Offenders, deviants or patients an introduction to clinical criminology 5th ed

Using new case examples, Herschel Prins draws on his own expertise and rience to examine the relationship between mental disorders and crime and looks expe-at the ways in which it should

Offenders, Deviants or Patients?

Offenders, Deviants or Patients? provides a practical approach to understanding both the social context and treatment of mentally disordered offenders Taking into account the current public concern, often heightened by media sensational-ism, it addresses issues such as sex and ‘historic’ sex offending, ‘hate’ crime, homicide and other acts of serious bodily harm

This fifth edition is fully updated and incorporates the latest research and reflects recent changes in law, policy and practice, including:

• DSM-V criteria

• groundbreaking work on neuro-physiological aspects of psychopathy

• the Coroners and Justice Act

Using new case examples, Herschel Prins draws on his own expertise and rience to examine the relationship between mental disorders and crime and looks

expe-at the ways in which it should be dealt with by the mental health care and criminal

justice systems Offenders, Deviants or Patients? is unique in its multidisciplinary

approach and will be invaluable to all those who come into contact with serious offenders or those who study crime and criminal behaviour

Herschel Prins has worked in the fields of criminal justice and forensic mental

health for over sixty years He has served on a number of public and voluntary bodies and has authored numerous books and articles

An introduction to clinical criminology Fifth Edition

Herschel Prins

Offenders, Deviants

or Patients?

by Routledge

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And by Routledge

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Routledge is an imprint of the Taylor & Francis Group, an informa business.

© 2016 Herschel Prins

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British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library.

Library of Congress Cataloging in Publication Data

Prins, Herschel A.

Offenders, deviants or patients? : an introduction to clinical criminology / Herschel Prins — Fifth Edition.

pages cm

Revised edition of the author’s Offenders, deviants, or patients?, 2010.

1 Criminal psychology—Methods—Great Britain 2 Prisoners— Psychology—Great Britain 3 Crime prevention—Great Britain

4 Forensic psychiatry—Great Britain 5 Mental disorders—

rehabilitation—Great Britain 6 Mental health services—Organization & administration—Great Britain I Title

This book is dedicated to the memory of my wife of over fifty years Always steadfast in support for all my endeavours, such support being instrumental, despite my doubts, in enabling me

to produce the first edition of this book way back in 1980.

First Viscount Samuel, A Book of Quotations, 1947, p.10.

‘When once the itch of literature comes over a man,

Nothing can cure it but the scratching of a pen’

Samuel Lover, Handy Andy, 1842.*

*Perhaps, in this day and age, we might substitute word processor for a pen.

List of figures and tables xi

1 Concerning the author – reflections and recollections 1

2 Troubled and troublesome minds – an orientation 21

3 The mentally disordered and criminal responsibility – a brief

4 Forensic mental health and service provision 102

5 Psychopathic disorder – useful concept or moral judgement? 151

6 Aggression and violence – extending the boundaries 184

Contents

4.1 Disposal of mentally disordered offenders through the criminal

5.1 From Pinel (1806) to the Home Office and Department of Health

Tables

2.1 Simplified classification of mental disorders (disturbances) 26 2.2 Some less well-known psychiatric and eponymous conditions 42

7.1 Common and less common descriptive terms for homicidal

behaviour 211 7.2 Presentations of, and motivations for, various forms of homicide 214 9.1 Police recorded offences of arson for the period April 2002–

No attempt has been made to conceal the identities of those individuals whose cases have been in the public domain (for example those who have been the sub-ject of extensive media coverage) In all other instances, the case examples derive from the author’s personal knowledge Every effort has been made to render the illustrations anonymous, and to this end composite accounts have been made Despite these necessary ethical precautions, it is maintained that the illustrations provide sufficient authenticity concerning the issues presented.

Note on case illustrations

I preface this book with a number of explanations First, why a fifth edition in view of the fact that longer intervals have elapsed between the publication of some

of the earlier volumes? The answer is simple, and I hope acceptable The pace of change in criminal justice and forensic mental health (or ill health as I prefer to describe it) has been increasingly rapid – as is the accumulation of new research and other data We have seen amending legislation on extended sentences for pub-lic protection – sexual offences, changes in mental health law and proposals for reform of the law in relation to homicide being just a few examples Some of these could only be adumbrated in the fourth edition This edition will examine, where possible, some of the effects of these changes A number of them have occurred as

a result of somewhat premature implementation – an unseemly rush to legislate; this phenomenon will be mentioned in this fifth edition Second, why insert a subtitle? With the exception of the first edition, few of the previous editions car-ried one, so why now? I have decided that this fifth edition should continue my own personal explorations in the field of clinical criminology, this term being an accepted one for the various matters discussed in the following pages My new

subtitle is An introduction to clinical criminology.1 A degree of modesty on my

Preface to the fifth edition

1 The term ‘clinical criminology’ seems to have gained prominence from about the 1960s onwards

My one-time colleague Professor Donald West has described the sub-discipline, in his usual cinct fashion, as follows: ‘Clinical Criminology refers to the study of the characteristics of indi- viduals who respond to their social circumstances in criminal behaviour’ (Personal communication,

suc-28 January 2013) Donald’s chair at the University of Cambridge Institute of Criminology was

in clinical criminology To the best of my knowledge, that chair was a first of its kind in the UK The multidisciplinary nature of criminology was very well depicted by the late Professor Sir Leon

Radzinowicz in his book In Search of Criminology (1961) He stated,

First, criminology is not a primary and self-contained discipline, but enters into the province

of many other sciences which treat of human nature and society Indeed, any advance made

in causative research into crime must arise out of advances in these other departments of knowledge (p.175)

For more recent approaches to this aspect see Garland (2002) and Kautt and Pease (2013).

part dictates that I should not attempt to provide definitive answers to questions as emotive and complex as those addressed in the following pages Hence the word

introduction It may interest some readers to know how I came to alight upon the

original subtitle – An Introduction to the Study of Socio-Forensic Problems – in

the first edition On reflection, I consider that at that time it was a fairly site (if perhaps slightly grandiose) description of the book’s content Forensic psychiatry, forensic psychology, forensic social work and forensic nursing have only really ‘come of age’ in more recent times (see Chapter 1).2 There is another slightly personal ‘take’ on that early choice Some years ago, on the occasion

appo-of our marriage, my wife and I received a telegram appo-of congratulations from my then colleague, the late Dr Peter Scott It contained the words ‘socio-forensic best wishes’ Such a term seemed to encapsulate the nature of our task and it remained

in my memory until Offenders, Deviants or Patients? came to be written Third,

I have to justify one or two omissions in the present volume There are no chapters

devoted specifically to female offenders or to the abuse of alcohol or other

addic-tive substances However, both these areas do receive mention at various places in

the text In respect of the latter, readers will see that it mostly follows the sequence

adopted in previous editions, except for changes in some of the early chapters Chapter 1 continues to provide an account of some of the general changes I have witnessed over a long period of time; I hope such an account will provide a con-textual background for the chapters that follow And so now to Chapter 1

References

Garland, D (2002) Chapter 1 in M Maguire, R Morgan and R Rainer (eds) The Oxford

Handbook of Criminology (3rd ed.) Oxford: Oxford University Press.

