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SD46 - MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS Version 3, 2017
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TRUST WIDE CLINICAL POLICY DOCUMENT
MULTI AGENCY PUBLIC PROTECTION ARRANGEMENTS
(MAPPA) PROCEDURE
Policy Number: SD46 Scope of this Document: All staff in Clinical Divisions Recommending Committee:
Local Division Safety Sub-Committee; Secure Services Security Committee
Approving Committee: Executive Committee Date Ratified: March 2017 Next Review Date (by): March 2019 Version Number: V3 2017 Lead Executive Director: Executive Director of Nursing Lead Author(s): MAPPA Lead;
& Nominated Local Division Consultant Psychiatrist
TRUST WIDE CLINICAL POLICY DOCUMENT Version 3 - 2017
Quality, recovery and wellbeing at the heart
of everything we do
2
Further information about this document:
Document name SD46 Multi Agency Public Protection Arrangements Procedure (MAPPA)
Document summary
MAPPA are the statutory arrangements for managing sexual and violent offenders. MAPPA is
not a statutory body in itself but is a mechanism through which agencies can better discharge their
statutory responsibilities and protect the public in a co-ordinated manner. Agencies at all times retain their full statutory responsibilities and obligations.
The relationship between MAPPA and mental health services are well documented, this protocol seeks to enhance the guidance by identifying local
arrangements.
Author(s)
Contact(s) for further information about this
document
MAPPA Lead - Single Point of Contact (SPoC) - Mark Sergeant -
0151 478 6550 – mark.sergeant@merseycare.nhs.uk
Nominated Local Division Consultant Psychiatrist -
Dr. Ruth McCutcheon – 0151 330 8013 – ruth.mccutcheon@merseycare.nhs.uk
Published by
Copies of this document are available from the Author(s)
and via the trust’s website
Mersey Care NHS Foundation Trust V7 Building
Kings Business Park Prescot
Merseyside L34 1PJ Your Space Extranet: http://nww.portal.merseycare.nhs.uk
Trust’s Website www.merseycare.nhs.uk
To be read in conjunction with
SD15: Health & Risk Assessment Management Meetings (H-RAMM) &
SA10: Clinical Risk Assessment Tools
This document can be made available in a range of alternative formats including various languages, large print and braille etc
Copyright © Mersey Care NHS Trust, 2015. All Rights Reserved
TRUST WIDE CLINICAL POLICY DOCUMENT MULTI AGENCY PUBLIC PROTECTION
ARRANGEMENTS PROCEDURE (MAPPA)
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1.0 Version Control:
Version History: V1 Mark Sergeant, Gary Smith June 2016 V2 Gary Smith, Dr. Ruth McCutcheon & Brian
Harrison October 2016
V3 Mark Sergeant Policy Group Executive Committee
December 2016 February 2017 March 2017
MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS SD46
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2.0 SUPPORTING STATEMENTS – this document should be read in conjunction with the following statements:
SAFEGUARDING IS EVERYBODY’S BUSINESS
All Mersey Care NHS Foundation Trust employees have a statutory duty to safeguard and promote the welfare of children and vulnerable adults, including: • being alert to the possibility of child/vulnerable adult abuse and neglect through their observation
of abuse, or by professional judgement made as a result of information gathered about the child/vulnerable adult;
• knowing how to deal with a disclosure or allegation of child/adult abuse;
• undertaking training as appropriate for their role and keeping themselves updated;
• being aware of and following the local policies and procedures they need to follow if they have a child/vulnerable adult concern;
• ensuring appropriate advice and support is accessed either from managers, Safeguarding Ambassadors or the trust’s safeguarding team;
• participating in multi-agency working to safeguard the child or vulnerable adult (if appropriate to your role);
• ensuring contemporaneous records are kept at all times and record keeping is in strict adherence to Mersey Care NHS Foundation Trust policy and procedures and professional guidelines. Roles, responsibilities and accountabilities, will differ depending on the post you hold within the organisation;
• ensuring that all staff and their managers discuss and record any safeguarding issues that arise at each supervision session
EQUALITY AND HUMAN RIGHTS
Mersey Care NHS Foundation Trust recognises that some sections of society experience prejudice and discrimination. The Equality Act 2010 specifically recognises the protected characteristics of age, disability, gender, race, religion or belief, sexual orientation and transgender. The Equality Act also requires regard to socio-economic factors including pregnancy /maternity and marriage/civil partnership.
The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision of services and in our role as a major employer. The trust believes that all people have the right to be treated with dignity and respect and is committed to the elimination of unfair and unlawful discriminatory practices.
Mersey Care NHS Foundation Trust also is aware of its legal duties under the Human Rights Act 1998. Section 6 of the Human Rights Act requires all public authorities to uphold and promote Human Rights in everything they do. It is unlawful for a public authority to perform any act which contravenes the Human Rights Act.
Mersey Care NHS Foundation Trust is committed to carrying out its functions and service delivery in line the with a Human Rights based approach and the FREDA principles of Fairness, Respect, Equality Dignity, and Autonomy
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3.0 CONTENTS
Section Section Title Page Number
Title Page 1
1.0 Version Control 3
2.0 Supporting Statements 4
3.0 Contents 5
4.0 Purpose & Rational 6
5.0 Outcome Focused Aims and Objectives 6
6.0 Scope 7
7.0 Definitions 7
8.0 Duties 8
9.0 Process 13
10.0 Consultation & Implementation 24
11.0 Training & Support 24
12.0 Monitoring 24
13.0 Appendices 25
14.0 Equality & Human Rights Analysis 63
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4.0 PURPOSE AND RATIONALE
4.1 Purpose This document sets out Trust Policy and Procedure in relation to Multi Agency
Public Protection Arrangement (MAPPA). The Trust expects all clinical
employees to understand these arrangements and understand their
obligations and duty in respect of MAPPA.
4.2 Rationale The aim of the procedure is to provide a framework which all clinicians
maintain the standards needed to comply with arrangements. It is the trust’s
policy to ensure that all staff has support in the delivery of these arrangements
through governance systems.
5.0 OUTCOME FOCUSED AIMS AND OBJECTIVES 5.1 MAPPA (Multi-Agency Public Protection Arrangements) is not a statutory
body in itself but is a mechanism through which agencies can better discharge
their statutory responsibilities. Police, Probation and Prison Services work
together with other agencies to manage the risks posed by violent and sexual
offenders (‘offenders’ can be an interchangeable term for ‘patient’ with
MAPPA eligible mental health patients) living in the community to reduce the
re-offending behaviour to protect the public, including previous victims, from
serious harm.
It aims to do this by ensuring that all relevant agencies work together
effectively to:
Identify all relevant offenders;
Complete comprehensive risk assessments that take advantage of
coordinated approach and information sharing across the agencies;
Devise, implement and review robust Risk Management Plans; and
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Focus the available resources in a way which best protects the public from
serious harm
5.2 This policy is to be used in support of the national guidance, and act as an
aide memoir, if you require clarity contact can be made with your local
Strategic Management Board (SMB) representative, MAPPA lead or Single
Point of Contact (SPoC).
5.3 This MAPPA policy will support the Memorandum of Understanding (MOU)
(http://nww.portal.merseycare.nhs.uk/LocalServices/MAPPA/MAPPA%20Doc
ument%20Library/MOU%20Merseycare%20final%202015.doc
5.4 This MAPPA and risk offender policy will support the Information Sharing
Agreement (ISA):
(http://nww.portal.merseycare.nhs.uk/LocalServices/MAPPA/MAPPA%20Doc
ument%20Library/ISA%20MAPPA%20Jan16.doc
6.0 SCOPE
6.1 This policy applies to Trust wide staff of all designation within all clinical
divisions and involves the management of all MAPPA nominals.
7.0 DEFINITIONS Table 1: Definitions
MAPPA Multi Agency Public Protection Arrangements
CROMP Clinical Risk Offender Management Process
FREDA Fairness, Respect, Equality Dignity, and Autonomy
SMB Strategic Management Board (Merseyside)
SPoC Single Point of Contact
MOU Memorandum of Understanding
MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS SD46
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ISA Information Sharing Agreement
RA Responsible Authority (Police, Probation, Prison)
LEAD AGENCY Agency responsible for the offenders care & treatment
CSM Clinical Services Manager
L&D Liaison & Diversion
OAT Out of area treatment
DTC Duty to Cooperate agency (e.g. health, social services)
8.0 DUTIES 8.1 Lead Executive Director – Executive Director of Nursing has delegated
responsibility to ensure a policy is in place and monitored.
8.2 Responsible Authorities- The Responsible Authorities (RA’s) (Police,
Probation & Prisons) are responsible for the co-ordination of Multi Agency
Public Protection Panels (MAPPPS) at Level 2/3, and will use the identified
SPoC in Mersey Care as a conduit for information and guidance regarding
mental health related matters. RAs will liaise with the SPoC for an initial
MAPPP meeting, and RAs will co-ordinate planning for a formal meeting.
8.3 Single Point of Contact (SPoC) - The SPoC is nominated by the Director of
Nursing and will represent Mersey Care on the Merseyside Strategic
Management Board and disseminate information via the Clinical Risk &
Offender Management Process (CROMP). The SPoC has wider Mersey Care
responsibilities in order to assist those services who have a regional or
national remit (Secure division).
