1. Setting the scene Case Vignette 1 Dr Swaraj Alkanti ST5 Psychiatry of Intellectual Disabilities The State Hospital

2. Mr Smith 34 year old man Borderline learning disability with an IQ of 71 (verbal IQ - 65, performance IQ - 82) ? Asperger’s Syndrome Index Offence - 1995 – Raped a 15 year old girl – Displays very little remorse Made subject to a CORO and admitted to TSH

3. Background Past psychiatric history Past medical history Family history Early childhood Relationships Employment Drug and alcohol history Forensic history

4. Discharge from TSH Discharged to local low secure unit in 2004 He was transferred to an open ward within the same hospital in June 2006 Early 2007 - Unescorted 15 min time out in the hospital grounds

5. Social networking Allowed access to mobile phone ISB group – Met Y – introduced Mr Smith to wider group Towards the end of 2008, staff became aware/suspicious of inappropriate use of mobile phone Access to the mobile phone reduced for an hour a day – Y offered him a spare handset Mid 2009 - Y bought a brand new phone with camera and internet for Mr Smith

6. Influence of technology Full access to the internet and various social networking sites like Bebo, Guys & Bi’s etc Feb’ 2010 – grounds access was suspended Described feelings of “anger and hatred towards everyone” and that he “just felt like I had to do something to get my freedom back” Thoughts about escaping from the hospital

7. Escape plan Y managed to bring in a screwdriver secretly and left it in the toilet for Mr Smith April 2010 – Staff found many of the prohibited items in his possession But not the screwdriver and the new mobile phone which he hid amongst his clothes in the drawer Made up his mind to escape that very night

8. Subverting security Escaped through his window by removing the restrictor bar, which was held in place by only 2 screws Planned to travel on a bicycle, using the “back roads” and eventually cross the border to England Planned to visit/establish relationship with a male in England he had “met” through a website Believed that the CORO would no longer apply once out of Scotland Discovered to be missing by the staff, the following morning at the breakfast time. He was located and apprehended by the Police the same day and returned to the ward

9. Readmission to TSH He was readmitted to TSH (in absence of Scottish med secure facility) in view of: -His past forensic history -The serious nature of the incident involving subverting security -His associations with (at least) two other known sex offenders and -His confession to making detailed plans over a number of months to effect an escape

10. Thank you