Restricted patients statistical bulletin: 2016
Source: data.gov.uk (2018-05-25)

Offender Management Statistics. Key statistics relating to offenders who are in prison or under Probation Service supervision.

It covers flows into these services (receptions into prison or probation starts) and flows out (discharges from prison or probation terminations) as well as the caseload of both services at specific points in time.

Restricted Patients 2016 
England and Wales 
 
Ministry of Justice 
Statistics Bulletin  
 
 
 
27 April 2017 

 
1 
 
Introduction 
A mentally disordered offender may be diverted from the criminal justice 
system to hospital for treatment by a court under the Mental Health Act 1983.  
Prisoners may similarly be transferred from prison to hospital or ordered to 
receive treatment before completing a custodial sentence. 
An offender can become a restricted patient by a number of routes.  
An offender1 may be ordered by a court to receive hospital treatment as a 
restricted patient both as well as or instead of a prison sentence.  
While in prison, an offender can subsequently be transferred to hospital from 
prison as a restricted patient by the Secretary of State.  
In addition, individuals may also become a restricted patient where they are 
found by a court to be unfit to plead or found not guilty by reason of insanity. 
Discharge refers to restricted patients released into the community, either as a 
conditional or absolute discharge. Those receiving a conditional discharge 
continue to receive treatment in the community, remain liable to for detention 
in hospital and may be recalled to hospital by the Secretary of State. 
Discharges could be ordered by either the Secretary of State for Justice, the 
First-Tier Tribunal (Mental Health) in England or the Mental Health Tribunal for 
Wales (which are independent judicial bodies with discharge powers separate 
from those of the Secretary of State).  
Disposals are all other outcomes for, and movements of mentally disordered 
offenders (e.g. return to prison custody) other than (i) discharges and (ii) 
transfers to another hospital in England and Wales. 
For those prisoners transferred to hospital who are serving a determinate 
prison sentence, the restrictions attached to the Secretary of State transfer 
direction will cease on the earliest date of release.  If they still require 
treatment in hospital, they will remain detained as unrestricted patients and 
not subject to the management of the Secretary of State for Justice. 
Legislative Framework  
The key legislation affecting this bulletin is the Mental Health Act 1959, the 
Mental Health Act 1983, as amended by the Mental Health Act 2007 and the 
Criminal Procedure (Insanity) Act 1964 as amended by the Criminal 
Procedure (Insanity and Unfitness to Plead) Act 1991 and the Domestic 
Violence, Crime and Victims Act 2004 (which came into force on 31 March 
2005). The 1959 Act was amended by the Mental Health (Amendment) Act 
1982 and was then consolidated by the 1983 Act which was largely 
                                            
1 Including untried and unsentenced offenders 

 
2 
 
implemented on 30 September 1983. The provisions of the two Mental Health 
Acts are similar and references below are to the 1983 Act only. In terms of 
admissions, the 1983 Act provides for:  
i. the diversion to hospital by the courts of convicted offenders who 
satisfy certain conditions (sections 37(1) & (2)) by making a 
hospital order. This may be with or without a restriction order 
under section 41, which has the effect of requiring the Secretary 
of State’s consent on all matters relating to leave of absence, 
transfer or discharge, except where the Tribunal orders discharge;  
ii. the admission of an unconvicted offender to hospital by the 
magistrates’ courts where they are satisfied that the person 
concerned meets the criteria for admission and has done the act 
or made the omission with which charged (section 37(3));  
iii. the imposition of a hospital order on unsentenced prisoners in 
their absence and without conviction for an offence (section 
51(5));  
iv. the recall to hospital, by order of the Secretary of State, of patients 
subject to restriction orders who were conditionally discharged 
(section 42(3));  
v. the court to impose a prison sentence on a convicted offender 
together with a direction for immediate admission to hospital, 
subject to restrictions (hospital and limitation direction under 
section 45A);  
vi. the transfer to hospital, by order of the Secretary of State, of 
prisoners serving a sentence of imprisonment (section 47). Under 
section 49 these patients can be made subject to a restriction 
direction, which has the same effect as a restriction order under 
section 41;  
vii. the transfer to hospital, by order of the Secretary of State, of an 
unsentenced or untried defendant in criminal proceedings who is 
held in a Prison Service establishment (section 48). In this case a 
restriction direction is mandatory. Civil prisoners and persons 
detained under the Immigration Act 1971 or under the Nationality, 
Immigration and Asylum Act 2002, may also be admitted under 
this section, but restrictions are not mandatory;  
viii. the transfer of patients from one part of the United Kingdom, 
Channel Islands or the Isle of Man to another. Those transferred 
to England and Wales are treated as if they had been admitted to 
hospital under the Act, so that some of them will, in effect, be 
subject to restricted hospital orders (part VI).  
 

