FORENSIC PSYCHIATRYFORENSIC PSYCHIATRY

DR MARTIN LAWLORDR MARTIN LAWLOR

CONSULTANT IN INTENSIVE CARE AND CONSULTANT IN INTENSIVE CARE AND FORENSIC PSYCHIATRYFORENSIC PSYCHIATRY

HSE-SOUTHERN AREAHSE-SOUTHERN AREA

CARRAIGMOR UNIT & CARRAIGMOR UNIT &

MERCY UNIVERSITY HOSPITALMERCY UNIVERSITY HOSPITAL

CORK CORK

LEARNING OBJECTIVESLEARNING OBJECTIVES

•UNDERSTAND THE NATURE OF UNDERSTAND THE NATURE OF FORENSIC PSYCHIATRY & LEVELS FORENSIC PSYCHIATRY & LEVELS OF SECURITYOF SECURITY

•UNDERSTAND THE SIGNIFICANT UNDERSTAND THE SIGNIFICANT LEGAL CONCEPTS FOUND IN LEGAL CONCEPTS FOUND IN PRACTICEPRACTICE

•DESCRIBE HOW RISK ASSESSMENT DESCRIBE HOW RISK ASSESSMENT OCCURS IN CLINICAL PRACTICEOCCURS IN CLINICAL PRACTICE

FORENSIC PSYCHIATRYFORENSIC PSYCHIATRY

•ASSESSMENT, TREATMENT AND ASSESSMENT, TREATMENT AND MANAGEMENT OF MENTALLY DISORDERED MANAGEMENT OF MENTALLY DISORDERED OFFENDERS OFFENDERS

•PATIENT AT THE INTERFACE OF LEGAL AND PATIENT AT THE INTERFACE OF LEGAL AND PSYCHIATRIC SYSTEMSPSYCHIATRIC SYSTEMS

•THERAPEUTIC USE OF SECURITY THERAPEUTIC USE OF SECURITY (PHYSICAL/RELATIONAL/PROCEDURAL)(PHYSICAL/RELATIONAL/PROCEDURAL)

•ADVISE COLLEAGUES REGARDING ADVISE COLLEAGUES REGARDING MANAGEMENT OF PATIENTS WITH MANAGEMENT OF PATIENTS WITH CHALLENGING/RISKY BEHAVIOURSCHALLENGING/RISKY BEHAVIOURS

FORENSIC PSYCHIATRYFORENSIC PSYCHIATRY THERAPY Vs SECURITYTHERAPY Vs SECURITY

•RESPECT FOR RIGHT OF PERSON TO RESPECT FOR RIGHT OF PERSON TO DIGNITY, INTEGRITY, PRIVACY AND DIGNITY, INTEGRITY, PRIVACY AND AUTONOMY AUTONOMY

•EQUIVELENCE OF CAREEQUIVELENCE OF CARE

•RECOVERY ORIENTATEDRECOVERY ORIENTATED

• LEAST RESTRICTIVE ENVIROMENT (EXPERT LEAST RESTRICTIVE ENVIROMENT (EXPERT GROUP ON MENTAL HEALTH POLICY)GROUP ON MENTAL HEALTH POLICY)

FORENSIC PSYCHIATRYFORENSIC PSYCHIATRY UK UK TREAT MENTALLY DISORDER OFFENDERS IN TREAT MENTALLY DISORDER OFFENDERS IN A RANGE OF PSYCHIATRIC SERVICES THESE A RANGE OF PSYCHIATRIC SERVICES THESE INCLUDE THE SPECIAL HOSPITALS: INCLUDE THE SPECIAL HOSPITALS: (BROADMOOR, ASHWORTH, RAMPTON)(BROADMOOR, ASHWORTH, RAMPTON)

INPATIENT - CONDITIONS OF MAXIMUM INPATIENT - CONDITIONS OF MAXIMUM SECURITYSECURITY

THESE ARE INDIVIDUALS WHO ARE SO THESE ARE INDIVIDUALS WHO ARE SO DANGEROUS THAT THEY WOULD CAUSE DANGEROUS THAT THEY WOULD CAUSE GRAVE CONCERN IF MANAGED ELSEWHERE GRAVE CONCERN IF MANAGED ELSEWHERE

