Nottingham attacks - verdict

[DrunkenElephant]

I live in Nottingham and feel terribly sad reading the news today.

Could these deaths have been avoided if the police and mental health agencies had done more? But then how can more be done when services are on their knees?

I don’t know the answer to either question, but my hearts go out to the families of Barnaby, Grace and Ian.

Assessing risk is an art rather than a science particularly when estimating the risk of an extreme event which is rare

Ii is partly based on patient symptoms for example command hallucinations [do this! do it now!] and delusions of control [being forced to think/act in a certain way outside the persons control] - the 2 occurring together significantly increase risk if the commands are of a violent/homicidal nature

But the major factor of 'past behaviour predicts future behaviour falls down when the event is rare and extreme and previous behaviour is relatively minor and common

So that's a hard call for the police even given evidence of risk/mental state from psych professionals in prioritising executing any warrant

i get the bed occupancy and updates regard available beds and those waiting for admission . It’s really alarming. Frequently there are no beds in trust and patients travel hundreds of miles. Placed away from family and support network

@Zone2NorthLondon I’m aware the professionals won’t get “done for manslaughter” but I do believe there were failings. I’m saying that if he’s seen as not being fully responsible then others are also culpable. I also believe he should have been done for murder as he planned an attack that night and I’m gutted for the families (one I personally know).

What is being done to help and support the families of the people murdered by this criminal. I bet that there is nothing for them.

There are community treatment orders, where someone who has been detained in hospital under certain sections of the MHA is released on the condition that they accept treatment. They can be returned to hospital if they don't comply without having to go through the process of getting them sectioned again.

I haven't heard of anyone being on a CTO for years (11, to be precise, when my DB was released on a CTO), and I rather suspect that cuts mean that there are insufficient staff to monitor people on CTOs once they're out in the community.

Yes I would like to know that too. Also those mown down and although they survived their injuries sound life changing. I listened to the live sentencing when the judge was talking about their injuries and how they are not surprisingly afraid of going out. I don’t think we should just accept that this is what happens .Things need to change.

@TeenLifeMum was he of sound mind when he planned/carried out the attack?

No. And that is why he has not been convicted of murder.

So you can’t make people have this I assume. Or maybe the question is what is the next step if they don’t have it?

Is action taken or are they within their free will to say no and to go

@ButterCrackers I will reverse that question
What support do you think there should be for the families . What would you put in place for them? Just out of interest

@DrunkenElephant is anyone of sound mind when murdering anyone?

I’d also add that anyone who is a paedophile isn’t of sound mind. Prison isn’t just punishment but about keeping society safe.

@TeenLifeMum society is being kept safe by him being in hospital for heavens sake. Actually safer. He can be medicated and treated properly by people medically trained. Which means me and my colleagues are safe in prison.. I repeat me have no training to deal with people ill like that . Its really not hard to understand

The law disagrees with you.

The whole point of specialist high security hospitals are to keep society safe. He will never be released. He could have been released from prison on parole after 20 years - how is that more safe for society?

Read the posts from the prison officer on here and tell me if you still think he should be in prison.

There have been numerous cases of people killing when they haven't taken their medication, so why on earth are they allowed out to roam free?

Probably because they are no longer unwell enough for them to be sectioned. We can't keep people in hospitals when they no longer meet the threshold for detention. Which would be fine if there were adequate community MH services, but there aren't. It's much more resource intensive than monitoring them in hospital.

The community mental health teams across the 2 counties and city where I work have been decimated, partly by cuts (one team has had its staff cut by nearly 50% in the last 12 years) but also because the staff that are left are burned out and leave for the sake of their own sanity and they are struggling to recruit replacements.

One former CPN of my acquaintance now works in the hospital of a Cat B prison, one has retired on ill-health grounds, another is working in a garden centre.

@golf7 - that’s why I said to be in a hospital until meds are working and under control. That may never happen but it can be included in the sentence that if within a set time frame he is controlled by medication, he would move to a prison. That’s what was expected by the families.

@TeenLifeMum the ONLY place he can be forced to take his medication is in hospital.

He will never be cured, so he’s moved to a prison, refuses to take medication again, staff can’t force him - then what?

Having seen what depot injections do to my bipolar DB, I'm quite uncomfortable about them.

He's like a bloody zombie, slurring, shuffling, can't seem to follow a conversation unless it's very simple and has become a complete recluse. He only goes out to get shopping and go to his MH appts.

I'm also not convinced that they're all that effective. A few months ago, when I spoke to him on the phone (he won't let me visit, won't have anyone in his house), he sounded very much as though he might be heading for a manic episode, and I suggested that he might ask his CPN to review the dosage. They increased it, and now he's even more zombie-like than he was before, so I wish I hadn't said anything now.

