We heard news last Thursday (24th January) a mental health patient had been moved from one hospital to another – transferred under s19 MHA, if you must know. It’s hardly headline stuff and yet it reached the BBC News website and people were interviewed about this. I’m not sure how much more newsworthy that would be if I had prefaced the word ‘hospital’ with use of the adjective ‘secure’. Moving a patient between one secure hospital and another is quite routine stuff – it happens in our NHS that patient’s needs change over time and they are moved between healthcare establishments. Well, this is what happened to Ashworth Hospital patient John Latus.
Mr Latus was convicted of murder in 2003, having killed his friend Colin Foulkes in Shrewsbury in 2001. This followed his conviction in 2002 for manslaughter (on the grounds of diminished responsibility) after he attacked and decapitated another Shropshire man before driving to North Wales where he attacked his mother, fracturing her skull. He was also convicted of attempted murder on her. When first convicted in 2002, he was given a restricted hospital order (s37/41) and admitted to a medium secure psychiatric unit.
After his murder conviction in 2003, he was imprisoned (the mandatory punishment for murder is life in prison) and from there, he was transferred back to the mental health system, and on this occasion, Ashworth High Security hospital in Merseyside. He has remained in their care ever since, until he was transferred recently to a medium secure unit in an unspecified location. This has naturally led to consternation, understandably including family. Julian Sander’s family has stated they will campaign for a change in the law, as they weren’t informed that he was transferred and have said the transfer is ‘a safety risk’. I want to try to reassure them and others as to why it’s not almost certainly not.
(I say “almost certainly not”, because everything is a safety risk, to at least some degree – having or keeping John Latus in Ashworth is a safety risk. But this decision should not only have been thought through carefully, but then authorised by a multiple people not always known for positive risk-taking.)
THERAPEUTIC SECURITY
Most ‘normal’ mental health units, for adults who are sectioned, are not considered part of the ‘secure’ mental health system. Adults of working age and older adults, when they are admitted to hospital are on ‘acute’ wards or rehabilitation wards as part of their care. But when the word ‘secure’ is used, it means something else – and we have various levels of therapeutic security within our mental health system. Imaginatively, they’ve called this ‘low’, ‘medium’ and ‘high’ secure care. We have three high secure hospitals in England – Ashworth (Merseyside), Broadmoor (Berkshire) and Rampton (Nottinghamshire) and then one more in Carstairs, Scotland. Welsh patients usually end in Ashworth, Northern Irish patients in Carstairs and female high secure care is often provided at Rampton Hospital, which has specialist units for female psychiatric patients in the most restrictive of settings.
‘Underneath’ those, are a network of medium and low-secure hospitals of various sizes. Most urban conurbations have at least one, often more, medium secure units, for example in Birmingham has Reaside Clinic and the Tamarind Centre – both MSUs for adult men; it also has Ardenleigh an MSU with two parts, 2/3rds female patients and 1/3 children and young people. Those units, although physically in Birmingham and run by Birmingham & Solihull mental health trust, receives patients from all over the West Midlands region. John Latus, being originally from the West Midlands region could have been transferred there or to the other regional MSU in Stafford.
One thing worth bearing in mind: High Secure hospitals are as ‘secure’ as a Category A prison – trying to get authorised admission to Ashworth is arguably as hard, if not harder than trying to get admission to Belmarsh prison. A medium secure unit is as ‘secure’ as a Category B prison, roughly speaking – many officers may have experience of trying to get in to them, because of police attendance at MSUs for various reasons and will now how hard it is with high walls, razor wire, timed lock-doors and central security control. Then, there are various internal locking doors for which staff carry keys, just like in the prison system. Keys are tightly controlled. It is this type of unit that John Latus appears to have been moved without any suggestion that he will be discharged soon.
SECURE DISCHARGE
When he was first imprisoned for murder, his movement to hospital would have been a prison transfer under section 47/49 MHA – this is known as a restricted transfer direction and has to be authorised by the Secretary of State for Justice. Once he’s arrived in Ashworth, it means he is then treated there as if he had been admitted under s37/41 on a restricted hospital order. Latus was told he would serve a minimum of 19yrs in jail before he could be considered for parole so now he’s in the clinical, secure system, the parole authorities will take account of his ongoing care AND the Secretary of State must maintain oversight and interest because he’s now a restricted patient, by virtue of his transfer. He will remain in the hospital system until he is clinically well enough to leave and this can happen in one of two ways.
- He is deemed to no longer require inpatient mental health care so he ‘remitted’ back to prison under section 50 MHA – this means he then serves his life sentence as normal until such time as the parole board authorise his release, if they ever do.
- OR, if the doctors were satisfied he was fit for discharge from hospital AND the Parole Board were minded to release him from prison, then and only then could he be discharged in to the community – there is nothing in this news of his transfer to an MSU which indicates this is imminent.
