Treatability and Treatment of Personality Disorder – Containment in a Structured Environment, Nursing Care, Engagement of Patient - Michael Ferguson v State Hospital Management Committee –  MHLR 69
Points Arising: In considering discharge, it was not necessary to consider the hypothetical question of whether the sentencing court would impose a hospital order on the basis of present knowledge of the patient’s condition; the requirement of treatability in relation to a personality disorder was satisfied by the structured setting that made F more settled and stable and cognitive behavioural therapy and counselling.
Facts and Outcome: F was a restricted patient in Scotland, held in high secure conditions; at the time of sentence, he was thought to have paranoid schizophrenia, but when anti-psychotic medication was discontinued and psychotic symptoms did not recur, it was concluded that he did not have a mental illness but a personality disorder. He argued that he should be discharged as he would not have been admitted to hospital on the basis of a personality disorder. The judge held that (i) it was not necessary to consider whether he would have been admitted to hospital on current knowledge of his condition, and not meeting the criteria for admission did not mean that discharge would follow; (ii) the structured setting of the hospital made F more settled and stable, and he had benefitted from cognitive behavioural therapy and counselling, and so he was treatable; treatment is not ineffective if the patient shows little inclination to engage (and there was evidence of hopeful signs as to F’s attitude). (iii) Treatment was necessary to protect the public from further offences and F from drug and alcohol abuse; and detention in the highly structured hospital was appropriate to allow F to make progress and protect against a breakdown.