M I C A Kernow	Bennet was a black patient in a medium Secure Unit, there because his illness of schizophrenia, starting in adolescence, had not yielded sufficiently with medication into a settled state, and he had not found a holding community life which gave him a way forward. During the long course of his illness he accumulated high dosage regimes, and multiple medications which added up to more than the national guidelines for good practice. But this is common enough in all people suffering from schizophrenia which is 'resistant', sometimes leading to an aggressive anxiety reaction to something puzzling; not just to people who are black and suffer schizophrenia. He had previously been violently aggressive, in circumstances not fully explicable or prepared by reaction to any particular provocation. Even after being well into a course of in-patient management where he had received clinically adequate treatment. He had previously badly assaulted a female nurse. Growth into maturity, on from adolescence stops when schizophrenia starts at that age. Beliefs taken on in adolescence - in this case 'Rastaman' remain throughout his illness as an attitude. It never got the normal 'wearing in' that moves adolescence to accomodate to adult society. That means he stayed outside ordinary conforming. He wanted to be treated that way. He could be arrogant and challenging if he was not 'respected',or if he decided - he said he was being disrespected. This apparently included expecting to be being addressed with latitude, tolerantly when he was not well, and which apparently allowed him to be over familiar, if he wanted to be. If he wanted put his arms around female staff, he expected to be able to, and he was allowed to. That would not have been allowed by white patients. Such allowance might be 'racism' His over-familiarity got him into final trouble when he interrupted a white patient on the same ward who had been on the ward telephone for a very short while and he demanded it for himself. Was that inter-racial misbehaviour ... 'you should give way to me - a Rastafarian when I ask for something'. When it was not given to him he hit the patient, driving the phone against his head Did he already know he was allowed some leeway because black That was the point at which intervention should have been made. This left bad feeling and continual confrontation and altercation for a while, during which the white patient went to Bennett's room abused him in racial terms and in terms of his colour, and hit him on the face several times. The argument and exchange of fists resumed late that evening When this did not settle down, nurses consulted their senior staff, who did not get into the situation themselves, and then the ward charge asked Bennett to move into and adjacent ward for separation. He thought it would be for a while, but it was explained soon by the female nurse - why left to her, had she seen the build up to this point, - in charge at the moment, that he would stay there overnight, but he gathered there was nothing to be done about the other person. He may have taken this as unfair in a lack of balance - why was he moved - but no sanction was applied to the other participant in aggression; and he may have chosen to see that, in racial terms. He hit the nurse violently on the face Two male nurses and two female nurses got hold of him and floored him, restraining him there, probably face down, likely for up to twenty minutes. He was killed by that. How could care come to that end? Police were brought in and it sems forbade any giving out of information. The family were kept at arms length. An Inquest was delayed as the police prolonged their coming to any conclusions, and forensic evidence about medication levels,and about the state of the body conveyed uncertainty. The Inquiry Chair took it upon the duty of the panel to address the question of racism. There was none in this Unit, although Bennet was always in a minority position with staff and other patients. The Inquiry panel seems to have taken the view that deliberately or unconsciously the decision to remove Bennett,and keep him away for overnight, was because he was black. The Inquiry does not try itself to envisage what would have been a reasonable course of action if the sequence started with two white patients, one of whom assaulted the other without provocation,and then the other insulted back in some personal way ... you're a 'queer ' or ' a 'snitch'... or something like that. Maybe intervention would have got there after the first blow, so that who started it was clearly distinguished ? Was there 'racism' in that Bennett 'was allowed to get away with' the initial unwarranted blow without reprimand, so that the other patient then had a grievance that it had not been dealt with properly ? Never the less the Inquiry took evidence from many 'expert' establishment names who all agreed there was racism in the NHS. This is what got the headlines. Racism was irrelevant to this particular case unless the Chair wanted to see Bennet as seeing racism where there was none. Or none from this staff. But that is a minor point in this Inquiry. There was racial abuse from the other patient. That is not institutional racism. It is part of a general racism in a large enough part of society in this country. If you are assaulted by a black man you are very likely to be angry and shout racial abuse. If blackman is assulted by a white one, then he will feel it is a racial situation. Why? Anybody would have reacted to his attack with some bad tempered response High temper is not a reflective state, and these were both patients. Perhaps the Inquiry Panel saw racism in the handling of this particular incident. They give no evidence for that, just their chosen 'identifying sensitivity' as to how a black person might have felt in those circumstances - that he was chosen to be removed from the scene when the other patient was not. But it was Bennet who started the fighting, and finally Bennet who hit the female nurse, which led to his fatal restraint. There might be some criticism in the fact that Bennet was not removed straight away or earlier. Or the other white patient, who gave him racist abuse. Or at least they both got a telling off - maybe Benett for starting it, the other for using racial language - it's wrong and forbidden on this Unit. But that is a general criticism of violence between patients, and is a difficulty for all patients - not just black patients, who suffer from a schizophrenia illness. The misleading danger in this Inquiry Report is it's emphasis on racism, which then diminishes the more general lessons to be learnt - the national disgrace in the funding for the care and treatment of a very difficult and bewildering illness - schizophrenia What are the professional staff able to do for someone suffering from a long-term and fluctuating psychotic illness of schizophrenia, when there is no adequately funding input for an adequate suitable aftercare programme, and none that can be fashioned in the face of a committed recalcitrance to accept service. What can community staff offer when there is no way in to a flexible engagement with sheltered occupational interest, and supportive companionship in the local community resources. There is no 'menu' for a weekly programme of regular activity which gives daily direction. Something that most adult people acquire some time. This is an adolescent who has no commercial skills, or acquired an ability or attitude to work. Community care never found for him some meaningful setting for his progress. Like many others with youthful schizophrenialeft to drift There are simple practical lessons here. One is suggested - if restraint has to be in a dangerously physical confrontation, then early intervention is necessary with doctor authority and explanation, still sufficiently respected to be acceptable The system for that here, just went wrong on simple failure to get a taxi to the right place. There was nobody on campus. There can be derived from this Inquiry - but not from the panel - practical front-line advice. When it comes to all out restraint, then management should bear in mind in a protocol the use of 'velcro' strapping to keep the legs together. It is better than an overwhelming person to person force. But also - get the doctor, and senior management, a senior nurse, in straight away, to show Unit confidence and clinical 'strength '. Here not possible Left without protocol in a culture of security rather than therapy, frontline nursing, without being able to offer a future hope, can't win. The Inquiry - apart from interviewing some of the actual restraint nurses, did not look to get the feelings of genuine other experts - those nurses who had been left to get on and deal with many such incidents personally, face to face. The ones they chose to hear, could have been asked - how many times have you been personally involved in this sort of emotional fighting, and what lessons did you learn from that. The Inquiry goes on a lot about minority culture and respect for it, but does nothing to examine what - in this case - Rastafarianism means. It's an excluding racist culture as much as any other minority. Try being a white Rastafarian Often for 'idealistic' youth it means an attitude which says get your reaction in first. Stand up for yourself. That's alright in the community, in your community, but it does not apply in a hospital setting. There, you co-operate. Majority culture rules, because this is their most expert way. And get better by helping the therapy. That's what the family should say in support. If they were ever taken on board in care mangement.   But here, the Inquiry says, they [ the family ] were never encouraged nor allowed in. That might be 'racism' except that it is very common feature in Reports after homicide ... the experience and views of people in the community who very often have observations very pertininent to care and treatment when patients are 'in the community ' are rarely made welcome and a part of 'the care plan' And rarely is there anything seton for the patient to do which has meaning for them giving a direction for their future and can be encouraged to take part in by the family   Where's the menu ?