Q. What is a hospital order?
The courts may make a hospital order instead of a prison sentence if they conclude the defendant needs medical treatment, which must be given in a hospital. They may do this on conviction for any imprisonable offence except murder. It is entirely a decision for the court, acting on the medical evidence. The Secretary of State has no influence.
The doctor responsible for the care of a patient with a hospital order (the Responsible Clinician, (R/C)) may give the patient leave to be in the community at his or her discretion when (s)he thinks it clinically appropriate to do so. The safety of others will form part of that decision. Where the patient is subject to a restriction order, the R/C must have the agreement of the Secretary of State to give leave. Agreement will only be given if the Secretary of State is satisfied that the leave can proceed without unacceptable risk to others. Leave may be for a brief period away from the hospital, or may extend over several consecutive days. The Secretary of State hardly ever agrees to detained restricted patients being in the community for more than one night before return to hospital.
Q. Why are high risk offenders given leave?
A Mental Health Act patient should not be given leave if (s)he presents a high risk of harm to others. Conviction for serious offences does not necessarily indicate that a patient is dangerous after receiving medical treatment. A patient who continues to present a risk to others may occasionally be allowed leave on compassionate grounds, but such a patient would be closely escorted to ensure that (s)he remains in custody.
Q. Are the local police told when the patient is out on leave?
Not on every occasion. The local force will be advised when the R/C of a restricted patient has authority to grant leave, and whether the authority is for escorted or unescorted leave.
The MAPPA Guidance requires hospitals admitting MAPPA eligible offenders (on new orders or on transfer from prison or other hospitals) to ensure that they note their MAPPA status on hospital records (so that they can consider MAPPA referral if necessary). It also requires them to notify the MAPPA co-ordinator (using MAPPA Form G) of those MAPPA eligible offenders who are, or who are about to be, discharged. If the hospital order is restricted, the police are advised by the Ministry of Justice of their location whenever it changes.
Q. Can they escape and who is told when this happens?
Yes, patients can escape from hospitals or abscond from their escorts while in the community. Where the patient is restricted, the hospital is required to inform the police and Mental Health Unit immediately.
Q. What about the victims?
Q. What can I expect from Mental Health Services at MAPPA meetings?
Where the offender is subject to a hospital order, the Responsible Clinician or other representative from the hospital or Trust should attend. In other cases, where local health services might have an input to the risk management plan, they may attend, send reports or contribute in other ways. This will depend upon the nature of the memorandum of understanding brokered locally by the Responsible Authority and Health Trusts.