Learning from Inquiries John Barrett Inquiry

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Learning from Inquiries John Barrett Inquiry

• Dr Kishore Seewoonarain
• Clinical Director for the Forensic Mental Health
  Services in Essex Runwell Hospital
• Dr Ann Stanley
• Consultant Forensic Psychiatrist/Lead
  Clinician Norvic Clinic

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New Trends

• Mental Capacity Act 2005
• Mental Health Act 2007
• Best Practice Guidance 2007
• New Ways of working for Psychiatrists 2005
• New Ways of working for everyone 2007
• John Barratt Inquiry 2006

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Shaftsbury Clinic

• 6 Consultant Forensic Psychiatrists
• 7 Specialist Registrars
• 6 SHOs
• 71 Medium Secure Beds
• 50 Community Patients
• 8,000,000 revenue

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Conflicts

• Forensic Services Trust
• Medically dominated service
• Medical staff
• Clinical v Academic

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Incident

• The event which gave rise to this
• Inquiry was the death of Denis
• Finnegan whose life was cut short on
• 2 September 2004
• when he was attacked without warning
• as he cycled through Richmond Park

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The Inquiry

• South West London Strategic Health Authority
• Wandsworth Council
• Metropolitan Police
• Health Circular HSG (94)27
• Robert Robinson Solicitor
• Jane Fenwick NED/SHA and Associate with
  Healthcare Commission
• Dr S Wood - Consultant Forensic Psychiatrist

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John Barratt

• Born on 1 August 1963
• Of Jamaican father and mother of Northern Irish
  descent
• 3rd eldest of five children
• Parents divorced when he was 14
• Age 6 taken into care with siblings as parents
  could not cope
• Returned to father and new partner but went back
  into care
• Suspended from school in 1979 assault on
  teacher
• No qualifications
• Studied dance and drama
• Education interrupted because of criminal
  activities starting at the age 14
• Singer, keyboard player and composer
• Short term relationships
• 2 long term relationships
• 2 or 3 children
• Onset of mental illness in 1995 while on holiday
  in Portugal

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Admission to Adult Mental Health Services
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Forensic Opinion

• 1st May 2000

• Assault on GF
• Sexually inappropriate comments
• Attack fellow patient ? PICU
• 24/5 2000 ? Open Ward
• Dr Yates, SpR 19 June 2007
• ? persistent delusional disorder
• To warn GF about risk
• Sec 25 supervised discharge order
• Home leave as open wards would not accept him/
  overruled by Prof Barnes
• 26/6 threw a cup of tea at another patient
• 2/7 verbally abused female patient
• 28/8 AWOL returned to ward same day

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Forensic Opinion

• 6th admission
• (Dr Bale)

• Forensic opinion requested but this did not take
  place

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Admission to Forensic Mental Health Services

• 8.1.2002 - Arrested for GBH X 3
• 9.1.2002 - Seen by Forensic Medical Examiner
• 14.1.2002 - Dr Oyebode, CFP, no abnormality in
  mental state
• 8.4.2002 - Interviewed by Dr A Bartlett, CFP
• 16.4.2002 - Transfer to Shaftsbury Clinic,
  Section 48/49 MHA 1983
• 23.4.2002 - ? Persistent Delusional Disorder
  with underlying narcissistic and antisocial
  traits.
• 14.5.2002 - Wider range of psychotic symptoms ?
  impression that he might be suffering from
  schizophrenia

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Admission to Forensic Mental Health Services

• 24.5.2002 - it is not honesty is always the
  best policy
• 18.6.2002 - do we believe GF?
• 22.6.2002 - GF glad that he was not granted
  unescorted ground leave risk of
  absconding, believing that his colleagues
  were making millions outside.
• 9.7.2002 - ? Persistent Delusional Disorder
  and Antisocial PD
• - Telepathic experiences
• - Incongruous laughter
• - Appears to be responding to auditory
  hallucinations - Other delusions (broken
  penis )

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Admission to Forensic Mental Health Services

• 5.8.2002 - JW told staff that patient was going
  to abscond on 16.8.2002, when court hearing
  was due.
• 13.8.2002 - Had asked assistance from brother,
  ie passport, NI number
• 15.8.2002 - Dr T Nayani ? Persistent Delusional
  Disorder
• 6.9.2002 - Declined a bed at Broadmoor Hospital
• 20.9.2002 - Section 37/41 after pleading guilty
  to index offences
• Soon after - Transfer into care of Dr G Mezey,
  CFP, to facilitate access to psychologist
• 15, 29.10,2002
• 5, 12, 19,
• 26.11.2002 - Ward round minutes paranoid
  schizophrenia
• Wanted to apply for passport to travel
  abroad following discharge in 10 months

