MAPPA and detained patients

Teresa Hensona* and Sharon Alicia Riordanb,c

aSt Andrew’s Healthcare, Billing Road, Northampton NN1 5DG, UK; bSchool of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; cReaside Clilnic, University of, Birmingham, Birmingham Great Park, Rubery, Birmingham B45 9BE, UK

(Received 17 October 2011; final version received 3 May 2012)

Recent research indicates a positive correlation between Multi-Agency Public Protection Arrangements (MAPPA) and reduction in reoffend- ing. Multi-Agency Public Protection Arrangements were introduced in 2001 to assist with the supervision of dangerous offenders by improving collaboration between agencies involved in their management. Since then there has been research into the value of MAPPA, but this has focused on offenders in the community. Many patients detained in psychiatric hospitals have committed MAPPA eligible offences and current Government guidance does not assist those concerned in the care and treatment of this small but significant group. In this pilot study this quantitative research looks at the views of professionals in relation to MAPPA and identified that a revision of the National MAPPA Guidance to take account of the specific issues for offender-patients would be helpful to staff who manage them and that additional training to those staff may also be of benefit.

Keywords: MAPPA; risk assessment; risk management; detained offender patients

Background

Debate about protecting the public from ‘dangerous’ offenders has increased since the 1970s, notably with cases such as that of Graham Young (Bowden, 1996). However, the term ‘public protection’ has become particularly synonymous with the criminal justice agencies since the government White Paper, Crime, Justice and Public Protection (Home Office, 1990). Through- out the 80s and 90s the balance of human rights towards public protection moved slowly to produce restricted parole and longer prison sentences with the Criminal Justice Act, 2001 enshrining these principles in legislation. The Crime (Sentences) Act, 1997 had strengthened the preventative measures

*Corresponding author. Email: [email protected]

The Journal of Forensic Psychiatry & Psychology Vol. 23, No. 4, August 2012, 421–434

ISSN 1478-9949 print/ISSN 1478-9957 online

? 2012 Taylor & Francis http://dx.doi.org/10.1080/14789949.2012.692095

http://www.tandfonline.com

and this continued in subsequent legislation such as the Crime and Disorder Act 1998, Criminal Justice and Court Services Act, 2000 and Sex Offenders Act, 1997.

Throughout this time period, Probation Services began to work more closely with other agencies such as Police, Health and Social Services and risk assessment and risk management became standard practice. Registra- tion of sex offenders enabled Police and Probation services to manage risks more effectively and the informal public protection systems were built on to be enshrined in statute by the beginning of this century.

Multi-Agency Public Protection Arrangements (MAPPA) were intro- duced with the Criminal Justice and Court Services Act, 2000, where Sections 67 and 68 set out the framework for the assessment andmanagement of sexual, violent or other serious offenders in the 42 Areas of England and Wales.

Recent research undertaken by the Ministry of Justice illustrated that offenders subject to MAPPA management had a lower rate of reconviction than those released prior to MAPPA implementation (Peck, 2011).

Within health settings, there remains confusion and much debate around referral processes, despite now three hefty tomes of guidance (Home Office, 2002; National Probation Service, 2004; National MAPPA Team, 2009) and other guidance such as those published by the Probation Service in the form of circulars, (see Home Office, 2002; Scott, Grange, & Robson, 2006, amongst others).

MAPPA and mental health

The use of MAPPA in long stay psychiatric hospitals is currently at best cursory. Since its implementation, there has been research into the working and effectiveness of the MAPPA, but these have understandably been focused on offenders in the community who are supervised by the Probation Service.

The current available literature focuses very much on risk of serious harm to others by offenders living in the community being overseen by Probation and Police (see Kemshall, 2001; Kemshall, Mackenzie, Wood, Bailey, & Yates, 2005; Maguire, Kemshall, Noaks, Wincup, & Sharpe, 2001). However, the particular issues for those offenders with mental health issues and offender-patients in particular are not highlighted despite the clear evidence of ongoing failures in information exchange (Such as: NHS London, 2010; Russell Patterson; NHS South East Coast and Surrey County Council, 2009 Daniel Gonzales).

Inquiries

Inquiries since 1998 have identified the many failures of the Care Programme Approach (CPA) in homicides (Laurance, 2002). In relation

422 T. Henson and S.A. Riordan

to mentally disordered offenders, specific guidance was implemented in 2005 with the Offender Mental Health Care Pathway (DOH, 2005). However, despite almost 20 years of CPA, almost all the recent inquiries continue to cite the failures of agency collaboration as key to tragedies (Manthorpe & Stanley, 2004). Houlders (2005) argues that there are specific issues around CPA in relation to mentally disordered offenders where he identifies the balance between clinical care and risk behaviour and argues that the additional controls of MAPPA should apply.

However, MAPPA does not appear to be a significant feature in mental health inquiries. Indeed, an examination of 60 Independent Mental Health Inquires published between 2003 and 2010 identified only 6 of 24 individuals who were eligible for MAPPA registration were registered. Of greater concern was that when eligible individuals were not registered, no reference was made regarding MAPPA and no recommendations were made that registration should have applied.

Despite clear failings to register being highlighted as early as 2005 (North Central London SHA, 2005; NHS London, 2006) it does not appear that this has made any significant changes regarding registration as most of the later inquiries show. The Richard Loudwell Inquiry acknowledged that mental health services were not involved with MAPPA and made recommendations that MAPPA should be explicit in CPA documentation (South East Coast NHS, 2006) yet recent inquiries have highlighted that, ‘‘multi-agency public protection approach is not in place’’ (The Hayes, 2008, p. 48).