Kautt, P and Pease, K (2013) ‘The Division of Labour in Crime Prevention: Crime

Sci-ence, Criminology and Criminal Justice’ Howard Journal of Criminal Justice 52:

39–54.

Radzinowicz, Sir Leon (1961) In Search of Criminology, London: Heinemann.

2 At the time of the appearance of the first edition there were very few British texts on forensic-psychiatric matters My book was never intended to be a substitute for these However,

it seems to have received a positive reception as an introductory text And so, subsequent editions have been intended to be just that – an introduction to the field by a non-‘medic’ and a non-lawyer –

a ‘layman’ Later works by forensic psychiatrists, forensic psychologists and others have provided more comprehensive accounts and will be referred to at various places later in this book.

I am both delighted and somewhat daunted to have been asked to write a foreword

to this fifth edition of Offenders, Deviants or Patients? Delighted because the first

edition of this book, published in 1980, was one of the first which I consulted

in trying to make up my mind, while still a student at Cambridge, on whether

I should join HM Prison Service as a graduate trainee That decision duly made, subsequent editions of this book stayed with me throughout my career as a prison governor Daunted because, as Prins himself describes in his concluding com-ments: ‘at my advanced age I think it highly unlikely that I would feel able to produce a sixth edition of this work.’ This rather focusses the mind

However, perhaps I should ignore the delightful awe that I feel – not eased by

my personal admiration for the author – and concentrate instead on why his book has remained in print for nearly 40 years There seems to me to be four reasons.First, the text is always thoroughly revised and refreshed in each edition by bringing in new cases which take into account legislative and institutional changes – and here we should note in passing that Prins is inevitably distraught by what has been happening of late to the Probation Service – with practical vignettes from his applied work to illustrate his arguments This fifth edition, for example, has new sections on stalking, domestic violence and hate and cyber crime, and we also get something of his more general views when Prins laments that we live in a

‘risk obsessed and overly safety-conscious society’

Second, in much the same way that Prins himself has crossed boundaries in his career – practitioner, probation officer and academic – this book remains filled with observations from and about music, art, literature and contemporary culture which take his prose about what some might regard as essentially dry, socio-forensic

matters into a whole new realm of academic writing In other words, Offenders, Deviants or Patients? remains what it has always been – a delight to actually read This is not something I could say about many academic books

Third, the basic premise of this book – perhaps best expressed in his opening chapter, when Prins introduces his vignettes – remains as important now as it has always been: ‘these vignettes demonstrate some of the problems involved

in making firm boundary lines between normality and abnormality, “madness” and “badness” they demonstrate the problems involved in selecting the most

Foreword

appropriate modes of management in the interests of both the offender-patient on one hand, and the community on the other.’ Here too we should note that, with one eye on the developing academic criminology market, this fifth edition (like the

fourth) retains a subtitle, An introduction to clinical criminology This seems to

me an accurate enough description of what the work contains and further reflects

how it has been updated since 1980, when the subtitle was An Introduction to the Study of Socio-Forensic Problems It also suggests something about criminology’s own journey as an academic discipline over the past four decades – a journey whose path has been considerably eased by a generation of academics such as Prins

Finally, and despite the fact that Prins is neither a psychiatrist nor a lawyer –

some might argue because he is neither – he writes about forensic, medical

prob-lems both from the inside and from without This offers him an unique perspective and therefore a wonderful opportunity to celebrate his boundary-crossing career and use it to his best advantage Modest to the end, at one stage Prins worries that

he might be seen as a ‘Jack of all trades and a Master of none’ Nothing can be further from the truth, as generations of past, present and future students of crimi-nology must surely attest

Professor David WilsonCentre for Applied CriminologyBirmingham City University

This fifth edition, as with earlier editions, could never have seen the light of day without the help of numerous individuals, some of whom are members of my family, close friends and colleagues past and present However, I must make abso-lutely clear that none of these is to be held responsible for any omissions or other errors on my part A number of central government departments have provided

me with helpful information They are: the Home Office, the Ministry of Justice, the Office of National Statistics, the Department of Communities and Local Gov-ernment, HM Inspectorate of Constabulary and the Mental Health Tribunal My special thanks to my daughter, Helen, and her partner, Trevor, for constant sup-port, both emotionally and in various practical matters To my son, Jeremy, and his partner, Mandy, I express my gratitude for similar support and for, on occa-sion, interrogating the Internet on my behalf! I have received sound advice from

my long-standing friend Professor Ronnie Mackay of De Montfort University

in respect of certain legal issues I am also grateful to my one-time postgraduate criminology student Nick Janicki of the National Probation Service, Manchester, for advice concerning the management of sex offenders Sincere thanks go to

my very good friend (and former postgraduate student) Dr Stevie-Jade Hardy, lecturer in hate studies in Leicester’s Department of Criminology, for being very supportive throughout my current endeavours.3 I also owe a very big debt of grati-tude to my colleague Dr Sarah Hodgkinson, senior lecturer in our Department of Criminology, for helping me to get to grips with the difficult concept of the social construction of reality, and for assistance in a number of other ways It is now many years since I was actively involved in teaching medical undergraduates, initially at the University of Leeds, and subsequently at Leicester University However, I have had the considerable advantage of being able to follow my young friend Dr Hannah Williamson from sixth-former through her distinguished student record at Nottingham University’s medical school This relationship has helped

me very considerably to keep up to date with medical education in general, and

Acknowledgements

3 Because not all such behaviour is motivated by hate, the research team has suggested that a better descriptive term would be ‘targeted hostility (victimisation)’.

with developments (or, maybe in some cases, a sad lack of them) in the sation of our National Health Service As with previous editions, none of this book would have seen the light of day without the ‘IT’ expertise of my good friend Mrs Janet Kirkwood, ably supported by her husband, David I owe a con-siderable debt of thanks to them both My continuing thanks to my senior editor, Joanne Forshaw, and all her colleagues at Routledge (Taylor and Francis) for their long-standing encouragement and patient support in the face of my occasional obstinancy! Special thanks go to Kirsten Buchanan and Marie Roberts of Apex CoVantage Finally my warm thanks to my friend Professor David Wilson for his insightful Foreword.

organi-Chapter 1

Concerning the author – reflections and recollections

‘Been there, done that, got the T-Shirt’.

Late twentieth-century advertising slogan Jonathon

Green (ed.), Cassell’s Dictionary of Slang, 1998, p.74

‘Those who cannot remember the past are condemned to repeat it’.

George Santanya, philosopher, The Life of Reason, 1905, Vol.1, Ch.12

I must stress at the outset that what follows is somewhat partial A number of my readers may even find it idiosyncratic For example I have not included anything but the barest details of my early life These may be found in Prins (2010) Suf-fice it to say that some members of my family were heavily involved in work with adult offenders and disadvantaged young people Being orphaned as an adolescent

no doubt played an important part in my later career choices.1 Following a period

of not particularly glorious employment in industry and commerce and a period of national service in the Royal Air Force, I opted for teacher training However, my applications to teacher training colleges were not successful; thus countless numbers

of young minds were saved from my ministrations! A social science diploma was followed by probation training and subsequent entry into the Bedfordshire service early in 1952 Training for probation work in those far-off days was provided by the Home Office It was very much practice based and, by today’s standards, might be regarded as not very ‘academic’ In my view such criticism would be unwarranted because the course equipped students for the very wide range of duties undertaken

at that time.2 What follows presents merely a ‘birds-eye view’ of my experiences in

1 I come from a fairly ‘Orthodox’ Jewish background My parents were raised in the Orthodox ion, but in their later years adopted what is known today as the ‘Liberal’ or ‘Reform’ tradition My late wife and I, following our marriage, also followed this path Today I would describe myself as a

fash-‘Jewish Agnostic’ This is because I believe in and value the more historical and practical elements

of Judaism but have reservations about a number of Jewish religious beliefs and practices At a more general level I have similar views about a number of other great religions.

