This document provides background information on a 41-year-old male patient who has been detained under the Mental Health Act since 2010. It details his family, social, criminal, substance use, and psychiatric histories. Regarding his psychiatric history, he has a history of psychosis dating back to 1993 while imprisoned, with episodes of relapse presenting with hallucinations and delusions. He has a diagnosis of schizophrenia. The document also discusses his risk factors such as personality traits like callousness and impulsivity, as well as ongoing risk management.

1. Laura Davis
ST3 to Dr Ozdural
Forensic Psychiatry

2.  Mr P
 Age 41
 Section 37/41 MHA
 Been on Kedleston LSU since June 2010

3.  Born in Northern Ireland 1970
 Normal birth
 One of 12 children
 Second youngest
 Father was a Sergeant Major in the Army
 Moved around regularly
 Mother died in a car accident in 1976 and the
family moved to Nottinghamshire
 Raised by Father
 Contact with CAMHS
 ?ADHD
 No history of abuse or disadvantaged upbringing

4.  History of truancy at school
 Also in trouble for smoking and fighting
 Suspended at the age of 13
 Left school at 16
 1 GCSE in English grade 5
 Painting and decorating course 1 year
 Various jobs
 Sacked for turning up late and missing days
 Last job worked at an abattoir in Northern
Ireland 1995 for 8 months
 Never married, no dependents

5.  One of 12 siblings
 Mother died 1976 in car accident
 Father died 1999 MI
 1 brother died in 1989 from a motorcycle
accident
 2 brothers committed suicide
 No family history of mental health problems

6.  Alcohol – binge drinker
 Magic mushrooms as a teenager
 Cocaine
 Crack cocaine
 Cannabis
 Heroin

7.  1988 – convicted for assault
 1989 – probation order for TWOC
 1990 – fine for criminal damage
 1990 – 18 months in YOI for burglary and
assaulting a police officer
 1991 – 5 years imprisonment for indecent
assault on a female with ABH
 1996 – 7 years imprisonment for 3 counts of
rape, ABH and 3 threats to kill
 2006 – S37/41 hospital disposal for arson

8.  Drinking all day.
 Heavily intoxicated and in a „rage‟ thinking about
girlfriend who had recently left him for his friend.
 Felt life was being „unfair‟ and everything was
going against him.
 A woman was walking in front of him. She was
about 40 and he thought she was good looking.
 He overtook her and gave her a „peck‟ on the lips.
She looked shocked. He was then full of rage and
head-butted her. He started hitting and punching
her. Fractured nose, suspected fractured cheek
bone and multiple lacerations
 He dragged her to a grass verge, pulled her
knickers down and put his finger into her vagina.

9.  Reports say that over a period of time he raped his
niece, assaulted her and made threats to kill.
 He reports that he had been drinking with his sister.
 Dropped off at her house
 Her daughter L (aged 16) had been asleep in lounge.
 He followed her upstairs but said he had not been
planning anything then.
 He went to L‟s room to „talk to her‟. Became
aroused, started kissing her and she had told him to
get off and fallen on the fall. L had said that he had
hit her
 He put her back on the bed and had sex with her. She
did not consent.
 Made her commit a further sexual act whilst he was in
possession of a knife
 Did not think of L as his Niece.

10.  Regretted what he had done, went downstairs to
get knife. Asked L to kill him with the knife „in
the kidneys‟
 Told L he would kill her if her Mum came in the
room after she had returned home.
 He then went to bed.
 Said he was „pissed up‟ and the „opportunity was
there and I took it‟.
 Denied having mental health problems when
arrested and sentenced.
 Arrested 12 hours later
 Released 1999

11.  Day prior
 Cut his throat with an intent to die
 Distressing auditory hallucinations
 Been using crack cocaine
 Attended A&E and discharged
 Voices intensified
 Female voice telling him to kill himself/set a fire.
 Worse at night time.
 Caused him to feel low and distressed.
 Lit a fire in response to command hallucinations
 Set fire to TV cabinet using clothing
 Informed warden who contacted Fire Brigade
 Seen day after arson in prison
 Auditory hallucinations every night several years, no increase
in intensity/frequency, stable mental state, slightly low
mood but no evidence of relapse

12.  Age 14 hearing noises and voices. Remitted
spontaneously
 3 previous admissions including prison transfers
and informal admission.
 First psychotic illness 1993 whilst imprisoned for
indecent assault.
 Paranoid, thinking people were talking about him.
 Hearing the voice of his dead brother externally
 Felt there was a conspiracy against him and that
somebody was trying to kill his family.
 Self neglect (stopped eating, drinking, washing)
 Tried to hang himself by his laces.