8.4 Where an RA has identified a person in need of an initial MAPPP meeting
under Level 2/3 and the individual is not known to services or the clinicians
involved are not identified, then the SPoC will use division MAPPA leads as a
contact point to identify those who will need to attend a MAPPP. The SPoC
will identify the clinicians involved with a persons care and ensure that those
MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS SD46
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identified from health & social care will be in attendance and ensure the
MAPPA chair is aware of stakeholders involved in the process.
8.6 Clinical Services Managers (CSM)
It will be the responsibility of the CSM to agree governance arrangements in
their own areas and cascade information via their own governance meetings
and teams as appropriate. The CSM’s will be the senior manager responsible
for a service line across Local and Secure divisions.
8.7 MAPPA leads
Identified MAPPA leads will act as a conduit between MH services and the
SPoC and the Liaison & Diversion (L&D) team. The role will involve
supporting the SPoC i.e. identifying MAPPA cases within own services.
8.8 Staff
It is the responsibility of all staff to ensure that they understand MAPPA and
their responsibilities to identify & notify MAPPA eligible service users and risk
manage them in conjunction with partner agencies.
8.9 Strategic Management Board
The supervision and oversight of this public protection work is carried out by
Merseyside’s Strategic Management Board (SMB), it has a range of
governance-related functions, including monitoring performance, ensuring
anti-discriminatory practice, measuring compliance with the MAPPA Key
Performance Indicators (KPIs), and producing the annual MAPPA report. The
Criminal Justice Act 2003 introduced the requirement for MAPPA Strategic
Management Boards to have 2 lay advisers. Lay advisers are members of the
public, not normally connected to the criminal justice system, whose role it is
to hold MAPPA to account. The Duty to Cooperate agencies (DTC which MCT
MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS SD46 Page
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is one) are also SMB members and support the governance arrangements at
this highest strategic level.
8.10 Role of MAPPA Co-ordinator
It is the MAPPA co-ordinators responsibility to
To support strategic management board arrangements.
MAPPA co-ordinators responsibility to ensure that all MAPPA
arrangements are adhered to across the Merseyside area.
To support Mental Health Trusts through the Mental Health sub group
Table 1 - Nominated SMB members:
Operational
Manager (SPoC) – Mark Sergeant
Liverpool
Community Justice
Centre
0151 478 6550
Mark.sergeant@merseycare.nhs.uk
L&D Manager
(Deputy SPoC) – Gary Smith
Liverpool
Community Justice
Centre
0151 478 6550
Gary.smith@merseycare.nhs.uk
Head of Forensic
Social Care, (Deputy SPoC) –
Rob McLean
Ashworth Hospital,
Parkbourn,
Liverpool, L31
1HW
0151-473-2808
Robert.mclean@merseycare.nhs.uk
Executive
Director of
Nursing- Ray
Walker
V7 Building Kings
Business Park 0151 473 2965
ray.walker@merseycare.nhs.uk
Nominated
Medical Lead (Secure Services) – Gill Holt
Reed Lodge, Scott
Clinic
0151 430 6300
Gillian.holt@merseycare.nhs.uk
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Table 2 Support for Mersey Care NHS Foundation Trust Divisions – ‘MAPPA Leads’
MAPPA Champions BASE CONTACT DETAILS
Mark Sergeant, Gary
Smith, CJLT
Managers
(Local Services)
Liverpool
Community Justice
Centre
0151 478 6550
Mark.sergeant@merseycare.nhs.uk
Gary.smith@merseycare.nhs.uk
Robert McLean,
Head of Forensic
Social Care/
Nominated Officer
for Safeguarding
(Secure Services)
Ashworth Hospital,
Parkbourn,
Liverpool
L31 1HW
0151 473 2808
Robert.mclean@merseycare.nhs.uk
Dawn Hayes (Local Services)
Broadoak Unit 07980 795 301
Dawn.hayes@merseycare.nhs.uk
Paul Hart (Local services)
Switch House 0151 527 3400
Paul.hart@merseycare.nhs.uk
Jimmy Cousineau
(Local services) Broadoak Unit 0151 250 5204
Jimmy.cousineau@merseycare.nhs.uk
Alex Henderson
(Local services) Switch House 0151 527 3441
Alex.henderson@merseycare.nhs.uk
Rachel Mercer
(Secure Services) Scott Clinic 0151 431 5117
Rachel.mercer@merseycare.nhs.uk
Dr Ruth McCutcheon
(Nominated Medical Lead - Local
Baird House 0151 330 8013
Ruth.mccutcheon@merseycare.nhs.uk
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Services)
Philipa Riding
(Nominated lead – Specialist Learning Disabilities Division)
Whalley 01254 821 396
philippa.riding@merseycare.nhs.uk
Staff that have concern about risk and public protection should contact their SPoC, SMB member or local MAPPA Lead for advice and support. (NB It should
be noted that at times the MAPPA lead or nominated deputies might change due to
change in an individuals role function)
Table 3: The MAPPA Coordinators for adjoining areas are:-.
MAPPA manager
Area Contact details
Jayne Philips
Susan Boydell-
Cupitt
Merseyside
Lancashire
Cheshire
Manchester
Jayne Phillips - email
jayne.phillips@probation.gsi.gov.uk and / or nwnps.merseyside.mappa@probation.gsi.gov.uk
Telephone 0151 777 1358 or MAPPA unit 0151 955
0886
Susan Boydell-Cupitt – email
MAPPA@lancashire.probation.gsi.gov.uk Tel:
01772 552700
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9.0 PROCESS MAPPA Eligibility 9.1 There are three categories of violent and sexual offenders who are managed
through MAPPA: The principal issue in establishing the threshold for referral
to MAPPA is that of risk of serious harm.
Category 1 – Registered Sex Offenders:
- i.e. service users who are currently on the Sex Offenders Register
- will be managed at Level 1 by police but may be referred up for active
MAPPA management at level 2 or 3 if required (depending on level of risk)
Category 2 – Violent Offenders:
- i.e. service users who have been convicted of a violent offence under
Schedule 15 and having received either a sentence of 12 months custody
or more and currently on licence, or an eligible order imposed by the court
(i.e. S37/41, S45a, notional S37, CTO following discharge from S37,
guardianship and not guilty by reason of insanity).
- will usually be managed at Level 1 by health if they have the eligible order
having been convicted of a violent offence under Schedule 15 , but may be
referred up for active MAPPA management at level 2 or 3 if required
(depending on level of risk)
- If a service user has a conviction for a violent offence under Schedule 15
and is no longer subject to the eligible order or they have served their
sentence and are no longer on licence, they do not automatically require
management under MAPPA however the option to refer to MAPPA is
available dependant on level of risk and should be discussed with MAPPA
SPoC.
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Category 3 – Other Dangerous offender: - Service users not eligible under Category 1 or 2 but who are considered
by the Responsible Authority or lead agency (i.e. Mersey Care) to pose a
risk of serious harm to the public. For the purpose of this policy, serious
harm is defined as:
“An event, which is life-threatening and/or traumatic, from which recovery, whether physical or psychological, can be expected to be difficult or impossible.”
– These service users have to have been cautioned for or convicted of an
offence which indicates that he or she is capable of causing serious harm
and which requires multi-agency management due to the level and
immediacy of current risk. This might not be for an offence under Sch.15 of
the CJA 2003. These service users will all be managed under Level 2 or 3
if accepted for MAPPA.
9.2 There are three levels of MAPPA Management:
Level 1: Ordinary Agency Management (i.e. managed by a single agency;
Health/Police/YOS)
Level 2: Active Multi-Agency Management (Police, Probation, Prison led)
Level 3: Active Multi-Agency Management (Police, Probation, Prison led)
Identification 9.3 Identification is the process for clinicians to establish which of our service
users have become MAPPA eligible by virtue of a current mental health
disposal imposed at court using the Identification document (MAPPA I). This
will normally involve service users who have been sentenced by the courts to
an order under the MHA/ Insanity and subsequently admitted to an inpatient
area.
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9.4 All MAPPA eligible offenders having received an eligible Mental Health Act order
(both MAPPA eligible offence and sentence) upon sentence must be identified within
3 days of sentence or admission to hospital. Section 48 patients may become
MAPPA qualifying on sentence, or already be MAPPA eligible on account of a
previous conviction.
9.5 Mersey Care has procedures to ensure that there are systems in place to identify
MAPPA nominals within 3 days and that Part 1 (MAPPA I) is completed. As a fail-
safe procedure, at the first care programme approach (CPA) meeting or equivalent, a
designated member of the care team should be nominated as responsible for
ensuring that the offender has been marked as a MAPPA offender on the internal
management/ record-keeping system.
9.6 The Trust is measured on their compliance with the completion of Part 1 of the
Identification form. The trust must have a 100% compliance rate for completing Part
1 within 72 hours of a service user receiving a MAPPA eligibility order at court. This
must also be reflected on the service users MAPPA web-form by entering the
eligibility order date in the ‘Date of MAPPA eligibility’ field.
Notification
9.7 Notification is the process to notify the MAPPA Co-ordinator of a service users
impending release into the community/unescorted leave of absence using
Part 2 of the MAPPA I form (Identification/Notification). The MAPPA guidance
timeframe for completion of notification is 6 months prior to
discharge/unescorted leave of absence. The notification process will involve
service users who have been sentenced by the courts to an order under the
MHA and subsequently admitted to an inpatient area.