2 For accounts of the development of probation work and training see Burnett, 2007, Prins, 1964,

2007a and Smith, 2006 See also a range of articles in the Howard Journal of Criminal Justice.

criminal justice and forensic mental health care My reminiscences are not presented

in discrete compartments Instead, I have tried to provide a sequential account ering almost 60 years, divided, where helpful, into year ‘bands’

cov-One phenomenon stood out very clearly This was the small-scale nature of bation work and its organisation For example, by today’s standards, the service was a comparatively small enterprise It was not particularly hierarchical, neither was its organisation complex, as is the case today Some areas did not even have a principal probation officer (as they were then called) in charge Bedfordshire was one such area It was headed by a senior probation officer with a comparatively small number of main-grade staff Contact with ‘clients’ in what was a predomi-nantly rural area (apart from the boroughs of Bedford, Luton and Dunstable) was facilitated by ‘reporting centres’ These were situated in a variety of locations, for example church halls or local authority offices such as health centres These were often in quite isolated locations Today, I have little doubt that these would be

pro-regarded as quite inappropriate (pace Dr Reid – ‘not fit for purpose’) This would

be largely on the grounds of breaching health and safety regulations I think few of

us considered the possible hazards to which we were exposing ourselves Whether this blithe indifference was a good or a bad thing is no doubt open to debate In five years’ service in the county I recall being physically intimidated by a client on only one occasion (I found the chairman of our quarter sessions far more intimidating – see later!) Another more general aspect of the service in those early days was its country-wide small-scale membership One could attend an annual general meet-ing of the National Association of Probation Officers (NAPO) and know personally more than a handful of those attending Another notable feature was the almost total absence of women principal officers in the service I recall an exception being the redoubtable Kate Fowler, principal officer in Sheffield As I shall demonstrate later, in more recent times some things have changed significantly for the better.Not only was the Probation Service small-scale, but other services were simi-larly constituted The fairly recently established Children’s Departments (through the Children Act of 1948) were only just beginning to get into their stride A nota-ble exception to the predominantly male leadership in the Probation Service was the appointment of women as Children’s Officers as heads of the new departments Perhaps this reflected the notion that women were more likely to have a better understanding of children’s (particularly small children’s) needs Mental health services were also very small-scale, having their origins in Poor Law organisation and practice In those early days mental health duties were carried out by Reliev-ing Officers, subsequently entitled Duly Authorised Officers, and then by Mental Welfare Officers and of course much later by Approved Social Workers under the

1983 Mental Health Act as subsequently amended by the 2007 Act.3

3 Under the Mental Health Act, 2007 (implemented in October 2008), the role of the Approved Social Worker has been expanded to include non-social-work professionals, such as clinical psycholo- gists, occupational therapists and nurses To reflect this expansion these personnel are designated as Approved Mental Health Professionals (For an excellent discussion of the Act and the many issues arising from it see Fennell, 2007.)

The Prison Service was also comparatively small-scale Local prisons (for example Bedford) were run by a governor (sometimes a former senior military officer), a handful of ‘warders’ (prison officers), a chaplain and a part-time medi-cal officer (usually a visiting GP) In the ensuing decades things have changed quite dramatically The independent Prison Commission disappeared when the Home Office assumed total responsibility for prison affairs, and luminaries such

as Sir Lionel Fox and Alexander Paterson disappeared from the scene Today, prison administration consists of a mixture of complex organisation and gross overcrowding, leading to hardship for inmates and staff alike

I return to my early days in the Probation Service My reason for doing so is that it was in those early days that I first developed my long-standing interest in forensic psychiatric matters (known today as forensic mental health) This new title reflects today’s greater multidisciplinary approach to mentally disordered offenders My immediate predecessor had decided to emigrate with his family

to Australia However, his planned departure was in jeopardy because one of his

‘clients’ had killed his wife The police were anxious that my former colleague should stay in the UK to give evidence at the Assizes In the event, they were per-suaded to rely on a sworn statement as to his knowledge of his client The latter was subsequently committed to Broadmoor (High Security) Hospital I recall that there was no formal inquiry held into the circumstances leading up to the murder The client had been on probation and was known to the mental health authori-ties Today, an independent inquiry would have of course been mandatory (see later comments) Although I had no personal involvement in the case, its features intrigued me My interest was heightened by the fact that the local asylum (as it was then called) was located within one of my court areas Under the 1948 Crimi-nal Justice Act, the hospital could, if it agreed, receive offenders on probation with a requirement that they receive in- or outpatient treatment for their mental condition if this was of a fairly minor nature, and they agreed to the treatment Thus began my acquaintance with those offenders who became the subject of both criminal justice and mental health interventions, often a complex relationship In those early days the probation officer’s statutory functions were solely concerned with making arrangements (in consultation with the treating psychiatrist) for the amendment or discharge of the order However, this limitation did not stop me from furthering my interest in matters forensic-psychiatric! This interest had been lying dormant since my student days on the Home Office training course Dur-ing our training we were fortunate in having excellent lecturers on the topic of psychiatric aspects of delinquency; examples being the late Professor Trevor Gib-bens, the late distinguished psychoanalytic psychiatrist Dr Denis Carroll and the late Dr Peter Scott, with whom I was subsequently to work as a psychiatric social worker at Stamford House Remand Home for Boys.4 This is an appropriate point

to refer to the ground-breaking Criminal Justice Act of 1948; ground-breaking

4 For those readers interested in examining the contribution, past and present, of psychoanalytic and associated approaches to probation work see Prins, 2007b – notably endnotes 1–6 See also my

book Psychopaths – An Introduction (2013) at pp 81 et seq.

because some of its provisions tend to be forgotten in the welter of criminal justice legislation passed in the past few decades Not so long ago Lord Justice Judge, addressing an audience of law students and lawyers, noted that in the past 10 years Labour had created more than 3,000 new criminal offences, produced 115,000 pages of legislation and passed numerous bills including 24 criminal justice meas-ures He commented on the fact that between 1925 and 1985 we managed with only one each decade.5

The 1948 Act had appeared as a bill in 1939, but was shelved on the outbreak

of World War II, as were plans for the East-Hubert psychiatric prison, later to become Grendon Underwood and now known simply as Grendon (see Home Office, 1939) This milestone piece of legislation abolished flogging as a penalty (except for assaults on prison staff; that penalty was also subsequently abolished) The Act introduced two new sentences – Corrective Training (CT) and Preventive Detention (PD) for ‘habitual criminals’ (a provision introduced in the Prevention

of Crime Act, 1908) Borstal was brought more into line with contemporary ideas,

in the new guise of Borstal Training And, as already noted, the Act introduced a new power for the courts to impose probation orders with a requirement for men-tal treatment The statutory frameworks for this penalty have been modified over the years; for example the offender’s consent to the making of such an order is

no longer required, and the imposition of such an order counts as a conviction for sentencing purposes The other point to note is that the term ‘probation order’ is now subsumed as an option under a ‘community treatment order’ The term ‘pro-bation’ and all that goes with it is sadly fast disappearing and, in particular, the discrete work of the probation officer (see later) Many of the provisions of the

