According to Professor John Gunn, the origins of forensic psychiatry in Britain were in the Royal Medico-Psychological Association (RMPA), the forerunner of the Royal College of Psychiatrists. A small group of interested people, including Professor Trevor Gibbens, Professor Denis Hill and the criminologist Professor Nigel Walker, formed a Forensic Subcommittee of the RMPA under the chairmanship of Broadmoor Hospital's physician superintendent Dr Patrick McGrath. They were joined in about 1965 by John Gunn, when he went to the Institute of Psychiatry. The group became a section of the RMPA and then a section of the College until it eventually became the Faculty of Forensic Psychiatry.
However, John Gunn regards the real founder of forensic psychiatry to be Sir William Norwood East, a prison medical officer who became an academic and wrote extensively on the subject. His books included Medical Aspects of Crime, which John Gunn has revisited in this issue's ‘Memory Lane’ (Gunn Reference Gunn2024). Norwood East's Royal College of Physicians obituary describes him as:
‘one of the first prison medical officers to show a complete command of the technical aspects of forensic psychiatry which he gained from the practical application of a wide reading in theory. The result was that while he advocated such wise reforms as the treatment of the mentally abnormal in a special penal institution and respected the arguments of lawyers, he remained essentially a clinician anxious to set every individual problem of criminal behaviour in its practical medico-legal frame without the ornaments of vapid excuse and sentimentality’ (Trail Reference Trail2019).
Paddy McGrath had a close link with Dr Hugo Milne, the Bradford-based psychiatrist, who may be best known outside Yorkshire for his stoic defence of the unanimous psychiatric opinion that Peter Sutcliffe, popularly known as ‘the Yorkshire Ripper’, was suffering from paranoid schizophrenia. In 1976 Milne opened what is believed to have been the first in-patient psychiatric unit for the treatment of both male and female offenders in open psychiatric conditions in England and Wales (Milne Reference Milne and Wood1982). Named Waddiloves Hospital, it was situated on its own on the edge of Bradford's ‘red-light’ district and on land gifted to the National Health Service by the Waddilove family, which had made its fortune in check trading. Its remit was the treatment of people with drug and alcohol problems as well as forensic patients. There were 15 beds and also day-patient and out-patient facilities. It admitted patients on their way out of special hospitals, direct from the courts under Part V of the Mental Health Act 1959 and as a condition of bail, and on probation orders.
The Grange and the first Grange Annual Conference
Hugo Milne went on to set up, with his fellow Wakefield consultant forensic psychiatrist Dr Terry Kay, a West Yorkshire training scheme in forensic psychiatry. In 1979 the scheme's first senior registrar in forensic psychiatry was appointed. This was Dr Peter Wood, who had just completed his general professional training in psychiatry in the army. Milne retired in 1982 and Wood was appointed as consultant forensic psychiatrist, also taking over Milne's private rooms in Eldon Place, Bradford. When the Eldon Place lease expired, Wood purchased The Grange, Cleckheaton, in 1998. It had all the appearances of a large Victorian mansion but it had been purpose built in the 1950s for the elderly surviving member of a family whose much larger family home had been bequeathed to a charity.
At The Grange, Peter Wood drew together a number of psychiatrists, psychologists, an occupational physician and others, who rented consulting rooms mainly for the purpose of carrying out medicolegal assessments but not just for criminal proceedings. They prepared reports in family court cases, personal injury civil proceedings, including clinical negligence cases, chancery proceedings where wills were in dispute and in employment, professional regulatory, immigration, asylum and extradition cases. There was also a monthly evening meeting at which Grange ‘users’, as they were known, presented cases and gave talks on medicolegal topics. These meetings went some way towards providing the highly specific education and training on the interface between mental health and the law that was required to achieve the objectives in the users’ personal development plans. Out of these meetings, and in order to expand the educational and training function of The Grange, it was decided to hold an annual conference.
The first Grange Annual Conference was held in 2001 at The George Hotel, Stamford. Most of the speakers were Grange users but one invited speaker was a district judge and the Conference's first after dinner speaker was the late Sir James Hunt, a High Court judge who lived locally. The Conference, which was for some years peripatetic, quickly attracted attendances by psychiatrists and psychologists engaged in medicolegal work further afield and, as the years went by, although Grange users have continued to contribute to the Conference programme, there have been presentations by lawyers, including two Irish Supreme Court judges, four UK Supreme Court Judges, circuit and High Court judges, solicitors, barristers and coroners. Leading psychiatrists and psychologists have attended to talk about the interface between their areas of clinical practice or research and the law. The Conference pioneered medicolegal case-based discussions, which are now more generally established in medicolegal peer groups, and cross-examination training has now become a regular component.
The Grange Annual Conference today
The Grange Annual Conference is now the leading annual conference for psychiatrists engaged in medicolegal work. There are bursaries or discounted rates for trainees. The numbers attending, remotely and in person, are usually no more than 40, so the size lends itself to an interactional teaching style and the opportunity for dialogue with the speakers. The Chatham House Rule is applied. This allows delegates to express opinions and comments safely and engage in often revealing and challenging debate. In this respect, the Conference is markedly different from other more formulaic conferences.
For over a decade the Conference has been held in the idyllic surroundings of Ripley Castle and its Boar's Head hotel and highlights of the Conference have included a formal dinner, with invited guest speaker, in the Castle's Library, and the option of a tour of the Castle guided by Sir Thomas Ingilby, Bt. This year the Conference moves to the equally atmospheric Hazelwood Castle.
Until Peter Wood's retirement in 2014, and his sale of The Grange Consulting Rooms, the Conference arrangements were made entirely ‘in house’ by his personal assistant, the late Alison Marshall, and my personal assistant, Debbie Small. Although The Grange has ceased to exist as consulting rooms, Peter Wood has kindly given permission for the Conference to continue as The Grange Annual Conference and to use The Grange logo. The conference programme is now planned by the four Grange Conference Trustees, Dr Danny Allen, Dr James Briscoe, Dr Asif Ramzan and myself, and the conference organisation is now carried out by Lynne Christopher and the staff of her Mental Health Education and Training Network (ETN). ETN is a specialist provider of education and training events for psychiatrists and other mental health professionals.
The Conference continues to be planned so that it satisfies as many as possible of the educational requirements that are in delegates’ annual peer-approved personal development plans. So, the Conference is a blend of relevant statute and case law, rules and procedure, ethics and professional issues, along with updates on the range of clinical areas about which mental health professionals provide expert assistance to courts and tribunals.
The content of this special issue of BJPsych Advances reflects the content of the Conference programmes and we are grateful to the following past speakers for contributing to it: Dr James Briscoe, Professor Alistair Burns CBE, The Hon Mr Justice Peter Charleton, Professor John Gunn CBE, Dr Nicholas Hallett, Professor Rajan Nathan and Dr Natalie Wortley.
Acknowledgements
I am grateful to Dr Peter Wood and Professor John Gunn for assistance with this article.
Funding
This work received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
Grange Conference Trustees collectively receive a proportion of any profit made by the Conference. These funds are held in a trust fund for the purpose of offsetting any loss made by a future conference and in order to provide bursaries and discounted rates in appropriate cases. K.R. does not personally benefit financially from the Conference. K.R. is a member of the BJPsych Advances editorial board and did not take part in the review or decision-making process of this article.
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