9.8 This is to ensure that all MAPPA Offenders/ Patients (MAPPA nominals) are
identified even though they may be several years away from discharge and that the
MAPPA co-ordinator is notified and therefore aware of all MAPPA offenders being
managed by mental health services.
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9.9 Notification must be sent to the MAPPA Co-ordinator of the area where the offence
was committed and to the Co-ordinator of the local area i.e.
nwnps.merseyside.mappa@probation.gsi.gov.uk and to
mcn-tr.Criminal-Justice@nhs.net
(http://nww.portal.merseycare.nhs.uk/LocalServices/MAPPA/MAPPA%20Document
%20Library/Notification%20Part%201%20and%20Part%202.doc).
(Appendix 1)
9.10 The responsible clinician has discretion to communicate significant events to the
MAPPA coordinator at any stage that may involve a move outside the secure
perimeter e.g. leave out of the hospital grounds or transfer to a different hospital. This
applies also to clinicians treating patients on trial leave away from the hospital where
they are liable to be detained. It is difficult to inform of every occasion whereby
someone has leave, however whenever there are significant events this must be
achieved.
9.11 The trust is measured on its compliance with completion of Part 2 of the Identification
/ Notification form. The indicator is described as follows: all service users discharged
from an inpatient spell during the reporting period for which multi-agency
management is required (MAPPA Level 1, 2 or 3). Thresholds: Green 100%; Amber
>=90%; Red <=90%.
Referral to MAPPA 9.12 A referral for active MAPPA management (i.e. level 2 or 3 MAPPA meeting)
will be made when eligibility criteria is met and serious risk of harm to others is
considered to be imminent and highly likely (see Appendix 4 – MAPPA Q).
These are cases that will require a multi-agency response in order to robustly
manage the risk of serious harm to the public. A referral to active MAPPA
management under Level 2 or 3 could occur at the same time as a notification
is submitted.
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9.13 Referral into MAPPA is not required if the case can be safely managed at level 1
ordinary agency management where Health is the lead agency, though other
agencies can be invited. Notification alone is sufficient.
9.14 There may be occasions when clinicians identify community service users that have
historical MAPPA eligible offences and present with a current serious risk of harm to
the public that requires a multi-agency public protection response to manage the risk
and ensure public protection. These service users would fall under Category 3
offenders and should be referred into MAPPA for Level 2 or 3 MAPPA management
using MAPPA Q for guidance.
9.15 For the benefit of streamlining the referral process to MAPPA and to maintain
information systems and for audit purpose, a single point of referral is advised which
will be via the CJLDT on mcn-tr.Criminal-Justice@nhs.net
9.16 Referral to MAPPA is governed by local and national guidance, and MAPPA specifies
that a referral for MAPPA, (Appendix 2 - MAPPA A referral form), is completed when
an individual is identified as needing ‘additional value’ to the risk management plan.
9.17 Four Pillars Risk Matrix must be completed and attached to MAPPA A referral form.
Please select the Four Pillars Risk Grid from this link. Whilst probation related
document the four pillars are transferable to mental health language.
9.18 All MAPPA eligible offenders managed under Level 2 and 3 must have
comprehensive risk assessments in line with Level 2/3 assessments detailed within
Trust policy SA10 (e.g. HCR-20). Where existing HCR-20 has been completed
during an inpatient admission, this can support the development of the community
based risk-assessment and inform the CMHT risk management plan. Level Two risk
assessments involve a little more work than Level One assessments and risk
formulation and risk management planning are detailed and explicit. The same tools
may be used as in Level One assessments but the practitioner spends more time
thinking about the information to hand, preparing a formulation and designing a risk
management plan (eg at a CPA Risk Assessment, pre-leave risk reviews, pre-leave
risk review). Because of the detail and the attention given to the way in which harmful
outcomes might occur in the future, Level Two assessments are likely to be
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informative of risk over quite short time periods (hours, days) as well as up to weeks
and even several months from the time of assessment. The trust expect that for
those service users who present with such risk that make them MAPPA eligible under
Level 1, 2 or 3, should have detailed, comprehensive and robust risk assessments to
ensure on-going public protection and effective risk management.
9.19 Any urgent action that needs to take place should be taken first, i.e. contact the
police, 999, and thereafter arrangements for referral to MAPPA taken. The SPoC
should also be kept informed about these events and advice should be taken from
the SPoC or members of the L&D team where there are uncertainties.
9.20 The referring clinician from the lead agency will be informed of the referral outcome
and will be invited and expected to contribute along with other stakeholders to risk
manage as necessary
Level 1 review 9.21 The responsibility for managing those offenders / patients as previously described in
Section 9 at Level 1 for the purpose of MAPPA sits with the Trust as the lead agency;
however the MAPPA guidance specifies that the MAPPA I form part 1 should be sent
to the MAPPA co-ordinator to notify of the MAPPA eligibility. *must specify offence*
9.22 Good practice suggests that risk assessment is more likely to be transparent and
defensible if:
- All reasonable steps have been taken, and reliable assessment methods have
been used.
- Information has been collected and thoroughly evaluated.
- Decisions have been recorded (and subsequently carried out).
- Policies and procedures have been followed.
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- Practitioners and their managers have adopted an investigative approach and
have been proactive.
9.23 Most mental health cases will be managed at MAPPA level 1, which is ordinary
agency management, but this does not exclude other agencies being involved or
preclude information-sharing with other agencies. All Mersey Care staff must give
cognisance to issues around their duty of confidentiality with regard to patient
information, balanced against the need to share information that is directly relevant to
ensuring public protection (further guidance given in MAPPA national guidance and
Royal College of Psychiatrists).
9.24 Level 1 reviews will involve liaison with other stakeholders involved with the
individual’s health & social care and can involve the service user if appropriate. The
Level 1 review can form part of a service users CPA review or MDT. National
MAPPA guidance stipulates that agencies must have arrangements in place to
review cases managed at level 1 in line with their own policies and procedures.
Mersey Care has adopted the Merseyside MAPPA Strategic Management Board’s
piloted advice for all lead agency reviews at level 1 which is 16 weekly. There will be
exemptions from Level 1 reviews, where the identified nominal is not receiving leave
or until a point 6 months before the identified nominal is consideration for leave, i.e.
High Secure. This will be discussed at the CPA reviews. At the review, the care
team will complete the Level 1 review form, which is held in the service users
electronic record. The Level 1 review form incorporates the Four Pillars, as per
national guidance and is used to monitor and review the current risk management
plan and consider any escalation in risk that would indicate the need to consider a
referral to active MAPPA management under Level 2 or 3. For inpatient areas Level 1
reviews start the process of communication with stakeholders and supports MAPPA
being factored in to discharge planning. Level 1 reviews and the completion of level 1
review forms are only required at the stage when the patient is going to have
unescorted leave outside the perimeter wall or discharge from the hospital, this level
1 review process should begin 6 months before the patient enters the community as
is the case with the notification process using part 2 f the mappa I document. This
review will capture the risk based conversations amongst the care team and other
stakeholders if indicated and will support robust risk management planning as the
patient begins to make the transition back into the community.
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9.25 Level 1 reviews will be subject to performance monitoring and must have 100%
compliance with the 16 week meeting timeframe. Meeting dates should be recorded
via the service-users MAPPA web-form held in Clinical Pathways. The Level 1
review form documentation must also be completed at each meeting and recorded in
the Patient Documents section of e-PEX. Guidance around MAPPA pathways/web-
forms and Level 1 review documents can be found in the e-PEX MAPPA recording
section on the Trusts MAPPA SharePoint page here.
9.26 All MAPPA eligible offenders managed under Level 1 must have comprehensive risk
assessments in line with Level 2/3 assessments detailed within Trust police SA10
(e.g. HCR-20). Level Two risk assessments involve a little more work than
Level One assessments and risk formulation and risk management planning
are detailed and explicit. The same tools may be used as in Level One
assessments but the practitioner spends more time thinking about the
information to hand, preparing a formulation and designing a risk
management plan (eg at a CPA Risk Assessment, pre-leave risk reviews, pre-
leave risk review). Because of the detail and the attention given to the way in
which harmful outcomes might occur in the future, Level Two assessments
are likely to be informative of risk over quite short time periods (hours, days)
as well as up to weeks and even several months from the time of assessment. Where existing HCR-20 has been completed during an inpatient admission, this can
support the development of the community based risk-assessment and inform the
CMHT risk management plan. The trust expect that for those service users who
present with such risk that make them MAPPA eligible under Level 1, 2 or 3, should
have detailed, comprehensive and robust risk assessments to ensure on-going public
protection and effective risk management.
9.27 For all persons who are in an ‘out of area treatment’ (OAT) bed, and are known to
Mersey Care and who are subject to the MAPPA provisions, it is the treating care
team where the offender currently resides in hospital who has the responsibility for
co-ordination of the level 1 review process.
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Information gathering
9.28 Information gathering is a key component to risk assessment, formulation and risk
management and it is vital that those involved in risk management processes and
MAPPA meetings that all relevant information relating to risk assessment and
management processes within health is obtained and gathered together for the
MAPPA meeting, i.e. CPA documentation, risk assessment etc. This information
should be gathered prior to a MAPPA meeting and therefore should be readily
accessible within existing health care records.
9.29 All relevant practitioners should be investigative when gathering information and
ensure that information from partner agencies are available and accessible, i.e.
housing etc.
9.30 Where up to date risk assessments and management plans are not available these
should be completed prior to a MAPPA meeting, and any additional risk assessments
completed.