VERY HIGH PHYSICAL / PROCEDURAL AND VERY HIGH PHYSICAL / PROCEDURAL AND RELATIONAL SECURITYRELATIONAL SECURITY

FORENSIC PSYCHIATRYFORENSIC PSYCHIATRY •MEDIUM SECURE UNITS MEDIUM SECURE UNITS

-BUTLER REPORT 1975 -BUTLER REPORT 1975 LESS THAN SPECIAL GREAT UNLOCK WARD LESS THAN SPECIAL GREAT UNLOCK WARD LESS PHYSICAL THAN SPECIAL HOSPITAL/VERY HIGH LESS PHYSICAL THAN SPECIAL HOSPITAL/VERY HIGH PROCEDURAL AND RELATIONAL SECURITYPROCEDURAL AND RELATIONAL SECURITY

•LOW SECURE (LESS PHYSICAL SECURITY / GREATER LOW SECURE (LESS PHYSICAL SECURITY / GREATER RELATIONAL SECURITY/HIGH PROCEDURAL SECURITYRELATIONAL SECURITY/HIGH PROCEDURAL SECURITY

REHABILLITATION EMPHASISREHABILLITATION EMPHASISMAY INCLUDE HOSTELSMAY INCLUDE HOSTELS

•DISTRICT HOSPITALSDISTRICT HOSPITALS OFFENDERS MENTALLY DISORDERED WHO ARE NOT A OFFENDERS MENTALLY DISORDERED WHO ARE NOT A RISK TO THE PUBLICRISK TO THE PUBLIC

•EXCEPTION IS PSYCHIATIC EXCEPTION IS PSYCHIATIC INTENSIVE CARE UNIT WHERE INTENSIVE CARE UNIT WHERE PATIENTS ARE ACUTELY PATIENTS ARE ACUTELY DISTURBED AND MAY DISTURBED AND MAY PRESENT A RISK TO OTHERS OR PRESENT A RISK TO OTHERS OR TO THEMSELVES-UK TO THEMSELVES-UK 6 WEEKS LIMIT ON STAY6 WEEKS LIMIT ON STAY

LEGAL ISSUES-FITNESS TO BE INTERVIEWEDLEGAL ISSUES-FITNESS TO BE INTERVIEWED

FITNESS TO BE INTERVIEWED:FITNESS TO BE INTERVIEWED: DEEMED FIT TO BE INTERVIEWED ON THE DEEMED FIT TO BE INTERVIEWED ON THE BASIS OF CLINICAL ASSESSMENTBASIS OF CLINICAL ASSESSMENT

Based on my examination, I have formed the Based on my examination, I have formed the opinion that xx is fit to be interviewed by the opinion that xx is fit to be interviewed by the Gardai in relation to YYYGardai in relation to YYY-IN CLEAR CONSCIOUSNESS-IN CLEAR CONSCIOUSNESS-FULLY ORIENTED-FULLY ORIENTED-DID NOT APPEAR TO BE SUGGESTIBLE OR -DID NOT APPEAR TO BE SUGGESTIBLE OR ABNORMALLY ACQUIESCENTABNORMALLY ACQUIESCENT

LEGAL ISSUES-FITNESS TO PLEADLEGAL ISSUES-FITNESS TO PLEAD

FITNESS TO PLEAD( BE TRIED):FITNESS TO PLEAD( BE TRIED):

DEEMED UNFIT TO BE TRIED BY DEEMED UNFIT TO BE TRIED BY REASON OF MENTAL DISORDERREASON OF MENTAL DISORDER

NOT ABLE TO UNDERSTAND THE NOT ABLE TO UNDERSTAND THE NATURE AND COURSE OF NATURE AND COURSE OF PROCEEDINGS PROCEEDINGS

LEGAL ISSUESLEGAL ISSUES UNFIT TO PLEAD:UNFIT TO PLEAD:AS EVIDENCED BY BEING UNABLEAS EVIDENCED BY BEING UNABLE

-TO PLEAD TO A CHARGE -TO PLEAD TO A CHARGE

-TO INSTRUCT THEIR LEGAL REPRESENTATIVE -TO INSTRUCT THEIR LEGAL REPRESENTATIVE

-TO MAKE A PROPER DEFENCE-TO MAKE A PROPER DEFENCE

-CHALLENGE A JUROR-CHALLENGE A JUROR

- UNDERSTAND THE EVIDENCE.- UNDERSTAND THE EVIDENCE.

