Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-10T14:17:37.173Z Has data issue: false hasContentIssue false

Chapter 3 - Outcomes from the Key Inquiries and the Evolution of Modern Forensic Psychiatry

Published online by Cambridge University Press:  06 June 2024

By
Kevin Murray
Edited by
Mary Davoren  and
Harry G. Kennedy
Mary Davoren
Affiliation:
Broadmoor Hospital and West London NHS Trust
Harry G. Kennedy
Affiliation:
Trinity College Dublin
Get access

Summary

This chapter offers an account of the key events shaping modern forensic psychiatry since the 1950s, including legal reforms, political initiatives and key reports which have influenced practice. These are summarised in a narrative beginning with the 1959 Mental Health Act and concluding with the most recent Wessely proposals for reform. The critical clinical events including the cases of Graham Young, Peter Sutcliffe, Christopher Clunis and Michael Stone, the Carstairs escapes and the Butler, Reed, Blom-Cooper, Fallon and Tilt reports are discussed. The chapter includes a commentary on the development of medium-secure services and the refocussing of high-secure care since 2000.

Keywords

Forensic psychiatry evolution, 1950s–2020smental health legislationPowellAarvoldButlerReedBlom-CooperFallonTiltMedium-secure serviceHigh-secure hospitalSpecial hospitalCarstairsGraham YoungPeter SutcliffeChristopher ClunisMichael Stone
Type
Chapter
Information
Seminars in Forensic Psychiatry , pp. 65 - 91
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gunn, J, Taylor, P. Forensic Psychiatry: Clinical, Legal and Ethical Issues. London, Butterworth Heineman, 1993.Google Scholar
Percy, E. The Royal Commission on the Law Relating to Mental Illness and Mental Deficiency. The Percy Report. Cmnd 16. London, HMSO, 1957.Google Scholar
Bluglass, R, Bowden, P (eds) Principles and Practice of Forensic Psychiatry. London, Churchill Livingstone, 1990, p. 1173.Google Scholar
Dell, S. Murder into Manslaughter. Maudsley Monographs 27. Oxford: Oxford University Press, 1984.Google Scholar
Opening address, National Association for Mental Health Conference, 9 March 1961: http://enochpowell.info/wp-content/uploads/Speeches/1957-1961.pdf, p. 38.Google Scholar
Ministry of Health. Special Hospitals: Report of a Working Party (the Emery Report). London, HMSO, 1961.Google Scholar
Speech at Broadmoor Centenary Lunch, 26 June 1963. http://enochpowell.info/wp-content/uploads/Speeches/1962-1963.pdf, p. 44.Google Scholar
Rollin, H. The care of the mentally abnor-mal offender and the protection of the pub-lic. Journal of Medical Ethics 1976; 2: 157–62.Google Scholar
Gordon, H. Broadmoor: An Inside Story. London, Psychology News Press, 2011.Google Scholar
Tidmarsh, D. Secure hospital units. BMJ 1974: 286.CrossRefGoogle Scholar
Tilt, R, Perry, B, Martin, C et al. Report of the Review of Security at the High Security Hospitals, Department of Health, 2000.Google Scholar
Tennant, G, Parker, E, McGrath, PG, Street, D. Male admissions to the English Special Hospitals: 1961–1965 – a demographic survey. BJPsych 1980; 136: 181–90.Google Scholar
Report on Security in NHS Psychiatric Hospitals. London, DHSS, 1973 (the Glancy Report).Google Scholar
Bowden, P. Graham Young: The St Albans poisoner. Criminal Behaviour and Mental Health, 1996 Supplement: 17–24.CrossRefGoogle Scholar
Home Office. Report on the Review of Procedures for the Discharge and Supervision of Psychiatric Patients Subject to Special Restrictions. Cmnd 5191. London, HMSO, 1973.Google Scholar
Anon. Editorial: dangerous patients. BMJ 1973; 1: 247.CrossRefGoogle Scholar
Interim Report of the Committee on Mentally Abnormal Offenders. Cmnd 5698. London, Home Office and Department of Health and Social Security, 1974.Google Scholar
