Crown Court for Northern Ireland Decisions

Acceptance of your plea by the prosecution

The factual background

"Its terrible what a cheese knife does to you."

At midnight another witness heard a large bin being dragged across the yard. This was is in fact seen by another witness. You attempted to bring the bin to your front door. You even tried to pull it into your flat. You were unsuccessful in this attempt and thereafter pushed the bin back over to its position in the yard.

Your initial presentation to the doctors after your arrest

"They put a chip in my head. If you want me to get better take the . . . chip out. That is all you have to do."

You were verbally abusive and described voices.

The lack of a high security hospital in Northern Ireland

(a) The lack of a high security hospital can lead to extremely ill prisoners having to endure the most distressing and debilitating mental illnesses without receiving adequate treatment which humanity requires that they should receive. This could amount to a breach of Article 3 of the European Convention depending on the facts of each individual case.

(b) It places pressures on prison staff in that they have to deal with extremely ill prisoners in prison accommodation. In that respect I note that Maghaberry Prison does not have a psychiatric ward nor is there a full time doctor resident in the prison.

(c) It can lead to the public being exposed to risks which should be avoided. In essence in this case there is a choice between a hospital order with restrictions and a discretionary life sentence. If a prisoner suffers from a dangerous personality disorder then that is one of the factors that I should take into account in deciding which order to impose. If I impose a hospital order with restrictions then the Mental Health Review Tribunal could well be obliged to release the offender into the community even if he had a personality disorder and that personality disorder created a substantial likelihood of serious physical harm to others. In some cases, though in the event not in this case, such a dangerous personality disorder could be completely hidden by a mental disorder and remain hidden throughout the period leading up to sentence by virtue of a lack of treatment of the mental disorder. If appropriate treatment had been given then it would not have remained hidden. Lack of treatment prior to sentence could result in an inappropriate sentence being imposed with increased risks to the public.

(d) The inability in practise to use an interim hospital order under article 45 of the Mental Health (Northern Ireland) Order 1986 and the inability to remand to a hospital under article 43 of the Mental Health (Northern Ireland) Order 1986. These are valuable powers utilised in England and Wales. The statutory powers are available in Northern Ireland but due to the lack of a high security hospital they cannot be used in this case and in similar cases.

"There are substantial obstacles to admission to the State Hospital for service users from Northern Ireland. Currently people who are remanded to prison and who are suffering from mental disorder that warrants transfer to a high secure service cannot be remanded to a hospital outside the Northern Ireland jurisdiction and thus cannot receive appropriate treatment in conditions of high security until their case has been dealt with by the courts. The provision of psychiatric treatment in prison is strictly limited, for example, a prisoner who is so mentally ill that he or she does not appreciate the need for treatment cannot be given treatment in prison under the protection of mental health legislation. Such a prisoner may have to remain on remand in prison for a prolonged period, perhaps a year or more, without receiving adequate treatment. Similarly individuals whose circumstances may warrant an interim hospital order to the State Hospital cannot be transferred outside of the Northern Ireland jurisdiction. Section 81 of the Mental Health (Scotland) Act 1984 (as amended by The Mental Health (Northern Ireland) (Consequential Amendments) Order 1986 specifically excludes people subject to remand for assessment or treatment or to an interim hospital order (Articles 42, 43 and 45 of the Mental Health (Northern Ireland) Order 1986) from the arrangements for removal to Scotland of patients in Northern Ireland. It is a highly unsatisfactory situation that service users from Northern Ireland are unable to have access to treatment and care in conditions of high security when their condition requires it."

The report continued:

"The principles of this Review require that all service users have ready access to high quality care. It is, therefore, essential that all service users have access to assessment, treatment and care in conditions of high security if their condition requires it. However, certain service users are denied this option, namely prisoners on remand and people who may benefit from assessment and treatment in a high secure service while the subject of an interim hospital order. There are substantially fewer admissions to high secure services from Northern Ireland than from other jurisdictions in the United Kingdom. Certain service users in Northern Ireland remain inappropriately placed in prison when they should be in hospital. The Review considers that the current arrangements are highly unsatisfactory. It strongly urges that a solution is found urgently and as a matter of priority." (emphasis added)

