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ANNEX B2
RISK MANAGEMENT
1. The criteria for a restriction order is set down in section 59(1) of the Criminal Procedure (Scotland) Act 1995. This criterion is concerned only with risk to others: "…. risk that as a result of his mental disorder he would commit offences if set at large…". Where a restriction order is under consideration there would be expected to be detailed consideration of the background history and current index offence and its circumstances.
2. When a person is given a compulsion order and restriction order (or equivalent) and admitted to the mental health system, the Scottish Executive Health Department ( SEHD) is responsible for assessing and managing the risk that person presents. To do this it is necessary to have good quality information on particular aspects of the patient's background and their treatment and progress in hospital. Detailed risk assessment is a key part of this process.
3. Risk assessments may be carried out using protocols or assessment tools that have proven validity for the category of people that the assessed patient falls into ( e.g. mentally disordered offenders, prisoners, sex offenders). In most cases where mental disorder is also an issue, the assessment should consider not just statistical (or actuarial) assessment but attempt to place the risk the patient presents in the context of his/her past history and current offending (clinical risk assessment). More specifically this means:
- personal and family history;
- criminal history and history of violence;
- substance misuse;
- psychiatric history;
- assessment of personality; and
- other relevant risk factors for the population group the patient falls into ( e.g. sex offender risk factors).
4. In preparing reports for the SEHD it is important that the RMO should also address the issues below:
- whether the patient is detainable under the 2003 Act and if so for what reasons;
- the level of security which the patient requires;
- the potential risk factors in the future ( e.g. non-compliance with medication, substance abuse potential);
- the patient's attitude to his index offence, other dangerous behaviour and any previous victims;
- what is known about the circumstances of the victim and the victim's family;
- whether the patient still shows undesirable interest in the victim or victim type;
- any access to the victim or victim type and the patient's attitude towards them;
- the outward evidence of change, how has the patient responded in stressful situations. Describe any physical, verbal or sexual aggression by the patient;
- if substance or alcohol abuse were relevant factors in the patient's previous behaviour the patient's present attitude to these and the therapeutic inputs which have addressed these;
- any outstanding issues which need to be addressed with the patient. Set out the short and longer-term treatment plans; and
- patient's attitude to supervision and the quality of their relationship with the multidisciplinary team.
5. Where the patient has a mental illness the report should address the following:
- How, if at all, the patient's dangerous behaviour relates to his mental illness;
- which symptoms of mental illness remain;
- whether the patient's condition is currently stable and whether this been tested in various circumstances;
- the effect of medication on the patient's illness and how important is it in maintaining the patient's stability;
- the extent of the patient's insight into their illness and the need for medication;
- whether the patient complies with medication in hospital, whether they do so reluctantly and whether they are likely to continue with medication outside the hospital setting; and
- what are the early signs which indicate a relapse in the patient's illness and what signs would indicate immediate action was required by the patient's multidisciplinary team.
6. Where the patient has mental impairment:
- whether the patient benefited from treatment or training and if so how;
- whether their behaviour is now more acceptable, whether the patient is unpredictable or impulsive, and how this might be managed safely; and
- whether the patient now learns from experience and takes into account the consequences of their actions.
7. Where the patient has a personality disorder:
- which characteristics are useful and which cause problems;
- which personality issues are considered to relate to the index offence;
- what treatment approaches have been adopted;
- how effective the treatment has been and in what ways this shows;
- how generalised the patient's learning has become and shows itself and how much is context specific; and
- which areas of functioning continue to be a problem, how this showed in the past and present, and how it may be managed in the future.
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