Why Are some Mentally Ill Patients Treated Like Criminals?

I wouldn’t normally subject you to two blogs in one day, but I have just come across the case of Joe PARASKEVA. Joe is a young man who was sentenced to serve an IPP, or indeterminate sentence (for public protection), following a conviction for arson.  This offence was committed whilst detained under s2 Mental Health Act in a Hackney psychiatric ward following which he was arrested, charged, remanded, tried and imprisoned.

His mother, Linda MORGAN, launched a campaign to have him transferred from prison to hospital, to continue to receive treatment for his mental health problems and various national charities took up his case to highlight it as being especially harsh.  This case serves to demonstrate the very real challenges discussed hypothetically in previous blogs about in-patient offending and how to reach a prosecution decision.  It shows how serious the consequences are.

Highlighting Joe’s case back in June, an article in the Guardian by Amelia GENTLEMAN asked the question, “Why are some mentally ill patients treated like criminals?” as if to imply a black / white distinction between mutually exclusive groups.  It is this ever-offered distinction I wish to contest as it is absolutely clear to me that we must get better at recognising the grey areas which necessitate blurring it.

And we must be prepared to debate this: we cannot have a situation where we unnecessarily and outrageously criminalize (young) people with mental health problems; but nor can we have a situation where those with mental health problems who offend are unable to be held to account by the law where this is both possible and appropriate.  I remind: some parts of the Mental Health Act 1983 can only be accessed via the criminal justice system.  This may be right or wrong, but it is the law as it stands today.

I regularly post this on twitter; “Should offenders with mental health problems be diverted? ‘Depends; and no policy from government, police or health has ever said otherwise’.”  For all the words that have been written over the decades, nothing says ALWAYS YES or ALWAYS NO.  It is a complex decision with far-reaching consequences.

For this reason, not all diversion decisions should be taken by the police at the investigation stage.

Whilst being horrified about Joe’s case, one can see why he’s endured the route that he has.  Clearly two psychiatrists and an AMHP felt able to ‘section’ him, originally under s2 MHA.  However, the psychiatrist(s) who offered information during the criminal justice process stated he was not suffering from mental disorder.  So one can at least begin to understand why a prosecution was considered?

Trust me(!), it is often a difficult task to persuade the CPS to prosecute someone who was sectioned on a mental health ward at the time of the offence but clearly the CJ process has proceeded in Joe’s case on the basis of views that following assessment under s2, Joe was not suffering from a mental disorder.  This may have been right or wrong, but it appears to have been the view offered at the time.  Subsequently, after conviction, further opinion has suggested in fact, that Joe does have mental health problems so thankfully he has been transferred back to hospital from prison under s47/49 and is receiving treatment and care.   The originally imposed sentence can now be served out as a restricted hospital order, subject to the ongoing assessment of clinical need.

Far more generally than this one case – it is perfectly possible to suffer from mental disorder; AND to be ‘sectionable’ under the law; AND  STILL be capable of understanding the nature and quality of acts done.  Equally, it is perfectly possible that someone’s mental disorder and / or their treatment, may render them UNABLE to understand the nature and quality of the act done and a prosecution would not be possible.  There are some cases where it may not be easy to know and a fuller psychiatric assessment may be needed and / or a fitness to plead or fitness to stand trial hearing becomes necessary.

Let us also remember, that ‘insantiy’ – a legal concept, not a medical one – is a defence, to run at trial.  It is a matter for the defence to raise, not one for the prosecution to pre-emptively negate in advance.

To determine which may be the case in any particular investigation, the police, the CPS and then the courts will need INFORMATION which allows them to know or to at least infer what they may be dealing with.

<< Update – 12/12/12: Joe PARASKEVA took his case to the Court of Appeal on 12th December 2012 and after reviewing the medical evidence and securing a new update, the Court ruled that he “was suffering from a mental disorder both at the time of the offence and sentence.”  As such, his sentence has been changed and he has been made subject to a Restricted Hospital Order, under section 37/41 Mental Health Act.

The Mental Health Cop blog won the Mind 2012 Digital Media Award, in memory and in honour of Mark Hanson.
The Awards celebrate the “best portrayals of and reporting on mental health in the media.”

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13 thoughts on “Why Are some Mentally Ill Patients Treated Like Criminals?

    1. That’s very kind of you to say so. I think this stuff just falls into place in one’s mind once you’ve spent time understanding the debate from the point of view of the ‘other’ organisation and its professionals.

      Grateful for your feedback, as my thoughts haven’t quite hit the mark, for some. Thanks.

  1. A wise man proportions his belief to the evidence. David Hume. We all know, that first thought can change, hind sight is so powerful ! One day we will work together for the good of all. Until then we will battle with the I am better than you brigade ! Well written, well done xxx

  2. Saw your link on Gadget and felt I had to reply.

    Mental health is a huge and misunderstood problem in this country. There does not appear to be enough help for people that find themselves deteriorating mentally. It is a subject where if you talk to the ‘normal’ people ‘normal’ people tend to shy away and not want to know.

    This country does not embrace the outcasts. They are left to rot. That’s what is wrong.

    Good on you for bringing it up.