"All are agreed that the defendant requires treatment with powerful antipsychotic medication which requires monitoring facilities which are not available within the prison health care system in Northern Ireland. I am advised that there is no mechanism for the transfer of a prisoner on remand to the high security psychiatric facility at Carstairs and as a result a prisoner in the position of the defendant cannot be provided with the medication which the clinicians consider appropriate to the treatment of his condition during his remand. It is clearly in the public interest that prisoners on remand who are suffering from serious psychiatric conditions should receive appropriate medical treatment in order to address those conditions and diminish the extent to which they are a danger to themselves and others. Any administrative obstacles to this course need to be re-examined in order to seek to secure that outcome." (emphasis added)

Your criminal and psychiatric history together

with difficulties in personal relationships

"He is presently not in communication with any family – mother lives in the West Midlands . . . he says that he is currently not on any treatment . . . the main problem appears to be that he hears voices within his head with which he converses . . . I have started him on a low dose of anti psychotic medication . . . he appears to be fairly typical of mild schizophrenia . . ."

"Concerns raised regarding his possible forensic history and his intimidating personality . . . social worker is concerned that we have not been given a full history of possible risk with this man . . . today Mark was clearly paranoid – he did talk to us but seemed irritated at times and distracted – he is guarded and suspicious and quite intimidating . . . Mark is resistant to the idea that mental health services have anything to offer him . . . he has seen Dr Bell on 11 November 2004 but this meeting did not go well from Mark's perspective and he has no intention of seeing Dr Bell again . . ."

"Informed by social worker that Mark has been taken into custody following a fire at his flat."

"This gentleman has quite florid psychosis – he has schizophrenia and is quite agitated and volatile – he behaves strangely, hears voices and believes that there is someone out there going to do him in . . . He has ideas of reference with regards to television and radio which he believes are passing messages on to him . . . He also has very little insight into his problems and can deny that he has any problems."

"Informed by social services that Mark's case has been closed as he is in prison . . ."

"Mark turns up at Woodstock Lodge today – he has been released from prison on charges of arson as the Northern Ireland Housing Executive state that the fire was due to an electrical fault . . ."

However 4 days later on 16 June 2005 the South East Belfast Health and Social Services psychiatric services wrote to your general practitioner discharging you from the clinic on the basis that you were in prison in Maghaberry. It appears that you were then lost to consultant referral until 5 December 2006 when you were re-referred by your general practitioner, but did not attend.

Personal background of the offender

Representations of behalf of the victim's family

"There are two aspects of this terrible journey I had no wish to go on. Firstly, the loss of my son, secondly the manner in which he was taken. The loss is unbearable but the manner in which he was taken is much more than unbearable. My heart has been broken and my very soul has been torn apart. . . . My son adored his children; they were his pride and joy and they have lost a loving father . . . I relive what I imagine to be my son's last moments every day. I was caring for my elderly mother when my son was dying. Was he in pain? Did he call for me? I wish my brain would stop thinking as I cannot stand the thoughts. My mother did not get out of her bed after this and died shortly after; William's death hastened her death. My life has been devastated, I have isolated myself and avoid meeting concerned neighbours and friends as they ask me how I am and I cannot answer them for crying.

. . . I was told my son died quickly and now realise that he did not, the more about the incident I find out, the more it hurts. Finally, I am a mother whose son has been murdered in the most brutal way, he was not given any comfort or dignity when he died and as a mother I find this, and the loss, just too much to bear."

Sentencing options. Whether a determinate custodial sentence appropriate. Whether you meet the criteria for the imposition of a discretionary life sentence.

(a) A discretionary life sentence. In passing such a sentence I would fix a tariff period to represent the elements of retribution and deterrence. After the expiry of the tariff period you would only be released into the community if it was no longer necessary for the protection of the public to detain you. That decision will be taken by the Parole Commissioners. Your release would be a release on licence and if you breached any conditions of your licence you could be returned to prison. The Parole Commissioners in arriving at any decision in your case would have the benefit of the views of the Probation Service, psychiatrists, psychologists, the Prison Service the Police Service of Northern Ireland and any other group or individual deemed to be appropriate given the particular circumstances of your individual case.

(b) A hospital order. Article 44 of the Mental Health (Northern Ireland) Order 1986 enables the Crown Court to make a hospital order where, as here, the offender has been convicted of an offence punishable with imprisonment provided that two conditions are met. The first condition is that the court is satisfied on the oral evidence of an appointed medical practitioner and on the written or oral evidence of one other medical practitioner that the offender is suffering from mental illness or severe mental impairment of a nature or degree which warrants his detention in hospital for medical treatment. The second condition is that the court is of the opinion, having regard to all the circumstances, including the nature of the offence and the character and antecedents of the offender, and to the other available methods of dealing with him, that the most suitable means of dealing with the case is by means of a hospital order. If a hospital order is imposed then "Once the offender is admitted to hospital pursuant to a hospital order or transfer order without restriction on discharge his position is almost exactly the same as if he were a civil patient. In effect he passes out of the penal system and within the hospital regime." see R v. Birch [1989] 11 Cr App R(S) 202 at 210. Accordingly the offender can be discharged from hospital in the same way as a civil patient.

