Memorandum of Procedure on Restricted Patients

5 MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS

5.1 Multi-Agency Public Protection Arrangements (" MAPPA") and Care Programme Approach (" CPA") for restricted patients have a common purpose of maximising public safety and the reduction of the risk of serious harm. Although the same underlying principles of gathering information apply, CPA focuses on the care and treatment likely to minimise the risk posed, whilst MAPPA focuses on multi agency management of risk. Within the MAPPA framework, the CPA process will remain the vehicle for planning a person's care and treatment and for risk assessment and management planning.

5.2 The underlying concept of MAPPA is to provide systems and processes for relevant agencies to share information about individuals who represent a risk to the community. Where appropriate, the agencies will cooperate to put together plans to assess and manage these risks. It is important to emphasise that the remit of the Multi-Agency Public Protection Panel (" MAPPP") is scrutiny of risk assessment, information sharing and risk management plans and not an opportunity to have a case conference ⁴⁴.

5.3 As indicated in CEL(2007)7⁴⁵, as part of their responsibilities under the 2005 Act, Health Boards have to be able to demonstrate the effective establishment and implementation of the arrangements between Agencies for the management of offenders who are subject to MAPPA arrangements. Each Health Board (and the State Hospitals Board for Scotland) should therefore have identified a senior manager responsible for providing:

• the assurances on the quality of the operation of CPA; and
• the statistical information required for the MAPPA coordinator.

5.4 The Guidance note on the extension of the 2005 Act to restricted patients ( CEL 19 (2008) provided guidance on the immediate actions to be taken by Health Boards in relation to restricted patients, and explained both how restricted patients would be assessed and managed within the MAPPA framework as well as the ongoing responsibilities of Health Boards and patient care teams under the 2005 Act.

5.5 It should be noted that by complying with the Guidance for Forensic Services circulated in October 2007 ( CEL 13(2007), and by the use of the CPA detailed in that CEL, Health Boards will be able to meet many of their obligations under MAPPA. As indicated in Annex C of CEL 13 (2007), CPA is to be adopted as the mechanism for regular review of all restricted ( CORO, HD and TTD) patients; Annex B of that CEL also provides a Governance checklist in respect of the quality of clinical services provided to patients by their services and clinicians.

5.6 There are three levels of management in the MAPPA model:

Level 1 Ordinary Risk Management

Level 2 Local Inter-Agency Risk Management

Level 3 Multi-Agency Public Protection Panel ( MAPPP)

5.7 The management of restricted patients, including those on conditional discharge, will normally be at Level 1 or 2. A MAPPA level can normally only be allocated by the MAPPA Group when a patient is being considered for unescorted ground parole, suspension of detention from hospital (granted under section 224 of the Mental Health (Care and Treatment) (Scotland) Act for restricted patients) ( " SUS") or conditional discharge.

5.8 The MAPPA coordinator must be notified immediately following admission to hospital of a restricted patient. The Local MAPPA co-ordinator should also be notified when a restricted patient is transferred between hospitals or returned to prison. The MAPPA Notification Form must be used.

5.9 There are 3 key stages at which a MAPPA referral must take place, using the MAPPAReferral Form :

• when the patient is being considered for unescorted ground parole or unescorted SUS for the first time - following scrutiny of the risk assessment and management plans MAPPA will indicate whether or not they are content with the plans. Once agreement is reached the Responsible Medical Officer (" RMO") should submit the request for SUS to the Scottish Ministers in the usual way;
• when suitable accommodation has been identified in the community as part of the planning for conditional discharge - SUS may continue as usual whilst this process is underway; and
• when the RMO is considering recommending the revocation of the compulsion order or the revocation of the restriction order.

5.10 However, there may be occasions involving transfer or escorted SUS from the State Hospital when the risk is considered to be high. In these exceptional cases a referral to MAPPA level 2 may be appropriate. However, a police view should be sought before a decision is made to make a MAPPA 2 referral. Other examples of possible MAPPA 2 referrals:

• if a patient is already on unescorted SUS or unescorted ground leave and the care team considers the risk presented by the patient might be best managed at MAPPA Level 2 or above; or
• if a patient is on conditional discharge and the clinical team and others involved through the CPA process consider the risk presented by the patient might be best managed at MAPPA Level 2 or above.

