M ental I llness C oncerns A ll	D. gave up a professional practice in middle age when he suffered an injury; part of the settlement of that meant that he should not take on other work for pay. Somehow he had to find a new direction for purposeful involvement. . He had sufficient means. The children of the marriage were grown and away. There had been two years when D and his wife shared an extended holiday on their boat But the wife then decided to move out. D. killed his wife and returned home to kill himself. She had moved far away from the domestic home, trying to end the marriage, and trying to have brought her husband to be reconciled to that. D. had reacted with drinking , taking overdoses of medication tablets, and uttering threats of risk exposure, even exhibiting a gun so that an overnight 'seige' ended in his being taken to a police station. That scene never gets a ful explanation, nor does it;s contribution to any risk asesessment D. had not sought psychiatric help. There had been no previous psychiatric illness, nor was any such diagnosis made. But he was prescribed anti-depressant medication - the specific kind not made known - which was changed by the consultant psychiatrist Why does the Inquiry report not detail the medication and it's management ? The issue of violence early in the introduction of ssri and snsr drugs - suicide and homicidal attacks is an ongoing situation that needs recording. On the abrupt NHS presentations of distress, D was put in contact with the secondary mental health services. He generally broke off, or limited his engagement with after care Three separate psychiatric assessment recommendations for detention were issued by consultant psychiatrists on account of high risk to self and others. The recommendations were never followed because either D. accepted informal admission ( for a stay of days only ) or because the second supporting recommendation was not agreed; by a police surgeon, and by the family doctor. The contact with the secondary specialist mental health service was spread over three months. It stopped by mutual agreement nine weeks before the final tragedies on mutually good and agreed separation terms. D, was primarily in receipt of NHS service, although the wife was seen regularly by liaison from the secondary mental health community team in the GP primary service. What is not made clear, and this is essential for a Public Inquiry of this sort,is whether whoever was seeing the wife at the surgery level, was part of fhe team making decisions, and how the information from that surgery led contact was ever made known to the lead decsion maker attending to the predicaments of D. The wife was seen also when D was admitted [ together with D, separately ?] , and a risk was made clear to her although the terms of this are not stated. A risk to the wife was mentioned in support of a psychiatric recommendation. Who shared reports of what risk at what level, we are not informed. At what level of risk, and how this was assessed and by whom this was addressed - at a team level or in mutual discussion with some supervision is not stated but is clearly the important crux of decision. The separation did not come to a complete break, because the wife continued to return in contact to try and resolve the break up, but not to continue the marriage. The couple received other private mental health counsel, which was continued in the last nine weeks, after D. and the NHS service had agreed to discontinue NHS contact. What that was about is not disclosed. Some voluntary work in South Africa was suggested. There may have been more service from the family doctor contact than is mentioned here. D. received medication but what that was and who prescribed it, and what confidence there was in it being tken continuously is noy stated. is not detailed. What transpired in the last few days is not described. The Inquest report was examined but gets no comment. There is no suggestion that the family raised any questions there - as victims themselves. The family wanted nothing to do with the Inquiry. Go to comment Hayes; 'D' back to Inquiry List back to Home page.         E-mail reaction is welcome mica@didgy.freeserve.co.uk