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Admission to Forensic Mental Health Services

• 17.12.2002
• thereafter - ? Delusional Disorder
• 21.1.2003 - Team willing to support C/D in March
  2003
• - 1 hour of escorted ground leave on
  7.1.2003
• - Missing OT sessions
• - Mental state settled in the last month
  but sexual innuendoes resurfaced
• 28.1.2003 - 1 hour of unescorted ground leave
• 25.2.2003 - 1 hour of ground leave per shift
• 6.3.2003 - Transfer medium secure rehabilitation
  ward
• 1.4.2003 - Unlimited unescorted ground leave
• 9.4.2003 - 1st escorted area leave to Tooting
  (applied for on 4.3.2003)
• - SHO to apply for unescorted area
  leave upon her return from holiday

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Admission to Forensic Mental Health Services

• 29.4.2003 - Home Office had asked for enquires
  to be made about victims
• 13.5.2003 - No overt symptoms but smiling
  constantly
• Had masked symptoms in the past
• 16.5.2003 - Hearing whispers
• 19.5.2003 - Says he had stopped his medication
  for one week in the previous week
• Asked not to be penalised for this
  non- compliance
• Late May - Poor attendance at OT
• 7.6.2004 - Bought flowers for RMO
• 20.6.2004 - Unrealistic plans on discharge
• Taking it easy
• Partying
• Not working

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Admission to Forensic Mental Health Services

• 21.7.2004 - 2 hours of unescorted area leave X 2
  weekly
• 1.8.2004 - Unescorted area leave to Covent
  Garden with GF to celebrate birthday
• 9.9.2004 - Felt at risk of using alcohol and
  drugs
• Sept 2004 - Not attending any OT activities
• 25.9.2004 - Application for an overnight home
  leave
• 10.10.2004 - MHRT ? C/D
• (To reside at his home address)
• Report by Dr Ferris, SpR
• Evidence given by Dr Dhar, SpR

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• CPA
• Statement of risk
• Early signs of relapse and action plan
• Care plan

• 23.9.2003
• 27.10.2004
• 18.5.2004

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• 10.10.2003
• to
• 23.4.2004

• O/P
• Dr Dhar, SpR monthly
• Only one entry 11.11.2003
• April 2004 onwards
• Dr Dein

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• Home Office Reports
• Social Supervisor
• Social Supervisor
• Psychiatric Supervisor

• 10.11.2003
• 4.2.2004
• 22.4.2004

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• Hearing whispers for 48 hours but better now
• Stress, pressure to produce creative ideas to
  order
• Hearing voices again
• Admitted to Adult Psychiatric Ward, Springfield
  Hospital
• ? Risperidone (8?12mg daily)
• CPA meeting ? discharge
• No structure today
• Declined to work at Old Peoples Home
• Refer to OT

• 19.4.2004
• 12-18.5.2004
• May 2004

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• July 2004
• 29.9.2004
• 2.8.2004
• 4.8.2004

• JBs mother rang Social Worker
• Wildness coming back
• Been like that for the past couple of
  weeks.
• - JW also rang Social Worker re
• Debts of 2000
• Becoming cold and flat
• JBs brother also contacted Social Worker
• Hearing voices
• Seen by Dr Mezey (? 3 week leave)
• Urine positive for cannabis

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• 9.8.2004
• 19.8.2004
• 26.8.2004
• 31.8.2004
• 1.9.2004

• Smelling of alcohol
• Pressured speech
• Verbally threatening
• Disenchanted by the music he was working on
• Seen by Dr Dein
• Seen by Dr Dein
• Dr Mezey returns from leave
• Plan to recall patient if he did not agree
  to voluntary admission
• Late for appointment
• Clearly psychotic
• Agreed to be admitted rather than be recalled

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RMOs Decision

• Would prefer not to come to hospital
• Preferable to being recalled
• Remain on unit until assessed by GM
• Unlimited leave in secure garden
• Section 5(2) if patient wishes to leave
• Pursue recall thereafter

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RMOs Decision

• Telephone call from GM
• Technically he is not informal
• One hour unescorted ground leave per shift
• If he fails to return, GM to contact HO for
  formal recall
• S 5(2) to be implemented if he wishes to leave
• GM to see tomorrow