  3. This is long overdue.

    But the good news is that with proper treatment a lot of mentally ill people do get better. The worry is that whilst they are unwell they may do acts which take them before criminal courts.

    1. But criminal courts are where we have proper, detailed discussions of relevant issues; not just the evidence, but also the mental health or capacity questions. clearly, if someone is stealing mars bars or even committing minor assaults there will be little public interest in taking it that far. However, if people are persistently committing criminal acts whilst not engaging with MH services OR have committed very serious crimes, then the issues of mental health / capacity, fitness to stand trial etc., should be determined in criminal courts.

      It is also true to say, that psychiatrists disagree with each other and argue over diagnosis and the relationship between a patient’s condition and their potential legal liabilities. Courts are there also, to referee those psychiatric disagreements and weigh the opinion against the evidence.

      1. I agree and I could have written a whole lot more but wanted to register my support for what you are doing.

        I pride myself in manageing a few years ago to get a Guardianship Order for a young woman who suffered from auditory hallucinations and acted upon orders to steal things from shops. Sometimes she would steal just one chocolate. She was deemed unfit to plead by two consultants. She was a terrible burden on her very supportive family who effectively had her under 24/7 supervised house arrest.

        With the benefit of some good old social work from a London Borough I was able to get the court to make the order and vest it in that local authority. The young lady did not commit any further offences.

        Sadly the consultants did not like a Guardianship Order being used in such situation but my research of the Butler Report suggested that this was indeed a suitable use of it.

        With the oft quoted statistic of one in four of us suffering some form of mental health illness in a lifetime, one of those four might deteriorate so badly as to commit a serious act. That is why this is important to all of us, even if we think that there is no way that we could become the victim, we might be the perpetrator!

        Other issues are whether the accused is a criminal with a MH illness as opposed to a mental health patient who has acted in a way which is criminal.

        On the fringes are people with conditions such as ADHD.

        Finally I remember going to an address with an Approved Social Worker and a Psych to re-take a mental patient. The Psych said nothing and did nothing other than note things on a clip board, it was left entirely to me and my colleague to try and persuade the person to come quietly.

        Noew as I keep offering on IG’s blog, if there is anything that I can do to assist you as a Lawyer then you need only ask. I have access to a Law Library for instance.

  4. I think that it’s highlights a number of issues. I always find cases where professionals agree to disagree and this leaves people unsure of the facts. I did work with a person before and one doctor said they had personality disorder then another doctor said they had psychosis…. so i would say communication is the key!

    1. There are known issues with the consistency of psychiatric diagnoses compared to other healthcare specialities. This is for certain obvious reasons, but it doesn’t help people affected by the arguments.

  5. Once again you address this head on…Thank you! Honesty hurts, but lies hurt more!
    I feel until we have a national system in place, where anxiety in Leeds is still the same as anxiety in London and not based on opinion (people are often labeled by flawed personalities and in response to targets!) ….we will be debating this ad infinitium!

    Parity of terminology must be a priority as must completely independent investigations. The latter I feel is where most of the devil is hidden in the detail. It seems, the criminal element of mental illness (which does exist ) is often glazed over and the person (is either sent to prison or a secure hospital and basically left to someone else to sort out!) But its lack of real investigation, lack of public education, lack of staff, lack of training, lack of beds, lack of research et al which all contributes to “we’ll just call the police if they are any bother” Police can restrain them if non-compliant!

    I find it amazing how we expect a person with a broken brain to think straight….yet would not expect a person with a broken leg to walk! Its people who are genuinely mentally ill that I feel for. People who are placed on mixed wards and have to endure loud aggressive behaviour, when a calm therapeutic, environment is needed (as indicated in many a robust policy)
    Of course there are many reasons for poor mental health and long term mental illness……lots seems to relate to life’s experiences and how we handle them! Seems self medicating with drugs and alcohol can tip the balance too….but why then does “Dual-diagnosis” remain mainly confined to paper ! Where are the reams of expensive, glossy research which fail to translate to wards or community?

    But not being a trained expert, I am only going on life’s experience and what I have discovered after 7 years exploring the NHS complaints system. I am now mindful that we need a working complaints system, (a complaints pool where every trust pays in and trust who fail local resolution pay in substantially more for independent invetsigations!) a tenable investigation system, a dedicated Minister for Mental Health,with a remit for detention in hospital/prisons plus a dedicated Commission for service users like the Mental Health Act Commission was.. The transference of MHAC remit to “safeguard the interests of detained patients” to CQC has been a failure and must be addressed!

    This is a very complex subject but it cant be ignored any longer! No longer can it be seen in compete isolation!

    1. “Dual-diagnosis” does exist and is often used as the justification for the denial of treatment under either heading. Some health trusts do consciously declare that they will detox then deal with the mental and physical health issues. Others declare that the patient is untreatable and effectively exclude the patient from anything helpful which is when the police/prisons have to be involved in the process of containment.

  6. 29 July 2012
    Dear Mental Health Cop,
    A few months have gone by since you wrote this very illuminating article, and much has been in the news about terrible events in Scandinavia.
    How would you deal with a person who states that he/she is sane and kills?
    Where is the “natural laws” by which we all live?

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