M ental I llness C oncerns A ll	This is a condensed summary of a more extended Report that went 'confidentially' - what else - to the commissioning Health Authority - this truncated version 'anonymised' at their request. And very limited. Gray had committed sixty-two offences, including assault and sex offences. He had taken street drugs since an earlier age, and continued to do so variably. He 'settled' into a broken relationship which produced two children. Gray aged 34, was a mental health service recipient since he was twelve, categorised as a personality disorder until after an offence when he shoved woman out of her car, was charged, then after the Court made a recommendation of a Hospital Order with Restriction under Sec. 41Mental Health Act, sent to a Regional Secure Unit, and there was firmly diagnosed as suffering from schizophrenia. The social supervisor for the Home Office was the LAsocial services department After seven months he was transferred to a general mental hospital, and after nine months an Appeal Tribunal allowed his conditional discharge - the conditions being that he reside where told, that he attend a day hospital as directed, and accept such visits as thought necessary from a CPN and a Social Worker. He continued to be sometimes ill, and remained engaged with the general mental health services after his conditional discharge by Tribunal from the Forensic Service. Supervision was then more loosely enforced. There was never a shared risk assessment. The Report says nothing about the support and contact for his partner - the carer. This partner/carer had expressed a wish, when receiving her own independent psychiatric assessment because of low mood and poor social support during the pregnancy that she might attend any Care Programme Approach review of Gray. She had been told on the telephone by Gray that he had thoughts of killing his parents. A note from her psychiatrist was seen at the last CPA meeting about Gray. Two months later, the final tragedy occurred when he was allowed, without Home Office knowledge or a full review, to attend the third pregnancy labour at the home of his partner. At the time he had been in hospital over the previous four months - informally. Awaiting labour his partner and he went out for a walk. Gray strangled his partner, directed to do so by 'a voice'. Those professionals who knew him and are accepted as being dedicated and attentive by the Inquiry, did not bring to multi-disciplinary sharing, a recurrent declaration that he had said he might kill; himself, his parents or his partner. The medication management of his illness is not revealed here, although his medication may have been changed some time before the event. Not even whether the medication was oral or by depot regime. Review Downham; R.Gray Home Page	E-mail reaction is welcome mica@didgy.freeserve.co.uk