Report of the Committee on Mentally Abnormal Offenders. Cmnd 6244. London, HMSO, 1975.Google Scholar
Parker, E. The development of secure provision. In Gostin, E (ed.) Secure Provision. London, Tavistock, 1985.Google Scholar
Department of Health HSC (IS) 61, July 1974.Google Scholar
Cohen, R. Where did the money go? Health and Social Service Journal, 30 September 1977.Google Scholar
State Hospital, Carstairs: Report of Public Local Inquiry into Circumstances Surrounding the Escape of Two Patients on 30 November 1976 and into Security and other arrangements at the Hospital. Edinburgh, HMSO, 1977.Google Scholar
Mawson, D. A doctor’s view. In Kaye, C and Franey, A (eds) Managing High Secure Care. London, Jessica Kingsley, 1998.Google Scholar
Department of Health and Social Security. Report of the Review of Rampton Hospital: The Boynton Report. Cmnd. 8073. London, HMSO, 1980.Google Scholar
Lancet. Commentary from Westminster. 1980; 316: 1094–5.Google Scholar
Bowden, P. Psychiatric Bulletin of the Royal College of Psychiatrists 1981; 5 (1): 15–16.Google Scholar
Treasaden, IH. Current practice in regional interim secure units. In Gostin, L (ed.) Secure Provision. London, Tavistock, 1985.Google Scholar
Bluglass, R. The development of regional secure units. In Gostin, L (ed.) Secure Provision. London, Tavistock, 1985.Google Scholar
Royal College of Psychiatrists. Secure Facilities for Psychiatric Patients: A Comprehensive Policy. London, RCPsych, 1980.Google Scholar
Royal College of Psychiatrists. The Future of the Special Hospitals. London, RCPsych, 1983.Google Scholar
Bowden P. Bulletin of the Royal College of Psychiatrists 1983; 8 (3): 54.Google Scholar
Brittain, R. The sadistic murderer. Medicine, Science and the Law 1970; 10: 198–207.CrossRefGoogle Scholar
Kay, T. Book review: Voices from an Evil God by Barbara Jones. Journal of Forensic Psychiatry 1993; 4 (2): 380–5.Google Scholar
MacCulloch, M. Letter: the trial of Peter Sutcliff. Journal of Forensic Psychiatry 1993; 4 (3): 583–9.Google Scholar
Gostin, L. A Human Condition. London, Mind, 1975.Google Scholar
A Review of the Mental Health Act 1959. Cmnd 7320: London, HMSO, 1978.Google Scholar
Bluglass, R. Review of the Mental Health Act, 1959: A summary of the White Paper. Bulletin of the Royal College of Psychiatrists 1978; 2 (11): 192–6.CrossRefGoogle Scholar
Bluglass, R. The Mental Health Act 1983. In Bluglass, R and Bowden, P (eds) Principles and Practice of Forensic Psychiatry. London, Churchill Livingstone, 1989.Google Scholar
Hansard. HC Debs. Ser 5. 849 (23 January 1973), 77.Google Scholar
Hilton, C. Changes between the 1959 and 1983 Mental Health Acts (England & Wales), with particular reference to consent to treatment for electroconvulsive therapy. History of Psychiatry 2007; 18 (2): 217–29.CrossRefGoogle ScholarPubMed
X v The United Kingdom – 7215/75 [1981] ECHR 6 (5 November 1981). www.bailii.org/eu/cases/ECHR/1981/6.html.Google Scholar
Snowden, P. Regional secure units and forensic services. In Bluglass, R and Bowden, P (eds) Principles and Practice of Forensic Psychiatry. London, Churchill Livingstone, 1989, p. 1383.Google Scholar
Health Advisory Service. Health Advisory Service Report on Broadmoor Hospital. London, Health Advisory Service, 1988.Google Scholar
Edwina Currie, minister for health, quoted in BMJ, 26 November 1988, p. 1357.Google Scholar
Kaye, C, Franey, F. The inheritance. In Kaye, C and Franey, A (eds) Managing High Secure Care. London, Jessica Kingsley, 1998, pp. 44–5.Google Scholar
Smith, R. Broadmoor slammed, reforms proposed. British Medical Journal 1988; 297: 1357.Google Scholar
