King had received care from the adult mental health services since 1989.Inquiry Capon; King
On 21st January 2005 Richard King was convicted of the killing of the partner of his mother-in-law on August 8 2004 at that time on extended leave from an informal admission during the previous month
Toxicology showed cannabis in urine and blood.indicates he had taken cannabis the night before.
... "apart from his wife's statement, there is no evidence his illness after cannabis was any worse than usual "
" the abnormal experiences and beliefs that he had immediately prior to the killing
were neither new nor qualitatively different except his assertion that his wife, for the first time,
his wife told him that ... ( the victim ) ... had sexually abused her "
This Inquiry follows a well worn route along a simple journey.
Richard King suffers from schizophrenia over ten years. He gets just so far with early work. His schizophrenia then breaks up any forward moves into holding a job. He meets someone who is a service usr cared for by learning difficulty agency teams.and marries. He has little to do and finds the cannabis trade, in a neighbour, using it regularly.
His wife may be well have been considered as someone who herself was receiving care – she is described as a service user with a care plan and the agency looking after her one handling learning disabilities.- and that therefore her role as a responsible carer was less considered and her views not given the ordinary degree of recognition. In one sentence the Report refers to herand her husbans as having similar clinical conditions
They move from a supported flat to one more independent; one which neighbours a known drug user
He is at first more or less controlled in illness for five years, managed by depot injection schedules which eventually gives pain at the injection site. When the dosage was rediced the illness returns.He asks to switch to tablet medication which is never established in a settled and securely appreciated way.
He does not always keep up with oral medication.
In the final admission before the tragedy, he has resumed a depot regime and has taken it for six months, at a fortnightly moderate dosage, a little more than his earlier stabilising routine.
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A number of aggressive incidents have occurred and are noted but they are considered separately and do not accumulate to a recognised pattern of others being at more than at a low risk during 25 risk assessments.
He is known to carry a knife
He was known to be subject to auditory hallucinations when ill...
There was assertive intervention to the mental health services from the father of richard king reminding the professional staff that there were concerns about aggression and danger and requesting a more secure placement.
It seems likely that an appeal from the wife to an on duty community team just before the tragedy, received no response and no documentation..
Because a social worker was visiting the married couple in support of the wife, the social worker may have been looked at as the key lead when the couple wee in any critical situation. In fact the care co-ordinator for King was a community team nurse, who had not much experience in that role. and had no regular supervision to turn to, and learn from.
The Panel interviewed the line managers for the
Social Worker and Community Mental Health
Nurse. It was apparent from these interviews,
and the evidence presented to the Panel, that the
practice of the Social Worker and the Community
Mental Health Nurse were not of the professional
standard expected.
The issues which
exposed had clearly not been picked
management practices. In particular
appraisals had not taken place.
Attempts to transfer all the care of the couple to the Trust caring for King were not accepted
the Panel is clear that if a husband and wife both
suffer from similar illnesses and they are service
users of separate agencies, they should have a
joint care plan. This should be established by a
joint assessment in order to be sure that the care
plan for each spouse takes full account of the
needs of the other, and that the involvement of
separate agencies would not give rise to mistakes
or omissions.
S Potter, Mrs King’s Community
Nurse, considered that it would be better for her
to be a service user of the Mental Health Care
Trust. Dr N Verma, Mrs King’s consultant, agreed
with this view because of the particular nature of
her illness.
.It was the social worker who visited on a cry for help from the wife which led to the last admission, the social worker who persuaded him, conveyed him to hospital, where he was then an informal in-patient.for three weeks . Thereafter his supervision may not have been as firm as would have happened if he was a detained patient. The final attack happened when he was on informal leave agreed by the ward , extended and then endorsed by a ward doctor who had not seen him for approval. The final depot injection is given eight days before the tragedy.
Line management - frequently a confused area of management - is looked into. Here the panel Report is of the view that it is line manager responsibilty and duty to see that the activity of clinical business is taking place, mentioning in particular that it is lne management who see to it that the arrangements for clinical supervisioon are in working order. The arrangements, not what goes on about the clinical issues in a particular case. but that the opportunity and the ability to have supervision, and that the system is functioning, is in place within those arrangements.
That takes us further, but leaves unexamined who makes sure the practice of supervision makes the process easy to approach or engage . Who calls the supervsion into place - the supervisor or the supervised.
It is an important dilemma.
'" The management role of consultants needs to be examined. The locality manager seems to have non-clinical line manager responsibilities for the doctors in the team"
The 20 bed ward admission was full. It was not the usual one.
Between February and the last admission in July there were locum consultants who had no awareness of King.
He was visited, perhaps not on the twice weekly basis desired by a previous locum, and King was largely stable. The Panel Report doubting this by quoting one single weekly contact apprehending relapse, although this was followed next week by reporting stability again.
Recently Cmh nurses, consultants and social workers in the teams were often changing
The community mental health nurse assigned to King for three months befoe the offence is a locum nurse.
His last consultant arrived, new to King, four weeks before the tragedy. The previous consultant – a locum for eight weeks had left four months earlier. Who was put in charge by the Trust in the meanwhile??
The previous consultant for three years had left five months before the tragedy.
During the last admission, King absconded and that was not properly dealt with. There should have been intrusive visting.
Was the Social worker with prior familiar with the household, probably mainly with the wife, who had been able to persuade King at the time of the crisis on the time of the admission, and especially dealt with the wife, was she available to do a 'follow on' home situation assessment, perhaps this time accompanied for protection.
The Social Services records indicate that at a
meeting on 9 August 2004 when Richard King’s
wife was present, she alleged that Richard King
had taken some illegal drugs prior to leaving their
flat at approximately 3:20am before going to
Sheringham where the homicide occurred.
An Officer of North Norfolk District Council has
also told the Panel that there were several known
drug-dependent persons living in the vicinity
where Richard King and his wife lived
Two social workers who were involved gave evidence.
The stance adopted was that King was on extended leave, so that the offence was carried out whilst King was in NHS care. There was not a proper care plan.
After the Court disposal King said the fatal attack on the partner of the mother of the wife was because the wife told him she had been assaulted by him.
The only direct quote from the wife is from police records made on the night before the offence.
*** I have rungthe active team tonight but they did not admit him in or nothing,
I think they should have done "
The local teams show no record, but a record would have been made only if some action followed on
There was no personal recollection, but nobody who might have received the call, was addressed in face by the Panel.
There is no account of the results of the mandatory internal Review.
The addendum dealing with documents accessed does not mention any internal Review.
That is odd because one of the panel members is the medical director, and the Chair is a non-executive member, of the Norfolk and Waveney Trust Board.
Comment Inquiry Richard King
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