9.31 All information that is of a sensitive nature should be held within restricted access
sections of care records, i.e. previous MAPPA minutes.
9.32 All MAPPA cases must be subject to a warning (red stripe) marker on epex or the
electronic patient records system used in your clinical area.
Standard for attendance at Level 2 and 3 MAPPA meetings
9.33 Where a person who is subject to a MAPPA meeting but has not been identified as
having a mental disorder or is currently not known to mental health services but there
are expressed concerns by an RA about the person’s mental state, then the L&D
service via the SPoC will attend as an advisor to the MAPPA meeting.
9.34 Where a person has been identified for MAPPA and is known to mental health teams
then the most appropriate practitioner (this could be any person who has in depth
knowledge of the person) must be in attendance. Where this practitioner is a band
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without significant decision making powers (clinically) they must be supported at the
meeting by their manager.
9.35 A practitioner / manager who are in a position to make strategic decisions on behalf
of Mersey Care should also be in attendance. This representative should be
identified at an early stage.
9.36 A medical representative, ideally the responsible clinician (RC) or Consultant if not
subject to the provisions of the mental heath act should be in attendance, though
where apologies are sent then a suitable deputy should be in attendance.
9.37 At all times there must be an appropriate representative of mental health services
with knowledge of the person (independent of the L&D service) at MAPPA meetings.
It is unacceptable for there to be no attendance at MAPPA meetings from health as a
duty to co-operate agency (DTC).
9.38 Commitment to this process must be given a high priority and attendance at MAPPA
meetings must be a priority whenever practicable, MAPPA meetings are the highest
level of risk management for high risk service users. Personal responsibility to attend
MAPPA meetings is with the individual.
9.39 Attendance at a MAPPA meeting is a participative process and attendees will be
expected to be involved in the discussion of risk and public protection, the gathering
of information and appropriate information sharing. All Mersey Care staff must give
cognisance to issues around their duty of confidentiality with regard to patient
information, balanced against the need to share information that is directly relevant to
ensuring public protection (further guidance given in MAPPA national guidance and
Royal College of Psychiatrists).
Non-Attendance
9.40 If a person involved in a Level 2 or 3 MAPPA meeting and is unable to attend then a
MAPPA non attendance summary needs to be completed and forwarded to the
MAPPA chair.
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http://nww.portal.merseycare.nhs.uk/LocalServices/MAPPA/MAPPA%20Document%
20Library/MAPPA%20none%20attendance%20meeting%20summary.docx
9.41 The reporting of non attendance of mental health professionals invited to a Level 2 or
3 MAPPA meeting will be monitored via the chair and ultimately through the SMB
audit process. This is performance managed via the SMB and attendance should be
90%.
9.42 It is the SPoC’s responsibility to discuss with those concerned, the reasons for non
attendance and if indicated discuss with team manager.
Exit from MAPPA
9.43 A person will be discharged from MAPPA once they are no longer subject to the
arrangements in Section 9.0 (Eligibility criteria). The MAPPA I form (part 4) must be
completed and returned to the MAPPA co-ordinator. An example of a person
discharged from MAPPA would be a person on a S37/41 who has been absolutely
discharged.
Governance arrangements
9.44 There are a number of arrangements and meetings which form the governance
arrangements for MAPPA within Mersey Care and with our partner agencies and the
Clinical Risk & Offender Management Process (CROMP) sits central to these
arrangements
(http://nww.portal.merseycare.nhs.uk/LocalServices/MAPPA/SitePages/CROMP.asp
x
9.45 The Clinical Risk & Offender Management Process (CROMP) will feed into 4
separate areas:
1. Strategic Management Board (SMB),
2. Strategic Management Board Mental Health Sub group
3. Local services Safety Governance meeting
4. Secure services Security Committee
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5. Specialist Learning Disabilities division Governance Arrangements
10.0 CONSULTATION & IMPLEMENTATION
Consultation and implementation will be in accordance with the implementation plan
and will take into account national guidance. The policy will be reviewed to reflect
amendments to MAPPA protocols on a two- yearly basis, the L&D service will work in
consultation with key stakeholders and appropriate external agencies including
Merseyside Police Service, National Probation Service and service users.
11.0 TRAINING AND SUPPORT
Members of the Liaison & Diversion Service will deliver a series of road shows and
awareness raising sessions across the divisions over a 12-18 month period. The L&D
team are contactable 7 days a week for any guidance required. The MAPPA SPoC
and Deputy SPoC and MAPPA leads are also available for guidance and advice. The
Trusts SharePoint MAPPA web page is also a valuable resource for all things
MAPPA related and easily accessible via the trust website.
12.0 MONITORING
Monitoring will occur through the Clinical Risk & Offender Management Process
(CROMP), which is a bi-monthly meeting. Compliance with the policy will be
overseen by the MAPPA SPoC and any issues in relation to compliance will be
escalated through existing governance arrangements. Annual reports will be
provided to the Quality Assurance Committee.
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13.0 APPENDICES Appendix 1
NOTIFICATION OF MAPPA-ELIGIBLE DETAINED PATIENT (MENTAL HEALTH)
MAPPA I
Part 1 identification To be completed at admission to hospital
1. CATEGORY OF OFFENDER The patient must fall into one of the MAPPA Categories summarised below. Please tick one box below.
1. Registered sexual offender
2.Violent or other sexual offender
An offender convicted (or found not guilty by reason of insanity or to be unfit to plead and to have done the act charged) of murder or an offence specified under Schedule 15 or s.327(4A) of the Criminal Justice Act 2003 who has been sentenced to 12 months or more custody (this includes indeterminate and suspended sentences), detention in a youth detention accommodation for a term of 12 months or more, a hospital order (with or without restrictions) or a guardianship order.
3. Category 3 offender/possible future Cat 3 offenders(other dangerous offender): a person who has been cautioned for or convicted of an offence the circumstances of which indicate that he or she is capable of causing serious harm and which requires multi-agency management. This might not be for an offence under Sch.15 of the CJA 2003*.
2. OFFENDER INFORMATION Last name:
First name(s):
Date of birth:
Aliases:
Last known address before hospitalisation:
Home area:
Gender:
Ethnicity:
3. DETAINED IN HOSPITAL Name of responsible clinician:
Hospital:
Please indicate the relevant section and basis for detention of Mental Health Act from
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the list below:
Hospital order (s37 MHA 1983)
Restricted hospital order (s37/41 MHA 1983)
Guardianship Order (s37)
Hospital and limitation direction ( s45a MHA 1983)
Transfer direction (s47 MHA1983) (prison transfer without restriction)
Transfer direction (s47/49 MHA 1983) (prison transfer with restriction)
“Notional s37”
4. DETAILS OF CONVICTION OR CAUTION Index offence
Date of conviction and court / caution
Sentence (and sentence expiry date where relevant)
5. VICTIM CONCERNS Has the victim asked to be kept informed of relevant dates and decisions by Hospital Managers under the Probation Victim Contact Scheme?
If YES name and contact details of VLO
Please state what information has been provided and summarise any concerns that the victim might have
6. SIGN AND DATE Signed:
Name:
Date:
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Part 2 Notification of Leave and Discharge Planning
7. DETAILS OF LEAVE
Details of community leave arrangements Please provide as much detail as possible. Include dates and relevant addresses and details of any exclusion zone. Confirm below whether escorted or unescorted:
Escorted
Unescorted
Date of next CPA/ CTP if applicable
8. MENTAL HEALTH TRIBUNAL/CONDITIONAL DISCHARGE PLANNING Date of next tribunal hearing if applicable.
Details of discharge (including any conditions) [include dates and address]
9. CONTACT DETAILS OF LEAD CLINICIAN Name: Hospital: Telephone Number(s): Email Address: 10. CONTACT DETAILS OF FORENSIC SOCIAL WORKER Name: Hospital: Telephone Number(s): Email Address: 11. SIGN AND DATE Signed:
Name:
Date:
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Part 3 INFORMATION 12. INFORMATION HELD BY MAPPA CO-ORDINATOR/MAPPA UNIT Is there any information known to MAPPA Unit, including information held on ViSOR or Probation case management systems regarding this patient which should be shared to help manage the risk to the public?
If YES:
ViSOR:
Other relevant information e.g. from Probation systems
Information provided to Responsible Clinician by (provide name, role and contact details):
Date sent:
Information copied to: (MAPPA Unit to cc other mental health professionals involved ViSOR Officer, Probation Officer, MAPPA Unit in home/discharge area as applicable) * Further information on MAPPA Category 3 can be found in Chapter 6 – Identification and Notification of MAPPA offenders and Chapter 26 - Mentally Disordered Offenders and MAPPA. NB: On receipt of this form back from the MAPPA Unit, the responsible clinician should check information in section 10, and then :
• update the risk assessment • update the risk management plan • notify the MAPPA Unit of any change of address • at the appropriate time in line with guidance make and record a clear decision whether
the case can be managed a level 1 or whether to make a referral to the MAPPA unit for management at level 2 or 3.
If MAPPA level 2 or 3 management is required, Mental Health as the lead agency, should make a referral to the MAPPA unit in the area where the patient is to be conditionally discharged. MAPPA A should be used in accordance with the MAPPA Guidance. Further information on referral to level 2 or 3 is found in Chapter 7 – levels or management or Chapter 26 - Mentally Disordered Offenders and MAPPA under the “Making a referral to MAPPA level 2 and 3” section.