Edwina Currie voices regrets over Jimmy Savile after inquiry criticism. The Guardian, 26 June 2014.Google Scholar
Kirkup, B. Jimmy Savile Investigation: Broadmoor Hospital Report to the West London Mental Health NHS Trust and the Department of Health. London, Department of Health, 2014.Google Scholar
Baxter, R. Provision for mentally disordered offenders. Home Office Circular 66/90, 3 September 1990, MNP/90 1/55/8. www.cps.gov.uk/sites/default/files/documents/legal_guidance/Home%2520Office%2520Circular%252066%252090.pdf.Google Scholar
Department of Health, Home Office. Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. London, Department of Health, Home Office, 1991.Google Scholar
Department of Health. Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. London, Department of Health, 1993.Google Scholar
Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. Final Summary Report. Cmnd 2088. London, HMSO, 1992.Google Scholar
Reed, J. Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. Working Group on Psychopathic Disorder. London, HMSO, 1994.Google Scholar
Eastman, N. Hybrid justice: Proposals for the mentally disordered in the crime (sentences) bill – The ethical, legal and health service cost implications. Psychiatric Bulletin 1997; 21: 129–31.CrossRefGoogle Scholar
Chiswick, D. Reed report on mentally disordered offenders. BMJ 1992; 305 (6867): 1448–9.CrossRefGoogle ScholarPubMed
Blom-Cooper, L. et al. Report of the Committee of Inquiry into Complaints about Ashworth Hospital, Cmnd 2028, vols 1 and 2 (Chairman: Sir Louis Blom-Cooper). London, HMSO, 1992.Google Scholar
Sulitzeanu-Kenan, R. Mental State of Inquiry: Tragedy, Policy and Accountability in the Case of the Ritchie Inquiry. Washington, DC, American Society for Public Administration, 2008.Google Scholar
Zito, J, reported in Daily Mail, 29 June 1993.Google Scholar
Ritchie, J, Dick, D, Lingham, R. The Report of the Inquiry into the Care and Treatment of Christopher Clunis. London, HMSO, 1994, p. 105.Google Scholar
Guardian, 25 February 1994.Google Scholar
Department of Health and Social Security. Report of the Committee of Inquiry into the Care and Aftercare of Sharon Campbell. London, HMSO, 1988.Google Scholar
Griffiths, R. Community Care: Agenda for Action. London, HMSO, 1988.Google Scholar
Simpson, A, Bowers, L, Miller, C. The history of the Care Programme Approach in England: Where did it go wrong? Journal of Mental Health 2003; 12 (5): 489–504.CrossRefGoogle Scholar
Report of the Committee of Inquiry into the Death at Broadmoor Hospital of Orville Blackwood and a Review of the Deaths of Two Other Afro-Caribbean Patients: ‘Big, Black and Dangerous?’ London, Special Hospitals Service Authority, 1993.Google Scholar
Royal College of Psychiatrists. Consensus Statement on the Use of High Dose Antipsychotic Medication (Council Report CR26). London, Royal College of Psychiatrists, 1993.Google Scholar
Kaye, C, Franey, A. Inquiries and inspections. In Kaye, C and Franey, A (eds) Managing High Secure Care. London, Kingsley, Jessica, 1998, p. 237.Google Scholar
Independent Inquiry into the Death of David Bennett. Norfolk, Suffolk and Cambridgeshire Strategic Health Authority, 2004.Google Scholar
Ramsbotham, D. Patient or Prisoner? A Discussion Paper for HM Chief Inspector of Prisons. London, The Home Office, 1996.Google Scholar
Singleton, N, Meltzer, H, Gatward, R et al. Psychiatric Morbidity among Prisoners: Summary Report. Office for National Statistics, on behalf of the Department of Health. London, HMSO, 1998.Google Scholar
Fallon, P, Bluglass, R, Edwards, B, Daniels, G. Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital (the Fallon Report). London, HMSO, 1999, p. 193.Google Scholar
Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital: Comments of the Royal College of Psychiatrists. Psychiatric Bulletin 1999; 23: 452–4.Google Scholar
Response to the Fallon Inquiry: From the Ashworth Hospital medical staff. Psychiatric Bulletin 1999; 23: 461–2.Google Scholar
Hansard HC. Deb. 12 January 1999, vol. 323, cc. 107–23.Google Scholar
Exworthy, T, Gunn, J. Taking another tilt at high security hospitals. BJPsych 2003; 182: 469–71.Google Scholar
Murray, K. Data presented at Broadmoor seminar on high risk patients, November 2009.Google Scholar
The High Security Psychiatric Services (Arrangements for Safety and Security) Directions, 2019.Google Scholar
Murray, K. The high security hospitals: Ashworth, Broadmoor and Rampton Hospitals. In Puri, B and Treasaden, I (eds) Forensic Psychiatry: Fundamentals and Clinical Practice. London: CRC Press, 2017.Google Scholar
Hansard, HC. Deb. 15 February 1999, vol. 325, cc. 601–14.Google Scholar
Maden, A. Dangerous and severe personality disorder: Antecedents and origins. British Journal of Psychiatry 2007; 190 (Suppl. 49): S8–S11.CrossRefGoogle Scholar
National Institute for Mental Health in England. Personality Disorder: No Longer a Diagnosis of Exclusion. National Institute for Mental Health for England (NIMH(E)), 2003.Google Scholar
Department of Health and the Home Office. Managing Dangerous People with Severe Personality Disorder. Proposals for Policy Development, 1999.Google Scholar
Moran, P. Dangerous severe personality disorder: Bad tidings from the UK. International Journal of Social Psychiatry 2002; 48 (1): 6–10.CrossRefGoogle ScholarPubMed
Szmukler, G. Violence risk prediction in practice. British Journal of Psychiatry 2001; 178: 84–8.CrossRefGoogle ScholarPubMed
Craissati, J, Minoudis, P, Shaw, J et al. Working with Personality Disordered Offenders: A Practitioners Guide. London, Ministry of Justice, 2011.Google Scholar
National Offender Management Service (NOMS). The Offender Personality Disorder Strategy, 2015.Google Scholar
Tyrer, P, Duggan, C, Cooper, S et al. Medicine, Science & the Law 2010; 50: 95–9.CrossRefGoogle Scholar
R v LV; R (LV) v SSJ [2015] EWCA Crim 45, [2015] EWCA Civ 56.Google Scholar
Robinson, R, Coleman, K, Sensky, T, Walker, M. The Independent Review into the Care and Treatment of Mr Anthony Hardy. London, North Central London Strategic Health Authority, 2005.Google Scholar
Robinson, R, Fenwick, J, Wood, S. The Independent Inquiry into the Care and Treatment of John Barrett. London, South West London Strategic Health Authority, 2006.Google Scholar
Salter, M. Serious incident inquiries: A survival kit for psychiatrists. Psychiatric Bulletin 2003; 27: 245–7.CrossRefGoogle Scholar
Shepperd, D. Learning the Lessons (2nd ed.). London, Zito Trust, 1996.Google Scholar
www.hundredfamilies.org.Google Scholar
Crichton, J. A review of published independent inquiries in England into psychiatric patient homicides, 1995–2010. Journal of Forensic Psychiatry and Psychology 2011; 22: 761–89.CrossRefGoogle Scholar
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Independent Homicide Investigations. University of Manchester, 2008.Google Scholar
National Confidential Inquiry into Suicide and Homicide annual report, England Northern Ireland Scotland and Wales, 2019. University of Manchester.Google Scholar
Re C (Adult: Refusal of Medical Treatment) [1994] 1 All ER 819, [1994] 1 WLR 290 (H.C.).Google Scholar
Appelbaum, PS, Grisso, T. Assessing patients’ capacities to consent to treatment. The New England Journal of Medicine 1988; 319 (25): 1635–8.CrossRefGoogle ScholarPubMed
HL v UK (2004) – App no 45508/99; 40 EHRR 761.CrossRefGoogle Scholar
