1. Mental Health Newsletter
28 June 2013
1. Ashworth - Ian Brady’s bid to return to prison rejected
After an 8 day hearing, on Friday 28th
the Mental Health Tribunal decided that he continues
to meet the MHA criteria and should remain in hospital.
The nub of his argument was that he has no detainable disorder at all and should be
returned to prison where he can choose his next step ─ this will include the option of starving
himself to death. This patient holds the record for maintaining a hunger strike since
1999 ─ although there is some doubt about his intentions, given that he supplements his NG
feed with ordinary food (although he denied it when giving evidence). We questioned how it
could be appropriate to return him to prison so that he could exercise this option.
Ashley Irons has represented Ashworth Hospital in relation to various Ian Brady complaints,
challenges, judicial reviews and tribunals over many years. He conducted the advocacy at
the 2011 tribunal including cross-examining the patient upon these intentions.
This application for transfer to prison was heard in public. There was never any question of
him being discharged into the community, because he was sentenced in 1966 to life
imprisonment ─ which means life.
It was argued on his behalf that if he has a disorder, it is a Personality Disorder and that
convicted prisoners with PD are no longer sent to hospital for treatment. Prisons now
provide that treatment. In other words if he was convicted now for his offences, he would not
be sent to a high secure hospital at all therefore, it is inappropriate to remain.
The hospital said that he had PD alongside mental illness (MI), specifically schizophrenia.
The evidence of this were hallucinations, delusions and paranoia. It was said by the
patient’s experts that any examples of these presentations were rare and were a product of
his personality rather than indicative of an underlying mental illness.
The patient instructed 3 well respected experts Dr Adrian Grounds, psychiatrist, David
Glasgow, psychologist and Professor Gournay, nursing. What their considerable experience
had in common was an absence of extensive and recent clinical caseload in medium or high
security facilities. In contrast, Capsticks’ Ashley Irons recommended the
opposite ─ clinicians who were employed in the NHS with a fulltime caseload. The
experience of Drs Mark Swinton and Caroline Logan led to them concluding that in practice
one does not see his symptoms/ presentations being attributed to PD.

2. We do not know what the reasons of the tribunal were and these may take a few weeks to
arrive. The tribunal simply announced that the patient continued to meet the MHA criteria
and consequently there would be no transfer recommendation.
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It was presented on behalf of the patient that any underlying MI did not meet the nature or
degree test, as there was little sign of it, for 20 years.
Ian Brady had refused to speak to his RC for over 10 years and refused to give an interview
to anyone instructed on behalf of the hospital. Unsurprisingly this led to his lawyers arguing
that the hospital’s case was fatally weakened as they could not assess the patient in
interview. However the weakness in their case is that none of them had read all of the vast
volumes of papers about him, unlike his RC, Dr Collins and had not forensically cross-
referred assertions of what was said in interview against what was recorded, except in a few
instances. A criticism we made of their reports was that much was occupied with self-report
rather than a forensic analysis. Secondly, the Trust witnesses considered the interviews
held by the 3 experts. Thirdly, the patient on the 7th day of the hearing spoke for around 4
hours, during the course of which signs and symptoms of a disorder at work were evident.
It was said that evidence of him responding to auditory hallucinations was not always clearly
recorded and was in any event uncommon and did not disable him or affect his actions. As
regards paranoid delusions, it was said that they were all rooted in real events and from that
point of view were understandable (even if wrong as they were) such as his belief that staff
were spying on him and interview rooms are bugged.
On behalf of the hospital it was said that schizophrenia does not vanish and it was common
ground that he had it in the 1980s. Delusions do not have to be bizarre. Furthermore the
hallucinations are in effect “breakout symptoms” and there were frequent descriptions
suggestive of hallucinations even if not clear. 2 of his experts accepted 1 or 2 examples, if
taken at face value, could be evidence of psychotic symptoms, but believed they were not.
We argued that there was overwhelming evidence that he holds fixed-false paranoid beliefs
that cannot be explained away simply by the context in which he lives. A significant incident
last year was when he blamed a patient for making a noise during a telephone call with his
solicitors, when that patient was sitting reading a magazine and making not a sound! In oral
evidence the patient continued to blame staff for not intervening to stop what that patient
was doing. In other words he has a delusion and he continues to believe it.
The public hearing heard that he had a habit of holding a pen, with a cap off, in front of him
when walking around the ward in apparent anticipation of an attack (yet he has never been
attacked on his ward).

3. The hospital agreed that the patient had severe PD, specifically antisocial and narcissistic,
however the scale of the paranoia was grossly in excess of what would be associated with
PD, as confirmed by the hospital’s clinical expert.
A major issue was whether there was adequate treatment either for MI or PD.
Concerning MI, no medication had been given because of side-effects when tried, coupled
with the fact that the patient was better, in terms of being more settled, now than he had ever
been. This was down to the skilled nursing that met the test that a Court had accepted from
Professor Eastman, in particular “managing the environment to minimise the effects of the
disorder”. It was said on behalf of the patient that the milieu therapy could not be said to
have had any beneficial impact and consequently it was not treatment under the MHA. This
was a difficult position to sustain, given the detail presented of the care plans and how they
were put into effect provided by Dr Collins and the ward charge nurse. The latter gave
graphic examples of interventions to prevent escalation and anticipating events to avoid
arousal, which in turn would bring about even greater challenging behaviour.
It was said that good prison officers could provide the kind of care that the patient needs and
we await the Tribunal’s view upon that as indeed with everything else.
It was the hospital’s case that if there was a transfer decision, he would relapse in the near
future. That in prison he would come into conflict rapidly and would end up in segregation,
with which Professor Gournay agreed. That it could not possibly be said that going to prison
to enable him to exercise an option to starve himself, was appropriate – furthermore,
compulsory feeding had already been held to be treatment for his mental disorder by the
High Court, when challenged by Ian Brady in 2000.
Consequently whilst the above represents some of the arguments and evidence that were
heard in public, we await the reasons behind the Tribunal’s decision.
To discuss these issues further and the implications, please contact Ashley Irons or the
Capsticks mental health team.