PC Nina Mackay

This post is dedicated to the memory of PC Nina Mackay, Metropolitan Police, who died in service from stab wounds in 1997.

Magdi ELGZOULI is shortly to be released from secure mental health care.  In 1997 he killed Nina Mackay as she entered his flat with other officers to arrest him for breaching bail following a previous arrest involving possession of knives.  He subsequently pleaded guilty to manslaughter on the grounds of diminished responsibility and has been within the secure or forensic mental health system since.

We’ve known his release is coming: in 2008, the Daily Mail reported the potential for his release, amidst knowledge that ELGZOULI had been having four hourly periods of leave from hospital to assist with reintegration.  The latest Daily Mail headline suggests that he is now deemed safe … unless you are a police officer.  Psychiatrists are reported to be worried that encounters with the police on patrol could adversely affect his mental state.  That’s not the total of what I’m worried about.

Notwithstanding sensationalist headlines, legitimate questions are being asked this morning about whether the decision to release is correct; whether he should ever be released; and especially about any decision to release which is taken in the face of suggestions that he still potentially poses a risk to police officers.

Because if this doesn’t work seemlessly, guess who is going to get called?

• Police officers are the very people who will be ‘offender managing’ him in the community as part of the Multi-Agency Public Protection or MAPPA arrangements, along with community forensic mental health services;
• Police officers will be the ones to arrest him on recall if this doesn’t work;
• Police officers have all manner of unplanned, immediately necessary contacts with very many members of the public.  Why wouldn’t this happen with this man?
• Police officers in the United Kingdom are routinely equipped with a stab vest, an aluminium tube and a small tin of pepper.
• Also, they are usually equipped with an extraordinary compulsion to face danger despite their accoutrements.

It was reported in 1997 that he was an exceptionally prolific user of cannabis and we know the association this can have with inducing psychotic states and with raised risks of violence in a very limited number of schizophrenia patients. <<< This statement is NOT about stigmatising all patients: we are specifically debating here a convicted homicide patient, with a history of violence and drug abuse.  Nothing here should be construed as having wider applicability.

The police, under our 19th Century Peelian traditions, actually are the public and are entitled to just as much protection in the face of forseeable risks as anyone else.

Nina Mackay’s father, retired Metropolitan Police Chief Superintendent Sidney Mackay, has stated his view that the man who killed his 25 year old daughter should never be released.  There has been call for some while that anyone who kills a police officer, mentally ill or otherwise, should never be released as it symbolises far, far more than an attack on the person of the officer.  It is an attack on the State itself.

I want to cover a question from @ProtectRPolice who asked how the decision to release would have been taken:

Firstly, as a ‘restricted hospital order patient’ (s37/41 MHA), ELGZOULI’s doctors were never and are not, fully at liberty to take important decisions about his release, his leave from hospital or even the kind of hospital in which he’d be detained.  By virtue of the Crown Court imposing this order upon him, it is signifying he poses “a serious risk of harm to the public” and so becomes subject to oversight by the Ministry of Justice’s Mental Health Unit.

The MoJ MHU takes decisions of behalf of the Secretary of State for Justice (currently, Ken Clarke) about the detention, leave and release of restricted patients and does so in the public interest, to protect us from these identified harms.  So doctors can do nothing without MoJ say so and they, the MoJ, are known to refuse and frustrate requests made by psychiatrists about leave or release for restricted patients.

When the time approached where DRs believed that ELGZOULI may be suitable to have leave from hospital – probably escorted, supervised leave to begin with – they would have had to prepare a comprehensive risk assessment and satisfy the Ministry of Justice that this was safe, proportionate and that contingencies were in place should anything go awry.  As leave increased in time and / or frequency and / or supervision, the DRs would have had to complete ever more risk assessment, evidencing the appropriateness.  This would remain true up until any suggestion that ELGZOULI be released from hospital.

Secondly, whilst detaining under s37/41 as a restricted patient, ELGZOULI would periodically have had opportunity to apply to a Mental Health Review Tribunal to secure his release.  This is a panel consisting of a Judge (or a QC who is a Recorder), a Psychiatrist and a lay person who must consider whether it is appropriate to release.

Thirdly, when released it is far from the case that ELGZOULI will just be shown the door and allowed to get on with it.  He will be released from hospital under a system called ‘conditional restricted release’ (s42 MHA).  This means that various conditions will be imposed upon him and supervised by community forensic mental health specialists.  Such conditions may include, initial residence in a hostel or ‘step-down’ facility where 24/7 staff can supervise albeit far less restrictively than when he was in hospital.  If successful, residence may subsequently move to supported housing or an independent dwelling but there could still be other conditions, ie, that he continue to comply with outpatient and other medical appointments which are intended to ensure ongoing supervision and management of risks.

And for all this time, ELGZOULI will be subject to close oversight by MAPPA – Multi Agency Public Protection Arrangements.  These will provide a multi-agency framework within which information about risks should be shared and assessed, so that agencies other than mental health services can take appropriate action, either in terms of ongoing supervision (police offender managers) or in the event of a trigger incident – absence, further offence, etc. – can instigate contingencies.  MAPPA offenders often have trigger plans prepared to be instigated immediately with people like police duty inspectors overseeing their immediate implementation.  This could be a patient not complying with residence requirements, medical appointments and so on; or could be in response to particular incidents, like a 999 call to the police to this man or his place of residence.

If at any stage the clinicians fear that rehabilitation and recovery are threatened and that risks are manifested, the Ministry of Justice can issue a warrant for his return to hospital.  At such time, he would again become subject to the legal frameworks of s37/41.  Of course, the warrant would be executed by the police arresting him  …  which is how the problems started in the first place and where Nina Mackay was tragically killed.

One can imagine that if arresting him for any reason to return to hospital, nothing other than armed police would be deployed given a previous homicide offence against an officer.

As to the subject of whether he should ever be released; and what, if anything, should be done around potential risks police officers would face if they had cause to have dealings with Elgizouli – this is the most difficult part of it and does all of the above mitigate risks adequately?  Maybe, maybe not.

It can never be ruled out that ‘normal’ uniformed police officers may come across him; whether by chance or because of a call which does not reveal nominal links which allow trigger plans to be considered or implemented.  Whether officers will know they have come across him is uncertain – over time the conditions applied to his release may loosen and his ability to travel as he wishes will increase.  The fear is, a chance encounter with an unarmed, uniformed officer and we’re straight into ‘PC Jon Henry’ territory: an officer unknowingly dealing with a mental health patient who proceeds to commit a grievous offence.

As for the reported logic in the latest Daily Mail headline that he is safe as long as he is not living in an area with many police; this just seems too absurd for words.  I’d love to know more about this: however, London is very heavily policed:  almost 25% of the police for 15% of the population.  But then, I’ve come across some pretty strange thinking in my time working mental health so there is just something in my head than cannot rule it out  …  fingers crossed all round that this has been properly thought through.

The structures are certainly there to suggest it should have been: let’s just hope the checks and balances have worked.

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Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2012

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I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – www.legislation.gov.uk