LEGAL ISSUES-INSANITYLEGAL ISSUES-INSANITY GUILTY BUT INSANE GUILTY BUT INSANE

1843 MC NAUGHTON RULES 1843 MC NAUGHTON RULES

““EVERY MAN IS PRESUME TO BE SANE, UNLESS THE CONTRARY EVERY MAN IS PRESUME TO BE SANE, UNLESS THE CONTRARY BE PROVED"BE PROVED"

'' IN ORDER TO ESTABLISH A DEFENCE ON THE GROUND OF '' IN ORDER TO ESTABLISH A DEFENCE ON THE GROUND OF INSANITY IT MUST BE CLEARLY PROVED THAT AT THE TIME OF INSANITY IT MUST BE CLEARLY PROVED THAT AT THE TIME OF COMMITTING THE ACT THE ACCUSED PARTY WAS LABOURING COMMITTING THE ACT THE ACCUSED PARTY WAS LABOURING UNDER SUCH A DEFECT OF REASON, FROM DISEASE OF THE UNDER SUCH A DEFECT OF REASON, FROM DISEASE OF THE

MIND, AS NOT TO KNOW THE NATURE OR QUALITY OF THE ACT MIND, AS NOT TO KNOW THE NATURE OR QUALITY OF THE ACT HE WAS DOING, OR IF HE DID KNOW IT THAT HE DID NOT HE WAS DOING, OR IF HE DID KNOW IT THAT HE DID NOT

KNOW THAT WHAT HE WAS DOING WAS WRONG''KNOW THAT WHAT HE WAS DOING WAS WRONG''

1974 DOYLE Vs WICKLOW COUNTY COUNCIL1974 DOYLE Vs WICKLOW COUNTY COUNCIL

-UNABLE TO STOP HIMSELF DUE TO MENTAL DISORDER-UNABLE TO STOP HIMSELF DUE TO MENTAL DISORDER

LEGAL ISSUES-INSANITYLEGAL ISSUES-INSANITY INSANITY (CLIA 2006) INSANITY (CLIA 2006) -PERSONS DID NOT KNOW THE NATURE AND -PERSONS DID NOT KNOW THE NATURE AND QUALITY OF THE ACT OR QUALITY OF THE ACT OR

-DID NOT KNOW WHAT HE OR SHE WAS DOING WAS -DID NOT KNOW WHAT HE OR SHE WAS DOING WAS WRONG ORWRONG OR

-WAS UNABLE TO REFRAIN FROM COMMITTING THE -WAS UNABLE TO REFRAIN FROM COMMITTING THE ACT. ACT.

-SPECIAL VERDICT NOT GUILT BY REASON OF -SPECIAL VERDICT NOT GUILT BY REASON OF INSANITYINSANITY

-CHARGED WITH MURDER BUT REDUCED TO -CHARGED WITH MURDER BUT REDUCED TO MANSLAUGHTER ON GROUNDS OF DIMINISHED MANSLAUGHTER ON GROUNDS OF DIMINISHED RESPONSIBILITY.RESPONSIBILITY.

LEGAL ISSUESLEGAL ISSUES CRIMINAL LAW INSANITY ACT 2006 CRIMINAL LAW INSANITY ACT 2006

MENTAL DISORDER= MENTAL DISORDER=

-MENTAL ILLNESS-MENTAL ILLNESS

-MENTAL HANDICAP OR -MENTAL HANDICAP OR

-ANY DISEASE OF THE MIND WHICH DOES -ANY DISEASE OF THE MIND WHICH DOES NOT INCLUDE INTOXIFICATION OR WITHIN NOT INCLUDE INTOXIFICATION OR WITHIN THE MEANING OF THE MENTAL HEALTH ACT THE MEANING OF THE MENTAL HEALTH ACT 2001. 2001.

PATIENT IS SENT TO DESIGNATED CENTRE.PATIENT IS SENT TO DESIGNATED CENTRE.

RISK ASSESSMENTRISK ASSESSMENT

IN CLINICAL PRACTICE RISK IN CLINICAL PRACTICE RISK ASSESSMENT REQUIRES A BALANCE ASSESSMENT REQUIRES A BALANCE OF BOTH OF BOTH RISKRISK AND AND PROTECTIVEPROTECTIVE FACTORSFACTORS

Combination of methods:-Combination of methods:-•CLINCAL JUDGEMENTCLINCAL JUDGEMENT•ACTUARIAL (VRAG)ACTUARIAL (VRAG)•HYBRID-STRUCTURED CLINICAL HYBRID-STRUCTURED CLINICAL JUDGEMENT-HCR-20JUDGEMENT-HCR-20

