Psychological letters in criminal cases: bail conditions and curfews

Medical evidence in criminal proceedings is usually discussed in terms of fitness to plead or sentencing. There is a quieter point where a psychological letter changes someone’s daily life far more directly, and it is barely discussed at all: bail conditions, and curfews in particular.

The following describes a pattern seen across several cases, with all identifying detail removed or altered. Nothing here relates to an identifiable person.

The pattern

A person is arrested. They are held overnight. Their home is searched while they are in custody, and their belongings, including private ones, are gone through and left disturbed. Devices and documents are seized. They are released without charge, on pre charge bail, with a curfew requiring them to be at a specified address overnight. Then the return date moves. And moves again. Months pass with no charging decision.

What arrives in the consulting room some months later is often a person who was functioning perfectly well beforehand and is now, quietly, not. They are still going to work. Nobody at work knows. And they are describing recurrent intrusive recollections at night, avoidance of anything associated with the police, disturbed sleep, a persistent sense of threat, and a low mood that has deepened steadily in step with the length of the process.

Why the curfew is the clinical point

Here is the mechanism, and it is the part a letter exists to explain.

If the search happened at the person’s home, that home has become the single most reminder saturated environment in their life. It is where the intrusive recollections occur, and they occur most often at the point of getting into bed, because that is the moment the mind stops being occupied and the memory arrives.

A curfew requires the person to be in that place, overnight, every night. It does two things at once. It schedules a nightly re exposure to the trigger, and it removes the one regulatory strategy that reliably works for most people in that state, which is to leave and get air. Grounding techniques that work perfectly well elsewhere tend to fail in the environment the trauma is attached to.

That is not an argument about fairness or proportionality. Those are matters for the court. It is a clinical description of a maintaining factor: a condition that would otherwise be expected to settle is being renewed nightly by a specific, identifiable and modifiable circumstance.

The other half of the picture is duration. Ordinary post traumatic presentations concern something that happened and is over. Here the stressor is live. Each postponed return date restarts a cycle of anticipation and disappointment, and anticipatory threat is one of the more corrosive things a person can be asked to live with indefinitely.

What the letter can properly address

A psychological letter in this setting should do a small number of things well.

It should reach a diagnosis against recognised criteria, in United Kingdom practice usually the World Health Organisation ICD 11, and show how the criteria are met rather than simply naming the condition. Where post traumatic stress disorder is in question, that means addressing re experiencing, avoidance and persistent sense of current threat individually, with the evidence for each.

It should quantify what can honestly be quantified. How many nights a week the intrusive recollections occur. Over how many weeks. How many hours of enforced presence in the triggering environment the condition has now involved. These are not invented figures; they come from the person’s own account, and they turn an impression into something a court can weigh.

It should set out the mechanism plainly: this condition, this environment, this restriction, this consequence, and this expected change if the restriction were varied.

It should include a proper risk assessment, and it should include the parts that do not assist. If there is a history that bears on risk, it goes in. A letter that reads as balanced is the only kind a court can safely act on.

And it should be precise about its own limits. A doctor should say what would improve, and should also say what would not. Varying a curfew does not resolve a post traumatic stress disorder. The investigation continues, the other reminders continue, the depression continues, and the treatment needs continue. What varying the curfew does is end a nightly and foreseeable repetition. That is a narrower claim than the one an advocate might want, and it is far more likely to be accepted.

What the letter must stay away from

The doctor does not comment on the alleged offence, and should not be told what it is. It has no bearing on the clinical question and knowing it can only contaminate the assessment.

The doctor does not comment on the investigation, its conduct, or its likely outcome.

The doctor does not express a view on flight risk, on public protection, or on what conditions the court should impose. Those are judicial questions. The letter provides the clinical material and stops.

The doctor does not treat the person’s fear as evidence about the underlying case. Someone can be genuinely traumatised by a process that turns out to have been entirely properly conducted. The two questions are separate and a letter that conflates them is doing nobody any favours.

Frequently asked questions

Can a psychological letter be used to vary bail conditions?

It can be submitted in support of such an application. What it supplies is the clinical basis: a diagnosis, a mechanism connecting the condition to the specific condition complained of, and an opinion on what would change. Whether to vary the condition is entirely a matter for the court.

Does the doctor need to know what I have been arrested for?

No, and it is better if they do not. The clinical assessment concerns your mental state and the effect of the restrictions on it. We would not ask, and we would expect you to decline if the question somehow came up.

Is this only relevant to curfews?

No. The same reasoning applies to any condition that repeatedly places a person in contact with a trauma reminder, or that removes a coping strategy they depend on. Conditions requiring regular attendance at a particular police station are the other common example.

What if I have already been charged?

The letter still has a role, both in relation to bail and, later, as material a court may wish to consider. The clinical questions do not change; the forum does.

Will you write that my mental health means the case should not proceed?

No. That is not a medical opinion and any letter offering one would be worth very little. A doctor documents the clinical position. What follows from it is for lawyers and the court.

How to arrange an assessment

Clinique Alpa prepares psychological medical letters and reports for criminal proceedings, written by Dr Mitesh Parmar, a GMC registered and MedCo registered GP with a parallel medico legal practice. Assessments are recorded, conducted for the purpose, and currently by secure video.

If you are instructing on behalf of a defendant, tell us the question you need answered and the date of any hearing. If you are approaching us directly, it is usually worth speaking to your solicitor first about whether a letter or a fuller report is the right document.

Start with our medical reports page or read about medico legal reports. To ask about fees and availability, telephone 020 8882 8088.

Dr Mitesh Parmar, Principal GP and Clinical Director at Clinique Alpa. MBBS MRCGP, GMC number 6113670.