M ental I llness C oncerns A ll	Draft 1. Rehmann, known to suffer from schizophrenia, was left at home with his wife and the three childen in their arranged marriage, without medication which he had refused; for two years without contact with the mental health services. There was no plan in place to keep up-to-date with how he was behaving. Finally the wife reported domestic violence, and illness, to the family doctor, who decided a MHAct admission was necessary to intervene in the illness and to protect the wife and children. Birmingham North mental health service had a rigid protocol that all first contact was to be with the home treatment team, who would attend and assess, which they did within twenty minutes, and which then decided that admission was necessary, passing that on to be accomplished by a third party, the LASocial Services, to arrange a home visit to make out the appropriate MHA examination and the Forms required, before admission. On arrival, Rahmann showed those visitors to the door. They left, completing the Forms, but did not or could not make the connections, when they thought it necessary to call for police assistance in accessing R. and removing him, as they thought after their initialcontact, resistance might be the response. The procedure for that eventually had to wait till the next day, thirty-six hours after the initial GP contact, and leaving the wife and the children in the original situation overnight. Once the wife and children left the next day, Rahmann was approached and agreed to be taken to hospital. Because the bed in the hospital originally reserved for him, had been taken, he was taken to a different hospital towhich the the MHACT Forms were not addressed. Neverthless the Order for detention and observation was illegally applied. Rehmann did soon get transferred to the originally designated admission Unit, staying there for a Section 2 twenty-eight day period, that Order being extended on the last possible day, after the tragedy, for a further six months enforcement. There is gap in the information Report which is puzzling but correct. It seems Rehmann was not given medication against schizophrenia, probably because he settled into a peaceful composure without incident and without prominent illness behaviour on the ward., possibly because it had seemed not very efficacious on an earlier admission. The quietness and absence of any florid illness, seems to have influenced the consultant to take time to review the whole picture, and in the event , perhaps encouraged by a temporary deputy having given apparently successful escorted leave, unescorted leave of one half an hour three times in a day, to go out to the local shops, was allowed on the say so of the nursing at the times. Rehmann is likely to have acquired a knife during one of these . On the evening when he stabbed and killed his wife in front of their children, thern stabbing himself ineffectually, he was not observed to be unwell on the ward, and had been given leave at seven o'clock in the evening, failing to return. Although his wife had obtained an strong anti-molestation order from the Court, backed up by power of arrest, the Inquiry Report believes that the consultant had her agreement for Rehmann to have leave, presumably with some reassurance as to the likelihood of misbehaviour. Although depot medication over two months had not dented misbeliefs, it is wrong that medication was withheld on this final admission for eighteen days, only started two days before unescorted leave was allowed, wrong because the medication would not have had time to be effective, and leave should have been withheld, even if only to try to lessen the force of any paranoia, before leave was granted. Comment on Eldergill; Rahmann back to Inquiry List back to Home page.   back to Inquiry Link page       E-mail reaction is welcome mica@didgy.freeserve.co.uk