5.11 The RMO leads the contribution to MAPPA in respect of restricted patients under his or her care. The RMO is responsible for making patient Notification and/or Referrals to the local MAPPA co-ordinator at appropriate points and copying these documents to the Scotland Government Health Directorate (" SGHD"). Further details of the MAPPA processes are contained in CEL 19 (2008)⁴⁶ and in the following chapters relating to SUS, conditional discharge and revocation of the compulsion order or restriction order.

5.12 The Scottish Ministers will reflect in their Position Statement for submission to the Tribunal the following information - A MAPPA meeting was held on [date]. MAPPA level is [state level]. The MAPPA group support the recommendation by the RMO for unescorted SUS.

5.13 For those Tribunals considering conditional discharge, revocation of the compulsion order or revocation of the restriction order SGHD will contact the relevant MAPPA co-ordinator to request that a Minutes Executive Summary be prepared for lodging at the Tribunal (which in turn will be copied to the patient and other parties ).

5.14 The table below is the proforma of statistic collected on restricted patients.

RESTRICTED PATIENTS ( RP'S):	NUMBER
a) Number of RP'S:
i) Living in your area on 31 st March 09:
ii)During the reporting year:
b) Number of RP's per order:
i) CORO:
ii) HD:
iii) TTD:
c) Number within hospital/community 47:
i) State Hospital:
ii) Other hospital no unescorted SUS ( SUS):
iii) Other hospital with unescorted SUS:
iv) Community (Conditional Discharge):
d) Number managed by category between 1 April 2008 and 31 March 2009: 48
Level 1 - ordinary agency risk management:
Level 2 - through inter agency risk:
Level 3 - MAPPA, (critical few):
e) Number of RPs convicted of a further crime of sexual harm or non sexual violence 49:
i) MAPPA Level 1:
ii) MAPPA Level 2:
iii) MAPPA 3:
f) No of RPs on SUS:
i) who did not escape/abscond or offend:
ii) who escape/absconded:
iii) who escaped/absconded and then offended:
iv) where escapes/absconsion resulted in withdrawal of SUS:
g) No. of RPs on Conditional Discharge:
i) who did not breach conditions, not recalled or did not offend:
ii) who breached conditions (resulting in letter from the Scottish Government): 50
iii) recalled by the Scottish Ministers due to breaching conditions:
iv) recalled by the Scottish Ministers for other reasons:

SUMMARY OF PATIENT JOURNEY (CHAPTERS 6-14)

ADMISSION [ CHAPTER 6]

• Predisposal orders
• Post disposal orders and directions
• Transfers from outside Scotland

MANAGEMENT IN HOSPITAL [ CHAPTER 7]

• Admission/three month report
• Annual reports
• Mental state and appropriate detention

SUSPENSIONS OF DETENTION [ CHAPTER 8]

• Application and feedback
• Types of SUS

Programme of planned SUS

• Grounds leave/access
• Emergency SUS
• Change in RMO

TRANSFERS [ CHAPTER 9] Transfer to another ward within the same hospital Transfer to another hospital with equivalent level of security Transfer to another hospital involving a reduction in the level of security Transfer to the State Hospital from conditions of lower security Transfer to Scotland Transfer from Scotland		TRANSFERRED PRISONERS [ CHAPTER 13] Transfers between hospital and prison Release on licence SUS
		TRIBUNAL [ CHAPTER 14] Applications by patient or named person Review of CORO Review of HD or TTD References by Scottish Ministers Hearings Appeals to the Tribunal by patient or named person Appeals from Tribunal to the Sheriff Principal by a variety of parties Appeals from Tribunal to the Court of Session by a variety of parties Reports and attendance Excessive security
PLANNING FOR CONDITIONAL DISCHARGE [ CHAPTER 10] Appropriate Conditional Discharge Information for the Tribunal Pre-discharge procedures Information to the supervisors Conditions of discharge
MANAGEMENT WHILST ON CONDITIONAL DISCHARGE [ CHAPTER 11] Reporting requirements Role of supervisors Liaison with other professionals Changes in location or supervisors Breach of conditions Concern about patient's condition

END OF SPECIAL RESTRICTIONS [ CHAPTER 12]

• CORO patients: either revocation of the compulsion order (which simultaneously revokes the restriction order) or revocation of the restriction order (in which case patient drops down to Part 9 of the 2003 Act
• HD patients: revocation of the hospital direction, or earlier release of the prisoner from their term of imprisonment [ CHAPTER 13]
• TTD patients: revocation of the transfer for treatment direction, or earlier release of the prisoner from their term of imprisonment [ CHAPTER 13]