Ok,who else is culpable? Can you explicitly explain what you mean?You seem very unaware of the professional role. Did you read my lengthy response to you?

The legal process isn’t about appeasing angry public or delivering outcomes that will make the families happy. It’s about process, precedence and guidelines

If it’s agreed it’s manslaughter then the professionals involved should also be done for manslaughter because they did not do their jobs.

Splendid idea. Let's extend that principle to all our NHS and public sector staff, shall we, and see what it does for recruitment?

@TeenLifeMum
Going to explain it again.. slowly .. as several have tried and you seem to he struggling to grasp it.

So he is in hospital. He has some medication and is 'better' and under control ... he then gets moved to prison

Prison is staffed by officers . Discipline staff. Who have as I have repeatedly explained reveived NO training medically or in mental health barring the odd suicide awareness course and some neuro diversity training. There is inpatenients in prison mostly for people who are physically unwell. Some who have mental health issues (we have a prisoner with advanced dementia in mine ) there is nursing staff. Basic nursing care often by HCA not specialist trained psychiatric nurses like you would get in a 'mental' hospital.

So he would 1. Most likely deteriorate again. He would feel better. Believe he was OK and not want to take his medication.. in hospital on an order he can be made to. Actually forced. In prison he can't. He would be a prisoner. Not a patient and can refuse or he could attempt to divert or conceal his medication. Meds in prison are done quickly often before the handful of staff many of us burnt out depressed with ptsd or having umpteen other prisoners on our case about something all. At the same time (imagine a wing of 180 grown men strong many very very violent but with the mentality of toddlers. They get jealous if someone has something rhey want. They want what they want and they want it NOW (a toddler Trows a sippy cup and lays on the floor) a prisoner ties a noose and strings up often for attention or to manipulate or they attack another inmate. Once all that is dealt with we are then rushing the men off to court to education work the gym or the exercise yard . There is little time to interact or notice things that would be picked up by I repeat trained medical professionals in a smaller more intense setting.

Lastly if he's sent back he's then a PRISONER not a patient. He is then treated as such with the situation of parole or being moved later on in their sentence to more open conditions. Do you actually want that. Prison isn't somewhere people are locked away and never see light of day just to make someone like you happy. The staff other prisoners and the public WILL be better protected and safer by him being in hospital.

Is that easier??

What help can he get other than this or being in a facility?

By that I mean what would need to happen to kerp
society safe if it’s not either of these things

Just out of interest why do you reply like that? The families should get justice and support for their health.

@golf7 rather pointless discussing as you clearly think I’m stupid - did being condescending make you feel good? (I’m currently enjoying a moment having received my latest masters scores where I got three high distinctions from a Russell Group uni, which I do alongside full time work and being a parent - perhaps not as thick as you think I am).

I agree with Barnaby’s mum’s words. I think there’s been many failings in supporting this mentally ill individual and in bringing justice for those families.

@ButterCrackers but in what form do you suggest ? Yes they should be supported and that be ongoing. I ask as you raised it what form you think that should take ? Ita a thread where we are discussing failings in the mental health and some would say justice system of this country. Entirely reasonable question to ask

@TeenLifeMum congratulations. Academic ability clearly hasn't crossed over into understanding basic common sense though. The man is unwell and should be in hospital not a prison . Period. Several others have pointed this out yet you persist in pushing this idea od him being hurried out of hospital and into prison to satisfy people who don't feel justice has been done. To he'll with the logistics of this or the consequences. I have to deal with individuals who shouldn't be in prison every day let alone someone on this scale of ill mental health so I feel incredibly strongly and I cannot for the life of me understand what you think that prison would achieve that a secure hospital won't

He's not a risk to society as far as I am aware, but when he is manic he is a risk to himself. However, he hasn't had a manic episode for over 10 years now (although he has an unusually long cycle, so that could just mean he's due for one!).

In an ideal world, I'd like someone to pop round daily, to make sure he takes his meds, so he doesn't have to have the depot injections, to see if oral meds improve his quality of life. I'd also like him to have regular visits from a MH support worker to encourage him to get out of the house occasionally, even if just for a cuppa or a walk, maybe help him sort his house out a bit (I very much suspect he lives in squalour and possibly hoards, because he won't let anyone in his house). Then maybe support him to go to a MH wellbeing centre during the day occasionally, where he can actually have some social contact in a supportive environment.

If he lived in my Trust area, he could get a fair amount of this, but he lives over 3 hours drive away and I don't know what services are available there. If anyone reading works for the North Essex Trust and has any suggestions, I'd love to hear them!