1948 Act were subsequently abolished or amended substantially For example, the sentences of Corrective Training, Borstal Training and Preventive Detention were also abolished but have, to a certain extent, made a number of fresh appear-ances as the ‘extended sentence’ in its various guises, for example the current provision in the Criminal Justice Act, 2003, for those convicted of certain violent and serious sexual crimes to be given indeterminate sentences One consequence

of this particular penalty has been the exacerbation of the current overcrowding

in our prisons Later enactments introduced the Parole System, the Suspended Sentence and an ever-increasing range of community sanctions It is worthy of note that the Parole System (as amended from time to time) relies heavily on forensic-psychiatric input and, from its inception through the Criminal Justice

5 As reported by Robert Verkaik, law editor, The Independent, 31 October 2007, p.41 Lord Justice

Judge’s points were reinforced some three weeks later by the Lord Chief Justice (Lord Phillips of Worth Matravers) when he suggested that prison overcrowding was not only due to the fact that

‘ministers had failed to recognise the impact of legislation enabling judges to hand down longer sentences’ He added that ‘unless Parliament is prepared to provide whatever resources are nec-

essary to give effect to the sentences judges choose to impose, Parliament must re-examine the

legislative framework for sentencing ’ (emphasis added) Reported in The Independent, 17

Novem-ber 2007, p.7.

Act, 1967, has mandated the presence of a psychiatrist on those panels of the Parole Board considering life-sentence and other serious cases In recent times, other forensic mental health professionals (such as forensic psychologists) have become involved in the Board’s work.

1950s and 1960s – the wider field

This period saw a further number of far-reaching innovations in the delivery of criminal justice and mental health care My justification for a high degree of selec-tivity is that my observations arise out of personal acquaintance with some of them The year 1957 witnessed a significant change in the law concerning the relationship between mental disorders and homicide As I shall show in a later

chapter, the Homicide Act of 1957 was introduced following the 1953 Report of the Royal Commission on Capital Punishment (Gowers Commission, 1953) In general terms, the Commission had recommended a widening of the scope for seriously disordered mental states to be proffered as a defence to a charge of mur-der If such a defence was accepted the charge of murder would be reduced to that of manslaughter on the grounds of diminished responsibility This provision derived in part from its long-standing use in Scotland In practice, it currently sits alongside the more restrictive McNaghten Rules As is so often the case with new legislation, high hopes were raised during the statute’s early days However, the wording of Section 2 of the Act, and to some extent Section 3 (which dealt with the vexed issue of provocation), have led over the years to a number of some-what difficult exchanges between the law and psychiatry Such exchanges were,

of course, not new For example, the late Dr Henry Yellowlees received something

of a ‘mauling’ when he gave evidence for the defence in the trial of John George Haigh – the so-called acid bath murderer It is a sad fact that, because of such encounters, some general psychiatrists of my acquaintance have become reluctant

to enter the criminal court arena.6 Following closely on the heels of the Homicide Act came the Mental Health Act of 1959 The Act modernised existing mental health legislation which had its roots in the outmoded nineteenth-century empha-sis on legalism The Act was of considerable forensic-psychiatric importance Under the new legislation, it became possible, on the basis of medical evidence, for the courts to commit seriously mentally disordered offenders to hospital in lieu

of other penalties Written medical evidence from two authorised medical titioners (almost always psychiatrists) was required for the implementation of an unrestricted order However, for the implementation of an order restricting the dis-charge of the patient (to protect the public from serious harm) one of the medical practitioners was required to give oral evidence Prior to the 1959 Act, the proce-dures for admitting seriously mentally disordered offenders to hospital had proved

prac-6 For discussion of a number of these issues see Cooper and Morris (2004), Morris and Cooper (2011), the Law Commission (2006) and the chapter on homicide in this book.

Blom-somewhat cumbersome and were used infrequently Another important feature of the 1959 Act was the introduction of the controversial category of psychopathic disorder This category continues to bedevil law, psychiatry and psychology, and

is dealt with in detail later in this book and in Prins (2013) The Act also duced Mental Health Review Tribunals enabling patients, under the Act’s civil and criminal powers, to appeal their detention As with the Parole Board, psychiatric inputs (in respect of both reports to Tribunals and membership of Tribunal pan-els) were of considerable significance During the 1960s I witnessed a number

intro-of other changes intro-of ‘socio-forensic’ interest The Suicide Act intro-of 1961 removed the offence of attempted suicide from the statute book This liberalising piece of legislation eliminated the comparatively rare, but nonetheless distressing, criminal prosecutions for such behaviour Not only distressing for the defendant, but for any relatives and professionals who might also be involved (as in my case, as a probation officer) Another highly significant change occurred during this period

As a result of the Sexual Offences Act, 1967, private acts of adult consenting male homosexuality were decriminalised In my early days as a probation officer, I had

to attend court and to provide reports on adult males who were likely to receive

a prison sentence for this behaviour In addition, they were sometimes subjected

to quite inappropriate homilies by sentencers (for example recorders or chairmen

of quarter sessions) The manner in which the change in the law came about is

of considerable interest It reveals the complex chains of events often involved in changes in policy and practice In 1957, the Wolfenden Committee on Homosexu-ality and Prostitution (Home Office, 1957) recommended a change in the law on what it had come to regard as essentially private acts The Committee acknowl-edged that although many people considered these actions immoral and/or irreli-gious they should no longer be the concern of the criminal law Some considerable

time later a cause célèbre seems to have added weight to the Committee’s

propos-als A group of well-known older men had been sentenced to varying terms of imprisonment for acts of indecency with young airmen An assumption seems to have been made that the older men had ‘corrupted’ the younger It subsequently transpired that this might not have been entirely the case The imprisonment of the perpetrators caused some disquiet As a result, those at the highest levels of law enforcement advised police forces to exercise discretion in bringing prosecutions unless public decency had been infringed or consent was in doubt Subsequently, the existing law appears to have fallen into disuse and the time became right for the 1967 Act to be passed, with the decriminalisation that followed

Two further developments during this period are worthy of note First, the mate success of the long-fought battle to abolish the death penalty for murder (by the Murder, Abolition of Death Penalty Act, 1965) The cause had been champi-oned by the efforts of protagonists such as the late Sidney Silverman, MP in the House of Commons, and by the late Frank Dawtry, who had been the secretary

ulti-of the National Council for the Abolition ulti-of the Death Penalty (later the highly effective secretary of NAPO), and others Various attempts to re-introduce the death penalty since the 1965 Act have always failed, in my view mercifully Not

only had a number of people been hanged in error before abolition, but a number

of others would have suffered this fate as a result of wrong convictions A further humane outcome for members of the psychiatric profession is that they do not have

to attest to an offender’s mental fitness to be hanged, as is the case with some of their American counterparts; in my view an odious and unethical practice Another enactment that demonstrated a more sympathetic approach to human frailty was the introduction of a woman’s lawful right to an abortion by the Abortion Act of