If at some stage in the future the clinicians in charge of his care are minded to discharge AND the Parole Board agree on full release, he will be discharged from the restricted system under what is known as ‘conditional discharge’, see section 42 MHA for more details. This essentially means, he’s released subject to conditions (residence, medication, drug testing, curfew or whatever’s considered relevant) and if the view is taken that there are problems in the community, any conditionally discharged patient can be recalled to hospital under s42(4) MHA.
REASSURANCE
In short, there’s nothing really to see here – and if there comes a point where MSU care should leave to authorised leave from hospital or further transfers to low secure care, then we could see a position that someone is discharged conditionally to a community forensic team. From this point, that could take years yet – there’s certainly no indication it may happen soon and my best guess is that it would be highly unlikely. Not unheard of and NHS services do on occasion get this stuff wrong; but in fairness to them, there are two things worth bearing in mind –
- Re-offending rates by restricted patients discharged from care are very low compared to those we see after release from prison.
- The recommendation to discharge from secure care cannot be taken by the doctor(s) alone – a ‘restricted’ hospital order or transfer direction does not restrict the patient, it restricts the doctor(s) in charge of their care.
Restricted patients cannot be discharged from a secure hospital, transferred between secure hospitals or authorised to take leave from a secure hospital unless that opinion is supported by the Ministry of Justice mental health team, acting on behalf of the Secretary of State. This means filling in a lot of forms, including detailed risk assessments, etc., and the MoJ are prone to saying, “No!” to requests psychiatrists have made for permission to grant leave, transfer or discharge.
The rules on informing families of homicide victims about things is that families are entitled to know when prisoner-patients are released, or granted leave. The fact that someone is moved from one hospital to another is not currently within the list of things they must be informed about. Take your view on that, by all means – I’m merely outlining why this may not have happened. Perhaps we can see why: news of this transfer has led to outcry when the real punchline here is that a patient has been moved from Category A type security to Category B type security. Still quite hard to break out of a Cat B prison, even if you are inclined to try.
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.
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Mental Health Cop 
Thanks for the reassurance – appreciate your clarity.
There are a couple of things here that I’m not sure are strictly accurate.
There’s reliable evidence to show that that re-offending by restricted patients is not actually very low.
Some studies show around half of those released from psychiatric medium secure units commit further crimes, and that around 14% go on to commit very serious offences.
eg: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/longterm-outcomes-after-discharge-from-medium-secure-care-a-cause-for-concern/42D9D2C682AB8E2A7319640B4A0723CF
A study by Baxter (Journal Forensic Psychiatry Vol 10 No 1 Apr 1999) following up 63 patients released from the Bracton Centre Medium Secure Unit found that two thirds – 67% – had reoffended violently within ten years.
It is true that restricted patients need the say so of the Ministry of Justice to be released (in reality a civil servant from the Mental health case work section), but in reality they can only go on what the treating clinicians tell them, which can sometimes be inaccurate and/or over-optimistic (particularly if there are pressures on beds and the need to move people on).
You’ll remember one of the findings of the Nicola Edgington inquiry (who was also held at the Bracton) was that:
“Correspondence to the Ministry of Justice did not fully reflect Ms A’s behaviour and presentation”
(This was of course a patient who had previously killed her own mother, so the clinicians & social supervisors clearly knew what risk she posed when unwell).
The investigation also found that:
“The care team were too ready to accept Ms A’s account of potentially worrying situations, and not enough weight was given to alternative accounts and no attempt was made to get the views of family members involved”
and
“Ms A’s potential risk of violence to others in the community was not adequately considered by her care team, particularly on occasions when there were worrying reports about her behaviour”
And this is not an isolated case – the Ministry of Justice current official guidance for social supervisors says:
58. A repeated theme in reports into homicides committed by discharged restricted patients is the reluctance of supervisors to send reports to the Ministry of Justice that showed clients in an unfavourable light. It is absolutely crucial to the effectiveness of your supervisory role that reports should be comprehensive and honest. Reports should never overlook or minimise problems for fear of jeopardising the patient’s progress. This is not in the patient’s interest and can lead to the most serious consequences.
Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/631276/guidance-for-social-supervisors-0909_2.pdf
My understanding is that victims’ families should be informed about any change in an offender’s circumstances, particularly around leave, as they are often asked about potential exclusion zones.
All valid stuff, and I’ve learned a few things there. The remark I made (admittedly without sourcing it) about re-offending rates is a comparison with re-offending rates when compared with prison or community sentencing from the courts. That’s normally measured over 2yrs, not a decade, and it’s markedly lower (based on the literature I’ve used to find out). Fully accept over a 10yr period it can only be higher still, but as I don’t know reoffending rates over 10yrs from prison and community sentences, it’s hard to comment on how the comparison holds. I’m really glad I now know about the 67% figure, though as it helps further contextualise it and I hope readers of the blog know I’m not trying to push a particular agenda (other than keeping cops out of trouble for things that aren’t really their fault). Have argued elsewhere the oft-repeated trope of ‘no more violent’ doesn’t hold up to scrutiny in several important different ways.
Thanks for commenting.
Thank you 👍 newish AMHP here. You are so good at explaining issues with total clarity. Don’t stop please I read everyone 😊