M ental I llness C oncerns A ll	R., the perpetrator, was the youngest of nine childen whose father was chief engineeer in the local pit. Her mother was a nurse and so were two sisters. The family was always in touch. R. left home at sixteen, working as an auxiliary nurse, after quitting a nurse training course. Aged twenty she married a local village man, who was at the time a merchant seaman, but later R. and he took up pub work . It did not work . Both drank and argued. There was violence between them. They divorced and R went back to her parents with two children. R never took personal charge of her two children again, leaving them with her parents when after two years she secured her own home, but visited the children daily. Some months after obtaining her own home she met Y, who later moved in with her. R stabbed Y after an altercation, arising whilst both were drinking alcohol, and some months after Y had moved into R.s home . Neither R nor Y ever engaged with the local substance abuse services, neither that funded by health, nor that provided by the separate Local authority social services. Both were offered that, but did not engage with the many appointments offered. They both were taken on by the local psychiatric service, but this also was a matter of broken attendance. Y. left school without qualifications. Part of his schooling was special help for dyslexia. His family were always in touch and supportive. He was always in work and had few health problems during the fifteen years of his marriage- which then ended in divorce - why is not described - his ex-wife leaving the area with the three children. For the last eleven years of his marriage he worked in a brewery, and during the year after the marriage broke down, his drinking became uncontrolled, compounded by his acquiring and using and misusing sedatives. His family doctor restrained the latter usage, but the alcohol misuse led to his admission to hospital and on one occasion there was a sedative overdose. He embarked on a relationship with a woman friend, and they had one child .That ended after seven years, when he was told to leave. Some months later he took up with patient R. and moved into her house. Neither R. nor Y. took up offers of help. They never wanted what the local offered. Those services were not geared to reach out to establish contact and ease people into their systems. The single handed family doctor service tried to sustain things, but were on their own. It is not clear how a service can be therapeutic if there is no force behind it. The Report of the Inquiry is significant because of its description of this locality mental health service in action. Management changes never delivered an integrated mental health service.They were fully taken up with the consequences of their own reorganisations. Having separated off Local Authority mental health social services, then - in-patient nursing from community nursing and then that from psychiatry and social work, this car may have looked sound but it had no driver and no engine. Reviewed	E-mail reaction is welcome mica@didgy.freeserve.co.uk