1967 The movement for reform had been spearheaded by the likes of Madelaine Simms, and in the Commons by David (now Lord) Steele Recent events indicate that abortion is still a somewhat contentious issue Even its early supporters (such

as Lord Steele) have expressed concern in recent times about untoward quences of the legislation, such as the steady increase of terminations in recent years Overall, the period I have just outlined appears to reveal a trend towards a less legalistic and punitive approach to criminal and deviant behaviour

conse-The 1970s onwards

This period witnessed a number of further important changes The Courts Act,

1971, removed the ancient and somewhat arbitrary distinction between Courts

of Quarter Sessions and Assizes The latter courts were presided over by some colourful personalities Many onlookers looked forward to the formal opening

of the Assize – the ‘red judge’ carrying his nosegay of sweet-smelling herbs (a reminder of the days when the smell of bodily secretions and the threat of the plague were very evident) The judge would be followed by his retinue, includ-ing the black-stockinged high sheriff and other dignitaries Judges’ reputations went before them Some had reputations for severity; others demonstrated a more humane approach Some were keen to expedite ‘gaol delivery’, one of the impor-tant functions of the Assize being to empty the gaols of those awaiting trial (gaol delivery) The late Lord Chief Justice Goddard espoused this latter function with enthusiasm and dispatch when he vacated London to go on circuit Occasion-ally those who presided over the quarter sessions (‘chairmen’ in the counties and ‘recorders’ in the boroughs) would demonstrate somewhat unprofessional behaviour One such chairman of quarter sessions, before whom I used to appear, seemed to take a perverse delight in haranguing the professionals who appeared before him, be they fellow members of the Bar, the police, psychiatrists or the Probation Service His behaviour became so untoward that complaints were made about his conduct with the result that the County Sessions Committee did not renew his appointment when it expired (However, sad to relate, he continued to sit as recorder in the borough.) For my part, I regarded him as one of the most unpleasant members of the legal profession I had met My impression is that, with the introduction of Crown Courts under the 1971 Act and the subsequent ration-alisation of the courts of higher jurisdiction, such unwelcome ‘eccentricities’ have become very infrequent Today, with one or two exceptions, the judiciary exer-cises its functions in a highly professional manner Moreover, those holding high

judicial office have been quick to champion the rule of law against over-heavy political reactions to antisocial behaviour (see earlier comments concerning the proliferation of criminal justice legislation in recent years) Today, such a stance

is becoming increasingly important when we live in a risk-obsessed and overly safety-conscious society; a risk consciousness fuelled by less-than-responsible elements of the media, who appear more intent on boosting sales than on respon-sible journalism, as recent events have indicated The late 1960s and early 1970s witnessed significant changes in what we describe today as ‘youth justice’ In my early days as a probation officer, we often dealt with children who had commit-ted offences or who were ‘beyond parental control’ With the introduction of the new social services departments (SSDs) following the reports of the committees chaired by Dame Eileen Younghusband (DHSS, 1959) and Sir Frederick Seebohm (Home Office et al., 1968), this aspect of our work passed to these new depart-ments For a variety of reasons, I do not think this was an entirely helpful devel-opment First, probation officers had, over many years, built up a good deal of expertise in dealing with the needs and problems of antisocial children and young persons Such experience was not all that common in the early days among those who staffed the newly created SSDs In addition, these children’s needs had to be dealt with in competition with the needs of the elderly, the mentally ill and the handicapped (Prior to these post-Seebohm developments, the needs of children had been the specific focus of attention in the local-authority children’s depart-ments established under the 1948 Act.) Second, the new service was based on the false assumption that the newly created generic social worker could be ‘all things

to all people’ Such an assumption seemed based on a mistaken interpretation

of the Seebohm recommendations The report actually recommended the

intro-duction of generic training – a rather different matter Third, with the removal

of probation officers’ contact with this younger age group, a useful opportunity

had been lost for the former to see at first hand the developmental patterns which

might produce later antisocial behaviour – in other words, the loss of ‘hands-on’ experience and awareness of an important aspect of human growth and develop-ment Alongside these changes was a decision to decriminalise some forms of juvenile misbehaviour Formal and informal police cautions (now known as warn-ings and reprimands) were to replace court appearances, provided the offence was of a fairly minor nature and was admitted by the young person involved The changes referred to earlier in providing a less legalistic approach to juvenile offenders seem to have stemmed in part from the practice introduced in Scotland, namely ‘Children’s Hearings’ These followed the report by Lord Kilbrandon (Scottish Home and Health Department, 1964) (A more recent development has been the greater awareness of the special needs of children seen in the combining

of local-authority children’s and education services.)

1980s onwards

The 1980s onwards saw other important developments in the fields of criminal

justice and forensic mental health (or, as I prefer to describe it, forensic mental ill

health) The Mental Health Act, 1983, in its reform of the 1959 legislation (see earlier in this chapter), gave greater powers to Mental Health Review Tribunals

(MHRTs) Under the 1983 Act, Tribunals could now authorise the absolute or conditional discharge of offender-patients detained under Hospital Orders with

Restrictions (Sections 37/41) Under the 1959 Act they could only recommend

discharge to the Home Secretary As a result of this new power the presidents

of Tribunals hearing such cases had to be of senior status, such as a recorder or circuit judge The recently enacted Mental Health Act, 2007, does not change this practice, but abolishes the power to make restriction orders with limits of time (see Prins, 2007b for further details of changes of forensic interest) The 1983 Act also introduced the Mental Health Act Commission – a body charged inter alia with the inspection of psychiatric and mental handicap hospitals and units As a sometime member of the commission, I thought the body was becoming some-what unwieldy I also considered that more guidance should have been provided

to counteract the slightly overzealous views and activities of one or two mission members My past experience as a former member of a central govern-ment inspectorate – the Home Office Probation Inspectorate – had taught me that inspection was not only an onerous responsibility, but was also one that always needed a light, nonetheless firm, touch It was not a position to be held by the reforming zealous An important non-statutory body merits mention here Fol-lowing the lethal activities and subsequent conviction of the late poisoner Graham Young, a non-statutory board was established (known initially as the ‘Aarvold Board’ after the chairman of the inquiry into Young’s activities) It subsequently became known as the Home Secretary’s Advisory Board on Restricted Cases Its purpose was to provide an additional screening device for cases such as Young’s that were considered to require ‘special care in assessment’ Over the years, refer-rals to the Board by the Home Office became much less frequent (probably due in part to increasing confidence in MHRT decision making) The Board was even-tually wound up in September 2003 Forensic psychiatric representation on the Board always played a very significant part in its activities.7

com-During past decades various proposals have been put forward for further reform

of mental health legislation In essence, the forensic debate has hinged on the

resolution of the conflicting needs of the individual on one hand and the protection

of society on the other Many trees must have been felled to provide the reams of paper for the various Green and White Papers and the three bills that came before both houses of Parliament Some aspects of the legislation eventually enacted will

be considered in later chapters

7 The Board’s membership consisted of two forensic psychiatric members, two senior members from the Probation and Social Services and two ‘independent members’ with knowledge of the criminal justice system It was chaired by a senior lawyer, usually a circuit judge In addition to setting up the Aarvold Committee, the Home Secretary of the day established a wide-ranging committee of inquiry into the more general problems arising from the activities and management of mentally abnormal offenders The report of the committee – under the chairmanship of the late Lord Butler

of Saffron Walden (a former liberal-minded Home Secretary) – is essential reading for those who wish to understand present provisions (Home Office and DHSS, 1975).

