M ental I llness C oncerns A ll	No service held her under a spell of clear observation. Which was necessary here. After the initial hospital diagnosis of schizophrenia , under conditions favourable to diagnosis and sustained treatment , and the best basis for future management, the symptoms of schizophrenia are recorded as responding to medication. The only system which could structure the care that was called for, in this unruly life, would have been a prolonged compulsory period of closed psychiatric observation under street drug free conditions. Imprisonment did not reveal any other disorder than schizophrenia. AB was expelled from school when aged fourteen, for sniffing glue and beahviour problems, and that was the end of her schooling, and of any orderly living She continued subsequently to be very often seeking and taking drugs; alcohol, cannabis, cocaine and heroin In hosital she was seen to be bizarre and suffering from schizophrenia. an observation recorded as ... when free from street drug influence. Her behaviour cleared with neuroleptic medication which was the basic treatment to be continued when discharged. Her social situation never settled and depot courses were irregular and insufficient. A community companion noted she was better when keeping on a depot schedule Professional response was sometimes that it was a personality disorder habit and that would not be treatable It is clear that she suffered from schizophrenia, and that her compliance was never achieved. It is wrong to reproach someone with the illness schizophrenia for not keeping in touch. It must surely be the professional systems that have to use what powers they are given to try to maintain a fom of supervisonand control This is possible with a Mental Health Act Treatment Order and a following extended leave whilst being able to be recalled and re-admitted. Profesional staff are opposed to applying Sec17 - the extended leave option, because .... 1. they are unsure as to the legality - part of any arrangement should involve a degree of 'hospital care' 2. If the patient disappears or if anything goes wrong whilst on leave , the professional supervision will be blamed. 3, there are not the resources in the community to be able to set up a 'whole life' interest for schizophrenia which would hold up patients engagement in outside activities, A setup there can give ongoing observation and reporting of progress. Natural observation is available rather than resentful reporting. 4 'confidentiality is strongly pushed by the professional bodies. That gets in theway of receiving community observation of the behaviour of th illness 'in between' professional point interview examination, so that the degree of continuingilness is poorly judged ... not sectionable as I saw them ... 5. Asking others to report on illness behaviour 'in between' breaches trust building, and also leads to suspicion and resentment of the observer reporting in, so that future ill behaviour is concealed from them also; and also the observers reporting in are exposed to recrimination which may be violent and fatal and 6. sometimes there is lttle explanation, little emphasis or understanding, that even if there seems to be little day to day benefit from medication that the medication still protects from falling into florid illness, and is therefore a 'civic' and a family duty on patient to avoid breakdown, and risk of unpopularity in the community The answer to all that is to keep the sources of incoming information, confidential and protected, and/or to make it clear at the very beginning of ongoing engagement that the rule of the professional team is that community observation is obligatory , a need to know. for the benefit and best interests of the patient. Generally what happens is that there is insuffiicient sheltered conmmunity placements upon which a whole life style can be made available for the professional staff to put in place with their professional companionship.   So, no blame there either. The patient drifts out of contact without a settled base. During the two and a half years prior to the attack she is never in a care syatem, and was without medication. Home Page Back to Inquiry Sedgman; AB Back to Inquiries Link Page         E-mail reaction is welcome mica@didgy.freeserve.co.uk