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Judge seeks answers from Home Office on failing mental health system

I imagine Judge Peter Jacobs will be listening with special interest today when controversial plans to allow mentally ill people to be detained against their will are discussed in the Commons.

Last week he was forced to jail a mentally ill man because there was no alternative available in the community care system.

He was so incensed, that he asked Home Office officials to explain why, at a time when our prisons are full, proper systems of care in the community were not in place.

But by the end of last week, and ten days later, the frustrated judge was still waiting for a response.

He had no choice but to jail David Millward, 47, of no fixed abode, to 12 months, stating:

I repeat that in this case there is a diagnosis of mental illness which the psychiatrists say does not warrant detention in hospital. Any prison sentence I pass cannot be indeterminate and nobody has provided any alternative.

“This is ironic at a time when prisons are full and concern is expressed in some quarters about the presence of people in your condition in prison.?

Millward had admitted a third breach of a restraining order preventing him from entering the area where his mother lives, near King’s Lynn, Norfolk, or from visiting her home.

He has in the past threatened to kill his mother and police have been called out on a regular basis as he frightens her, the mere thought of him being there frightens her. He has previously been detained under the Mental Health Act, but his condition has since deteriorated even further.

Millward has been a manic depressive for 25 years and during elevated moods his behaviour is destructive. In addition, he has a primary personality disorder which is untreatable.

Judge Jacobs described his frustration:

“This defendant should take his medication under a regime which would ensure he takes it. If I turn him out, his mother is at the end of her tether and has had enough. If I turn somebody out and they re-offend, I am then criticised for letting them out. I am not prepared to release him unless there is a regime in place.

“This is a classic example of how the system is failing. The system does not provide proper care in the community. If you are going to have care in the community, you must have proper residential care for people like him.

“He should not be in prison, but no-one comes up with any alternative. Every year I have a couple of dozen such cases like this and I say the same things and nothing ever happens.”

Judge Jacobs believes Millward should be treated in semi-secure accommodation with an alcohol ban in place, backed up by the threat of jail.

I do feel sympathy for these sick people, they cannot help the way they were born, and their families must feel so helpless and desperately sad that they cannot help their own kith and kin. Mental illness is a terrible cross to bear, those afflicted do not conform and need support.

Why has the Home Office not responded to the judge, how can these mentally ill criminals be helped if there is nowhere suitable for them to go?


34 Comments

  1. Hi Ellee, if we could get in touch, but not in the blog it would be much appreciated.

    Anne

  2. Brilliant post Michelle. Years ago we had prisons for criminals and institutions for the mentality insane or ill. No we don’t have the latter and not enough of the former.

  3. There really is quite a debate on this one, which is good news. Thanks for all your comments. As for the boring topic of doctors pay… you should ask me how much I get paid… I do not work as an NHS psychiatrist for the money. I love my job and the patients teach me more about life than life itself. As for health care, the best summary I’ve ever read was from John le Carre:
    “A national health service is the litmus test of any decent society. The question is not whether we should have one, but how good we can make it.”
    Michelle

  4. This is a problem in every country. The current thinking on psyciatric illness is that you don’t lock people away in institutions but you must have community services in place to deal with these people. Of course the second part of the equation never happens or only half heartedly so you end up with all these lost souls, most often homeless on the streets. Of course, non compliance with medications is a huge problem but you can only force them to take medications in a controlled situation. What’s the answer? Prison certainly isn’t.
    jmb

  5. Sadly I think it`s the same everywhere. Too many troubled people and not enough resources to look after them properly. Just heard today about William and Kate. A surprise but they are still young. I bet whoever had started making china plates etc with them on it are upset. Heard that was already in the process for when they got married.

    tea
    xo

  6. Itsa the same here. they dismantled the mental health system, and so the only “safety net” is arrest…

    Pathetic,stupid etc
    I would happily pay more tax for better health, better roads/communication ( as maalie will tell you its hopeless here) etc….

  7. Is there an arguement then ?I guess you will be need to get you butler to pop over the West wing and check and few details men sana. I may do a post about it soon , and I will let you know.Currently I am doing something else

    Anne- Sorry about my insensitive use of Language. I get so sick of being told all the things I am not allowed to say I go a bit far the other way sometimes .

