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Learning from Inquiries – John Barrett Inquiry: 

Learning from Inquiries – John Barrett Inquiry Dr Kishore Seewoonarain Clinical Director for the Forensic Mental Health Services in Essex – Runwell Hospital Dr Ann Stanley Consultant Forensic Psychiatrist/Lead Clinician – Norvic Clinic

New Trends: 

New Trends Mental Capacity Act 2005 Mental Health Act 2007 Best Practice Guidance 2007 New Ways of working for Psychiatrists 2005 New Ways of working for everyone 2007 John Barratt Inquiry 2006

Shaftsbury Clinic: 

Shaftsbury Clinic 6 Consultant Forensic Psychiatrists 7 Specialist Registrars 6 SHOs 71 Medium Secure Beds 50 Community Patients £8,000,000 revenue

Conflicts: 

Conflicts Forensic Services & Trust Medically dominated service Medical staff: Clinical v Academic

Incident: 

Incident The event which gave rise to this Inquiry was the death of Denis Finnegan whose life was cut short on 2 September 2004 when he was attacked without warning as he cycled through Richmond Park

The Inquiry : 

The Inquiry South West London Strategic Health Authority Wandsworth Council Metropolitan Police Health Circular HSG (94)27 Robert Robinson – Solicitor Jane Fenwick – NED/SHA and Associate with Healthcare Commission Dr S Wood - Consultant Forensic Psychiatrist

John Barratt: 

John Barratt Born on 1 August 1963 Of Jamaican father and mother of Northern Irish descent 3rd eldest of five children Parents divorced when he was 14 Age 6 taken into care with siblings as parents could not cope Returned to father and new partner but went back into care Suspended from school in 1979 – assault on teacher No qualifications Studied dance and drama Education interrupted because of criminal activities starting at the age 14 Singer, keyboard player and composer Short term relationships 2 long term relationships 2 or 3 children Onset of mental illness in 1995 while on holiday in Portugal

Admission to Adult Mental Health Services: 

Admission to Adult Mental Health Services

Forensic Opinion: 

Forensic Opinion 1st May 2000 Assault on GF Sexually inappropriate comments Attack fellow patient → PICU 24/5 2000 → Open Ward Dr Yates, SpR – 19 June 2007 ∆ persistent delusional disorder To warn GF about risk Sec 25 supervised discharge order Home leave as open wards would not accept him/ overruled by Prof Barnes 26/6 – threw a cup of tea at another patient 2/7 – verbally abused female patient 28/8 AWOL – returned to ward same day

Forensic Opinion : 

Forensic Opinion 6th admission (Dr Bale) Forensic opinion requested but this did not take place

Admission to Forensic Mental Health Services: 

Admission to Forensic Mental Health Services 8.1.2002 - Arrested for GBH X 3 9.1.2002 - Seen by Forensic Medical Examiner 14.1.2002 - Dr Oyebode, CFP, no abnormality in mental state 8.4.2002 - Interviewed by Dr A Bartlett, CFP 16.4.2002 - Transfer to Shaftsbury Clinic, Section 48/49 MHA 1983 23.4.2002 - ∆: Persistent Delusional Disorder with underlying narcissistic and antisocial traits. 14.5.2002 - Wider range of psychotic symptoms → impression that he might be suffering from schizophrenia

Admission to Forensic Mental Health Services: 

Admission to Forensic Mental Health Services 24.5.2002 - “… it is not honesty is always the best policy” 18.6.2002 - “do we believe GF?” 22.6.2002 - GF glad that he was not granted unescorted ground leave – risk of absconding, believing that his colleagues were making millions outside. 9.7.2002 - ∆: Persistent Delusional Disorder and Antisocial PD - Telepathic experiences - Incongruous laughter - Appears to be responding to auditory hallucinations - Other delusions (broken penis …)

Admission to Forensic Mental Health Services: 

Admission to Forensic Mental Health Services 5.8.2002 - JW told staff that patient was going to abscond on 16.8.2002, when court hearing was due. 13.8.2002 - Had asked assistance from brother, ie passport, NI number 15.8.2002 - Dr T Nayani → Persistent Delusional Disorder 6.9.2002 - Declined a bed at Broadmoor Hospital 20.9.2002 - Section 37/41 after pleading guilty to index offences Soon after - Transfer into care of Dr G Mezey, CFP, to facilitate access to psychologist 15, 29.10,2002 & 5, 12, 19, 26.11.2002 - Ward round minutes: paranoid schizophrenia Wanted to apply for passport to travel abroad following discharge in 10 months

