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MENTAL HEALTH - dangerous lunatics in insecure units

More than 100 patients escape from secure hospitals
By Ben Padley, PA
Tuesday, 9 September 2008

There were more than 100 escapes from psychiatric hospitals in England and Wales last year, it emerged today.

According to figures released to the BBC, at least 116 patients in medium and low security psychiatric hospitals escaped from the institutions or from their escorting staff.

Four patients remain at large. That compares to just five escapes from prisons and their escorting staff in 2007.

The number of escapes from hospitals amounted to 23 times more than from prisons.

The investigation comes in the wake of the case of Darren Harkin who raped a schoolgirl after absconding from a psychiatric unit.

The 21-year-old had also been allowed to build a vast collection of horror and pornographic DVDs while being detained for repeatedly stabbing his six-month-old step-brother to death in his cot.

Reading Crown Court heard how he escaped from the low-security Hayes Hospital, near Bristol, and brutally raped a 14-year-old girl.

Yesterday, Harkin, 21, was made the subject of a hospital order under the Mental Health Act and detained indefinitely at maximum security Broadmoor Hospital.

Former chief inspector of prisons, Sir David Ramsbotham said today's figures were "horrifying".

He told BBC Radio 4's Today programme: "It is a horrifying figure of course, but it's not one that surprises me because the medium and low secure units in the NHS do not have same degree of security a prison does."

He added: "The wake-up call is actually to the Government to build more facilities inside prisons because the public will know that those prisoners who have been sentenced for a crime and have mental health problems are being properly looked after inside what is essentially a secure place."

Professor Louis Appleby, national director for mental health in England, told the programme there had to be a "mature debate" in society about the appropriate care mentally ill people received.

It was an "inevitable consequence" some patients could escape from units as part of the "balance" needed between risk to the public and a "humane mental care system".

The incident involving Harkin was "appalling" and there was an inquiry under way.

He said: "It is important to understand what the figures mean.

"Obviously the incident which was in the news yesterday was an appalling incident and it quite clearly shouldn't have happened.

"There will be some very serious questions about the care that man received and the treatment decisions that were made and there is an inquiry going on which will report at the end of this month."

"On the broader issue... it is very important to understand what low-secure is for from a clinical point of view.

"The person in a low-secure unit is a person with a long-term low-grade illness such as schizophrenia. They are not a person who is a highly dangerous individual."

Professor Appleby said comparing escapes with those from prisons was not a "reasonable comparison".

"There is a difference here between a prison and a secure unit - a secure unit is a hospital - the people who are in it are patients and they are ill," he added.

"If you give the impression that there are 100 people are getting out and roaming the streets and threatening the public that is not an accurate impression about the risks that the mentally ill people present to the public."

He went on: "A prison removes people from society, a secure unit prepares people to return to society - its purpose is treatment and rehabilitation.

"If it's a humane society, we want people to return to normal life then we will have to accept the clinicians will make decisions which balance the risk people present and the care they need to receive to help them live a normal life."

He added: "We have to accept that a humane mental care system prepares people for life outside hospital and if some low-risk people are occasionally out of the hospital when they shouldn't be, that may be part of, it is not acceptable, but it is perhaps an inevitable consequence of getting that balance right."

Vote: Should dangerous lunatics be put down as it serves no purpose to keep them alive at taxpayers' expense?

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Members Comments

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dignitas 17-Oct-2008 21:2
i would say NO because killing someone who is 'mentally ill and dangerous' could mean anything and would allow our government greater freedom whilst eroding even further our liberties, afterall what constitutes mentally ill and dangerous? a serial child rapist, a repeat protester, someone throwing eggs at Gordon Brown?
ROBERTHBROWN 21-Sep-2008 13:52
Everyone has the potential of being dangerous to society, but should everyone also be put down because they could be considered dangerous. Mental health is an extremely difficult thing to deal with and access. Should someone with a mental health episode who became unstable and committed one of these terrible crimes whilst "Off their heads" so to speak be put down like a dog without the chance to become well again yet never to repeat such a terrible thing. If it happened to me ... I hope I would be given a 2nd chance to prove that just because I became mentally ill and did something so horrible and then got better having no memory of what I had done whilst unwell and then being told I was going to be put down ... I hope you would have mercy on me and spare me.

It is down to the medical experts to monitor my health & access my danger to society. If I am dangerous to society, I need to be held secure and medicated to reduce the risk that I may be to others including the medical staff.

I say NO to the question that has been presented.
steeleyespan 13-Sep-2008 8:4
Yes Andromeda I know that mentally disordered people DO commit violent crimes and serious sexual assaults (they are the people I work with) none of the examples you give relate to people who had escaped from their detention at the point when they committed the offence.

Now you are introducing a wider debate and I am assuming that you are not calling for the euthanasia of all mentally disordered people and would limit the 'solution' to those who have already committed violent crimes. Inquiry after Inquiry into the care and treatment of those who go on to kill and maim (usually a member of their family rather than a stranger) show that there are warning signs of deterioration in mental state prior to the tragedy occuring and often carers have tried, unsuccessfully, to get help for the sick person. It is a sad fact that if the resources available to forensic mental health services were available to community mental health teams, many of these tragedies could have been averted. So perhaps resouces could and should be more usefully spend on community mental health services...that way the number of dangerous criminally insane is reduced because they are successfully treated before they commit their violent crimes.