 
3 
 
Section 2 of the Trial of Lunatics Act 1883 enables juries to return a verdict of 
acquittal on grounds of insanity, and Section 4 of the Criminal Procedure 
(Insanity) Act 1964, as substituted by Section 2 of the Criminal Procedure 
(Insanity and Unfitness to Plead) Act 1991 and amended by section 22 of the 
Domestic Violence, Crime and Victims Act 2004 enables the court without a 
jury to find a defendant unfit to plead. The 2004 Act also gives courts a range 
of disposal options ranging from a hospital order with restrictions to an 
absolute discharge.  
In relation to disposals and discharges the Mental Health Act 1983 provides 
for:  
i. the removal of a restriction order by the Secretary of State so that 
the hospital order continues unrestricted (section 42(1));  
ii. the discharge of a patient with a restriction order, either 
conditionally or absolutely, by the Secretary of State, and the 
termination of the restriction order where discharge is absolute 
(section 42(2));  
iii. the return to prison of sentenced prisoners (section 50(1)a);  
iv. the return of unsentenced prisoners to prison to await court action 
where the Secretary of State or the court is satisfied that they no 
longer require treatment or no effective treatment is available 
(sections 51(3) & (4) respectively);  
v. the transfer direction ceases to have effect in respect of untried 
prisoners at the end of their remand period, unless they are 
subject to further remand or committal for trial (section 52(2));  
vi. the direction or recommendation by the First-tier Tribunal (Mental 
Health) or Mental Health Review Tribunal for Wales, of the 
discharge of a patient either conditionally or absolutely (sections 
72-74);  
vii. the absolute discharge by the First-tier Tribunal (Mental Health) or 
Mental Health Review Tribunal for Wales of a conditionally 
discharged patient (section 75).  
 
 
 
 
 
 
 
 
 

 
4 
 
 
Users and uses of these Statistics 
The contents of the report will be of interest to the public, the media, agencies 
responsible for offender management at both national and local levels, 
government policy makers and others who want to understand more about 
Multi-Agency Public Protection Arrangement (MAPPA) eligible offenders, 
including registered sex offenders, the use of restrictive orders and serious 
further offences. 
The statistics included in this publication meet a broad spectrum of user 
needs as shown below. 
 
User  
Summary of main statistical needs  
MOJ Ministers  
Use the statistics to monitor the offender 
caseload and the use of some restrictive 
orders.  
MPs and House of Lords  
Statistics are used to answer 
parliamentary questions. 
Policy teams  
Statistics are used to inform policy 
development, to monitor impact of 
changes over time and to model future 
changes and their impact on the system  
Agencies responsible for 
offender management  
Current and historical robust 
administrative data are used to support 
performance management information at 
national and local levels to complement 
their understanding of the current picture 
and trends over time  
Academia, students and 
businesses  
Used as a source of statistics for 
research purposes and to support 
lectures, presentations and conferences  
Journalists  
Used as a compendium of robust data on 
Restricted Patients so that an accurate 
and coherent story can be told on this 
subset of the offender population.  
Voluntary sector  
Data are used to monitor trends of 
Restricted Patients, to reuse the data in 
their own briefing and research papers 
and to inform policy work and responses 
to consultations.  
General public  
Data are used to respond to ad-hoc 
requests and requests made under the 
Freedom of Information Act.  
 
 

 
5 
 
 
 
Related publications 
 
Offender Management Statistics Quarterly Bulletin2: This bulletin provides 
key statistics relating to offenders who are in prison or under Probation 
Service supervision. It covers flows into these services (receptions into prison 
or probation starts) and flows out (releases from prison or probation 
terminations) as well as the caseload of both services at specific points in 
time. 
Re-offending bulletin3: This report provides key statistics on proven re-
offending in England and Wales. It gives proven re-offending figures for 
offenders who were released from custody, received a non-custodial 
conviction at court, received a caution, reprimand, warning or tested positive 
for opiates or cocaine. 
In both cases, these reports will enable comparability with those offenders in 
and released from prisons. 
MAPPA Annual Report4: This report provides key statistics relating to 
offenders who are managed by Multi-Agency Public Protection Arrangements 
(MAPPA). These are a set of statutory arrangements to assess and manage 
the risk posed by certain sexual and violent offenders and involves Police, 
Probation and Prison Services. 
 
