M I C A	Three brothers in this family had mental ilness. One ( LM ) was already diagnosed as suffering from schizophrenia. Another was away in Ireland, diagnosed as having a severe neurosis. The family interest and articulation was largely through their married sister. She attended ward reviews about LM but did not feel as thought they were in the loop, that their views and experience was asked for, that the family position was given the say or the entry contact that might keep the professional service and the family observations in touch. Greg Marden, the eventual perpetrator did not want to be classified with the same illness as his brother. To some extent this prevented a reserved contingency arrangement if G. should turn out to be progressing into a schizophrenia breakdown. His rejection might prevent earlier reconciliation towards the correct medication for that conditon, and dissuade him from keeping in touch with a supporting mental health team - for that contact might seem to be waiting for that illness to surface. In fact the initial mental health condition was met with an admission and a firm diagnosis of schizophrenia. But there was then a move out of the aftercare area, and accompanying that a break in medication delivery, so that G. was without medication at his next contact with the new area psychitrist, and at that presentation, there were no signs of active illness. The opportunity to press maintenance medication was lost. G. did not encourage further contact with a community team and the matter was left seemingly it being assumed that the experience of the married sister would lead to any early warning of illness coming into early psychiatric reaction. However there does not seemto have been an active invitation to contact with appropriate telephone contact infromation The married sister would 'know the ropes' because of her experince with the schiziphrenia illness in the other brother and its psychiatric management systems. As G. was living with the son of the married sister it seems to have been assumed that any return of more active schizophrenia in G. would come to early family notice and to early intervention which would draw in the mental health. It is quite wrong that someone carrying an earlier diagnosis of schizophrenia could be left without any system in place which would lead to psychiatric service. It was known that G. was set against being diagnosed with the same condition as his brother, and therefore ir could be known that he might not disclose early symptoms. Neither the family nor the family doctor were given any fallback prepared resonse if they were worried about G. developing schizophrenia. The working diagnosis should have been schizophrenia, presently dormant, and everybody keyed in to be prepared to see any change in behaviour as portending a more active form of that illness. In fact G did present oddly to the family doctor who misread the situation, never thought to check with the local psychiatric services, felt he was sufficiently knowledgeable about psychiatry, not to look up any previous letters but to took it upon himself confidently to prescribe a potent tricyclic anti-depressant, which anyone familiar with psychiatry would see as a possible provoking drug in the presence of dormant schizophrenia Anyone in psychiatry would have taken the presentation given to the family doctor by G. as a warning about misbeliefs that indicated underlying schizophrenia The only possible expalanation for the ill-founded self confidence of the family doctor would be the absence of any real warning in the final letter to the family doctor after the psychiatric services let G. go out of their contact. The basic fault here is the unwillingness to be definite about the fact that G. did have a schizophrenia which did once take him into hospital observation and definite diagnosisi. The Inquiry experts allow the Report to claim that 30% of first attacks of schizophrenia do not recur That spurious claim is an expanded claim which describes a follow up of a first illness which entirely remits and a normal life is taken up. This was not the case here. G. never returned to what would be normality for some one of his age. The Consultant psychiatrist who had let G. go was correctly concerned in hindsight that doing that without any 'lifeline' to be pulled in when it was looked for, was wrong. Schizophrenia - possible schizophrenia - always needs to be taken seriously, the necessary contingencies always in place and updated and reviewed regularly This family were let down. Back to Inquiry Holwill; Marden Inquiry Links List

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