M ental I llness C oncerns A ll	This is distressing and quite dreadful to read. The personal experience, often and clearly expressed, of the spouse - the chief family 'carer' - gets insufficient respect or response to its experience, from the professional care. Even when the day after discharge -from a very short admission time - a Carer Support Worker - ex-mental nurse - visits the spouse, gathers grounds for great apprehension, and writes a warning letter to the psychiatric Out-patient contact, the GP , and the Consultant of the catchment area team. The warning is received , discussed , and changes nothing. Subsequently the spouse is killed. The Trust has not put a care programme approach into effect, and does not know of its current working practice - which fails. At a multi-disciplinary ward meeting, preparatory to discharge arrangements, neither the ward nurse nor the social worker, the people most likely to be aware of the views of the visiting family, have anything to say. At that meeting delusional aspects are known to remain. Hundleby even during his five days admission period, has had much leave off the ward,and sometimes overnight. He has stayed up till 5.am during one night in hospital. There is in the hands of the HealthCare Trust a perfectly workable risk assessment list, six out of seven indicators pointing to risk. It is not used. Those professionals at the workface do not know of it, and it is not in their practice. The worries of the family carers are expressed but lead to no change to a discharge planfivedays after the excitement of a florid admission circumstance in which many accusations indicating paranoia have been expressed by Hundleby and documented as serious by specialist psychiatric junior doctors. Professional interview and observation thinks it can tell from that brief admission observation, the level of activity and duration of this paranoid illness and is wrong. It correctly establishes a working diagnosis at admission - that this may be a reaction of paranoid schizophrenia from amphetamine abuse, but it does not give time to consider what pressures - maybe illness itself - will have led up to the amphetamine misuse, that they may still be there and influence what will happen afterwards - to his close relationships. It then decides on a discharge without preparing any account of where the patient is going, or for a community contact, or informing his wife. There is information possessed by all the rest of the family - who are available to be spoken to - it is not given importance. It does not signify. In charge at the time of the initial decision making and assessment is an acting-up doctor, the one who will take the out-patient aftercare. When the Consultant returns, her only knowledge of Hundleby is what is presented to her at a ward round. This has already been effectively 'closed' to any change of direction. Should not the response to this Report, be that someone from above - the Regional NHS Executive puts the Authority and Trust under monthly updating report, to rectify this failing management ? Some kind of externalsupervision - be put in place till the visitor is satisfied every thing is as it should be. reviewed	E-mail reaction is welcome mica@didgy.freeserve.co.uk