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The victim ( Newby ) was a recent volunteer helper with a Charity largely concerned with the homeless , and had spells of duty at a Hostel run by the Charity . At the time he was beginning a 24 hour shift on a Saturday evening . Rous who been living at that Hostel for a year, was long known to be liable to expressions of schizophrenia. He was also outgoing and talkative, sometimes seen as a clown. He recited poems at his 'local'. He had no family background of contact or support. His medical care was delivered by his Family Practitioner who arranged his depot ) medication regime, advised by a consultant psychiatrist . There was no formal support system , but an idiosyncratic outreach servic , for difficult to place patients,supported Rous, idiosyncratic in that it was not formally connected to the Health Trust mainstream systems . That team gave Rous a keyworker until he was settled in the Hostel, and the keyworker accompanied Rous to the Consultant at the Trust Out-patients. Rous had an out-patient appointment during the week of the growing tension within the Hostel, but the appointment was cancelled , the Consultant , being unacquainted that there was anything other than usual, did not initiate any substitute contact . The local HealthCare Trust had not introduced a full community care arrangement, nor fully introduced the Care Programme Approach. They reminded the Inquiry that no funds had been given to them to develop this extra commitment, which therefore had to await a diversion from hospital based services, after those services had been reduced to make available monies and people trained to make up the new system . But a Trust Community Mental Health nurse was called in to the Hostel on the day before the tragedy to be consulted about what to do there with a fellow resident (B) who had been inceasingly disturbing the Hostel with her behaviour during the preceding two to three weeks.This was likely to be because that patient, and the community nurse, was connected to a HealthCare Trust day centre. There was a question as to whether she should be dealt with by the Mental Health Act . Nothing in fact was done, and a decision left till the Monday following The Inquiry found leaving that situation to be handled by a solitary inexperienced volunteer to be reprehensible .It was generally known , but not particularly remembered, that for Rous his illness was liable to be worse just before the next depot injection was due . The tragedy occurred on the Saturday, the day after his depot maintenance injection was given, it having been delayed by two days on this occasion . During the week prior to the event he chose to go to a street friend instead of to a centre that he normally and regularly attended. He expressed to the street friend that he was fed up with the situation at the Hostel who were failing to control or arrange remove, an actively ill woman resident ( B. in the Report ) with the illness schizophrenia. Usually he went to a drop-in Mind run day centre on Monday to Thursday, but not that week.The centre was not open at week-ends . He owed a support worker money which he had borrowed to go on a holiday with the Mind centre, and was short of money whilst paying back. There were contemporaneous worries with an old and a current woman friend . The Inquiry does not list his basic weekly income nor the source of it, but does refer to hand-outs -subs- for pocket money from the Hostel staff. On the actual Saturday day he had been drinking, had run out of money, and had pressured the Hostel care-worker (Newby) , on his own in the Hostel on the Saturday evening, for a money subscription and became annoyed that the response was inadequate. A back-up provision was not called in. The Inquiry notes an ethos in the Charity workers, exemplified by the supervisor in the Hostel in her handling of the of the difficulties of the other resident (B), that we cope with things ourselves. The trust and confidence the other residents had, would be undermined by experiencing the application of the mental health Act to one of them.Rous telephoned the police emergency line to say he was going to kill somebody, giving the hostel address, if nothing was done, using bad language and shouting. The receiving operator told him off and rejected him, put the phone down, and did not follow on from what he had heard . Rous later returned to the Hostel, confronted the case worker in the office at the hostel and stabbed him. |
The victim , whose name gives the title to the Report, was a young volunteer hostel care support worker with no mental illness experience, in a hostel which had accumulated lodgers who were there with the after effects following serious and enduring mental illness. It was not an after-care psychiatric hostel and the staff were not trained in that regard . The matron/warden did not know diagnoses. Some of the residents had some contact with the mental health services, but there was no official position of responsibility for the hostel as a whole as being a collective of the mentally ill, although the hostel lodgers were all reckoned to have mental health problems, and some were given medications there. The hostel was owned and run by a voluntary body, the Cyrenians , whose previous direction had been to do with the homeless , with the changes of funding from personal to Housing Benefit but who had moved into this area of dealing with resettling people who had nowhere else to go to . The organisation had no expertise or training in mental illness, other than that they had accumulated, on the way . Rous had been resident there for over a year. He also attended a 'drop-in' day centre run by the local MIND branch. He was described as different from the rest of the hostel residents, the only one with a long familiarity with street wise culture, set apart from others who were younger, had family to visit them, and were often academic. He is seen as someone who might well have felt himself excluded by his background. The nearest people to fall back on, for him, in trouble, were his street wise companions. The staff of the Hostel, apart from the matron who recognised his odd man out position , were from the volunteer culture, also with academic and middle class backgrounds. The victim had been attached to this Hostel only for a few weeks. Prior to this he had started as a volunteer with people who were not particularly mentally ill but were the traditional homeless population served by the Cyrenian charity. His residence was at a base home, with other volunteers, when they were not on duty. They had discussed with each other common worries about staffing the Hostel where the tragedy occurred, it being a different category of client to those they were confident in handling. One worried that one resident had a knife. At this new Hostel residence most of the other residents had been referred from the mental hospital service or from a special project for the mentally ill, as having a housing requirement . Six had been diagnosed as suffering a schizophrenia illness . They had come to be a Local authority Housing responsibility. The Housing Department in this case worked through a Housing Association, who in turn let out the house to the Cyrenian charity. There had been changes to Housing Benefit funding which followed placement of the homeless. The overall funding, inspecting, monitoring, accountability, supervising, and choosing criteria in that era were byzantine. The local authorities were taken up with houses for sale and their own property resource was scanty and overwhelmed. The hostel largely had to accept what the Housing Department nominated, unless they could substantiate a decisive rebuttal. When regulations that inform the Local Authority Housing Department about staffing requirement standards were looked at it seemed to say firmly that two staff should be on duty as the minimum, but a weekly time table of cover showed that there were times when only one could be there. The feeling of inevitability that some sort of tragedy is to come is overwhelming, as each bit of irritation and frustration accumulates, and arrives at a point in time when his medication control would be at its lowest ebb, and his illness most released.
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