It now remains for me to consider one or two more general developments in criminal justice and mental health My consideration of these is, again, highly selective Women now play a gradually increasing role in criminal justice and mental health care, whether as perpetrators of crime or as professionals engaged

in its prevention, detection and management For highly complicated reasons that are not entirely clear to me women appear to have become more involved

in the commission of sexual and violent criminality One explanation may be that the distinction between the socially acceptable and conventionally dictated roles between the sexes has become increasingly blurred, an aspect of what is often described as the ‘social construction of reality’ This will receive further mention

in the chapter on homicide Our attitudes towards and expectations of women still tend to be ambivalent Women who offend, particularly if the offence was of a violent or sexual nature, tend to veer between being ‘psychiatrised’ on one hand and ‘demonised’ on the other As an example, consider the widely differing views about Lady Macbeth’s mental state (see for example Prins, 2001) However, there are recent interesting examples of the increasing degree of gender parity in law and sentencing Section 66 of the Sexual Offences Act, 2003, makes the offence

of indecent exposure no longer an exclusively male prerogative Potential Lady Godivas be warned! (see the chapter on sex offending) It is gratifying to see that women now play a more prominent part in advocacy in criminal justice and mental health care Some of them, for example Gareth Peirce, Chami Chakrabati and Cherie Booth, have played significant roles in championing human rights

A growing number of women have been appointed as chief constables, as chief probation officers and as prison governors We have had a woman as a chief inspector of prisons and female Home Secretaries However, a number of serious concerns remain, according to Lord Neuberger, president of the Supreme Court

In a speech to the Institute of Government on 18 June 2013 he expressed disquiet about the lack of adequate representation from ethnic minorities in the ranks of the senior judiciary He also alluded to a very small representation of women among the senior judiciary’s ranks For example there is no ethnic minority rep-resentation on the Supreme Court bench, and only one woman, only 15 per cent representation by female judges in the High Court and only 5 per cent representa-tion by non-white judges He stated that ‘the duty of the judiciary to improved diversity also applies to the legal profession the legal profession must do more to improve diversity more broadly, if we really want to increase diver-sity, the problem has to be tackled throughout society, in our universities, schools and at home’.8 In other spheres women have been playing increasingly important roles – as chairs and chief executives of hospital trusts (including mental health care trusts) and, in the academic field, as a number of vice chancellors No longer can the male chauvinists among us continue to say ‘Frailty, thy name is woman’

(Hamlet, Act I, Sc ii 1 118).

8 As reported by Terri Judd, The Independent, 19 June 2013.

Recent times have also witnessed what two of my professional acquaintances

have rightly described as The Age of the Inquiry (Stanley and Manthorpe, 2004)

In 1994, the Department of Health (NHS Executive) issued a directive making

it mandatory to institute an independent inquiry into homicides committed by individuals known to the mental health services (This directive has recently been amended.) It is fair to say that there are strongly differing views as to the purpose, practice and usefulness of homicide inquiries (see for example the chapter in Stan-ley and Manthorpe, Prins, 2004) There had, of course, been a number of inquiries into mental health homicides and other matters before the former became manda-tory in 1994, for example into the abuse and lack of care of children and into the residential care of psychiatric and mental handicap patients More specifically, inquiries of the type envisaged in the 1994 directive had also been taking place, for example into the circumstances in which Sharon Campbell killed her social worker, Isabel Schwarz; as already noted, into the case of Graham Young, con-victed of poisoning his workmates whilst on discharge from Broadmoor (High Security) Hospital following previous convictions for similar offences; into the case of Daniel Mudd – also an ex-Broadmoor patient – who killed a fellow hostel resident while on conditional discharge In more general terms, we should also

be mindful of the cases of the killers nurse Beverley Allitt, Thomas Hamilton at Dunblane and of course Harold Shipman, Shipman and Allitt both best regarded

as ‘carer killers’ rather than, as some have described them, as ‘serial killers’ My personal experience of such mental health inquiries involved the chairmanship of three, into somewhat different incidents The first was into the death of Orville Blackwood – an African-Caribbean offender-patient at Broadmoor; the second concerned the absconsion, whilst on escorted day parole, of an offender-patient from a medium secure unit in Hertfordshire The man concerned had an estab-lished history of paedophilic conduct The venue he was allowed to visit – with only a single escort – was a theme park and zoo – popular with children! The third was into the killing of an itinerant in the centre of Leicester by a 19-year-old man known to the mental health, education, social and probation services My reflec-tions on these three somewhat different inquiries and on the very many others that I have read about can be summarised very briefly First, it is always easy to

be ‘wise after the event’ (described, as I recall, by my friend Dr Adrian Grounds

at Cambridge as ‘hindsight bias’) Second, the strain on all those involved in such inquiries is very considerable This applies equally to families of the victim(s), perpetrators and their families (often forgotten) and not only those under scrutiny, but also the members of the inquiry team Third, it seems right to question the extent to which these very costly activities produce ‘the goods’ This is a very dif-ficult question to answer We do not really know the extent to which lessons are learned It is satisfying to note that the recent guidance on the conduct of inquir-ies (already referred to) has focussed more precisely on their remit and conduct Offers of follow-up visits by inquiry teams are not always met with enthusiasm – indeed they may be refused initially, as was our offer in the Blackwood inquiry This particular inquiry revealed a worrying failure to understand ethnic issues

Sadly I note that, despite much endeavour in this area, our understanding of what Sir William Macpherson and his colleagues described as ‘institutional racism’ is far from as advanced as it should be (Home Office, 1999) Recent instances of numerous racist attacks involving serious injury or homicide attest to this Despite

a vast literature on the topic, I cannot discover any fundamentally satisfying answers as to why our black and other ethnic minority fellow citizens continue to

be represented disproportionately in our criminal justice and mental health lations Perhaps the answers are too complex to produce clear resolution, or is the fear of ‘dark strangers’ still predominant? I suspect that in most cases the ‘aliena-tion’ rests within us and not them Fourth, the all too frequent claim that a killing

popu-by the mentally ill could have been prevented popu-by more effective community care

is misconceived It is a worrying oversimplification to suggest that our nity care problems commenced largely as a result of the rundown of the mental hospitals in the middle and late 1960s The decarceration of the mentally ill had started in a small way some time earlier No doubt the problem was exacerbated

commu-by the somewhat unrealistic expectations that new pharmacological treatments would offer patients a speedy and non-relapsing return to the community The recent claims that community care has failed (so readily espoused by politicians and the media alike) are quite erroneous Many patients and offender-patients are well and safely managed in the community, quietly, competently and without pub-licity The other myth that needs dispelling is that deluded and hallucinated men and women are waiting to kill or seriously harm others at every opportunity The truth is that such fellow citizens are more likely to kill or harm themselves The seminal research by Professors Taylor and Gunn (1999) supports this assumption However, it is a sad truth that improved resourcing is still needed – within both general and forensic psychiatry They appear to continue to be the ‘Cinderella’ services within general health service provision

