelligence of the risk assessment
  process
• When consideration of escorted/unescorted or in
  certain circumstances escorted leave within
  hospital grounds
• Prior to accommodation being identified for
  patient progressing towards conditional discharge
• When a breach of condition occurs or if a patient
  is recalled
• Any other occasion when it can be demonstrated
  that a police officers presence is essential

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Police role cntd

• Police have two key roles in relation to
  management of restricted patients
• Sharing information to help the responsible
  authority (Health) assess and manage risk
  appropriately
• To help address community safety issues when
  patients are moving towards spending time in the
  community or discharge to the community

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Other general issues

• Prior to transfer to conditions of lower security
  it is not helpful to raise expectations of
  patient by giving a date for transfer prior to
  assessment by Dr Morrison and consideration by
  Scottish Ministers (irrespective of successful
  excessive security appeal)
• Dr Morrison reviews patients, in addition to the
  above, prior to key stages in rehabilitation
  process including
• Conditional discharge
• Revocation of compulsion order
• Revocation of restriction order
• Return to prison

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Support for those managing patients with PD

• A service has been established to provide support
  for teams working with restricted patients who
  have a diagnosis of personality disorder
• The service is provided on a voluntary basis,
  aimed at teams and provided by a psychotherapist
• The psychotherapist does not have clinical
  contact with the patient.
• Support could range from one-off consultation to
  ongoing reflective practice depending on needs of
  the team
• The aim of the service is not to provide a forum
  for clinical discussion or resolution of clinical
  disputes but is rather a means of providing
  support to teams in managing difficulties which
  arise when dealing with such patients.
• If you would like to avail yourself of the
  service you can e-mail margaret.morrison2_at_scotland
  .gsi.gov.uk

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• 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.go
  v.uk/Publications/2008/04/18144823/0

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Graeme Dickson Primary and Community Care
Directorate 0131 244 3210
Geoff Huggins Head of Division 0131 244 3749
Dr Margaret Morrison PMO Forensic
Psychiatry 0131 244 2809
Rosie Toal Team Leader 0131 244 2510
Audrey Montgomery Secretary 01383 825762
Jenny McNeill Me-Z Senior Casework Manager 0131
244 1818
Nova Brown Gr-Ma (incl Mc) Senior
Casework Manager 0131 244 2546
Fiona Currie A-Go Senior Casework Manager 0131
244 2459
Gordon Stirling Casework Manager 0131 244 2512
Denise Mitchell Casework Manager 0131 244 2171
Jenny Craigie Casework Manager 0131 244 2457
Noelle Perrett Casework Officer 0131 244 2545
Julia Hilton Casework Officer 0131 244 6929
Marian Webster Casework Officer 0131 244 2170