M ental I llness C oncerns A ll	Draft The issue raised is whether there was sufficient in the history to anticipate the final event. He had been aggressive and violent in the past. There was a prospective victim, at hand when he was declaring his inability to cope. When someone has clear hypomania, as he was observed to have under in-patient conditions, then his depressions must carry an endogenous component - that is, outside his ability to clear without medication. He has had anti-depressant medication in the past during depressive times, but we are not told what the medication was, nor is there any clear and categorical correlation with an effect - sufficient to be able to declare for him; this type of medication works for him, and it should be offered again if he becomes depressed again. In excessive alchol intake depression usually follows the drinking and does not yield to medication. <>Here, the evidence of hypomania is sufficient to be clear that he was liable to manic/depressive illness phases. He had carried and shown knives when he felt the need to defend himself, although never having to use one. He was noted to be unusually interested in knives. Not known to those seeing him in the psychiatry service, he had said at a police station in the weks prior to the event that he might kill his landlady. The assessment of risk may not have been updated to include the evidence of brain damage, the findings of which must have been sought for some reason. It is clear that he was down in mood, and in distress prior to the tragedy. He used knives as a threat. Admission consideration did not connect those two things with his stretched social position ,and a vulnerable companion. A decision to admit would have been because his social situation could not sustain him through a depressive phase, the persistence of which would weigh upon his personality - his coping failures. He was not thought to be sufficiently impaired by depression for admission to be necessary to happen. Simple asylum for awhile is not now considered possible. Admission - to be safe and sure - does not seem to have been considered. That is likely to be down to his drinking history. Weare not told of any 'bed' pressure. Back to Inquiry Robinson; Wild Home Page go to listed Inquiries page         E-mail reaction is welcome mica@didgy.freeserve.co.uk