RISK ASSESSMENTRISK ASSESSMENT

•MULTI DISCIPLINARY TEAM MULTI DISCIPLINARY TEAM

•KNOWLEDGE OF THE PATIENTKNOWLEDGE OF THE PATIENT

•EXAMINE MULTIPLE SOURCES OF INFORMATIONEXAMINE MULTIPLE SOURCES OF INFORMATION

•-MEDICAL NOTES-MEDICAL NOTES

-COLLATERAL HISTORY-COLLATERAL HISTORY

-VICTIM STATEMENTS-VICTIM STATEMENTS

-WITNESS STATEMENTS-WITNESS STATEMENTS

-CRIMINAL RECORD-CRIMINAL RECORD

RISK ASSESSMENTRISK ASSESSMENT

•SUMMARISE CIRCUMSTANCES OF PAST SUMMARISE CIRCUMSTANCES OF PAST VIOLENCE AND RECENT CHANGEVIOLENCE AND RECENT CHANGE

•DESCRIBE NATURE & CONTEXT OF PAST DESCRIBE NATURE & CONTEXT OF PAST RISKSRISKS

•IDENTIFY FACTORS THAT INCREASED RISKIDENTIFY FACTORS THAT INCREASED RISK

•RECOMMEND / PRIORITISE RISK RECOMMEND / PRIORITISE RISK MANAGEMENT STRATEGRIES MANAGEMENT STRATEGRIES

ASSESSING RISKASSESSING RISK •HISTORYHISTORY

--PREVIOUS VIOLENCEPREVIOUS VIOLENCE

-SOCIAL RESTLESSNESS-SOCIAL RESTLESSNESS

-POOR COMPLIANCE-POOR COMPLIANCE

-POOR ENGAGEMENTS-POOR ENGAGEMENTS

-DISINHIBITORY FACTORS-DISINHIBITORY FACTORS

-SOCIAL CONTEXT-SOCIAL CONTEXT

•ENVIROMENTENVIROMENT--ACCESS TO VICTIMACCESS TO VICTIM

•DYNAMIC FACTORSDYNAMIC FACTORS--SEVERE STRESSSEVERE STRESS

RISK DOMAINSRISK DOMAINS

•1. RISK TO SELF-SUICIDAL BEHAVIOUR1. RISK TO SELF-SUICIDAL BEHAVIOUR

•2. RISK OF SELF NEGLECT2. RISK OF SELF NEGLECT

•3. RISK OF ALCOHOL AND SUBSTANCE MISUSE3. RISK OF ALCOHOL AND SUBSTANCE MISUSE

•4. RISK OF NON COMPLIANCE WITH MEDS/AFTERCARE4. RISK OF NON COMPLIANCE WITH MEDS/AFTERCARE

•5. RISK OF VIOLENCE5. RISK OF VIOLENCE

•6. OTHER RISKS-ARSON/RISK TO CHILDREN/SEXUAL6. OTHER RISKS-ARSON/RISK TO CHILDREN/SEXUAL OFFENDINGOFFENDING

•7. PHYSICAL HEALTH7. PHYSICAL HEALTH

PROTECTIVE FACTORSPROTECTIVE FACTORS

•Engagement with team/rapportEngagement with team/rapport

•Previous achievementsPrevious achievements

•Compliance with Care PlanningCompliance with Care Planning

-Medication-Medication-OPD-OPD-Community Visits-Community Visits

•Family Support/Close relationshipsFamily Support/Close relationships

•Preferred Future (Hope)Preferred Future (Hope)

•Appropriate use of leaveAppropriate use of leave

•Access to Community ResourcesAccess to Community Resources

•Appropriate Living/Coping SkillsAppropriate Living/Coping Skills

RISK ASSESSMENTRISK ASSESSMENT

•WHICH RISKS ARE PRESENT?WHICH RISKS ARE PRESENT?

•HOW OFTEN ARE THEY PRESENT?HOW OFTEN ARE THEY PRESENT?

•IN WHAT CIRCUMSTANCES?IN WHAT CIRCUMSTANCES?

•WHAT IS THE CHARACTER OF THE RISK?WHAT IS THE CHARACTER OF THE RISK?

•WHAT CAN WE DO WITH IT?WHAT CAN WE DO WITH IT?

