Playing the Mental Health Card

I spent the first hour of my Saturday responding to all the ill-informed comments on the Northumbria Police facebook page, after their media release following the sentencing of Ethan Mountain at Newcastle Crown Court yesterday. He was convicted earlier this month of manslaughter on the grounds of diminished responsibility after unlawfully killing 62yr-old Joan Hoggett in September 2018. In the particular case, the defendant had been accused of murdering the victim in a tragic, random and unprovoked attack in Sunderland and the judge had ultimately directed the jury to find him not guilty of murder on the grounds that his mental state was diminished because of schizophrenia. He has now been detained indefinitely at Rampton (high-secure) hospital in Nottinghamshire under a restricted hospital order (s37/41 Mental Health Act 1983).


We’ve covered this stuff before, so this post is not to explain the various legal concepts outlined in the first paragraph: the links provided take you to previous posts. The point here is to address the ill-informed Facebook comments we saw on the Northumbria Police Facebook page. They were broadly of three types

  • Playing the ‘mental health card’
  • It was premeditated, so it really was murder.
  • Hospital is the ‘easy’ or ‘soft’ option.

But first, my own swipe at those who waded in with the various kinds of comments. It’s really easy to not do a medical degree and around 10-15yrs of post-graduate training and further qualification in forensic psychiatry. It’s SO easy to not do that, most of us made that very choice … all those books and tricky exams – forget it. I was much more interested in playing my bass and ultimately joining the police, so I did a music degree with about 4hrs of lectures a week. Loads of fun listening to CDs and playing in bands.  But this is why I don’t get to assess the mental state of murder defendants.

It’s also really easy to not become a criminal judge. The same point applies – most of us aren’t. I was happy enough to study for two big law exams, which I’m comforted to know are found difficult by some who have studied law, but it was two bursts of effort as I got on with being a policeman-officer. Most of us wouldn’t qualify in these professions, even if we tried hard and it’s really easy to swipe at those who bothered to work hard enough. Nor did any of us sit in Newcastle Crown Court earlier this month listening to evidence, reading psychiatric reports and taking an overview of the legal issues affecting the facts of the case. So Facebook is probably a p*ss-poor place to look for guidance about any of it, but the comment reinforces prejudice, ignorance and makes the world a dumber place. So it needs calling out. And I’m calling it.


Firstly, everyone charged with a criminal offence is assumed to be sane and to be able to be held responsible for their behaviour and actions. If someone wishes to raise a defence to a criminal charge, it is for them (in most cases) to do so in court and they must produce evidence that mental state is relevant. Only where a court is convinced of that evidence, can a defence (or partial defence) to a prosecution succeed. Criminal defendants themselves don’t get to just ‘play the mental health card’ in court and have a trip to a lovely hospital full of X-Boxes and hot-tubs surrounded by scented candles – you cannot leave a criminal court via a sentence imposed under the Mental Health Act unless two doctors, usually forensic psychiatrists in homicide cases, say that someone is so unwell because of their mental illness that they need to be ‘sectioned’ under the Act.

So psychiatric reports are required: this means doctors examining defendants and, oddly enough, asking themselves the question of whether someone is attempting to misrepresent behaviour and symptoms so as to deceive. It’s also fair to point out, that even where psychiatrists have reached a view, this view can be tested in court by the prosecution counsel or the judge. Quite famously, in the prosecution for murders of Peter Sutcliffe (the Yorkshire Ripper), there was suggestion to the court that the prosecution would accept pleas to manslaughter on the grounds of diminished responsibility. Given the high-profile nature of the trial, the judge heard from the medical experts before deciding whether to allow this and after satisfying himself the psychiatrists had reached their conclusions on partial information, ordered a full trial for murder.

So the system has checks and balances against unscrupulous people ‘playing the mental health card’ even if they do produce some evidence relating to their mental state.


Ethan Mountain took a bag of knives, wore a mask and travelled via the Tyneside Metro system before killing the poor victim. The fact there was an element of pre-meditation is evidence to Facebook that the court, presided over by an experienced criminal judge and after hearing evidence from forensic psychiatrists, got it wrong. There’s no evidence that the Facebook jury were in court to hear the evidence available to the actual jury, but even if they were: premeditation in actions is not, of itself, evidence of murder. The opposite is also true: the fact that an unplanned and spontaneous incident results in the unlawful killing of someone, doesn’t mean it isn’t murder. Pre-meditation is not irrelevant to consider amongst the overall evidence in a case: but it’s not the single, determining variable a prosecution or jury would be interested in when determining murder or manslaughter.

And repeating this next point is crucial: Ethan Mountain was found guilty of homicide – manslaughter. He is now a convicted criminal. He did not put forward an ‘insanity’ defence which would more or less means that he didn’t know what he was doing OR did not know what he was doing was wrong, because of his mental illness. So arguing that pre-meditation means it shows he knew what he was doing is fallacious: nobody anywhere, and certainly not the criminal court, did not argue at any stage that he didn’t know what he was doing. Diminished responsibility is what the law calls a partial-defence and specifically, it only relates to murder charges: it doesn’t prevent the conviction of someone for homicide it just reduces that conviction from murder to manslaughter.