Certain other developments are worthy of note by way of conclusion A ber of them concern improvements in crime detection The first has been accom-plished by developments in information technology, particularly in the use of sophisticated computer techniques Had such techniques been developed in the late 1970s and early 1980s the likes of Peter Sutcliffe might have been detected and apprehended sooner; he managed to evade arrest for some five years Subse-quent inquiries into the manner in which the investigation was carried out revealed

num-an enormous overload of unlinked information contained on hundreds of index cards This resulted in missed opportunities for what were, at the time, regarded

as isolated incidents (see Bilton, 2003) These days there is rapid access to puterised national and international databases enabling systematised information retrieval However, such advances have their downsides Witness the advent of cyber-stalking, Internet pornography and sexual grooming and, more recently, examples of missing sensitive personal data Maybe we should be mindful of the

com-advice of the chambermaid Prudence in Ben Jonson’s play The New Inn: ‘Beware

you do not conjure up a spirit you cannot lay’ (Act III, Sc ii) It seems to me that information technology can also facilitate over-hasty reactions to various events in our lives, for example the use of the ubiquitous e-mail This seems to

produce a veritable surfeit of often quite poorly thought through and insubstantial over-reactive responses Time expended in ‘penning’ a well-considered response may prove more productive in the long run The second aspect of crime detection that I have witnessed has been the ground-breaking introduction of DNA profiling

by Dr, now Professor, Sir Alec Jeffreys, at my own university’s genetics ment His pioneering work led to the first major criminal prosecution (of a local man) using such techniques He was eventually convicted of the sexual assault and murder of two teenage girls Perhaps we should note here that downsides also exist in this area of work One or two recent cases have shown on appeal that some forms of DNA profiling do not possess the universal exactness once supposed, thus leaving occasional areas of doubt concerning conviction Other advances in forensic science should be noted Forensic scientists have made a number of advances in the field of arson investigation (see chapter in this book) and in the fascinating fields of forensic entomology, forensic botany and foren-sic archaeology.9 Offender profiling (much popularised in the media, but in real-ity a much more modest enterprise) is now fairly commonplace In a number of instances it has led to arrests and subsequent convictions that might have been difficult to obtain without it However, in many cases it merely (but nonetheless importantly) serves to confirm for the police investigating officers that they are on the right track (This was certainly my own experience when asked by the police

depart-to help in a puzzling case of a series of arsons in a county in the south-east of England.) Media depictions of criminal justice and forensic mental health have been referred to briefly in this chapter Such comments now merit brief expansion During my time in the field, the written, oral and visual media have come into prominence The likes of Arthur Conan Doyle, Dorothy Sayers, Agatha Chris-tie, Margery Allingham, Ngaio Marsh and others have now become somewhat eclipsed by writers such as Ruth (Baroness) Rendell (AKA Barbara Vine), Baron-ess Phyllis (PD) James, Val McDermid, Ian Rankin, Minette Walters, Mo Hayder and Simon Beckett in the UK; Patricia Cornwell, Kathy Reichs, Thomas Harris and Tess Gerritsen in the USA; the late Michael Dibdin in Canada; Donna Leon

in Italy and Henning Mankell and many others in Scandinavia, to name just a few Television and the cinema have also played important parts in dramatising the work of forensic professionals Some of my older readers may recall one of the first depictions of the work of a forensic scientist in the late 1960s, with the late Marius Goring as the pathology expert Dr Hardy; and, of course, at a somewhat later date the ebullient Dr Quincey in the USA In recent times in the UK our TV screens have produced colourful if not perhaps very accurate portrayals, examples

being Cracker, Prime Suspect, Trial and Retribution, Silent Witness, Waking the

9 An article by Cahal Milmo in The Independent entitled ‘A Job for the Maggot Squad’, 13 May 2013

(p.18), reports that a number of museums have provided staff skilled in these fields to assist police forces, notably in the area of forensic entomology, because skill in this area enables time of death

in murder cases to be assessed with considerable accuracy The article also suggests that a number

of these museums have provided staff in this manner as a way of earning money to deal with their increasingly cash-strapped resources due to government spending cuts.

Dead , Wire in the Blood and Messiah, and we can watch shows from the USA like Crime Scene Investigation and Law and Order: Special Victims Unit To what

extent these, for the most part, entertaining fictional representations have ally led to an enhanced understanding of these matters on the part of the general

actu-public is far from clear Documentary programmes such as Crime Watch UK seem

much more likely to aid the public’s understanding, and in a number of cases they have assisted in the apprehension of offenders such as Michael Stone (see Prins, 2007c) I have always been interested in the manner in which our descrip-tions of aspects of sexual behaviour reflect shifts in cultural and moral beliefs In

my youth, sexual activities were always referred to euphemistically For example the newspapers always described buggery as a ‘serious’ or ‘unnatural’ offence Today, we speak or write quite freely about oral or anal sex, ‘blow jobs’ and ‘giv-ing head’; and ‘going all the way’ does not refer to reaching the bus terminus! Sexual behaviour as currently depicted in much written and visual media seems to have been stripped of much of its mystery Children are much more knowledge-able about sexual matters at a much earlier age Indeed, justified concerns have been expressed about the sexualisation of quite small children; a matter discussed further in the chapter on sexual offending The remainder of this book is devoted

to a detailed discussion of some of the matters raised in this opening chapter However, before that discussion, the provision of a selection of case ‘vignettes’ may help readers to understand the varied presentation of mental disorders that may afflict those labelled both ‘mad’ and ‘bad’ (and not infrequently as ‘danger-ous to know’)

The individuals described later and some of the problems they present (and discussed in more detail in the following pages) would fall within a fairly broad description of mental disorder Even so, others would fall outside such descrip-tions, for example persistent sex offenders and those who have committed serious violence In addition, some of them often present in somewhat dramatic fashion and make the headlines in the media Other cases present in less florid fashion, but will also present difficulties in disposal The point is well made by Vaughan and Badger – as follows:

The existing literature tends to concentrate on the issues raised by the most serious and dramatic cases These are often complex and fascinating for both clinical and legal reasons [however] they are usually far from the every-day experience of most practitioners

Vaughan and Badger, 1995: xiiThe following vignettes may help to illustrate this quotation

Vignette 1

‘Peter’ is in his 50s and comes from the north-west Some 20 years earlier he was sent to a special (now known as secure) hospital on a hospital order (with

restrictions on his discharge) under the Mental Health Act, 1983, having been diagnosed as suffering from ‘psychopathic disorder’ He has an extensive criminal record of sexual offences The victims of his last offence had been ‘wooed’ and

‘groomed’ by him for some time and were all young boys After some years in hospital, where he had received a range of ‘treatments’ for his sexual deviancy, he was discharged into the community He had been at liberty for about four years when he was apprehended for further offences of a similar kind; but in these latter offences he had used threats and degree of force to secure the compliance of his victims Those responsible for his supervision (a psychiatrist and a social worker) had believed he had been doing well However, despite his favourable presentation

to them, he had been involved over many months in serious sexual misconduct He was recalled to hospital from the community by order of the Home Secretary; he was also charged before the court with the new series of offences Following his conviction he was again made the subject of a further hospital order Since then

he has remained in hospital; unsurprisingly, he is a model patient but affords no optimism to those entrusted with his management that he has changed his basic sexual preferences His ‘psychopathic’ state is regarded as virtually ‘untreatable’

in psychiatric therapeutic terms A critical question must be: Should he have been awarded a psychiatric disposal at this last court appearance, or would a prison sentence have been more appropriate?