I believe about 12% of the overall NHS budget is dedicated to mental health services and I have no idea how much of this is allocated to forensic psychiatric services so cannot give you accurate costings for the resources you believe are misdirected.

I still believe the answer to your question must be no, simply because so many people have an improved level of mental health following their treatment and no longer pose a high risk of committing violent crimes whilst active psychotic symptoms are controlled.

Andromeda 12-Sep-2008 23:20
Reports of the mentally ill who have caused death:

1. Jonathan Zito's fatal stabbing by Christopher Clunis

2. "mentally ill man stabbed dad to death" - 05 September 2008 -
A mentally ill Clevedon man has pleaded guilty to the manslaughter of a father-of-three who he stabbed to death outside his home.

David Brown was said to have inflicted a 'single and fatal wound' to Christian Puttock with the intent to kill him, while the accused was suffering from an 'abnormality of the mind'.

His victim, a 34-year-old Merchant Navy officer, was killed on his wife Lisa's birthday, as he stood outside his home in Coxway, Clevedon.


3. A man with a history of mental illness stabbed a GP because he thought his medication was turning him into a woman.


While the Romans were regarded as civilised they were also capable of what one would call barbarism, eg the games where spectators were treated to live killing as entertainment.

I therefore take you to mean "compassionate society" when you talk about "civilised society".

Perhaps the crux of the matter is not whether we are "civilised", whatever that means, but whether we are being rational and directing our compassion in a societally useful direction.

Were all the violent and homicidal criminally insane removed, "civilised" life as we know it would still continue.

I have no doubt that it is satisfying to successfully rehabilitate someone who is mentally ill, but I wonder if resources were not better expended elsewhere where this exercise of compassion does not risk the innocent being hurt or killed by the criminally insane.

My point is that there is no compelling societal reason to keep those who are incurably dangerous and violent around.

To do so is misdirected compassion which we would do better to extend to the potential victims of the criminally insane, such as Jonathan Zito and the dad who was stabbed, because "civilised" society appears to be a meaningless platitude signifying misdirected compassion!
steeleyespan 12-Sep-2008 17:35
Andromeda the simple answer to your question is 'no those who commit crimes whilst experiencing the symptoms of psychosis or other mental disorder should not be 'put down'/ executed/ euthanised'. Unfortunately, you do misquote the statistics that I produced as they certainly do not relate to all violent or sexual index offences committed by Mentally Disordered Offenders and neither do they relate to crimes committed by 'escaped lunatics'. They merely relate to incidences of re-offending once people have received absolute or conditional discharges' from hospital. You will also note that the statistic for those committing violent or sexual crimes is not 7% but 2%. I also emphasise that there are problems comparing re-offending statistics between those on Hospital Orders and those in prison.

Having said that I do resent and refute your supposition that I am attempting to appear compassionate rather than acknowledge and recognise risk. In fact I would venture to suggest that my knowlege and awareness of risk is heightened because I work day in, day out with those who have been detained in hospital by the courts. I am also pleased to note that the medium secure unit where I work is not one of those in the figures quoted by the BBC Today programme.

Now I am interested to find out exactly how many 'escaped lunatics' have committed violent and sexual crimes whilst they have been 'absconded from hospital'.

As dreadful and serious as this recent case has been and the inquiry into what happened may well reveal that this particular individual should have been detained in a higher level of security than a 'low security' establishment, I am going to guess that there will be very few recorded incidents of violent and sexual crime committed by absconders.

Before you lynch me I also happen to believe that ONE violent or sexual crime against an individual, by anyone, either mentally disordered or otherwise is one too many and cannot and should not be tolerated by society. However, for the mentally disodered offender I do believe that treatment and therapeutic intervention is the correct way for a civilised society to go. I am proud to be part of those interventions and when a person's mental disorder is successfully treated and the individual can be safely and successfully returned to the community, it makes my job worth while.
Andromeda 11-Sep-2008 21:45
"steeleyespan" may be aware that I am in favour of the death penalty for those who have killed for no good reason, whether judged insane or not.

I notice that she does not give the ACTUAL numbers of ACTUAL violent assaults and killings committed by the criminally insane and has reduced them to a percentage or a mealy-mouthed "fewer than 1 in 10".

Perhaps details of who and how many were killed and seriously assaulted in what circumstances by the criminally insane will bring the matter to life for people who so loudly preach compassion and understanding.

One escaped lunatic who maims and kills anyone who does not be deserved to be maimed or killed by a lunatic is one too many.

I suppose people like you carry on like this because they think it would never happen to them and their loved ones, while I carry on as if it would and has.

Perhaps they are not being as empathetic and compassionate as they make themselves out to be since they appear to be giving more importance to their ability to appear compassionate while dismissing the actual risk that real people with real dependents capable of being hurt and killed, face.