So the system does not just insist that someone is guilty of murder or not guilty of murder on the grounds of insanity: this diminished responsibility option for courts and juries is something of a ‘middle ground’ where mental health issues affect how people think and operate, but don’t completely explain things.  It reflect the inconveniently complicated fact there is no easy way to untangle the relationship between mental state and human behaviour. It’s not ALL or NOTHING.  It’s not about MAD or BAD – these are false dichotomies.


The defendant is now a patient at Rampton Hospital in Nottinghamshire. He is a s37/41 restricted hospital order patient and will remain so for many years. Facebook is convinced that this is a ‘soft-option’ where he will have things ‘easy’. Here are some facts for you about that suggestion:

  • Many patients in the secure hospital system will never be released: Nicola Edgington is also at Rampton Hospital and in her case, she was convicted of murder and sent to prison. She was then transferred from prison under the MHA and will remain in Rampton and / or go back to prison for at least 37yrs, after the criminal judge imposed that minimum tariff on her custody.
  • Average detention time in secure care (for all offences) is longer than average time in custody for comparable offences leading to prison.
  • Whilst there is a particular concern about re-offending after discharge from the secure hospital system (again, see the Nicola Edgington case as an example of this), re-offending rates were once published as being much lower than re-offending after criminal sentencing.
  • In prison, some prisoners are locked up 23hrs a day – in Rampton, patients are required to meet and work with psychologists, psychiatrists and are under observation to some degree or other by mental health nurses and auxiliaries, 24/7.
  • Discharge from hospital is complicated: it requires clinical opinion but also the authorisation of the Ministry of Justice mental health unit, who exercise responsibilities on behalf of the Secretary of State

No-one is saying this system is perfect, but I’m saying it’s far from being a ‘soft’ or ‘easy’ option. As one forensic psychotherapist from Broadmoor once said, their job is to deconstruct people who may lack proper insight in to their actions and complex difficulties with emotion, empathy and so on and help them understand what they did. This can involve bringing people slowly to the most devastating truths of how they’ve ruined and indeed ended lives, as no doubt Mrs Hoggett’s family will live with this tragedy forever. Once they get some patients to the point of despair at understanding fully what they’ve done; they can work with them positively as treatment continues. None of this means that all patients can be released – some can’t and they never will be.


Oddly enough, I didn’t really glance at the Northumbria Police Facebook page in the hope of any inspiration. It wasn’t at the thought of seeing a detailed understanding of the law or the mental health system running alongside; no thought or hope that people who were nowhere near the courtroom might defer to the those who were there, whether that be the judge, the psychiatric experts whose evidence allowed for the diminished responsibility defence or the prosecuting or defence counsel. It just strikes me the whole bloody thing is so badly understood that we have people who are so frightened of what they don’t understand, they’re screaming in to the internet, frustrated for various reasons they could actually do something about if they wanted to. I hope this blogs helps people understand why the system is as it is – and it often works, without it ever claiming to be perfect.

What happened to Mrs Hoggett is a tragedy and for all I know there may be lessons in the case around the treatment and care of Mr Mountain. It is reported he had previously been ‘sectioned’ under the civil provisions of the Mental Health Act 1983 in 2017 – whether this means anything at all in the context of this offence, we are yet to learn. Again, Facebook latched on to this snippet of information as evidence that somebody, somewhere failed Mrs Hoggett. I can’t find anything that makes the argument clearly – but given a mental health patient has killed someone, there may well be an independent care review to follow in due course. The report in to Nicola Edgington’s care was not published until about 8yrs after the killing of Sally Hodkin so in this case, it may be some time away from appearing if a review has been commissioned. But it should be borne in mind by everyone: we cannot predict and prevent everything. We’ll have to see what’s said about whether anything went wrong.

You’re on a really slippery slope when you start second guessing experienced, highly trained professionals and juries in courtrooms who have taken the time to pour over the detail of tragedies like this when you haven’t. In many respects, it’s far easier (and it’s definitely much cheaper!) just to bang people up in prison for decades than it is to order their detention in a high-secure psychiatric hospital for treatment. Whilst the secure MH system is far from perfect, there are cases where it works well and people who have committed serious crimes are rehabilitated in a way they never would be in prison. Also important to remember that any secure-patient who is discharged is subject to a level of supervision in the community which far exceeds that for prisoners: it’s known as conditional discharge.

We’ve all got opinions on things. I think football should be definitely be banned and that idiots on FaceTube who can’t spell shouldn’t be allowed to operate electrical machinery or spread fear and loathing without prosecution. But I don’t get to rule the world, so I suspect we’ll just have to keep chipping away at the ignorance which abounds in the hope of making painfully slow progress.

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

Winner of the Mind Digital Media Award


All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019

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 –