M ental I llness C oncerns A ll	Like all previous Inquiries this one does not (cannot ? ) describe a catchment team working process which creates a working together team, within which there are multi-dsicipline representatives attending regularly, in which there is leadership, discussion, the airing of catchment problems out of which comes decision. Aged eighteen, Kippax is seen exhibiting hypomanic behaviour at a detention centre where he is for 'breaking and entering' . He is moved to a mental hospital where he receives treatment for a manic-depressive illness. There was a previous episode, occurring when he was seventeen, whilst in the the Army - which he joined from school. His mother has had clinical depression illnesses. Subsequently he rarely achieves a settled life style. There are further hospital admissions and further episodes of manic -depressive illness. There are criminal offences , and aggressive violence, during one of which assaults he caused his mother the loss of sight in one eye. He never achieves a steadying support social nexus. A short marriage breaks down. Drinking alcohol and gambling are added to his manic/depressive illness. The illness never seems to give long enough normal spells for him to pick up a life place or direction. A second matrimonial breakdown is accompanied by preoccupation with possessing rights with his daughter. The child will be with the mother. Psychiatric contact at the time is continual but leaves those social matters on one side - a matrimonial matter. A psychiatric Report for the solicitors acting for Kippax misses out on his violent side. Visiting catchment team professionals note that Kippax can see the connection between early sleep pattern change and the recurring mood illness, and that he deals with this by adjusting his tablet dosages. Staff are not able to open up a future hope by finding a regime which prevents relapses. In the last year he is involved with the inquest on the drug/alcohol death of a friend, a death where Kippax was present but drunk and in obtundity. Subsequently he believes the friends and family of the dead friend attach blame to Kippax, and that they will not let the matter rest. That aggravation continues but is not taken into a measured risk assessment. Basically staff find that Kippax is well able to use his personality to achieve his own way. In the final three months Kippax loses contact with staff that he previously learnt to talk with, and also lost any worthwhile contact with his daughter and ex-wife. Current staff had little experience of him to go on and compare his current mood state. He was likely to be drinking more and finding no coherence in day to day living. An attempt was set on to rehouse him away. He was having valium. A final malicious letter about the inquest on his friend with what sounded like an implication of threat to his daughter may have been a final straw. He says he phoned the mental health unit and left a message for his recent replacement social worker that he was not well. A row with his neighbour, about his daughter, in a familiar drinking session later that day, may have been behind Kippax killing the neighbour The Inquiry comments :- ..." not entirely surprising that a different picture of Kippax emerges from these accounts ( ..the information about the murder and what followed has come from other sources than the mental health professionals involved .. team Leader at the Unit .. declined to attend the Inquiry ..) to that painted by those involved in his care. The difference in perspective is not though entirely explained by the lack of knowledge within the Trust about the critical events. There is also a dimension of stance in the perception that the Kippax revealed by those events and their aftermath is not recognisable to the professionals involved with him up to that time. As there is a great deal of congruence between these critical events and important events in the history the conclusion must be : that the perception of the professionals involved in the care was inaccurate, and that this is because there was not enough understanding of the history." Reviewed	E-mail reaction is welcome mica@didgy.freeserve.co.uk