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Part 4 Exit from MAPPA To be completed by Mental Health services where patient no longer meets the criteria for MAPPA 11. ABSOLUTE DISCHARGE Where a patient, managed through MAPPA at any level, receives an absolute discharge this section must be completed and returned to the MAPPA Unit in the area where the patient is residing. It is at this point that the patient will no longer meet the criteria for being managed under MAPPA.
Date of absolute discharge and name of Responsible Clinician:
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Appendix 2 (to be completed in conjunction with Appendix 5)
REFERRAL TO MAPPA LEVEL 2/3
Fields marked with * are mandatory
MAPPA A
Name of MAPPA area:
Referral to which level? 2 3
1. CATEGORY OF OFFENDER * All agencies
The offender can fall into only one of the MAPPA Categories summarised below. Please place an X against only one of the following three Categories.
1. Registered Sexual Offender
2. Violent or other sexual offender:
An offender convicted (or found not guilty by reason of insanity or to be unfit to plead and to have done the act charged) of murder or an offence specified under Schedule 15 or Section 327(4A) of the Criminal Justice Act 2003 who has been sentenced to 12 months or more custody (this includes indeterminate and suspended sentences), detention in a youth detention accommodation for a term of 12 months or more, a hospital order (with or without restrictions) or a guardianship order.
3. Other dangerous offender:
Has been cautioned for or convicted of an offence which indicates that he or she is capable of causing serious harm AND which requires multi-agency management. This might not be for an offence under Sch.15 of the Criminal Justice Act 2003. Offenders convicted abroad could qualify for Category 3.
2. OFFENDER INFORMATION
Last name: * All agencies
First name: * All agencies
Date of birth: * All agencies
Aliases (including nicknames):
All agencies
Gender: All agencies
Ethnicity: All agencies
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ViSOR Reference:
(must be completed for all
Registered Sexual Offenders):
All agencies
PNC ID: * All agencies
Agency unique identifier: * All agencies
Prison: * All agencies
Prison number: * All agencies
Last known address before sentence:
Police / Probation
Proposed release address: Police / Probation
Current address if in community:
All agencies
GP name and address: All agencies
Social care legal status: All agencies
3. CONVICTION / CAUTION INFORMATION
Index offence / Relevant caution:
* All agencies
Date of conviction / caution: * All agencies
Sentence length and type: All agencies
Brief offence(s) details: * All agencies
Relevant previous convictions and pattern of offending:
All agencies
Other relevant information: All agencies
4. RELEVANT DATES
Automatic Conditional Release Date:
YOT / Probation
Parole Eligibility Date: YOT / Probation
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Non-Parole Date: YOT / Probation
Licence Expiry Date: YOT / Probation
Sentence Expiry Date: YOT / Probation
Post Sentence Supervision Expiry Date:
YOT / Probation
Home Detention Curfew: YOT / Probation
Community Order end date: YOT / Probation
Imprisonment for Public Protection:
YES / NO * Probation
Extended Sentence for Public Protection:
YES / NO * Probation
Lifer: YES / NO * YOT / Probation
Mental Health review date(s):
Mental Health
Sexual Offences Prevention Order:
YES / NO
Conditions:
* Police / Probation
Sexual harm Prevention Order:
YES / NO
Conditions:
* Police / Probation
Sexual risk Order: YES / NO
Conditions:
* Police / Probation
Registered Sex Offender Notification end date:
Police / Probation
Other Order: (e.g. Disqualification Order, Violent Offender Order, Terrorism Notification)
YES / NO
Type of Order:
Conditions:
* Police / Probation
5. DETAINED IN HOSPITAL Mental Health
Name of responsible clinician:
Hospital:
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Earliest possible discharge date:
Proposed release address:
Name / contact details of Forensic Social Worker:
Date of next tribunal:
Please indicate the basis for detention from the options below
Guardianship order – s.7/s.37 MHA 1983
YES / NO
Hospital order – s.37 MHA 1983
YES / NO
Restriction order – s.41 MHA 1983
YES / NO
Transfer from prison – s.47 MHA 1983
YES / NO
Other:
6. RELEVANT INFORMATION * All agencies
Reason for referral and how will active multi-agency management add value to the management of the risk(s) of serious harm?
What inter-agency work has been undertaken so far?
Equality considerations linked to risk of serious harm (if an offender is a child, consider the voice of the child)
Add any other relevant information (e.g. media handling, disclosure, medical issues etc)
7. RISK ASSESSMENT
RM 2000 Risk of Reconviction [complete for all sexual offenders] Police / Probation
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Level Date of assessment
RM 2000 Sexual:
RM 2000 Violent:
RM 2000 Combined:
ARMS Police/Probation
V High High Medium Low Date completed
Risk of sexual re-offending:
OASys Risk of Reconviction Prison / Probation
1 year % 2 year % Band Date completed
OGP:
OVP:
OGRS3:
OASys Risk of Serious Harm – (1) Risk in the Community Prison / Probation
V High High Medium Low Date completed
Children:
Public:
Known adult:
Staff:
Prisoners:
OASys Risk of Serious Harm – (2) Risk in Custody Prison / Probation
V High High Medium Low Date completed
Children:
Public:
Known adult:
Staff:
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Prisoners:
SARA Assessment [complete for all domestic abuse offenders] Probation
High Medium Low Date completed
Risk to partner:
Risk to others:
ASSET/ ASSET PLUS Risk of Serious Harm [complete for all offenders under 18]
YOT
V High High Medium Low Date completed
Risk of serious harm:
ASSET risk of reconviction Date completed
Any Other Risk Assessment Tools (for example, AIM2 and SAVRY)
All agencies (if applicable)
Date completed
Mental Health / Psychological Risk Tool Mental Health
Date completed
8. SAFEGUARDING All agencies
Child Protection Concerns (continue on additional sheet if required)
Are there any child protection concerns? If YES, answer a to c below
YES / NO / NOT APPLICABLE / NOT KNOWN *
a. What are they?
b. Is there an allocated social worker? If so, please give details
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c. Is the child or children currently subject to a Child Protection Plan?
YES / NO / NOT APPLICABLE / NOT KNOWN *
Child 1
Last name:
First name:
Date of birth:
Gender:
Relationship to offender:
Child 2
Last name:
First name:
Date of birth:
Gender:
Relationship to offender:
Child 3
Last name:
First name:
Date of birth:
Gender:
Relationship to offender:
Genogram Required/ Available?
YES / NO
Vulnerable Adult Concerns (continue on additional sheet if required)
Name:
Date of birth:
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Gender:
Does this person live with the offender?
YES / NO
Relationship to offender:
Name of social worker (if relevant):
Genogram Required/ Available?
YES / NO
Risks to the Offender
9. VICTIM CONCERNS All agencies
Outline any concerns about the victim of the index offence or potential victims:
Has the victim taken up the Victim Liaison Service?
YES / NO / NOT APPLICABLE / NOT KNOWN *
If YES, give contact details of VLO
Are there any domestic abuse concerns? If YES, answer a to e below
YES / NO / NOT APPLICABLE / NOT KNOWN *
a. What are they?
b. Has the victim been referred to MARAC?
YES / NO / NOT APPLICABLE / NOT KNOWN *
c. Has a meeting been held / Is a meeting due to be held?
YES / NO / NOT APPLICABLE / NOT KNOWN *
d. Date of meeting (if known)
e. Actions from MARAC
10. RISK ASSESSMENT AND MANAGEMENT PLAN * All agencies
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Lead Agency Risk Assessment Summary
Who is at risk?
What is the nature of the risk?
When is the risk likely to be greatest?
What circumstances are likely to increase risk?
What are the protective factors?
Lead Agency Risk Management Plan
Supervision:
Monitoring & Control:
Interventions & Treatment:
Victim Safety:
Contingency Planning
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11. ADDITIONAL MAPPA INVITEES All agencies
Invitee 1
Name:
Agency:
Address:
Email address:
Telephone number(s) (w) (m)
Invitee 2
Name:
Agency:
Address:
Email address:
Telephone number(s) (w) (m)
Invitee 3
Name:
Agency:
Address:
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Email address:
Telephone number(s) (w) (m)
Invitee 4
Name:
Agency:
Address:
Email address:
Telephone number(s) (w) (m)
Invitee 5
Name:
Agency:
Address:
Email address:
Telephone number(s) (w) (m)
Invitee 6
Name:
Agency:
Address:
Email address:
Telephone number(s) (w) (m)
12. REFERRING AGENCY INFORMATION
Referring agency: *
Name: *
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Grade: *
Office: *
Telephone number(s) * (w) (m)
Email address: *
Date sent to line manager:
Endorsement by line manager (where required by your agency)
Name:
Grade:
Office:
Telephone number(s): (w) (m)
Email address:
Date endorsed by line manager:
Once completed, please send this form to the MAPPA Co-ordination Unit.
ONLY USE SECURE EMAIL
Insert your email address here
If email is not secure, please fax to: Insert your fax number here
Date sent:
13. MAPPA CO-ORDINATION UNIT DECISION (for official use only)
Screened by:
Name:
Title:
Area:
Date referral received:
MAPPA qualifying offender? YES / NO
If NO, return form to referring agency line manager
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Comments:
Does referral meet threshold for Level 2/3? If YES, which level?
