Management Of Restricted Patients

Tighter safeguards on the management of restricted patients are to be introduced following the Mental Welfare Commission Inquiry into care and treatment that was set up following the conviction of a conditionally discharged patient for culpable homicide in March 2005.

Responding to the report on behalf of the Executive, Deputy Minister for Health and Community Care Lewis Macdonald announced changes which go beyond the recommendations of the report in building new protections for the public.

Mr Macdonald said:
“The protection of the public is paramount and we must act at all times in recognition of our duty to the public. We accept the findings of the Mental Welfare Commission Report and welcome the recommendations that have been made.

“Medical treatment and risk management are not the same. Irrespective of improvement and recovery in response to treatment, the risk posed by an individual patient must always be considered separately and determine the degree of liberty enjoyed by a patient.

“We are taking steps to address the deficiencies that have been identified by the Commission so that the public can have confidence in the services that are provided. In doing so we will go further than the Commission have proposed and build additional protections into the system.

“Effective risk management requires that all those engaged in a patient’s care have an understanding of the risks presented by the patient and of factors that might suggest a relapse in the patient’s condition and be prepared to act where those factors appear to be manifest.

“The changes that we have introduced are intended to strengthen the systems in place to ensure that professionals are working together effectively and within a framework of appropriate safeguards.”

Changes following the report:
As recommended, guidance is being issued today to Directors of Social Work that all restricted patients under supervision in the community should have a designated social worker accredited as a Mental Health Officer or a social worker who is directly supervised by a Mental Health Officer who will be directly involved in reviews of the supervision and care of the patient

Changes where the Executive is expanding on recommendations:
Recommendation: Formal written risk assessment and risk management plan, should be in place, before submitting a recommendation for Conditional Discharge
Response: These plans should be in place not just before Conditional Discharge, but also before consideration is given to unescorted leave (which is the point at which the patient is being tested out in the community), and those documents must be shared and understood by the clinical team working with the patient

Recommendation:
The Executive should identify the competencies that it expects in Responsible Medical Officers caring for restricted patients

Response:
Competencies will be developed, and the Executive will also work towards introducing an accreditation scheme for all Responsible Medical Officers working with restricted patients that will take account both of learning and assessed competence, including assessment of practice or performance. The aim is to introduce this scheme by April 1, 2007.

Additional work moving on from the recommendations:
The Executive has also invited the Risk Management Authority to review the arrangements in place for the assessment and management of risk in respect of restricted patients and to report to the Executive by the end of 2006

The MWC is an independent body which has duties in respect of the care and treatment of patients. Following the conviction of the patient in question the First Minister invited the Mental Welfare Commission to investigate the circumstances of the incident and to report to him.