His father is absent from five yearsof age. J has some childhood problems of defiance. He settled down later. There was no history of aggressive violence. He is living at home with mother and step father a younger sibling, and step family . His final diagnosis, at nineteen, is schizophrenia. That is a condition always to be taken seriously, as it cannot be certain what is going on mentally, so that the illness might be expressed floridly. It is always a potentially dangerous illness, until sufficient time for observation allows good judgement. That observation is likely to be too difficult to obtain when the patient is out of reach of professional watching. Someone exercising authority has to take a hold of the management of this illness. The guide should be that it is unpredictable in it's early stages. Here, neither the personal home nor the professional circuit takes charge. At this early stage the progression of the illness is not going to be clear. He is offered and declines admission. The only continuous observation is from his mother. Was she well informed ? Washer position examined - as a future longterm carer? Where is the Carer Assessment. Was medication sufficiently observed and supervised ? Both his mother and J sometimes do not keep appointments Here appropriate medication reduces the illness but his life does not improve or stabilise. He engages with no programme. It is not clear if the secondary service staff have a system of exploring and discovering interest or ambition so that they can sustain and support that interest with a needs examination and care plan. The Care Programme Approach . The medical lead is an SHO a training post, subject to turnover. 'J' many times fails to appear. So, community service is withdrawn - leaving no easily accessed reassuring contact point with the mother. His mother tries to keep in touch but may not be given authoritative direction about the seriousness of this illness. He lapses from the medication for schizophrenia. He is prescribed anti-depressant medication instead - one of the ssri medications.That is not a usual prescription on its own in schizophrenia He is more unsettled over days, shortly before the tragic event. Contact is offered but postponed by the mother. He kills his mother. Comment. The psychiatric advisor is experienced in dealing with schizophrenia, and has called, in her own capacity, for early intervention to be funded as one of the answers to the intractible despondency, defeat and the frustration that dealing with schizophrenia often evokes. Someone has to gain authority over the life and family of someone suffering from schizophrenia, and rearrange the world of the family and sufferer to deal with their new situation. The professional staff do not exercise it. Missed appointments are not given active follow up. They are instead the reason for disengaging. It is not made clear that medication is being taken. Very little is described about J - his school achievement, friendships, hopes, interests. There is nothing about the circumstances of the final event, surely something the step father could describe. This Report is uninformative and insufficiently acute. It says the event was not to be predicted. When can individual events like this ever be? What is the point of the remark ? The point really is was it ever given consideration. Sufferers live in a double orientation. They live in the real world - here - in the process of adolescence an uncertain immediate fuuture, not yet established with success away from the family; and then, to an extent less and more the influence - unpredicatably, the world of their illness takes over, yet cannot be described by them outwardly because they are living inside it - the tools they would have to use to reveal it, thinking and speaking, are the ones that are themselves subject to the illness, and part of it. Treatment is aimed at suppressing the slip back, into the illness having the authority over the individual. But, it will fail if what is left is not connected up to some form of acceptable living, at first a sheltered programme, a substitute but moving towards the challenge of full reality, and then a future prospect in the real world, that can be laid before the person. The changes need time to be made and the time has to be gained in some way. Previous regimes did this by formal admission to hospital - we, the experts in experience and training in this subject know better than you or your family what is needed - to think it out we have to be in control using the authority society has given us - detention - and using that 'protection' to rebuild a future that the family can see as feasible and possible. Back to Home Page Back to Inquiry List