If NO, return form to referring agency line manager
Comments:
Date referral accepted / rejected:
Date referring agency notified:
Meeting to which referral is to be taken:
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Appendix 3
MAPPA LEV
LEVEL ONE RISK REVIEW (MENTAL HEALTH)
This document must be completed as a team in accordance with MAPPA 2012 guidance, see MAPPA guidance.
Please ensure you have prepared for the review meeting by being able to
answer the questions below in conjunction with the Aide Memoire
DATE OF MEETING: Service User Name:
Date of Birth:
Initial or Review Meeting? :
Present:
Current Risk Of Serious Harm Level:
MAPPA Level: MAPPA Category:
Sentence date:
Index Offence:
Sentence:
Care Pathway Position:
When was last update of CPA Risk/ HRC20/ HR-JRAMP AREAS TO BE ADDRESSED IN MEETING Responsibility for completing specified in brackets
COMMENTS
1. Have actions from last MAPPA level 1 or CPA risk review been completed? What actions remain outstanding and why? (Care Coordinator & or Responsible Clinician, MDT)
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2. Care Coordinator & Responsible Clinician to provide an update on current risks and management of those risks. (please refer to Aide Memoire)
Does the RMP cover these key elements? • Supervision (offender engagement & motivation,
visiting regime, accommodation, aspirations of offender, what will supervision focus on?)
• Monitoring and Control (Licence / discharge conditions, surveillance, other control measures)
• Intervention and Treatment (Programme eligibility, counselling, medication, mental health, peer mentoring etc)
• Victim safety
3. What are the early warning signs and is the plan sufficient to identify them, respond to escalations in risk and deteriorating behaviour? Please describe what action you would take. (Care Coordinator & or Responsible Clinician, MDT)
Examples, disengagement with treatment, non compliance with medication, deterioration of appearance.
4. Who are you working/liaising with to manage the risks in this case? And what does this involve? Might they hold any information to support this review? (Care Coordinator & or Responsible Clinician, MDT)
Internal: OT/ SW/ CPN/ Support Worker/ Psychology/ SALT etc. External: Police/ Accommodation/ Support Staff/ Voluntary & 3rd sector services / Probation/ VLO/ YOS/ GP/ Health Visitor/ Family/ A&E (frequent attender?)/ Safeguarding Social Services/ Education (university links?) etc. NB: Job Centre Plus should a MAPPA J be completed.
5. Is Third Party disclosure required? If so: • What will be disclosed and by when. • Who will make it. • Who will receive it.
The MAPPA Guidance requires the risk assessment of all MAPPA offenders to identify
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those persons who may be at risk of serious harm from the offender. The Risk Management Plan must identify how these risks will be managed. As part of this process, the Responsible Authority must consider in each case whether disclosure of information about an offender to others should be made to protect victims, potential victims, staff, and other persons in the community. This applies to all categories and levels of MAPPA cases. The overriding factor is the need to protect the public and safeguard children. See guidance. 6. Is there any intelligence that should be shared with police to support public protection through the ViSOR system? Have we considered contacting the MAPPA manager on nwnps.merseyside.mappa@probation.gsi.gov.uk to see if ViSOR has any intelligence to assist our decision making (more so for sex offenders).
(ViSOR is a secure national database that has been developed to support MAPPA by assisting cooperative working between the three Agencies that make up the Responsible Authority. It is used in the joint management of individuals posing a risk of serious harm)
7. Using the MAPPA multi-agency risk of harm framework does this case remain at the same risk level and what is that risk level? (Care Coordinator & or Responsible Clinician, MDT)
8. From the information reviewed what is the agreed MAPPA Level and any other comments? (Care Coordinator & or Responsible Clinician, MDT - to input, include any areas for improvement or areas of good practice identified) Has consideration been given to this persons current MAPPA level, consider threshold test for active MAPPA management. Active Multi-Agency Management should ‘add value’ to the management of the offender (i.e. Answer the question, “what is it that the increased level of management will additionally provide to the effective management of this case?”
9. Date of next review: (Care Coordinator & or Responsible Clinician, MDT) (NB: review every 16 weeks or no less than every 6 months)
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10. Agreed actions: All Involved NB: If a Category 1 case please ensure this review is shared with the MAPPA unit so ViSOR can be updated. ACTION/OWNER TIMESCALE ACTIONS TO BE INPUTTED BY (Care Coordinator & or Responsible Clinician) DIRECTLY INTO ELECTRONIC PATIENT RECORDS
Print Name:……………………………………………………… Signature………………………………………………….. Date:………………………………………………………………… Risk Framework Offender Name: Seriousness Absence /
presence of protective factors
Imminence Risk Classification / Definition for MAPPA
Presents an ongoing risk of committing an offence causing serious harm
Pervasive risk and a lack of protective factors to mitigate that risk
More than likely to happen imminently. Requires long-term risk management to contain the risk (including long-term treatment). Will happen if controls are absent.
Very High There is imminent risk of serious harm. The potential event is more likely than not to happen imminently and the impact would be serious
Offender has a history of causing serious harm and remains capable of causing serious harm.
There are sufficient protective factors to mitigate that risk. The offender evidences a
Ongoing risk which will / could increase if protective factors ‘fail’, are absent or diminish. Protective factors
High There are identifiable indicators of risk of serious harm. The potential event could happen at
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In a very small number of cases, the offender may not have a proven offence history of causing serious harm, but there is evidence of risk factors and/or previous or current behaviours that indicate a propensity to cause serious harm.
capacity to engage with risk management strategies and/or comply with treatment. Some capacity to self-risk manage
require maintenance and support.
any time and the impact could be serious
May have caused serious harm in the past, but a repeat of such behaviour is not probable In a very small number of cases the offender may not have a proven offence history of causing serious harm, or current evidence of risk factors. Previous or current behaviours may indicate that there may be a propensity to cause serious harm, however the likelihood of such behaviour is not probable and is not imminent.
Will co-operate with risk management strategies and/or comply with treatment. Some capacity to self-risk manage with appropriate support. Presence of protective factors
Not imminent and a repeat offence is ‘on the balance of probability’ deemed unlikely.
Medium There are identifiable indicators of risk of harm. The offender has the potential to cause harm but is unlikely to do so unless there is a change of circumstances
May have caused serious harm in the past, but a repeat of such behaviour is very unlikely.
The balance of protective factors now substantially outweighs any risk factors. There are no current indicators of risk of serious harm
Not imminent and deemed very unlikely.
Low No significant current indicators of risk
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This table draws on the MAPPA Guidance; the OASys Handbook; and current legislation. ‘Risk Levels’ from Kemshall, Mackenzie, G; Mackenzie, S. and Wilkinson (2011) ‘The Risk of Harm Guidance and Training Resources’ (2011) NOMS/De Montfort University. Amended May 2012. Signed ………………………………………………….. Signed …………………………………………………….. Mersey Care Representative at Strategic Management Board
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Appendix 4
MAPPA Screening
MAPPA Q
Name of Offender: Date of Birth:
Step 1: Legality
Is the nominal a MAPPA Offender? (Please note that offenders can only be identified in one of the three Categories at a time. Offenders can only be considered for Category 3 if they do not meet the criteria for Category 1 or Category 2. Offenders only fall into Category 2 if they do not meet the criteria for Category 1. However, an offender who ceases to meet the criteria of one Category can be identified in a different category if they meet the relevant criteria.) Category 1. Registered Sex Offender (RSO) (W/M marker shown on PNC)
Schedule 3 SOA 2003: • convicted/cautioned and within Notification period or • subject of a SOPO
Category 2. Violent Offender (and ‘other sexual offenders’)
Murder or Schedule 15 of CJA 2003: • sentenced to custody for 12 months or more (including indeterminate and
suspended sentences)and on licence*, or • s37/41 restricted hospital order patient conditionally discharged from hospital,
or s37 unrestricted hospital order patient discharged from hospital on a community treatment order
Subject of a Disqualification Order *This includes persons sentenced to 12 months or more who are also the subject of a s47 transfer to hospital or a s45A hospital direction who have been discharged from hospital (such persons may be subject to a Community Treatment Order while also on licence. MAPPA eligibility as a Cat 2 ends when the sentence expires).
Category 3. Other ‘dangerous’ offender
The offender: • must have been convicted/cautioned for an offence that indicated they are
capable of causing serious harm to the public, and • poses a current risk of serious harm to the public that requires multi-agency
management at Level 2 or 3
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None of these categories apply: the offender is not a MAPPA nominal.
One of the three categories applies: proceed to step 2
Step 2: Do two or more agencies need to meet and actively collaborate to develop and implement a Multi-Agency Risk Management Plan? (If Police and Probation are involved, then three or more agencies – unless extra police resources need to be committed and/or actively co-ordinated)
For Mental Health patients: as above and/or does the Care Programme Approach (CPA) process need to be reinforced in order to manage the risk? Level 2 or 3 (Active Multi-Agency Management) should ‘add value’ to the management of the offender (i.e. Answer the question, “what is it that the increased level of management will additionally provide to the effective management of this case?”)
Issues and questions to be considered regarding L2 or L3 include: • does the offender/patient pose a current, active risk of serious harm to others? • is the amount and level of information available within different agencies such that a
discussion will facilitate a better understanding?; • is there a need to explore and reach a consensus (or record a formal difference)
between agencies about the level of risk or risk management?; • does the complexity of the case need a more co-ordinated approach to ensure
agencies are clear about their respective roles and responsibilities?; • would active multi-agency management assist in brokering the engagement of
other agencies and services in developing a risk management plan?; • for mental heath patients;
o is the nature of the risk such that it cannot be effectively managed through the CPA process?
o is it likely that a tribunal might lead to discharge against the recommendation of the treating team?
