M ental I llness C oncerns A ll	Inquiry Greenwood; Harrington .. first draft Harrington began to be ill in his late teens. He lived at home .Both parents were 'users' of the local mental health service. Mother had a community cpn attachment over many years before H. became ill. H got into difficult relationships with his College courses. It became apparent he was mentally disturbed. When he was eighteen he was admitted to an acute admission service, with the help of the police..He was transferred immediately to the more intensively supervised local Unit. There hewas treated for active schizophrenia and improved significantly. A referral to the local Medium secure Unit ws overtaken by his improvement. He returned to the admission unit. There, his supervision was less thorough. He associated with people on the Ward who obtained and used heroin. He acted silly It is likely he did not always swallow his medication on that ward. At his discharge Review, the Section 3 Order, which had succeeded an initial Section 2. Order was removed. He did not continue with medication His follow up was with a social worker in the local community team - the same team from which another team member was care coordinator to his mother. Four months later he killed a peer associate. Conclusions in the Report preamble The care provided by the GP practice was appropriate and responsive; The care provided by consultant psychiatrist Dr Latif and his staff in the psychiatric intensive care unit was commendable; The analysis and assessment consultant forensic psychiatrist Dr Plunkett carried out was commended but his leisurely response to the second referral was unhelpful; Consultant psychiatrist Dr Chattree failed to appreciate the severity of Mark's mental illness and con sequently did not take into account all the circumstances when considering Mark's discharge: arrangements from Darwen ward, and his subsequent care in the community. [ Paragraphs 231 et seq set out the particulars of these misjudgements, oversights, and shortcomings; both the community mental health staff and the police service worked entirely separately from each other even though the police knew Mark had a mental illness, although they did not know how serious it was, and the CMHT knew that a) Mark had regularly assaulted his mother, b) he was believed to have a firearm and c) they had been advised to inform the police if 'there was any raised perception of increased risk to others'; We strongly criticise the failure of care coordinator Mr Ellis-Dears to provide a service to Mark, and the irresponsibility of community mental health team manager Lindsay Griffiths in her team management. [ Mr Ellis-Dears: an Approved Social Worker in the community mental health team ] He had not read the ward clinical notes which were available to him, before making out his care plan. He did not like the working relationship that occurred at the pre-discharge meeting attended by him, by the consultant psychiatrist , and by the ward doctor. He believed other nurses were also uneasy about the working relationships. . footnote in the Report:- Mr Ellis-Dean ( an Approved Social worker ) was particularly critical of this ( pre-disharge ) meeting He said there was no consultation. Dr Chattree did not ask him about discharge. 'I believe the risk factors were not made transparent. I believe there was never an opportunity to I let's just work together and go ui the right direction. I believe there was a momentum to discharge this person and what I find interesting is that now the incident has happened. I have nursing staff approaching me saying we always knew this was going to happen and actually highlighted that to me. I think that is the same with the nursing staff. There is a culture where we sit there and put up with it. At the time. I had actually approached the nursing staff as I would usually do in the past and checked out with them, how did they feel about this person coming off the section'. ' What are the intentions? I believe that is a good way of working with the team and they were in total agreement with what I was saying. Having approached Dr Chattree I came away frustrated and disappointed and I notified my manager ( community Team Manager Lindsay Griffiths ) of this' . An important letter summing up the opinion of the tertiary forensic psychiatrist about the aftercare required, giving a likely outcome for Harrington, underlined in some respects for importance by ( Dr. Chattree ) - the lead consultant psychiatrist for Harrington - was passed to Ellis-Dear by Dr Chattree at a Review meeting , but was not discussed there. It was shown by Ellis-Dear, the community team Care Co-ordinator of Harrington, to his Community Team Manager - but she did not read it. In the community mental health team she managed , a CPN had been seeing the mother of Harrington over some years. There was no recorded sharing of the common interest in the Harringdon household in the Multi-disciplinary team meetings   The Integrated Care System was supposed to be a local version of the Care programme Approach. It had a serious shortcoming : it did not identify the roles and responsibilities of the consultant , or of the multi-diciplinary team Recommendation 29 ..... Disciplinary action should be considered in appropriate cases.	E-mail reaction is welcome mica@didgy.freeserve.co.uk

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