Release Schedule 
This bulletin was published on 27 April 2017 and includes calendar year 
statistics for the year 2016. 
The next publication of Restricted Patients Bulletin is scheduled to be 
published in April 2018. 
                                            
2 Offender Management Statistics: https://www.gov.uk/government/collections/offender-management-
statistics-quarterly  
3 Proven re-offending statistics: https://www.gov.uk/government/organisations/ministry-of-
justice/series/proven-reoffending-statistics 
4 MAPPA Annual Report: https://www.gov.uk/government/collections/multi-agency-public-
protection-arrangements-mappa-annual-reports 

 
6 
 
Definitions  
 
Admission  
The admittance of an offender to secure hospitals as determined by the 
sentencing court or Safer Custody & Public Protection Group (SCPPG) on 
behalf of the Secretary of State for Justice and/or where a patient’s legal 
category changes. In some cases, a patient may appear to have been 
admitted or discharged more than once within a given year, although he/she 
may not have physically moved. In particular, patients transferred from prison 
to hospital while unsentenced or untried can reappear in the figures as 
admitted under restricted hospital orders. Transfers between hospitals in 
England and Wales are not counted as separate admissions, unless the 
patient’s legal category also changes. 
 
Conditional Discharge 
Release into the community but patient remains liable to detention in hospital 
and may be recalled by the Secretary of State for Justice.  
 
Discharge  
Release from hospital into the community.  
 
Disposal  
Leaving treatment as a restricted patient other than as a discharge or a 
transfer to another hospital in England and Wales. 
 
High secure hospital  
High secure hospitals hold patients detained under mental health legislation, 
who require treatment under conditions of high security because of their 
dangerous, violent or criminal propensities. There are three high secure 
hospitals, Ashworth, Broadmoor and Rampton. 
 
Other Hospitals 
Other hospital refers to any psychiatric hospital in England and Wales, which 
provides secure mental health services. These include ‘medium secure’ and 
‘low secure’ hospitals and they admit other patients requiring mental health 
treatment as well as mentally disordered offenders. 
Restricted patient  
A mentally disordered offender (MDO) subject to a restriction order due to the 
risk of serious harm they pose to others and liable to a hospital order. They 
cannot be transferred between hospitals, discharged or allowed leave without 
consent of the Secretary of State for Justice.  The First-tier Tribunal (Mental 
Health) can also discharge restricted patients if they conclude that the criteria 
for detention in hospital under the Mental Health Act 1983 is no longer met. 

 
7 
 
Data sources, quality and revisions 
Information on Restricted Patients was obtained from the Public Protection 
Unit Database (PPUD) administered by the Mental Health Casework Section 
within the Safer Custody & Public Protection Group of Her Majesty’s Prison 
and Probation Service (HMPPS). (HMPPS was previously known as NOMS.)  
 
Explanatory notes 
Symbols and conventions 
The following symbols have been used throughout the tables in this bulletin:  
-    
= Not applicable 
0   
= Nil 
..   
= Not available 
(r)  
= Revised data 
(p)  
= Provisional data 
══  
= Discontinuity in the series 
 

 
8 
 
Contact points for further information 
Press enquiries should be directed to the Ministry of Justice press office:  
 
Tel: xx-xxxx-xxxx  
Email: xxx@xxx.xx 
Other enquiries about these statistics should be directed to:  
 
Nick Mavron, Head of Prison, Probation, Reoffending and PbR Statistics 
Ministry of Justice  
     7th Floor  
102 Petty France  
London  
SW1H 9AJ  
 
General enquiries about the statistical work of the Ministry of Justice can be e-
mailed to: xxx@xxx.xx 
 
General information about the official statistics system of the UK is available 
from www.statistics.gov.uk 
 
 
 
 
 
 
 
 
 
 
© Crown copyright 
Produced by the Ministry of Justice 
Alternative formats are available on request from 
xxx@xxx.xx