Too many bad outcomes for mentally ill offenders

FRIDAY, OCTOBER 21: Two recent cases have put services for mentally ill offenders at the top of the news agenda. 

And after reading the comments from lawyers, hospital staff and the Attorney General, it seems that this is not before time.

The most recent case is that of Shiloh Payne, a schizophrenic who has been sentenced to an indefinite period in a psychiatric unit after carrying out a vicious attack on his neighbour with a screwdriver.

According to reports on the case, Payne had not been taking his anti psychotic medication for several months.

As anyone who has knowledge of schizophrenia will know, withdrawal from medication can lead to paranoia, delusions and outbursts of violence.

The second case involved a sexual assault on a five-year-old girl by Merrick Seaman who also has severe mental health problems.

At the time of the attack in July 2010, the 25-year-old was an outpatient at the Mid Atlantic Wellness Institute (MAWI).

In this instance he was jailed for eight years and it has been said that Seaman will need “continued supervision” after prison.

Sentence

So in one case we have a sentence for an unspecified period at the very same facility (MAWI) that Payne had already attended numerous times before the attack on his neighbour. In the Seaman case it is Westgate prison.

In the absence of a long stay high security unit on the island, capable of dealing offenders with severe and ongoing mental health problems, these outcomes can only be viewed as the best of a bad lot.

Now the issue of a Mental Health Court has been raised again — something that has been toyed with over the years.

The argument here is that cases involving mentally ill offenders should be properly reviewed under the Mental Health Act so that they don’t just slip through the net.

Both Payne and Seaman were well known to mental health services but the message is that supervision and legal controls need to be tightened up.

In the UK, there is a Mental Health Tribunal system consisting of a lawyer, a medical expert and a layperson (though the ‘lay’ person is usually someone who has worked in a health or social services environment).

To all intents and purposes these tribunals are a ‘court’ whose main role is to review the case of a detained mentally ill person and to make decisions about any psychiatric patient leaving hospital.

When someone is released from a hospital, the tribunal can insist on an aftercare package including appropriate giving of medication.

But this tribunal system only works when the follow up care is properly carried out. There have been several high profile cases in the UK where patients have been released back into the community only to be badly let down by care teams who don’t have the skills or resources to ensure that they get the support needed.

Several of these mentally ill patients have then gone on to kill people and these extreme cases are often linked to them not taking crucial medication.

Victims

The flip side of the coin is that inadequately supervised mentally ill people can also be a danger to themselves and be exploited by other people.

More often they are the victims of crime rather than perpetrators. 

There has to be a balance between care of mentally ill offenders outside secure facilities and safety of the community at large.

But the two recent cases here in Bermuda have highlighted real gaps in mental health provision.

These need to be addressed both in terms of the legal structure — whether it is a specialist mental health court or tribunal system — and in terms of available long-term secure facilities.

Apparently, there is already a ‘statement of intent’ to allow patients with severe problems like schizophrenia to be treated in a secure facility in England.

It seems that this was agreed by the UK Government and the Bermuda Hospital Board in October 2010 and to date there has been no uptake.

Perhaps it’s time to turn a statement of intent into a reality? Or failing that, prepare to beef up the island’s existing facilities.

Maggie Fogarty is a Royal Television Society award winning TV producer and journalist currently living in Bermuda.