M I C A	Inquiry Curwen; 'A' Mr 'A' had phases of striking illness behaviour during which he was arrogant and believed he was John the Babtist or God or the leader of the IRA or SAS The illness phases were presaged and accompanied by poor sleep.All this led to a diagnosis of schizo-affective illness and treatement and control were tried out with depot neuro-leptics and with lithium - suggesting the working diagnosis was an affective illness with the cycles quickly moving into high illness mode which sometimes was accompanied by auditory hallucinations. The Inquiry suggests that he was never completely well, but that does not confidently arise from what they say inthe Report Inquiry Curwen; 'A' did well at school but his academic potential gradually waned and he left for ordinary work, each time dropping out for a while. At the beginning of some incidents of irrational behaviour he threw a fire hydrant at a window when he was impulsively holidaying in japan. Sent home he was seen by a psychiatric triad, and either street reaction drug or a burst of manic behaviour was diagnosed, leading to a prescription (in 1990 ) of haloperidol, which he soon stopped because of side effects. He told the psychiatrist that he believed that people with guns were after him and before going to japan had thought he was jesus. Sometime later he threw a brick at an estate agents window …. to draw attention to himself and wanting to be the king of England. A little later he broke a window at home with an umbrella.. It all led to a court appearance and a Court order for hospital admission, during which he felt persecuted by the IRA – he had irish connections- the KGB as he was jesus.He absconded several times bit after three months resolved, and later held a job in computing fro over five years, living with friend. Then he became ill again , heralded this time he later declared by a period of insomnia, ending in an abrupt assertive state, arguing and fighting with his house-mates whom he wanted to make leave without any real explanation He was readmitted and presented grandiose ideas similar to those previously shown. The diagnosis seems to have been accepted a s a manic depressive illness largely hypomania. He was subsequently treated with neuroleptic medication at a level used to treat schizophrenia. He never managed to regain steady employment or occupation, and relapsed whenever he discontinued the medication, Sometimes he took lithium erratically.. His family were never far away in support. He was eventually found work where his sister ran a business. In 1995 a Care programme Approach plane is made. The Inquiry panel Report comments:- It proved difficult to find a stabilising regime which he could comply with and remember , and believe in. The final tragedy involves somebody he saw whilst 'high' and 'mighty'. At a station he verbally abused two african girls who left his company, and a man, who returned near him to fetch a parcel. 'A 'pushed him under a coming train and killed him One explanation he recalled was that it was 'to save a nuclear war. 'A' was in shelterd work at this time working in the firm managed by his sister. The family had seen him becoming high and sleepless, during the previous fortnight He has missed one depot injection but was not seen by the professional contact as needing to be in hospital. The Inquiry report that a risk assessment policy was jnot really in place. 'A' had not been so aggressive before although very physically resistant in hospital at times when he could be violent That meant that a situation could arise in the community, particularly to people close, who should therfore be advised of this kind of eventuality In fact it was complete stranger who was the victim. The Inquiry Report criticises the lack of a plan B , a point of entry into the professional services when 'A' was known to be falling into psychotic expression of his illness. Here it seems the family may have assumed care was running at the secondary health responsibility and so, they did not approach the GP nor the social services direct. When patients who are clearly 'ill' are being seen by professional members of a team who do nothing , lay people are likely to think ...they must know what is the state of the illness, and doing nothing further must be at their intention. Unless thay receive some other direct guidance about what constitutes illness behaviour that needs an urgent or emrgency response. And also that illness can and may be concealed to professional observers, held back temporarily by the fear of admission, which becomes more florid and obvious when the patient is out of professional ken, off guard, and clear of intervention. If that happens , and a route in, is not given to lay carrers, then they will assume the professional care system knows about it, has decided nothing immediate needs to be done by them, and will respond in their own professionally judged time, Too late Back to Inquiry link page Home Page

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