M ental I llness C oncerns A ll	Not an easy run. S-P suffered since eleven years old from insulin controlled diabetes. An over balance of insulin can lead to hypoglycaemia. Hypoglycaemia can be accompanied by behaviour changes which can show as irritability or angry happenings - things that cannot be remembered as they are not completely in consciousness - but appear to observers to be happening in clear consciousness. Then again a sudden hypoglycaemia may lead to epileptiform 'fits'. S-R was thought to have epilepsy as a possible explanation for sudden alterations in mood and his misbehaviour. The possibility that his anger and assaults were down to hypoglycaemia was put forward by a solicitor as an underlying remediable explanation for his criminal behaviour. There is no evidence of observation that he ever had hypoglycaemia or inexplicable attacks when he was in custody ( once for two years ) or when in the mental illness admission unit. It would be very surprising if, in all his history, if his behaviour was down to hypoglycaemia, that he was never found unconscious or obviously disorientated and confused. But he was finally labelled as a personality disorder - meaning someone with repetitious socially bad behaviour, who did not seem to be able to control himself or respond to its consequences by changing to behaviour that would bring him into better regard. S-P had many criminal charges, started street drug use and alcohol at an early teenage, and was more or less 'in trouble' all his growing years. He is charged often with assault - apparently of an increasing nature, and is ' well known to the police ' and carries a knife. For one of these Court appearances a Forensic Psychiatrist tells the court - behaviour due to abuse of drugs - there is no evidence of personality disorder. Aged twenty-one after conviction for assault he is in prison for two years and after that under probation supervision. When does a criminal become a psychopathic personality disorder? Was he referred - then - for a forensic psychiatric opinion? He was on bail for an Offence Against a Person at the time he committed the killing. Who is responsible for assessing the risk of giving bail? Where is the difference between criminality, drug use and violence during adolescence and psychopathic personality behaviour? How was it this Court never asked for nor received an opinion from a forensic psychiatrist? There was a well described District Forensic Service provided by the Health Trust. Surely its business? The Inquiry Panel, headed by a law Professor, seems to think the fact of his self referral with a plea of asking for help as a background, warrants the diagnosis of the kind of personality disorder that fits into the psychiatric service. The issue will come up again when the Inquiry into the care of Michael Stone is completed. He also asked for help. The Inquiry Panel recognises that the criminal and violent behaviour was known to the medical people who were sceptical of their capacity to hold or manage S-P. He eventually got himself admitted again to the psychiatric admission ward having been banned fom a homelessness overnight refuge. A referral to a Forensic Psychologist - a curious title - not someone allied to the Forensic psychiatric services - by a trainee doctor in the mental illness service, for anger management, failed, when he did not take to the service, and did not turn up to an appointment.The trainee is supposed to be supervised by the only one of the three Consultants in post in that catchment area. The Forensic psychologist, who could not give an appointment to see S-P for seven months, then passed him back to psychiatry service with the additional comments that he had a history of violence, and was very angry with them. She sends an opinion in a letter to trainee junior psychiatrist who had referred him some six months previously, suggesting that the Consultant Psychiatrist considers a Care Programme Approach meeting. In Leicester at the time, the gatekeeping to a Care programme approach was set by the first mental health professional to see anybody, and in this case this would be 'ordinarily the admitting nurse' !! Whatever happened to an admitting doctor? The Consultant receives the letter when S-P has left after his final overnight admission and discharge. At the time he receives the letter, he has no point of contact with him. The Report is artless when it daintily touches on the activity and usefulness of a District Forensic Service in the area - whose remit suggests that it could have been drawn in to take supervision of any care that could be applied to S-P - but was never involved. The final event is in the flat which the Housing Department obtained for him, four months after his last contact - the out-patient interview with the Forensic psychologist.	E-mail reaction is welcome mica@didgy.freeserve.co.uk