The fact that the phrase "criminally insane" has been withdrawn and substituted with a catch-all "mentally ill" does a great disservice to those who are merely depressed, catatonic, manic, neurotic, suffering from OCD etc but not actually dangerous.

I will make another attempt at asking the question:

Should the incurably violent, homicidal and criminally insane be put down and prevented from being either a burden or menace to the taxpayer?

If not, why not?
steeleyespan 11-Sep-2008 17:40
A 'defect of reason' should be synonymous with a 'mental disorder' as currently defined by the Mental Health Act 1983.

In the 1983 Act, mental disorder is sub-divided into four categories:

• mental illness;
• mental impairment;
• severe mental impairment; and
• psychopathic disorder.

New mental health legislation will scrap the four categories and will introduce a broader definition of mental disorder. The new definition will be 'any disorder or disability of the mind'

Relevant to the proposal that dangerous lunatics should be euthanised/executed rather than receive treatment in hospital (like other sick people) are the available statistics in regard to re-offending following successful treatment and reintegration into society.

Re-offending rates for those first discharged from forensic services into the community are extremely low compared to those among people released from prison. 843 patients were discharged for the first time between 1999 and the end of 2003. Of the 717 matched cases (those located on the Police National Computer), fewer than 1 in 10 (7%) of those people re-offended within two years of discharge.

Of those released and matched, 2 per cent re-offended for violent or sexual offences. In comparison, the overall re-offending rate for adult prisoners within two years of release is 27 per cent for sexual offences and 46 per cent for violent offences (Home Office 2007b).
It is sometimes difficult to draw conclusions when comparing the re-offending rates of those released from prison and those discharged from forensic services. Some possible reasons for the comparatively low re-offending rates of those discharged from forensic services include:

- closer supervision of those discharged from hospital in the community than for ex-prisoners
(Section 117 of the Mental Health Act 1983).

- the nature of the original offence may have been directly related to the mental illness of the discharged person, and therefore the individual may be less likely to re-offend after receiving treatment

- admissions to forensic services include those charged but not necessarily convicted of a crime,so it is possible that they may not have actually offended in the first place;

- the impact of some psychiatric medication on lifestyle post-discharge may reduce offending behaviour;

- some people ‘discharged’ from forensic services remain in hospital voluntarily, and therefore are less exposed to the potential to re-offend.

However, the available statistics suggest that Andromeda's proposal would 'put down' people who can be successfully treated and return to life outside of the hospital setting.
Andromeda 11-Sep-2008 8:7
I have already pointed out that "dangerous lunatic" would be defined as someone who has already been convicted of arson, murder, manslaughter, GBH, rape and suchlike serious offences and have pleaded diminished responsibility because of a defect of reason under the McNaugten rules.

What is a "defect of reason"? Clearly it is something that makes us seem either mad or silly to others and causes us to make serious mistakes that no reasonable person exercising their faculty of reason would do.

Were the Aztecs mad for believing that the only way to appease their god was through human sacrifice? Or just genuinely mistaken? Were they just "going with the flow" as people tend to do or suffering from a defect of reason that we are all from time to time prone to if we aren't careful?

Methinks a comprehensive definition of insanity would be timely in our mad, mistaken and silly age. A lack of rigour and urgency in the making these distinction is surely the main cause of humanity's ills.

There is no possible benefit in keeping dangerous lunatics in secure units, only expense and the potential danger for others to suffer needlessly at the hands of the criminally insane.

If they do not escape they are a burden to the taxpayer.

If they do escape they are a menace.

Perhaps the best solution is for those who wish not to be so ruthlessly dispose of unproductive and dangerous rogue elements of society is to make them use their own money to keep them compassionately in secure or even insecure units and be personally liable for any damage, injury and death they cause when they escape.

They will soon change their tune!
jeffreymarshall 10-Sep-2008 14:52
Nice that steeleyespan's wise & well-informed comment began this thread - balancing the lunacy of the original proposal.

The mentally ill – particularly those who pose a risk, or have committed crimes - should be held securely. That’s it. Why should this be apparently so hard to achieve?

We should not start 'euthanising' people for reasons of administrative convenience – because, that is, security inside our hospitals for the criminally insane has been inadequate. Better to improve the security.

Even supporters of capital punishment should not contemplate killing those who cannot be considered wholly responsible for their crimes.

In future, perhaps, people may be euthanised for other reasons – for being a political nuisance to the government, perhaps.

Far better then not to create a precedent by which certain people who are considered an inconvenience may be disposed of at the behest of some bureaucrat from the Ministry of Terminations.

peejos 10-Sep-2008 10:30
How long is a piece of string? Who would set the parameters for assessing 'dangerous'? Once agreed some case would become notorious and the parameters would be enlarged to prevent that particular occasion. As psychiatry is by no means an exact science and the human brain virtually a blank canvas, who would make the decisons and on what evidence. Only recently there have been a number of infamous cases where so called specialists have had their own agenda which for a while was accepted as gospel and then totally destroyed on investigation.
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