M ental I llness C oncerns A ll	Allum ( A ) acquires asthma and a recurrent skin trouble when a year old. Aged eight he is referred to a child guidance clinic because of anxiety and misbehaviour. About this time his mother was receiving psychiatric treatment. He completes normal schooling at an average level,and then works in a factory and later as a bus driver. He marries aged eighteen, moving to be near his parents. Aged twenty-nine his mother dies , and three years later he is treated for depression by the family doctor. At the same period his wife is operated upon for a spinal complaint after which she continues to suffer. His father remarries two years later. A. meets someone else and for a time that year lives away with his sister and the new friend, whom he continues to see thereafter, even when he returns to home with his wife and four children. It seems he increasingly uses alcohol and cannabis, gambles, eventually is made redundant, and gets into debt. A family doctor consultation for physical complaints reveals delusional thoughts, and a disclosure of alcohol excess and drug use. He is referred to a local drug misuse Unit, but that evening vists his stepmother and threatens her with injury to her face. Tricked into calling the police about his misbeliefs, A. is arrested at the police station, charged with actual bodily harm, is clearly alert yet under the influence of a delusional process. He is seen by police surgeons and then by an Approved Social Worker and invited to enter hospital informally, and does so. The Report finds that insufficient information from the story obtained at the police station actually gets into the first contact record at the admitting hospital. This seems to raise for the Report an examination of the balance between estimate of risk and confidentiality especially if potential victims are revealed - but the Report gives no foundation for its highlighting of the issue. Despite his declaring at least some of the delusional thought material to the admitting doctor, someone decides his behaviour is explicable in terms of alcohol and drug abuse, self inflicted, worries coming from gambling to reduce debt but increasing it, so that he can be held responsible for the mess he is in , and that he can and should sort it out himself. He should not take advantage of a patient position without a proper basis. The ward Consultant - who seems not to be part of the decision to being on leave - will see him at Out-patients. After five days he has ground leave, and subsequently day leave to set about reinstating himself. He is refused a permanent domicile by a long term female friend. The Citizens Advice Bureaux report his distress at his lack of progress to the ward, as does his stepfather after he visits there. A. tells the ward of his failure, and that he will have to return to unsettled living, in estranged difficulties with his disabled wife, and their two teenage sons. The community aftercare services are withheld from him. He is not considered for the Care Programme Approach, till five weeks after his admission date. There was no attempt during his in-patient stay to obtain information from those who knew him in the community. As a consequence there is never any advice to his carers as to what to do in any setback. His family doctor is never brought into the picture. He returns, finding no alternative, to the setting which was previously placing him under strain, having lost his job, and his income, in substantial debt, and being rejected by the mental health services. In circumstances not revealed in the Inquiry Report he kills his wife. That is not thought to be the result of illness Reviewed	E-mail reaction is welcome mica@didgy.freeserve.co.uk