M ental I llness C oncerns A ll

M ental I llness C oncerns A ll

Foskell killed his first wife and the GP whom he had called out, battering them both. Twenty years later he killed a second wife, whom he had met whilst they were both 'users' of the mental health service, she more actively so, for management of a personality constrained by Obsessive Compulsive Disorder; he, being watched over, rather distantly himself, for signs of a recurrence of the rapid fall into severe endogenous depression, that was accepted as the root cause of the first killing.Initialsupervision was active as he progressed to absolute discharge after the first event, but was scanty in the last year after his discharge into hostel living. By this time he and the final victim had become a couple, not comtinuously living together, the eventual victim being the focus of supportive, careful and closer assessments by a social worker attached to the team that knew her, but not Foskell, well. Assessment became not so possible or comlete when she was replaced by someone else with less familiarity with the whole story. Foskell was by the last year being seen by a renowned forensic specialist, largely from the influence of the Home Office, but without any real authority and without a continuing team to give him observation, at his back. A last interview shortly before the final tragedy did not allow the psychiatrist to obtain the full picture, which was available to the brother of the victim The Inquiry Panel Report surprisingly, does not come to a clear position on the levelof medication during the last weeks and days, crucial because maintaining this and monitoring the dosage required, was relied upon to prevent the severe illness returning. Foskell revealed that he had stopped his lithium two months before the killing, and the Reort syas something about the amitryptiline being 'upped' by 25mgms, with out the Report being more explicit. Lithium is not so much a treating medication as preventing one, but amitriptiline was the essential without which a tragedy might be anticipated. The best indication of vulnerability to relapse, and the good reason for closer care is sleep problems appearing. The Report says at some point Foskell was sleeping only for four hours nightly, but does not elaborate. The Inquiry Report finds many things to criticise especially the distant supervision, and the splitting of follow up where couples are both problems. It is never made clear whether the victim e was warned that she might be a victim if medication was changed or became uncertain, or of the implicit and serious warning sign of sleep disturnbance in her partner. Comment back to Front Page. E-mail reaction is welcome mica@didgy.freeserve.co.uk