(c) A hospital order and a restriction order. The court has power under Article 47 to restrict discharge from hospital. A restriction order "fundamentally affects the circumstances in which the patient is detained. No longer is the offender regarded simply as a patient whose interests are paramount. No longer is the control of him handed over unconditionally to the hospital authorities. Instead the interests of public safety are regarded by transferring the responsibility for discharge from the responsible medical officer and the hospital to the Secretary of State alone (before September 30, 1983) and now to the Secretary of State and the Mental Health Review Tribunal. A patient who has been subject to a restriction order is likely to be detained for much longer in hospital than one who is not, and will have fewer opportunities for leave of absence,"see R v. Birch [1989] 11 Cr App R(S) 202.

(a) is not satisfied that he is suffering from mental illness or severe mental impairment of a nature or degree which warrants his detention in hospital for medical treatment; or

(b) it is not satisfied that his discharge would create a substantial likelihood of serious physical harm to himself or to other persons.

The psychiatric evidence and the conclusion as to

whether you have a dangerous personality disorder

"It seems more likely to be attributable to underlying personality problems, given that he was in contact with psychiatric services in 1993 and 1994 and was not, at that stage, noted to be psychotic.  It seems unlikely that he was overtly psychotic at those earlier dates."

Though he did go on to say

"one wouldn't want to diagnose personality disorder on the basis of offence behaviour alone, this would be quite a detailed assessment that would be required."

A. I think the risk of Mr Warwick engaging in bad tempered, impulsive, aggressive behaviour, a substantial proportion of that risk in that type of scenario does come from his inherent personality structure.

A. What anti-psychotic drugs will not treat will be hostile attitudes, anti-social attitudes, denigratory attitudes, they will require psychological interventions as part of the overall treatment package.

Q. …do you consider that his personality presents a serious risk of significant harm to the public?

A. I think his personality, when one looks at the medical evidence that we have, the descriptions of disfunctioning, the descriptions of his behaviours from the date of those papers, I think his behaviour has not been normal and I think his behaviour has been violent, and excessively violent and anti-social. Certainly his very early offences are more than likely attributable only to negative attitudes and to anti-social traits. As one approaches 1999 one has to take into consideration that schizophrenia could have been emerging at that time. It is widely accepted that from the time of the first admission you can count back five years and you can say within that five year period that there would be a contribution of mental illness to the offending, but going back beyond the five year period it is more than likely that that is a manifestation of anti-social personality disorder. And we have to assume because personality, robust personality normally does not change with time, if it is not treated and it's not effectively addressed then it will re-emerge whenever the mental illness has been treated.

Q. … do you consider that there is a serious risk of serious physical harm to the public through his personality?

A. Untreated yes, there is. I consider that that is a significant factor. The difficulty is that we don't know whether his personality is treatable or not treatable. Certainly there are elements of the personality that I have alluded to that will be treated in a secondary fashion by anti-psychotic medication but he will require, in a therapeutic setting, a full assessment of his personality and treatment of that personality. Unfortunately I haven't any evidence to date to say that his personality is treatable, or that it isn't treatable.

A. There's a personality aspect, there is also the possibility of abusing substances. There is also the possibility of a residuum of mental illness symptoms that do not distress the individual immensely but cause difficulties in his thinking and interactions that are left behind and one really doesn't know, until perhaps four, five, six, maybe eight years of treatment in a high secure setting, what we are going to be left with in the case of Mr Anderson Warwick.

A. … Alcohol tends not necessarily to badly affect mental illness symptoms, such as delusions and hallucinations but does tend to affect the underlying personality, it has a disinhibiting effect. So alcohol is unwelcome in a case such as this. Illicit drugs are an absolute contra-indication and are a very very potent risk factor.

"There are holes in the current mechanism, I have to concede that. I'm also aware that there is, there are plans to try and plug those gaps but I have no control over any of those and cannot give the court any certainty in those aspects of the future."

Discussion

Conclusion