This document provides background information on a 41-year-old male patient who has been detained under the Mental Health Act since 2010. It details his family, social, criminal, substance use, and psychiatric histories. Regarding his psychiatric history, he has a history of psychosis dating back to 1993 while imprisoned, with episodes of relapse presenting with hallucinations and delusions. He has a diagnosis of schizophrenia. The document also discusses his risk factors such as personality traits like callousness and impulsivity, as well as ongoing risk management.
2. Mr P
Age 41
Section 37/41 MHA
Been on Kedleston LSU since June 2010
3. Born in Northern Ireland 1970
Normal birth
One of 12 children
Second youngest
Father was a Sergeant Major in the Army
Moved around regularly
Mother died in a car accident in 1976 and the
family moved to Nottinghamshire
Raised by Father
Contact with CAMHS
?ADHD
No history of abuse or disadvantaged upbringing
4. History of truancy at school
Also in trouble for smoking and fighting
Suspended at the age of 13
Left school at 16
1 GCSE in English grade 5
Painting and decorating course 1 year
Various jobs
Sacked for turning up late and missing days
Last job worked at an abattoir in Northern
Ireland 1995 for 8 months
Never married, no dependents
5. One of 12 siblings
Mother died 1976 in car accident
Father died 1999 MI
1 brother died in 1989 from a motorcycle
accident
2 brothers committed suicide
No family history of mental health problems
7. 1988 – convicted for assault
1989 – probation order for TWOC
1990 – fine for criminal damage
1990 – 18 months in YOI for burglary and
assaulting a police officer
1991 – 5 years imprisonment for indecent
assault on a female with ABH
1996 – 7 years imprisonment for 3 counts of
rape, ABH and 3 threats to kill
2006 – S37/41 hospital disposal for arson
8. Drinking all day.
Heavily intoxicated and in a „rage‟ thinking about
girlfriend who had recently left him for his friend.
Felt life was being „unfair‟ and everything was
going against him.
A woman was walking in front of him. She was
about 40 and he thought she was good looking.
He overtook her and gave her a „peck‟ on the lips.
She looked shocked. He was then full of rage and
head-butted her. He started hitting and punching
her. Fractured nose, suspected fractured cheek
bone and multiple lacerations
He dragged her to a grass verge, pulled her
knickers down and put his finger into her vagina.
9. Reports say that over a period of time he raped his
niece, assaulted her and made threats to kill.
He reports that he had been drinking with his sister.
Dropped off at her house
Her daughter L (aged 16) had been asleep in lounge.
He followed her upstairs but said he had not been
planning anything then.
He went to L‟s room to „talk to her‟. Became
aroused, started kissing her and she had told him to
get off and fallen on the fall. L had said that he had
hit her
He put her back on the bed and had sex with her. She
did not consent.
Made her commit a further sexual act whilst he was in
possession of a knife
Did not think of L as his Niece.
10. Regretted what he had done, went downstairs to
get knife. Asked L to kill him with the knife „in
the kidneys‟
Told L he would kill her if her Mum came in the
room after she had returned home.
He then went to bed.
Said he was „pissed up‟ and the „opportunity was
there and I took it‟.
Denied having mental health problems when
arrested and sentenced.
Arrested 12 hours later
Released 1999
11. Day prior
Cut his throat with an intent to die
Distressing auditory hallucinations
Been using crack cocaine
Attended A&E and discharged
Voices intensified
Female voice telling him to kill himself/set a fire.
Worse at night time.
Caused him to feel low and distressed.
Lit a fire in response to command hallucinations
Set fire to TV cabinet using clothing
Informed warden who contacted Fire Brigade
Seen day after arson in prison
Auditory hallucinations every night several years, no increase
in intensity/frequency, stable mental state, slightly low
mood but no evidence of relapse
12. Age 14 hearing noises and voices. Remitted
spontaneously
3 previous admissions including prison transfers
and informal admission.
First psychotic illness 1993 whilst imprisoned for
indecent assault.
Paranoid, thinking people were talking about him.
Hearing the voice of his dead brother externally
Felt there was a conspiracy against him and that
somebody was trying to kill his family.
Self neglect (stopped eating, drinking, washing)
Tried to hang himself by his laces.