Department of Health. Report of the Expert Committee: Review of the Mental Health Act 1983. London, Department of Health, 1999.Google Scholar
Grounds, A. Reforming the Mental Health Act. BJPsych 2001; 179: 387–9.Google ScholarPubMed
Szmukler, G, Holloway, F. Maudsley Discussion Paper no. 10. Mental Health Law: Discrimination or Protection? London, South London and Maudsley NHS Trust, 2000.Google Scholar
HL Paper 79-1; HC 95-1. House of Lords, House of Commons. London, HMSO, 23 March 2005.Google Scholar
Hansard, 23 March 2006, Column 27WS.Google Scholar
Delmage, E, Exworthy, T, Blackwood NJ. The ‘Hybrid Order’: origins and usage. The Journal of Forensic Psychiatry & Psychology 2015; 26 (3): 325–36.CrossRefGoogle Scholar
Harbour, A, Needham, BH, Bolter, L. Independent Inquiry into the Care and Treatment of Richard Loudwell. Medway Primary Care Trust and Medway Council, March 2006.Google Scholar
Francis, R, Baird, J, Daniels, G. Independent Inquiry into the Care and Treatment of Peter Bryan and Richard Loudwell: A report for NHS London. NHS London, September 2009.Google Scholar
Mishcon, J, Exworthy, T, Lindsey, M. Independent Inquiry into the Care and Treatment of Peter Bryan: Part One. A Report for NHS London. NHS London, September 2009.Google Scholar
Gordon, H, Oyebode, O, Minne, C. Death by homicide in Special Hospitals. Journal of Forensic Psychiatry 1997; 8 (3): 602–19.CrossRefGoogle Scholar
Care Quality Commission: Investigation into West London Mental Health NHS Trust. Care Quality Commission, July 2009.Google Scholar
Eaton, L. Commissioners publish highly critical reports on mental health services. British Medical Journal 2009. https://doi.org/10.1136/bmj.b2978.CrossRefGoogle Scholar
Silva, E, Shepherd, A. Tick, tock, lock: night-time confinement in high security – history, practice, ethics and practicalities. BJPsych Bulletin 2019; 43 (1): 1–3. doi: https://doi.org/10.1192/bjb.2018.80.CrossRefGoogle ScholarPubMed
Thomson, L. Night-time confinement and the practice of realistic medicine. BJPsych Bulletin 2019; 43 (1): 32–4. doi: https://doi.org/10.1192/bjb.2018.83.CrossRefGoogle ScholarPubMed
Szmukler, G. Night-time confinement is an unacceptable hospital practice. BJPsych Bulletin 2019; 43 (1): 35–7. https://doi.org/10.1192/bjb.2018.82.CrossRefGoogle ScholarPubMed
European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Report to the Government of the United Kingdom on the Visit to the United Kingdom (CPT). Strasbourg, Council of Europe, 2017.Google Scholar
The High Security Psychiatric Services (Arrangements for Safety and Security) Directions. London, Department of Health and Social Care, 2019.Google Scholar
Ly, L, Foster, S. Home Office Statistical Bulletin 22/05: Statistics of Mentally Disordered Offenders. ISSN 1358–510X. London, the Home Office, 2004.Google Scholar
Ministry of Justice Statistics Bulletin: Statistics of Mentally Disordered Offenders 2008 England and Wales. London, Ministry of Justice, 2008.Google Scholar
Fazel, S, Fimińska, Z, Cocks, C, Coid, J. Patient outcomes following discharge from secure psychiatric hospitals: Systematic review and meta-analysis. BJPsych 2016; 208 (1). https://dx.doi.org/10.1192%2Fbjp.bp.114.149997.Google ScholarPubMed
Vowles and others [2015] EWCA Crim 45.Google Scholar
Peay, J. Responsibility, culpability and the sentencing of mentally disordered offenders: objectives in conflict. Criminal Law Review 2016; 3: 152–64. http://eprints.lse.ac.uk/64221.Google Scholar
R v Edwards [2018] EWCA Crim 595.Google Scholar
Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion. Final report of the Independent Review of the Mental Health Act 1983, December 2018.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×