Vignette 2

‘Margaret’ is in her early 60s She has had a severe alcohol problem for many years When in ‘drink’ she becomes uncared for, noisy, and abusive and frequently engages in minor ‘public’ order offences Over the years she has been the subject

of police ‘cautions’ (formal and informal), short prison sentences, probation, ods in detoxification centres and short spells in hospitals She ‘floats’ like some piece of flotsam on the waters of the health care and penal systems No one wishes

peri-to ‘own’ her and her condition is deteriorating slowly but steadily

Vignette 3

‘Cedric’ is in his early 50s He has a long record of offences of indecent exposure (‘flashing’) He admits readily that he has indulged in this behaviour on many more occasions than those for which he has been prosecuted and convicted He has received a range of penal and health care disposals, including numerous pro-bation orders combined with psychiatric treatment Despite the anxieties he feels

at each court appearance and sentence, he claims he is quite unable to break what has become a compulsion Probation officers, psychiatrists, psychologists and nurses have all been involved in various forms of therapy for his problems – to

no effect Fortunately, he is the type of exposer whose behaviour, although highly distressing to his victims, has not progressed to more serious sexual deviance, such as rape (see chapter on sex offences)

Vignette 4

‘Eroll’ is a 30-year-old African-Caribbean He is considered by some psychiatrists

to suffer from a form of schizophrenia that makes him highly suspicious of others and liable to engage in seriously aggressive behaviour when he feels affronted

or frustrated He lives in an area where he and his fellow African-Caribbeans are dealt with by the police more frequently than their similarly aged white contem-poraries His schizophrenic illness has been deemed to play a more significant role in his behaviour than the facts justify His behaviour and its origins pose significant problems for both law and psychiatry

Vignette 5

‘Mary’ is in her late 40s and is serving a life sentence for her third conviction for arson with intent to endanger life She has a record of preoccupation with fire since childhood, has engaged in making hoax calls to the fire services and has become involved in increasingly serious fire-raising behaviour At various times she has been diagnosed as suffering from personality disorder, from depression and from schizophrenia However, no one has felt that she easily fulfils the criteria for a conventional psychiatric diagnosis She has spent time in both ordinary and secure psychiatric hospitals In such establishments, she is both aggressive and disruptive; when in a state of tension she seeks to resolve it by lighting fires The circum-stances for which she received her current life sentence were that she thought her fellow residents in the aftercare hostel were ‘ganging up’ on her One evening, when they and the staff on duty had gone to bed, she poured a quantity of paraffin over the furniture in the communal lounge and set fire to it by means of a fuse made

from rags soaked in the same substance She then left the premises Fortunately, the

smoke detector in the room alerted the residents However, several of them suffered from the effects of smoke inhalation and needed brief hospital treatment Over the years, many approaches have been tried with ‘Mary’ There had been signs that she was beginning to find more acceptable ways of expressing her resentful and angry feelings and coping with the problems these created Despite this, the doc-tors who gave evidence at her trial were of the unanimous opinion that her condi-tion was untreatable within the terms of the mental health legislation The judge,

in sentencing her to life imprisonment, commented on her actual and potential dangerousness He indicated that she would not be released until those responsible for her management considered it safe to do so As we shall see subsequently, such judgements are notoriously difficult to make with a degree of precision

These vignettes demonstrate some of the problems involved in making firm boundary lines between normality and abnormality, ‘madness’ and ‘badness’ In addition, they demonstrate the problems involved in selecting the most appropri-ate modes of management in the interests of both the offender-patient on one hand, and the community on the other They also illustrate the problems that occur

in attempting to distinguish those who have merely a nuisance value and those

whose behaviour may have a more malignant quality These and allied issues are addressed in the chapters that follow.

Summary of key impressions

In concluding this first chapter, I list (in no particular order) key impressions of events and practices in the past few decades Some of them have already been mentioned I post two questions at the end of this brief summary which enable readers to add their own or substitute them for mine

1 Criminal justice (which I take to include penal policy and practice) and sic mental health have become much more complex and, at times, certain aspects appear somewhat unwieldy and ineffective

foren-2 A relentless increase has occurred in the prison population and the system does not have enough recourse to the use of more imaginative provisions

3 An over-reliance on criminal statistics as an index of crime resulted in a ure to recognise that, for example an apparent increase or decrease in crime may merely mean that the figures will vary in accordance with the variation

fail-in how crimfail-inal acts are dealt with and recorded by the various police ities A recent example of this possibility was the decision of the Greater Manchester Police Authority to re-designate certain forms of crime as ‘hate crimes’, thus fuelling fears that such crime is on the increase

author-4 The gradual introduction of a ‘payment by results’ policy and the increasing privatisation of criminal justice provision such as within the probation and prison services

5 Too hasty a resort to poorly thought out legislation Our politicians seem quite unable to tolerate ambiguity and uncertainty; this results in ‘quick fix’ measures

6 An inability to tolerate ‘risk’ in what has become increasingly a risk-obsessed and risk-averse society

7 The increasing downside of some forms of information technology that has not been adequately addressed

8 An increasing tendency to ‘medicalise’ problems of living as evidenced by

some of the provisions in the recent fifth edition of the Diagnostic and tical Manual of Mental Disorders (DSM-5)

Statis-These points are a somewhat idiosyncratic selection of trends In the light of this, readers may care to consider answering the following two questions

Questions

1 Suggest additions or deletions to my list

2 To what extent do you consider my recollection of key events in the past

60 years or so is in accord with your own experience or reading?

I have, of course, not included reference to some of the much broader issues of cern such as the state of the economy, the widening of the gap between the ‘haves’ and the ‘have nots’ and the concerns about the roles of the media in its various forms

con-Acts

Abortion Act 1967

Children Act 1948

Courts Act 1971

Criminal Justice Act 1948

Criminal Justice Act 1967

Criminal Justice Act 2003

Homicide Act 1957

Mental Health Act 1959

Mental Health Act 1983

Mental Health Act 2007

Murder, Abolition of the Death Penalty Act 1965

Prevention of Crime Act 1908

Sexual Offences Act 1967

Sexual Offences Act 2003

Suicide Act 1961

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Practi-tioner, Hook, Hampshire: Waterside Press.

————— (2013) Psychopaths – An Introduction, Hook, Hampshire: Waterside Press Scottish Home and Health Department (1964) Children and Young Persons, Scotland (Kil-

brandon Report), Cmnd 2306 Edinburgh: HMSO.

Smith, D (2006) ‘Making Sense of Psychoanalysis in Criminological Theory and

Probation Practice’, Probation: The Journal of Community and Criminal Justice 53:

361–76.

Stanley, N and Manthorpe, J (eds) (2004) The Age of the Inquiry: Learning and Blaming

in Health and Social Care, London: Routledge.

Taylor, P and Gunn, J (1999) ‘Homicides by People with Mental Illness: Myth and

Real-ity’, British Journal of Psychiatry 174: 9–14.

Vaughan, P J and Badger, D (1995) Working with the Mentally Disordered in the

Com-munity London: Chapman and Hall.

Further reading

The books listed here provide very useful orientations to the forensic mental health field Best used for ‘dipping into’

Boyd-Caine, T (2010) Protecting the Public: Detention and Release of Mentally

Disor-dered Offenders Cullompton: Willan Publishing.