M ental I llness C oncerns A ll	His previous life style is that of a lonesome withdrawn person, who fails to replace a supportive relationship, when it has broken down. He develops 'forced' misbeliefs accompanied by four or five days and nights of sleeplessness and excitement. Quite rightly a provisional diagnosis of drug reaction or a 'manic' spree of the manic depressive kind is contemplated as a diagnosis. But that is a provisional assessment , to be examined against the background of other information as it becomes available to the psychatric specialist. It should be set against the family account over a longer life span, against a drug estimation, against positive information which will come in due course. A sister and a friend were also available for their observations. He is thought to use cannabis, but with no previous florid reaction. That information was available from his parents who had provided some basic help when H. first began to reveal disturbed thoughts and misbeliefs. That information from the parents would have led to reservations about the 'abrupt' nature of his admission behaviour, and the diagnosis of that excitement. The first mental health service contact is outside his natural catchment area, at 3am being taken to the Casualty Ward by the friend who lived there - after his intrusion into the friend's home by breaking in. H. is taken to a casualty reception of a general hospital with an acute psychiatric Unit serving that different catchment area. A confusion as to who is his family doctor, leads to his being transferred to a ward of the correct hospital later that day, but to the wrong ward in the appropriate hospital. He is not seen by a doctor for two days, because the proper catchment service could not be decided. The examination of the casualty doctors and the opinion of the admitting triage nurse were considered to be sufficient - in view of the fact that he settled down quickly on the ward. The diagnosis remains a probable drug induced temporary psychosis. H. asked to see a doctor, and it was then that the proper catchment area team became involved. Observation over the subsequent three days decided he was normal again, and after a night leave at his parents home, with no adverse reaction, he was discharged. He had said he was going to take up work that the friend who had initiated his casualty visit had arranged for him in London. There had been no such offer. The friend kept in touch with H. after his discharge and noted a descent into illness again, and reported this to the parents in whose home H. was now staying. They also noticed the deterioration. It was not noticed on the first visit by a Community mental health nurse seventeen days after his discharge- an experienced nurse , but for some reasonone who was attached to a different team, who was not associated with the in-patient catchment team, and did not have the in-patient observations experience before him. Nor did he speak with the parents or any other informant. He found no signs of illness. It was left that there would be a catchment review later. Further deterioration led to Mrs Halewood speaking directly to the Ward as to who to contact for help in these circumstances. She was advised to take H. to the local Casualty department - it seems that advice was standard at the time. It was not what the ward doctor had recorded in his note of discharge - that was 'contact GP or the Team'. H. was taken to the Casualty and a doctor prescribed a sedative for insomnia. H. and his mother saw the family doctor the next day, and H. was prescribed a serotonin affecting medication. It may have provoked a feeling of rage. The discharge letter from the hospital does not seem to influence what the GP did. The next day Mrs. H. again rang the Ward for advice because her son was still jumpy. She was referred again to the local Casualty, but after responding that this had already been tried, the nurse turned up computer pages, and, seeing the name of the community nurse who had visited , took his name to mean that his was the right team to deal with Mrs H. - and passed Mrs H on to a telephone number that would be the wrong catchment Consultant office whic had no prior knowledge of H. A note there states Mrs H was offered an 'appointment' and this was passed to the proper Team the next day, but without any indication of urgency. That day, H. attacked his mother . Reviewed Home page	E-mail reaction is welcome mica@didgy.freeserve.co.uk