  8. mens sana

    before you finish that post NM, can we please not have another argument on Ellees blog-I’m very happy to have it out on yours

  9. No Ellee not at all frustrated, I’m too busy counting my money and working out how to enrich myself at the taxpayers expense to worry about this sort of thing

    Sorry I have a wild mouse.Men Sana there is nothing wrong with your seeking to maximise your earnings. Equally we must all act to cut back the clear abuse of the taxpayer who is not getting value for money. Obviously vastly over rewarded Doctors is only one of the problems but this fact does rather place your remarks under a cloud .

  10. No Ellee not at all frustrated, I’m too busy counting my money and working out how to enrich myself at the taxpayers expense to worry about this sort of thing

    Why wouldn

  11. mens sana

    No Ellee not at all frustrated, I’m too busy counting my money and working out how to enrich myself at the taxpayers expense to worry about this sort of thing

    Seriously, though, I think Michelle understands much more about this issue and I’m sure she faces similar problems every day-I don’t know how she stays sane. I think I would spend all day shouting at people and shorten my life by about 10 years.

    But it is this sort of problem that as Q9 says we have to address as a society by asking ourselves what sort of service we want to provide and then working out how to pay for it, not the other way round.

  12. mens sana, I know that you and Michelle must feel totally frustrated at situations like this, and yesterday’s post too, it must make your job very difficult.

  13. mens sana

    Hey Q9 we agree on this-hallelujah

    Mental health provision is appallingly underresourced in this country, because it is not fashionable. This judge was in an impossible situation, as you have to have a strong feeling that imprisoning someone like this may make things worse. I’m sure we have to have proper secure inpatient facilities for people like him

    But there is a real ethical and legal problem where people have an untreatable psychiatric condition and haven’t yet committed a crime, but are considered at very high risk of doing so-how should society deal with them?

    Thanks for this post Ellee

  14. Hi Elle, can’t find a link for Mens Sana on your blogroll, so had to thrash it out with him on your last post.

    Michelle, I’ll be happy to give you
    A Piece of My Mind – on this one too
    I’m sure we’ll agree on many things.

    We as a Society either care about the health and mental conditions that afflict the members of our community – or we don’t.
    The cost argument is often a ‘red herring’
    Do we find real solutions and then cost them, or do we cost them and tailor solutions to fit the bill, rather than the patient’s needs?

  15. Sally, I know you’ve had a tough time, and I’m so glad you have found great happiness now.

  16. Another thought….how do you keep them away from the alcohol if you don’t lock them away…he was out of his head everyday but no one ever saw him have a drink they are that sly and crafty.

    Sorry but I have become very hard …maybe its because of all I have had to deal with…

    Thank god I have decent boys and Have found great happiness !!! God really smiled on me around october time 🙂

  17. Ellee, as you know I have a story but find it hard to comment about it. Its my boys who suffer most, I have just learnt to deal with it.
    There Dad seems to be well at the moment but who can tell. They have not seen him since January but I have said he could come and visit next weekend while I am away,( he could come any week-end ) if he comes is another matter, and I can only hope we dont get a repeat preformance of the last visit.

  18. Obviously this issue is one close to my heart. It’s difficult to comment on this particular case without knowing all the details. But general points:
    1) Awaiting for any social services or specialist services accomodation, can be a long wait. It can mean patients remain in hospitals to wait for suitable placement, which is neither suitable for patient nor hospital.
    2) As community psychiatry treatment has increased the number of in-patient beds has decreased. The reduction in in-patient beds has been a crisis, and remains a crisis. Having care in the community money is giving with one hand but the other hand is taking away acute beds.
    I could write an essay on this and give you thousands of examples. Mental health is treated as a cinderella service, and the patients are often the ones who can not speak out for themselves. Doctors ask exactly these types of questions everyday. Michelle

  19. Hoping the problem will ‘go away’ is no solution to it all.

  20. Thanks Steven_L …apology accepted…I just saw a bit red.

  21. Thanks Steven_L…apology excepted…I just saw a bit red.

  22. Steven_L

    I’m sorry Anne, newmania started it. I was actually trying to stick up for the mentally ill, but had to come down to the London level to get my point across to him.

  23. electro-kevin

    I don’t agree that refusal to take medication or to stop drinking to excess mitigates nasty criminal behaviour and a prison seems the right place for him to be. Manic depressives need help and deserve our sympathy but ought not to be excused of their abuses once shown the way.

    I am glad that judges are not allowed to overrule qualified psychiatrists.

  24. Ellee, you just have this knack lately of touching on issues which give me the heeby-jeebies. Age and mental illness together are appalling. I don’t know what to even say about them.