• Would multi-agency management improve or expedite referrals for services under other agencies’ procedures?;
• would it support priority access to limited or specialist resources?; • it is necessary to plan more complex third party disclosure (e.g. where there may
be personal or community repercussions?; • is there a need to plan for media or community impact/interest?;
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• does the case require middle/senior management oversight outside normal processes?;
• are there any other issues that warrant a multi-agency approach? In light of these considerations does this case require active Multi-Agency Management at MAPPA Level 2 or 3? Yes: proceed to step 3.
No: the case can be managed at Level 1 (Ordinary Agency Management).
This decision should be endorsed by your line manager (or representative)
– see step 4.
Step 3: Is the case likely to attract a high level of media scrutiny and/or public interest in the management of the case and is there a risk of public confidence being damaged? If ‘yes’: consider referral to Level 3 If ‘no’: does the case
• require input from a senior manager due to complexities (e.g. cross border issues)?, or
• does the likely seriousness and the imminence of the risk or the complexity of the case require input from special or higher level resources, perhaps at short notice, that can only be committed by senior managers?
Yes: consider referral to Level 3.
No: refer to Level 2.
Step 4:
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Discuss this case with your line manager.
Decision not agreed: Reason/s ……………………………………
Decision endorsed by line manager
Retain at Level 1, Ordinary agency management. Refer into MAPPA (Level 2 or 3). Offender manager should complete the MAPPA referral form and send it to the MAPPA Administrator.
Offender Manager …………………..................... Date …………………. Line manager …..…………………………………. Date ………………….. For more comprehensive information, refer to:
• ‘MAPPA Guidance 2012 (Version 4)’, Sections 6.1 – 6.14 and Section 7, for details of MAPPA Categories and Management Levels
• NOMS Guidance, March 2011. ‘MAPPA Level 1 – Ordinary Agency Management Best Practice’
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Appendix 5
1. CATEGORY OF OFFENDER This section identifies which category brings the offender into MAPPA, and therefore avoids incorrect identification from the outset. The offender can only fall into one category. If they meet the criteria for more than one category they should be identified as the first category they meet the criteria for. Referrals to Category 3 will not yet be MAPPA offenders but should still be identified as other dangerous offenders until the referral is approved by the Responsible Authority. 2. OFFENDER INFORMATION
• Nicknames have been included as this is relevant for a number of reasons including gang membership • State the actual ethnicity, not the code. • ViSOR reference should be included when a ViSOR record has been created e.g. sexual offenders • Agency unique identifier should be included (e.g. PNC ID, nDelius reference number) • Where the offender was NFA prior to imprisonment that should be stated, and then the area to which
the offender has closest links indentified • The proposed release address should be that which has been approved
3. CONVICTION / CAUTION INFORMATION
• The index offence or relevant caution (for Category 3) is the offence/s or caution which has brought the offender into MAPPA
• Sentence length and type is the outcome of Court proceedings • Brief details of offence. Information must not be cut and pasted from the Pre-Sentence Report or any
other document. Use bullet points • Previous related offences should be included. • There may or may not be additional information the referring agency wishes to add
4. RELEVANT DATES Relevant dates are those which relate to the current sentence or order (input dates where known). 5. DETAINED IN HOSPITAL
Notes for completion MAPPA A
• The MAPPA Area should be identified at the top of the form • The referrer should identify the Level being referred to (2 or 3) • The agency that should complete each section is identified on the right hand side of the field
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This section should be completed by Mental Health Services and provides relevant information regarding the patient. 6. RELEVANT INFORMATION Reason for referral The reasons why the referral has been made may include concerns about:
• Behaviour and attitudes • Previous offences and patterns of offending • Information gathered from other agencies • The offender’s pattern of co-operation • Gang involvement • TACT involvement • Relevant psychiatric history • Diagnosed personality disorder • Information from Risk Assessment or risk of reconviction tool Disclosure issues
How will active Level 2 or 3 management add value to the management of the case over and above what is already being achieved?
• Key words are active and add value • Describe what additional resources etc the agencies involved in MAPPA can add to how the risk of the
serious harm the offender poses can be managed more effectively • Describe what is required from a level 2 or 3 MAPPA meeting in order to complete the risk assessment
or deliver a defensible Risk Management Plan.
What interagency work has been undertaken so far? Should include the outcomes of:
• Care Plan Approach Meetings • Child Protection Conferences • Professionals Meetings • Which agencies have been contacted and what they have contributed to the risk management plan? • MARAC
Equality considerations linked to risk of serious harm
• Consideration is to be given if any of the nine protected characteristics set out in the Equality Act 2010 (i.e. age, disability, gender reassignment, marriage & civil partnership, pregnant & maternity, race, religion or belief, sex, sexual orientation) apply to the offender
• Only comment on equality issues that could impact upon risk management, e.g. is the offender a vulnerable adult, does he/she have learning disabilities etc.
• If the offender is a child, consider the voice of the child
7. RISK ASSESSMENT The information in the header line indicates the type of offender the tool should be completed for. It is important to include the date the tool was completed. 8. SAFEGUARDING
• Children’s services keep records by the name of the child. To assist this agency, the name of the child
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and any other relevant information available should be provided to enable the coordination unit to invite the correct person to the meeting.
• Where the concerns relate to children in general, these should be specified. • Vulnerable Adult concerns should be noted, both in relation to the offender and those adults the
offender is in contact with. If in doubt, contact the local Safeguarding Adults Unit. • The vulnerability of the offender should be distinguished from the risks presented by the offender.
Where the offender is a child, it is important that the panel considers the needs of the child as well as the risks posed by them.
9. VICTIM CONCERNS This section should outline any known or suspected concerns regarding the victim of the index offence/s, previous offences or potential victims e.g. children, partners, vulnerable adults etc, and why the referring agency thinks those identified are at risk of serious harm. 10. RISK ASSESSMENT AND MANAGEMENT PLAN
Lead Agency Risk Assessment Summary Lead Agency Risk Management Plan These fields must be completed. Supervision Supervision is not limited to statutory supervision by the NPS but also includes engagement with any other agency that has a role in helping offenders lead law abiding lives. Examples of supervision:
• Office-based supervision. • Home visits (by police and probation) and other regular visits to the offender's premises. • Contact with healthcare professionals. • Interaction with staff in Approved Premises. • Tenancy support from Housing Associations. • Assistance from the Department of Work and Pensions (DWP) in finding work. • Actions to build on offenders’ strengths and protective factors. • Curfews
Monitoring and Control Monitoring and control are strategies aimed at controlling and reducing opportunities for harmful behaviour. Examples of monitoring and control:
• The use of licence conditions (see PI 09/2015 for details). • A licence condition placing restrictions on residence, for example, residing at Approved Premises. • Restrictions on associations, activities and movements. • Surveillance and electronic monitoring. • Polygraph examinations. • The use of Restrictive Orders.
Where offenders pose a continuing risk of serious harm, the police will consider whether these risks are high enough to justify applying for one of the following orders:
• Notification Order (Sexual Offences Act 2003 (SOA 2003) sections 97 to 101).
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• Sexual Risk Order (SOA 2003 sections 122A to 122K). • Sexual Harm Prevention Order (SOA 2003 sections 103A to 103K). • Violent Offender Orders (Criminal Justice and Immigration Act 2008, Chapter 4, Part 8).
Interventions and Treatment Interventions and treatment are activities that focus more on developing the offender’s own ability to avoid and manage risk situations and to build strengths and protective factors that enable desistance from offending. They may be mandatory, such as complying with a licence condition, or voluntary. They may include, but will not be limited to, accredited programmes. Examples of interventions and treatment:
• Attendance at accredited programmes, which address the causes of offending behaviour. • Interventions that emphasise self-risk management and which promote the use of internal controls over
the longer term. • Interventions which combine intensive supervision with the appropriate use of sanctions and
responding to non-compliance. • Supportive and integrative approaches where risk assessments indicate their usefulness, e.g. Circles of
Support and Accountability. • Referral for medical or psychological interventions as required. • Co-operation with drug and alcohol advisory services. • Involvement in other activities to divert the offender from offending, such as appropriate employment
or voluntary work. Victim Safety Victim safety strategies are designed to protect previous and potential victims from harm. Examples of victim safety actions:
• The disclosure of information to third parties. • Relocation of the victim. • Action by Children’s Services. • Exclusion zones and non-contact licence conditions. • Restraining Orders and other orders made by the Family Court
Contingency Plans Contingency plans should be included in all RMPs. They will include rapid response arrangements to changing situations or a deterioration in circumstances or behaviours. The following factors are associated with escalating risk.
• A change in situational risk e.g. increased proximity to victims, increased opportunity to offend in other ways, change in family circumstances etc.
• Deterioration in lifestyle e.g. loss of accommodation, relapse into drug or alcohol use, increased association with offending peers etc.
• Psychological factors e.g. increased preoccupation with offending or offending related issues, deterioration in mental or psychological wellbeing etc.
• Breakdown in supervision e.g. missing appointments, superficial compliance etc. 11. ADDITIONAL MAPPA INVITEES
Invite 1 must be completed by the referring agency identifying themselves. This will identify who needs to be sent an invitation to the meeting when the case is to be discussed.