CRIME AND MENTAL DISORDERCRIME AND MENTAL DISORDER

??? INDEPENDENT EFFECTS OF-??? INDEPENDENT EFFECTS OF--POVERTY / SCHOOL FAILURE / FAMILY HISTORY / POOR -POVERTY / SCHOOL FAILURE / FAMILY HISTORY / POOR PARENTINGPARENTING

IS THE EXCESS OFFENDING BEHAVIOUR IN THE IS THE EXCESS OFFENDING BEHAVIOUR IN THE MENTALLY ILL DUE TO POVERTY AND FAMILY MENTALLY ILL DUE TO POVERTY AND FAMILY PROBLEMS?PROBLEMS?

THERE IS STILL A LINK WITH PSYCHOSIS AND IN THERE IS STILL A LINK WITH PSYCHOSIS AND IN ADDITIONAL ALCOHOL AND DRUG MISUSE.ADDITIONAL ALCOHOL AND DRUG MISUSE.

KEY ISSUES ARE ACTIVE SYMPTOMS AND FAULTY KEY ISSUES ARE ACTIVE SYMPTOMS AND FAULTY REASONING WHICH DISTURB PERCEPTIONS FAR MORE REASONING WHICH DISTURB PERCEPTIONS FAR MORE THAN THE DIAGNOSIS THAN THE DIAGNOSIS

VIOLENCE IS ASSOCIATED WITH MENTAL ILLNESS VIOLENCE IS ASSOCIATED WITH MENTAL ILLNESS ((CLINICALCLINICAL FACTORS) AND FACTORS) AND BACKGROUNDBACKGROUND FACTORS SUCH FACTORS SUCH AS AGE, GENDER, EDUCATION AND SOCIO-ECONOMIC AS AGE, GENDER, EDUCATION AND SOCIO-ECONOMIC GROUPGROUP

CRIME AND MENTAL DISORDERCRIME AND MENTAL DISORDER

•ANTISOCIAL PERSONALITY DISORDER (ICD10) THERE ANTISOCIAL PERSONALITY DISORDER (ICD10) THERE IS GROSS DISPARITY BETWEEN THE INDIVIDUAL’S IS GROSS DISPARITY BETWEEN THE INDIVIDUAL’S BEHAVIOR AND PREVAILING SOCIAL NORMSBEHAVIOR AND PREVAILING SOCIAL NORMS

U.K. MENTAL HEALTH ACT 1983U.K. MENTAL HEALTH ACT 1983•PSYCOPATHIC DISORDER THAT IS A DISABILITY OF PSYCOPATHIC DISORDER THAT IS A DISABILITY OF MIND WHICH RESULTS IN ABNORMALLY AGGRESSIVE OR MIND WHICH RESULTS IN ABNORMALLY AGGRESSIVE OR SERIOUSLY IRRESPONSIBLE CONDUCT ON THE PART OF SERIOUSLY IRRESPONSIBLE CONDUCT ON THE PART OF THE PERSON CONCERNED.THE PERSON CONCERNED.

•COMBINATION OF IMPULSIVE BEHAVIOUR AND COMBINATION OF IMPULSIVE BEHAVIOUR AND DEFICIENT EMOTIONAL RESPONSES WHICH LEAD TO DEFICIENT EMOTIONAL RESPONSES WHICH LEAD TO FAILURE TO RESTRAIN FROM ANTI SOCIAL BEHAVIOURFAILURE TO RESTRAIN FROM ANTI SOCIAL BEHAVIOUR

•THE LIKELY KEY AREAS: VENTRO-MEDIAL PRE FRONTAL THE LIKELY KEY AREAS: VENTRO-MEDIAL PRE FRONTAL CORTEX AND THE AMYGDALA CORTEX AND THE AMYGDALA

VIOLENCEVIOLENCE

•VIOLENCE = ACTUAL, ATTEMPTED OR VIOLENCE = ACTUAL, ATTEMPTED OR THREATENED PHYSICAL HARM THAT IS THREATENED PHYSICAL HARM THAT IS DELIBERATE AND NOT CONSENTINGDELIBERATE AND NOT CONSENTING

•DECISION TO ACT VIOLENTLY CAN DECISION TO ACT VIOLENTLY CAN DEPEND ON ORGANIC, PSYCHOTIC OR DEPEND ON ORGANIC, PSYCHOTIC OR LEARNING HISTORY (VIOLENT SOCIAL LEARNING HISTORY (VIOLENT SOCIAL MODELS)MODELS)