  25. Darkersideofbridgetjones, I have been given a camera to use as a citizen journalist, I am still trying to get the hang of it. Anne’s story highlights many relevant points, I wonder if she would be agreeable for to record her story, with her son. And perhaps Dr Michelle Tempest too. You have given me some food for thought, it is an important subject.

  26. Anne, I agree that that kind of language is not acceptable, I expect/hope they were flippant throwaway comments rather than intentional.

    I was very sorry to read about your son, it must be heartbreaking for you to watch him change this way, as well as being difficult for your son who wants to be well enough to work again. I hope he gets the full treatment and support he needs.

  27. Darkersideofbridgetjones

    Dear Ellee,

    It is disgusting that mentally ill people are criminalised. There should be some suitable provision put in place for them. Care in Community clearly does not work, as many of these people end up homeless. My aunty in Scotland leaves in a flat above a woman with mental health issues, she has some supervision, but is simply inadequate. She does some really danergous things, like trying to set fire to her flat.

    Anyway, I know from some of my friends how hard it can be to get help. I have a lot of friends (I think it’s quite a common problem) do have somekind of mental health issue. Most of my friends end up going private.

    We need kids to be aware also of the dangers of smoking dope, that can trigger some really nasty mental health issues.

    It is all very stressful. PLease do a citizen journalist thing on it. It’s an area that interests me a lot.

  28. Newmania and Steven L

    Why are you calling them (Nuts) and (Moonbats)…that is just disgusting. You obviously have never had to live with someone who has a mental illness.

  29. Steven_L

    The town where I’m living at the moment, where I went to school, has a population of about 20,000 and 2 huge mental hospitals. It goes without saying we have a fair few ‘moonbats’ about. One of the hospitals is long-stay with a medium secure ward full of actual psychopaths the nurses can’t turn their backs on and have to keep zonked out all the time. The other has just been rebuilt on one of these PFI deals and for all that’s wrong with PFI it is a stonking hospital, all the staff are well chuffed with it. Every patient has an on-suite room.

    For all this we have never had one single instance of a mentally ill person murdering, or attempting to murder anyone in all the time I have lived here (23 years).

    Newmania I take your point about cities. This is one of the many bad things about cities, it all stems from the fact that in cities, especially London, no-one gives a stuff about each other.

  30. Something happened to my youngest son when he was about 15..self harming, drinking…and the mood changes were unbelievable….I can;t even start to describe them…It took us years to get help. He is on medication and sees a psychiatrist…not very often because he is so busy seeing other patients as well. They haven’t provided a community nurse for him, yes they say they are going to but when !!!Sometimes he needs to talk for hours..this you can;t do at the doctors. My son was a top student at school..with 500% attendance at his senior school..never had a day off there at all.He has worked in the past and He wants to work again, but can;t..All he is asking for is some help to get him back into work, someone to talk to…and guidance!!!!!

  31. Another great Post Ellee .The need for secure accomodation, has been ignored for years . They usually ( the nuts ) end up in Prison which is the main reasons our prisons are overflowing. It has been a real problem in cities where the streets are full of deranged and dangerous moon bats in transit

    I strongly suspect that quite a few escape to havens where lap tops are provided for them to post their bonkers gibberish on various blogs though.

    ( That Steven L is a borderline case for one..seriously you need to watch him)

  32. Steven, I understand what you say, and I don’t know this man’s previous convictions, but he appeared before a Crown Court, which is a high court in the UK with increased sentencing powers over magistrates because it was considered more appropriate that a judge sentenced him.

  33. Steven_L

    Judging by the facts you have given ‘criminal’ is a bit harsh. Family members often threaten to kill each other, the difference is this guy is deranged enough for it to mean something. So he walked into an area he’d been banned from, no more a ‘criminal’ that someone who breaks the speed limit in my book.

    I live in a town that boasts 2 huge mental hospitals, and know a fair few people that work in them. I don’t think much of the services down South, if he is schizophrenic and known to be a danger to himself or others when not medicated then they should be able to section him.

    Up here, the police would have known who he is, got in touch with the hospital, arranged to take him there and stayed while the doctor persuaded him to be admitted. That’s what care in the community is all about. Not being such a bloody bureaucrat all the time!

  34. It does seem that the Judge was in an impossible position. How can secure accommodation not be in place for someone like this? How can non-psychiatric staff in a prison be expected to be able to deal with him?

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