• The referring agency should also consider which other agencies would assist in the assessment and management of the risk posed by the offender. If there are more than six, complete on a separate sheet
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and attach to the referral
12. REFERRING AGENCY INFORMATION
This must be fully completed and endorsed by the line manager (this ensures that the line manager is fully aware of the case and the reason for the referral to MAPPA). For Mental Health Services, it may be more appropriate for a Doctor or other senior member of the team to endorse the form. If the referral is being completed by a line manager, the referral does not require endorsement if agreed by local agency protocol. 13. MAPPA CO-ORDINATION UNIT/ RESPONSIBLE AUTHORITY DECISION This section should be completed as appropriate to the SMB endorsed local process.
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Appendix 6
MAPPA process flow-chart for individuals sentenced to Hospital Orders (S37)
Court makes Hospital Order
Submit MAPPA I Part 1 to all MAPPA areas involved**. Mental Health are the lead agency for
S 37 patients
Not MAPPA (unless referred into Category 3)
Submit MAPPA I Part 2 notification to relevant MAPPA areas at first unescorted leave (or escorted leave if risk of abscond)
Hospital manager/nominated person to consider & manage victim issues before any S17 leave or discharge is granted.
Are they a Registered Sex offender or their Index offence listed on Schedule 15*? No Yes
Submit full referral to level 2
or 3 MAPPA management
using the MAPPA A
Case considered for S17 leave (escorted or unescorted) (has all risk information been collected using an investigative
approach?)
MAPPA unit register case & feedback relevant information to referrer
Notify MAPPA unit via the MAPPA I
Hospital screen for MAPPA Management level – is the plan robust enough for MAPPA 1 (ordinary
agency management) in the community? Yes No
Mental health to manage case as lead agency in line with MAPPA guidance (level 1
cases)
Level 2/3 MAPPA meetings scheduled in accordance with MAPPA guidelines
Evidence to suggest Risk Management plan is breaking down/ no
longer robust? Yes
Discharged with CTO
No
No longer MAPPA (unless RSO or category 3)
Hospital to notify MAPPA unit & hospital manager or Nominated person to
Contact victim/s
Remains MAPPA managed
Yes
RC agreeable to discharge patient Patient has tribunal review but discharge is
NOT supported by clinical team.
Plan to discharge without CTO
Plan to discharge with CTO
CTO dismissed/revoked MH to manage case as lead agency
(unless RSO) in line with MAPPA Guidance. **As patients may be in regional units away from their home MAPPA area and initial leave may be in a different MAPPA locality from the final discharge area, multiple MAPPA areas may be involved.
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Appendix 7
MAPPA process flow-chart for individuals sentenced to Hospital Orders (S37/41)
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Appendix 8
Section 47 / 49 transfer (Determinate sentence)
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Appendix 9
Section 47 / 49 Transfer (indeterminate sentence)
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14.0 Equality & Human Rights Analysis
Equality and Human Rights Analysis
Title: Multi Agency Public Protection Arrangements (MAPPA) Procedure
Area covered: Trust wide What are the intended outcomes of this work? This policy ensures the Trust has risk structures (i.e. CPA & MAPPA) and a robust risk assessment and management process to support the health, safety and well-being of service users, carers, staff and members of the public . It also ensures the trust is able to meet its responsibilities under ‘a duty to cooperate’ CJA 2003 and operates with defensible practises. The employees of Mersey Care NHS Foundation trust to understand these arrangements and understand their obligations and duty in respect of MAPPA. Who will be affected?
Mersey Care NHS Foundation Trust staff members, patients, service users, and indirectly, carers and members of the public
Evidence
What evidence have you considered? Whilst developing the policy :
• Criminal Justice Act 2003
• Equality and Human Rights Information available via Mersey Care NHS Foundation Trust Website
• Criminal Justice and Court Services Act 2000 published by HMSO (ISBN 0 10
544300 X)
• Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 (c. 25) published by HMSO
• Data Protection Act 1998 published by HMSO (ISBN 0 10
542998 8)
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• Department of Health: Care Programme Approach (90)
23/LASSL (90)11 published by HMSO (1990)
• Care Programme Approach (CPA) Policy published by Mersey Care NHS Foundation Trust
• Human Rights Act 1998 published by HMSO (ISBN 0 10
544298 4)
• Mental Health Act 1983 published by HMSO (1983)
• NHS Code of Practice (Confidentiality) published by Department of Health 2003 (33837)
• Sex Offenders Act 1997 published by HMSO (1997) (ISBN 0 10 545197)
• MAPPA Guidance
• Memorandum of understanding
Disability (including learning disability) During the MAPPA process disability is considered and any needs identified, and recorded. As a multi agency panel a plan would be devised to support this in line with public protection. Sex See cross cutting. Race. Issues in relation to ensuring people where English is a second language and ensuring they are able to fully understand and participate in any processes need to be in place. Age See cross cutting. Gender reassignment (including transgender). See cross cutting. Sexual orientation See cross cutting.
Religion or belief See cross cutting. Pregnancy and maternity After consideration there are no issues highlighted related to pregnancy or maternity apart from those linked to disability which would be addressed as above Carers After consideration there are no issues highlighted related to caring responsibilities Other identified groups None Cross Cutting
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Human Rights
Is there an impact? How this right could be protected?
Right to life (Article 2) Not engaged
Right of freedom from inhuman and degrading treatment (Article 3)
Supportive of a HRBA – this process is used in situations where there is a significant risk to an individual or members of the public, it is used as the least restrictive option, and a multi-agency approach is employed to meet the needs of the individual whilst managing risk, which can often prevent increased risk, entry into offending behaviour, arrest and criminalisation, therefore indirectly supporting the right of freedom from inhumane or degrading treatment
Right to liberty (Article 5) Supportive of a HRBA - this process is used in situations where there is a significant risk to an individual or members of the public, it is used as the least restrictive option, and a multi-agency approach is employed to meet the needs of the individual whilst managing risk, which can often prevent increased risk, entry into offending behaviour, arrest and criminalisation, therefore indirectly supporting the right to liberty
Right to a fair trial (Article 6) Supportive of a HRBA - this process is used in situations where there is a significant risk to an individual or members of the public, it is used as the least restrictive option, and a multi-agency approach is employed to meet the needs of the individual whilst managing risk, which can often prevent increased risk, entry into offending behaviour, arrest and criminalisation, therefore indirectly supporting the right to a fair trial/ The process of holdings the risk meetings in the absence of the person is held in Article 8.
There is a need to have a system in place to ensure no discriminatory influences are in place in relation to who should or should not be placed on MAPPA. Under MAPPA Guidance The strategic management board monitor equality and diversity impact issues and considerations are made in relation to equality, diversity and human rights of the subject. This is discussed as a multi agency panel and documented within MAPPA minutes that all attendees receive. They will not draw on stereotypical assumptions about groups that will be discriminatory in outcome.
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Right to private and family life (Article 8)
Supportive of a HRBA – the policy sets out a structure to consider any interference with a person’s human rights to be considered explicitly and ensure proportionality This policy refers to holding risk meetings which can have significant impact upon a person’s treatment and actions of key professionals without the person present. The process detailed within the policy includes decision making, without the individual present which may include interference with their human rights. The policy ensures a strict process is followed to ensure that interference with rights is proportionate to the risk posed to the public or specific individuals. Article 8 of the European Convention on Human Rights, given domestic effect by the HRA, provides a right to respect for private and family life, home and correspondence. Any interference with this right by a public authority (such as a criminal justice agency) must be “necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.” The sharing of information by MAPPA agencies for MAPPA purposes satisfies these conditions in that it is clearly aimed at preventing disorder or crime or administering justice. Provided the information shared is only used for MAPPA purposes the necessity test will be met, as information-sharing by way of MAPPA is not an excessive or unreasonable way of assessing and managing these risks.
Right of freedom of religion or belief (Article 9)
Not engaged
Right to freedom of expression Note: this does not include insulting language such as racism (Article 10)
Not engaged
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Right freedom from discrimination (Article 14)
Supportive of a HRBA - this process is used in situations where there is a significant risk to an individual or members of the public, it is used as the least restrictive option, and a multi-agency approach is employed to meet the needs of the individual whilst managing risk, which can often prevent increased risk, entry into offending behaviour, arrest and criminalisation, therefore indirectly supporting the right to freedom from discrimination
Engagement and Involvement detail any engagement and involvement that was completed inputting this together.
Consultation, engagement and support from MAPPA co-ordinator, CJLDT management team and data analyst, support and consultation from Margaret Brown Equality and Human Rights and Service User Carer lead Liverpool. Summary of Analysis Eliminate discrimination, harassment and victimisation The MAPPA Guidance ensures that issues of discrimination, harassment and victimisation would be addressed.
Advance equality of opportunity NA Promote good relations between groups NA What is the overall impact? Dependant upon the area considered, the overall impact of this policy is believed to be positive as it contributes to effective risk management, and aligns well with Mersey Care NHS Trust’s CARE values of continuous improvement, accountability, respect and enthusiasm. It can have a positive and beneficial impact upon individual’s lives, and contributes to public protection. Addressing the impact on equalities NA
Action planning for improvement
NA
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For the record Name of persons who carried out this assessment: Margaret Brown Rebecca Jones Date assessment completed: 14 07 2016 Name of responsible Director: Dr David Fearnly Date assessment was signed: 14 07 2016