13. Episodes of relapse tend to present similarly
Visual hallucinations of people in his cell
Feels people read his mind and will know about
his offences
Observed responding to unseen stimuli
Holds conversations with himself
Laughing inappropriately
Grandiose delusions “Son of God”, “devil has put
part of my brain under control”
Believed his brother entered his body and forced
him to commit rape
15. 1993 – attempted hanging
1996 – twice lacerated his neck in prison
2000 – overdose
82 paracetamol, 50:50 whether he would live
2006 – lacerated his neck
2006 – arson in a suicide attempt
16. October 2000 – sex in lift with mentally unwell patient
“it‟s always them coming onto me”
August 2008 – romantic interest in an OT.
Sent her a letter. Minimised incident „just a card‟
October 2008 –
Making sexual gestures behind backs of female staff
Put patient in a headlock and pulled him to the floor
Assaulted staff
Refused to answer questions, no remorse, inappropriately smiling
Has persistently minimised since, „not in control of actions‟
February 2010 –
Demanding to drink alcohol on ECL
Blamed staff for lack of clarity re S17 leave
Protested by climbing on roof of smoking shed
Threw a bowl at staff
AWOL – intoxicated
No remorse, thought he should be rewarded as he returned by himself
17. June 2010 – overfamiliar with female staff
April 2011 – AWOL, intoxicated
December 2011
Allegation of indecent assault against HCA
Protesting his innocence by going on hunger strike
No present charges
Prior to above incident was having large amounts of
unescorted leave
Currently
All leave suspended
Remains isolative
Refusing to speak to RC
Wants to be transferred to a different hospital
From review of notes he has done no SOTP work to date
18. Wathwood hospital 2007
Still affected by events from the past
Sense of failure and inadequacy
General attitudes
History of antisocial behaviour
Tendency to see the world as unfair and hostile to him
Uses self harm to demonstrate he is genuine in his remorse
Failure to consider consequences for and needs of victims
First offence
Emotional state of rejection, hurt and anger
Attempted to kiss her and she was shocked. This made him
angry at her rejection and he physically attacked her
Feelings potentiated by heavy alcohol consumption
Impulsive and opportunistic
Psychologist felt that the effect of the offence on his own life
may be overly represented in his sense of remorse
19. Second offence
No indication that he was experiencing any acute
emotional problems at time
Had been drinking but knew what he was doing
Opportunistic although the psychologist felt there may
have been some premeditation
Felt it would have been worse if she had been a
stranger. Indifferent to her being blood relative
The effect of the offence on his own life is
disproportionately represented in his remorseful feelings
in relation to the effect on the victim
Shouldn‟t have gone to prison – should have kept it in
the family
He believes it is unfair to be on the sex offenders
register as it will impact on his future relationships
21. Callous unconcern for the feelings of others
Gross and persistent attitude of irresponsibility
and disregard for social norms, rules and
obligations
Incapacity to maintain enduring relationships,
though with no difficulty in establishing them
Low tolerance to frustration and a low threshold
for discharge of aggression including violence
Incapacity to experience guilt or to profit from
adverse experience particularly punishment
Marked proneness to blame others, or to offer
plausible rationalisations for the behaviour
that has brought the individual into conflict
with society
22. Marked tendency to act unexpectedly and
without consideration of consequences
Marked tendency to quarrelsome behaviour
and to conflicts with others, especially when
impulsive acts are thwarted or criticised
Liability to outbursts of anger or violence, with
inability to control the resulting behavioural
explosions
Difficulty in maintaining any course of action
that offers no immediate reward
Unstable and capricious mood
23. 1 month duration
At least 1 of
Thought echo, insertions, withdrawal or broadcasting
Delusions of control, influence or passivity, clearly referred
to body or limb movements or specific thought, actions or
sensations; delusional perception
Hallucinatory voices – running commentary or discussing
patient or other voices coming from some other part of the
body
Persistent culturally inappropriate delusions
Or 2 of
Persistent hallucinations in any modality when accompanied
by delusions or overvalued ideas
Neologisms, breaks or interpolations in train of thought –
incoherence or irrelevant speech
Catatonic behaviour
Negative symptoms
Notes de l'éditeur
was not aroused, too drunk, this is why didn’t rape her. regretted it, police caught him week later. later said committed through brothers influence
March 2010 said his body committed offences but not his mind. Mind taken over by spirits