The Central Criminal Court ordered W.B. to remain in the Central Mental Hospital after finding that he continued to suffer from paranoid schizophrenia and needed inpatient care. The order followed a jury’s verdict of not guilty by reason of insanity on a charge of aggravated sexual assault. In a judgment delivered on 7 April 2011, Mr Justice Garrett Sheehan criticised aspects of the treatment W.B. had received, while concluding that the law required continued detention in the hospital until a Review Board order under section 13 of the Criminal Law (Insanity) Act 2006.
The jury returned its special verdict on 8 February 2011. At the start of the trial, W.B. admitted forcing his way into a security lodge in an industrial estate in County Dublin in August 2008, assaulting a male security officer and sexually assaulting him. The judgment records that the assault lasted about 35 to 40 minutes. W.B. then left the lodge, took a vehicle from two security officers and crashed it into a bus at a local shopping centre. The account of the incident is set out in the judgment; the jury’s verdict was by reason of insanity.
Psychiatrists for both the defence and prosecution gave evidence that W.B. had paranoid schizophrenia. His treating psychiatrist, Dr M.M., reported that he remained seriously ill and represented a grave risk to others. The court considered her report and the psychiatric evidence, and found that W.B. continued to have a mental disorder and needed inpatient care or treatment.
The judge said the court’s options were constrained: the Central Mental Hospital was the only designated centre, and section 5(2) provided for inpatient care rather than outpatient treatment. The court therefore had to order continued detention there until the Review Board made an order under section 13.
The judgment raised concerns about W.B.’s care, including the emphasis on antipsychotic medication and its physical side effects, limited exploration of the causes of his illness, and the treating psychiatrist’s failure to build a meaningful therapeutic relationship with him. It also questioned how his initial refusal of Clozapine was handled, noting that family members and staff were enlisted to persuade him to accept treatment.
The judge further highlighted differences in review protections between people detained under the 2006 Act and patients admitted under the Mental Health Act 2001. Under the provisions discussed in the judgment, review for a person detained following an insanity verdict could occur at intervals of up to six months. The court’s order addressed W.B.’s inpatient detention; the judgment did not determine a separate treatment plan or order discharge.