13.  Episodes of relapse tend to present similarly
 Visual hallucinations of people in his cell
 Feels people read his mind and will know about
his offences
 Observed responding to unseen stimuli
 Holds conversations with himself
 Laughing inappropriately
 Grandiose delusions “Son of God”, “devil has put
part of my brain under control”
 Believed his brother entered his body and forced
him to commit rape

14.  Previous
 Flupenthixol
 Thioridazine
 Stelazine
 Lithium
 Risperdal consta
 Modecate
 Current
 Haloperidol decanoate 125mg 2 weekly

15.  1993 – attempted hanging
 1996 – twice lacerated his neck in prison
 2000 – overdose
 82 paracetamol, 50:50 whether he would live
 2006 – lacerated his neck
 2006 – arson in a suicide attempt

16.  October 2000 – sex in lift with mentally unwell patient
 “it‟s always them coming onto me”
 August 2008 – romantic interest in an OT.
 Sent her a letter. Minimised incident „just a card‟
 October 2008 –
 Making sexual gestures behind backs of female staff
 Put patient in a headlock and pulled him to the floor
 Assaulted staff
 Refused to answer questions, no remorse, inappropriately smiling
 Has persistently minimised since, „not in control of actions‟
 February 2010 –
 Demanding to drink alcohol on ECL
 Blamed staff for lack of clarity re S17 leave
 Protested by climbing on roof of smoking shed
 Threw a bowl at staff
 AWOL – intoxicated
 No remorse, thought he should be rewarded as he returned by himself

17.  June 2010 – overfamiliar with female staff
 April 2011 – AWOL, intoxicated
 December 2011
 Allegation of indecent assault against HCA
 Protesting his innocence by going on hunger strike
 No present charges
 Prior to above incident was having large amounts of
unescorted leave
 Currently
 All leave suspended
 Remains isolative
 Refusing to speak to RC
 Wants to be transferred to a different hospital
 From review of notes he has done no SOTP work to date

18.  Wathwood hospital 2007
 Still affected by events from the past
 Sense of failure and inadequacy
 General attitudes
 History of antisocial behaviour
 Tendency to see the world as unfair and hostile to him
 Uses self harm to demonstrate he is genuine in his remorse
 Failure to consider consequences for and needs of victims
 First offence
 Emotional state of rejection, hurt and anger
 Attempted to kiss her and she was shocked. This made him
angry at her rejection and he physically attacked her
 Feelings potentiated by heavy alcohol consumption
 Impulsive and opportunistic
 Psychologist felt that the effect of the offence on his own life
may be overly represented in his sense of remorse

19.  Second offence
 No indication that he was experiencing any acute
emotional problems at time
 Had been drinking but knew what he was doing
 Opportunistic although the psychologist felt there may
have been some premeditation
 Felt it would have been worse if she had been a
stranger. Indifferent to her being blood relative
 The effect of the offence on his own life is
disproportionately represented in his remorseful feelings
in relation to the effect on the victim
 Shouldn‟t have gone to prison – should have kept it in
the family
 He believes it is unfair to be on the sex offenders
register as it will impact on his future relationships

20. 1. Diagnosis
2. Risk
3. Management

21.  Callous unconcern for the feelings of others
 Gross and persistent attitude of irresponsibility
and disregard for social norms, rules and
obligations
 Incapacity to maintain enduring relationships,
though with no difficulty in establishing them
 Low tolerance to frustration and a low threshold
for discharge of aggression including violence
 Incapacity to experience guilt or to profit from
adverse experience particularly punishment
 Marked proneness to blame others, or to offer
plausible rationalisations for the behaviour
that has brought the individual into conflict
with society

22.  Marked tendency to act unexpectedly and
without consideration of consequences
 Marked tendency to quarrelsome behaviour
and to conflicts with others, especially when
impulsive acts are thwarted or criticised
 Liability to outbursts of anger or violence, with
inability to control the resulting behavioural
explosions
 Difficulty in maintaining any course of action
that offers no immediate reward
 Unstable and capricious mood

23.  1 month duration
 At least 1 of
 Thought echo, insertions, withdrawal or broadcasting
 Delusions of control, influence or passivity, clearly referred
to body or limb movements or specific thought, actions or
sensations; delusional perception
 Hallucinatory voices – running commentary or discussing
patient or other voices coming from some other part of the
body
 Persistent culturally inappropriate delusions
 Or 2 of
 Persistent hallucinations in any modality when accompanied
by delusions or overvalued ideas
 Neologisms, breaks or interpolations in train of thought –
incoherence or irrelevant speech
 Catatonic behaviour
 Negative symptoms