Admission to Forensic Mental Health Services: 

Admission to Forensic Mental Health Services 17.12.2002 & thereafter - ∆: Delusional Disorder 21.1.2003 - Team willing to support C/D in March 2003 - 1 hour of escorted ground leave on 7.1.2003 - Missing OT sessions - Mental state settled in the last month but sexual innuendoes resurfaced 28.1.2003 - 1 hour of unescorted ground leave 25.2.2003 - 1 hour of ground leave per shift 6.3.2003 - Transfer medium secure rehabilitation ward 1.4.2003 - Unlimited unescorted ground leave 9.4.2003 - 1st escorted area leave to Tooting (applied for on 4.3.2003) - SHO to apply for unescorted area leave upon her return from holiday

Admission to Forensic Mental Health Services: 

Admission to Forensic Mental Health Services 29.4.2003 - Home Office had asked for enquires to be made about victims 13.5.2003 - No overt symptoms but smiling constantly ‘Had masked symptoms in the past’ 16.5.2003 - Hearing whispers 19.5.2003 - Says he had stopped his medication for one week in the previous week Asked not to be penalised for this non- compliance Late May - Poor attendance at OT 7.6.2004 - Bought flowers for RMO 20.6.2004 - Unrealistic plans on discharge: Taking it easy Partying Not working

Admission to Forensic Mental Health Services: 

Admission to Forensic Mental Health Services 21.7.2004 - 2 hours of unescorted area leave X 2 weekly 1.8.2004 - Unescorted area leave to Covent Garden with GF to celebrate birthday 9.9.2004 - Felt at risk of using alcohol and drugs Sept 2004 - Not attending any OT activities 25.9.2004 - Application for an overnight home leave 10.10.2004 - MHRT → C/D (To reside at his home address) Report by Dr Ferris, SpR Evidence given by Dr Dhar, SpR

Slide19: 

23.9.2003 27.10.2004 18.5.2004 CPA Statement of risk Early signs of relapse and action plan Care plan

Slide20: 

10.10.2003 to 23.4.2004 O/P Dr Dhar, SpR monthly Only one entry – 11.11.2003 April 2004 onwards – Dr Dein

Slide21: 

10.11.2003 4.2.2004 22.4.2004 Home Office Reports Social Supervisor Social Supervisor Psychiatric Supervisor

Slide22: 

19.4.2004 12-18.5.2004 May 2004 Hearing whispers for 48 hours but better now Stress, pressure to produce creative ideas to order Hearing voices again Admitted to Adult Psychiatric Ward, Springfield Hospital ↑ Risperidone (8→12mg daily) CPA meeting → discharge No structure today Declined to work at Old Peoples’ Home Refer to OT

Slide23: 

July 2004 29.9.2004 2.8.2004 4.8.2004 JB’s mother rang Social Worker Wildness coming back Been like that for the past couple of weeks. - JW also rang Social Worker re: Debts of £2000 Becoming cold and flat JB’s brother also contacted Social Worker Hearing voices Seen by Dr Mezey (→ 3 week leave) Urine positive for cannabis

Slide24: 

9.8.2004 19.8.2004 26.8.2004 31.8.2004 1.9.2004 Smelling of alcohol Pressured speech Verbally threatening Disenchanted by the music he was working on Seen by Dr Dein Seen by Dr Dein Dr Mezey returns from leave Plan to recall patient if he did not agree to voluntary admission Late for appointment Clearly psychotic Agreed to be admitted rather than be recalled

RMO’s Decision: 

RMO’s Decision Would prefer not to come to hospital Preferable to being recalled Remain on unit until assessed by GM Unlimited leave in secure garden Section 5(2) if patient wishes to leave Pursue recall thereafter

RMO’s Decision: 

RMO’s Decision Telephone call from GM Technically he is not informal One hour unescorted ground leave per shift If he fails to return, GM to contact HO for formal recall S 5(2) to be implemented if he wishes to leave GM to see tomorrow