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

•ORGANIC-Delirium/DementiaORGANIC-Delirium/Dementia

•PSYCHOTICPSYCHOTIC

•SUBSTANCE MISUSE-Intoxication/WithdrawalSUBSTANCE MISUSE-Intoxication/Withdrawal

•AFFECTIVE-BPAD/AGITATED DEPRESSIONAFFECTIVE-BPAD/AGITATED DEPRESSION

•PERSONALITY DISORDERPERSONALITY DISORDER

•LOW IQLOW IQ

VIOLENCEVIOLENCE

•VIOLENCE IS A RESULT OF A VIOLENCE IS A RESULT OF A RESPONSE TO SITUATIONS WHICH RESPONSE TO SITUATIONS WHICH HOWEVER MISTAKINGLY ARE BELIEVED HOWEVER MISTAKINGLY ARE BELIEVED TO BE SUFFICENTLY PROVOCATIVE TO BE SUFFICENTLY PROVOCATIVE

Case studyCase study

M. A 47 YEAR OLD SEPARATED WOMAN M. A 47 YEAR OLD SEPARATED WOMAN

DATE OF ADMISSION 29.07.06DATE OF ADMISSION 29.07.06

ALLEGED STABBING OF 22 YEAR OLD ALLEGED STABBING OF 22 YEAR OLD DAUGHTER TO DEATHDAUGHTER TO DEATH

LOCAL TAXI RANG 12 MONTH OLD LOCAL TAXI RANG 12 MONTH OLD GRANDSON TO A&E CUH TO CARRAIGMORGRANDSON TO A&E CUH TO CARRAIGMOR

COMMAND HALLUCINATIONS THAT HER COMMAND HALLUCINATIONS THAT HER DAUGHTER WAS 'DEVILISH'DAUGHTER WAS 'DEVILISH'

Case studyCase study PERSONAL HISTORY 2 SONS 24 AND 15, 1 DAUGHTER (RIP), SEPARATEDPERSONAL HISTORY 2 SONS 24 AND 15, 1 DAUGHTER (RIP), SEPARATED

PAST PSYCHIATRIC HISTORY PAST PSYCHIATRIC HISTORY

1ST CONTACT WITH SERVICES OCT. 00 1ST CONTACT WITH SERVICES OCT. 00

ATTENDED OPD FOR 12 MONTHS AFTER THIS. ATTENDED OPD FOR 12 MONTHS AFTER THIS.

1ST ADMITTED NOVEMBER 01. DEPRESSION WITH PSYCHOTIC SYMPTOMS 1ST ADMITTED NOVEMBER 01. DEPRESSION WITH PSYCHOTIC SYMPTOMS

TREATED WITH ECT TREATED WITH ECT

ATTENDED OPD FOR ONE YEAR.ATTENDED OPD FOR ONE YEAR.

2ND ADMISSION SEPTEMBER 032ND ADMISSION SEPTEMBER 03

7 MONTH HISTORY OF ALTERED MENTAL STATE 7 MONTH HISTORY OF ALTERED MENTAL STATE

PARANOID DELUSIONS BIZZARE BEHAVIOR PARANOID DELUSIONS BIZZARE BEHAVIOR

DIAGNOSIS SCHIZO AFFECTIVE DISORDER DIAGNOSIS SCHIZO AFFECTIVE DISORDER

JAN 2005 ADMITTED TO CUH JAN 2005 ADMITTED TO CUH

HEARING VOICES SINCE 03HEARING VOICES SINCE 03

Case studyCase study

‘‘SHE SAID SHE WOULD DIE IF SHE DID NOT SHE SAID SHE WOULD DIE IF SHE DID NOT DIVULGE WITH THE DEVIL THIS MEANT TO DIVULGE WITH THE DEVIL THIS MEANT TO WORSHIP THE DEVIL’WORSHIP THE DEVIL’

SHE STATED THAT AT 3.30 A.M OUR LADY SHE STATED THAT AT 3.30 A.M OUR LADY SPOKE TO HER VIA WATER DRIPPING FROM SPOKE TO HER VIA WATER DRIPPING FROM THE TOILET “YOU KNOW WHAT YOU HAVE TO THE TOILET “YOU KNOW WHAT YOU HAVE TO DODO

“ “YOU WANT ME TO KILL J.” YOU WANT ME TO KILL J.”

‘‘I HAVE ONLY GOT ONE SHARP KNIFE (THAT I HAVE ONLY GOT ONE SHARP KNIFE (THAT WILL DO)’WILL DO)’