M I C A	JM came into hospital mental health services, because he pleaded guilty to a charge of theft, and the Court imposed a Mental Health Act Hospital Order and a Restriction Order. The offence was rather more than simple theft and involved a threat of serious assault. in a context of ill behaviour. Psychiatric reports prepared for the Court reported the presence of treatable severe mental illness. The question of drug abuse did not arise. He was detained in the South London Hospital which covered the area in which the offence was committed. This was not the neighbourhood of his upbringing. When his illness was considered to have responded to medication , his return to ordinary living arrangements was felt likely best to be achieved in his home base area. He had at first expressed doubts about this . He had not wanted his family to be approached by the social worker. Later, when an appeal Tribunal appearance concluded that his illness had been well controlled , and that he should now be prepared for discharge to satisfactory aftercare, his social worker was able to use this Statutory request for a social work report to aid the decision of the tribunal, to visit and see the family. The Tribunal conditions then allowed his transfer to a local hospital, near his family, there to prepare a resettlement. He remained subject to conditions. He was eighteen months in the south london hospital. The diagnosis there was schizophrenia . It was confirmed. In hospital he had relapsed into that illness when medication was withdrawn, and responded again when the medication was re-introduced. He then transferred to the rehabilitation unit in the hospital near his home . The Inquiry does not refer to any contact with family members during this placement. During the six month stay, the diagnosis was changed by the Consultant psychiatrist in charge of the Unit to that of personality disorder, with drug abuse occasionally causing psychotic symptoms. The medication for schizophrenia was stopped. Subsequent brief inexplicable behaviour observed and presented by relatively inexperienced people in the hospital was disregarded and dismissed.	A trial residence outside hospital in a Mind hostel was unsuccessful. His behaviour was unusual and frightening to one resident. The social worker was worried about his attitude. The hostel managers felt he should leave in short case. He was returned to hospital. His return was considered to be just a social stay until an alternative placement was found. Following a Detaining Order under the Mental Health Act any discharge has to invoke aftercare arrangements between Social care and Health care . Shortly after this return to hospital, JM took himself off, left the hospital and there was no further contact until he was in custody after the eventual tragedy, weeks later. The Inquiry report criticises the lack of attention to what was required when JM went absent without leave. His absence made it all the more important that the needs assessment of the Care programme Approach be reviewed at a multi-disciplinary meeting. What was needed had now changed.The key worker should set in motion what further action might be necessary. Cp. Review Mabota Asked to see the patient in custody immediately after the tragedy , the experienced Consultant in charge of the rehabilitation Unit, maintained his view that schizophrenia was not present. Subsequent opinion from five other specialists thought the illness was , and had always been , one of schizophrenia. Further observation, in his final secure hospital commitment , confirmed the diagnosis of schizophrenia, and confirmed the adequate behaviour response to medication for that condition . E-mail reaction is welcome back to Inquiries Home page Review Mitchell