M ental I llness C oncerns A ll	Staff not to blame for couple's deaths 26 October 2001 Liverpool Daily Post Mental health staff and social workers could not have prevented a schizophrenic man from killing his wife and taking his own life, an inquiry has ruled. Christopher and Eunice Watts died at their home in The Glen, Palacefields, Runcorn, on December 4, 1999. Mr Watts, 57, stabbed his wife with a pair of scissors and strangled her before taking a fatal overdose of anti-depressant drugs. He was found unconscious in the kitchen surrounded by hundreds of pills and died nine days later in Whiston Hospital. The inquiry, carried out by the former Halton General Hospital NHS Trust, stated: "There was no evidence of major systems failure in the provision of care." It found that guidance and policies were followed to the letter and staff acted within the highest professional standards. Mr Watts was diagnosed as paranoid schizophrenic aged 19. He had a history of violent behaviour and had previously assaulted and threatened to shoot his wife. Mrs Watts, 55, also suffered from a schizophrenic disorder. The couple had received psychiatric treatment at Halton Hospital for many years. At a two-day inquest last year Dr Malcolm Green, consultant psychiatrist at Halton Hospital, said Mr Watts' records showed he had expressed intention to kill. In October 1999, he was sectioned under the Mental Health Act but a tribunal released him against the recommendations of his psychiatrists and social worker. The inquiry's report stated: "The decisions made were within the normal practice of mental health services throughout the NHS. "We believe it important to realise serious incidents can occur even in services which meet all the standards of the National Service Framework and Department of Health guidance." The inquiry made 28 recommendations, which have been adopted as a mental health action plan by North Cheshire Health Authority and North Cheshire Hospitals NHS Trust. The plan includes changes to the way risk assessment is carried out, a drive to recruit more consultant psychiatrists and enhanced training in mental health for junior doctors. Alan Doran, chief executive of North Cheshire Health Authority, said: "We would like to express our deepest sympathy to Mr and Mrs Watt's family in what was a very tragic case. "We would like to take this opportunity to express our sincere appreciation to the staff of the mental health unit at Halton Hospital for the extremely professional manner in which they cared for the couple." Ged Taylor, Halton Borough Council's director of social care, said: "While this report is the result of a distressing set of circumstances, it highlights that Halton has social care and health teams which are professional and caring and in which local people should feel confident." The inquiry was chaired by Dr Donald Dick, former director of the NHS Health Advisory Service. It interviewed 36 witnesses over nine days in March and April of this year.   This Inquiry is - unusually - conducted by a two member panel, led by a Medical member. Although the decision of the Tribunal Appeal is a significant issue there is no legal representative on the panel Inquiry reports are a condensation and selection from many documents and witnesses. It is doubly difficult when the care of two interlocking patient careers are the concern. Much must be left out. It leaves irritating gaps. This one like many others does not describe the working practice in the catchment areas concerned - that is the composition of who is in the catchment mental health team meeting as a team, and what is their working practice in meeting together and reporting to each other. Is there a regular habit of regular attendance at regular routine meetings for catchment review which all attend so that the habit of open discussion can occur in doubtful areas of working practice? There are two victims here. The middle-aged couple both had previous broken marriages which left them with grown up children in the neighbourhood. Christopher Watts kept in more touch - a son visiting quite often. Eunice Watts was less connected with her children. The couple met whilst both were patients at the local mental hospital and married, living in the house owned by Eunice. They continued to be supported and became well known to the mental health services, both health and LA Social services, who worked together and met together often. Their progress was often the subject of full team discussion. Strangely the Report lists in detail an accumulating menu of medication which the perpetrator had acquired until the two years before these stories complete, but then says little in particular about that used in the last few weeks of the victim. Christopher Watts was eventually accepted as showing symptoms of chronic paranoid schizophrenia but continued with tri-cyclic anti-depressant medication and sedatives; tricyclic medication is solely for endogenous moods. Christopher Watts was always, from early family days, and often later, abruptly bad tempered. During his illness he was in dispute and resentful, often abusive and threatening to members of his family, but without physical violence on persons. He certainly threatened to kill, both his own family, and his wife Eunice at times when any lingering motivation should have subsided. He also drank too much at times. He was abnormally jealous of Eunice, whom he accused of unfaithfulness. He became dependent upon her for general maintenance and continuity, conspicuously failing to keep things going when she became ill during the final weeks. His last admission happened just prior to that of his wife, she by this time in her own illness becoming overactive and sleepless; his 'collapse' following a misunderstanding with her and her whereabouts. His upset reaction drew forth a combined home visit and following that his compulsory admission [ section 2. a twenty-eight day observation period of detention ] for closer assessment of his current mental state. The Inquiry Report notes that neighbours had heard him threatening to kill Eunice in the previous two weeks, and a brother heard him talk of suicide. He appealed to a Tribunal Review hearing which decided, after six days in hospital, that further detention for assessment was not necessary - that could be carried out at home - and removed the Order.The Inquiry records the reasoning of the Tribunal in removing the detaining Order.   Eunice Watts was supported as a 'carer' by a local voluntary group. She received lithium medication in an earlier illness - medication solely restricted to the control of mood illnesses. Subsequently the Inquiry records she often showed delusional material - described in the Report as low key , a curious absence of information. The diagnosis is important as her final illness is not seen from what is described in this Inquiry report as other than an over jovial overexcitable careless hypomania - not schizophrenia. Mood illness occurs in clear phases cut with normality in between. Some diagnostic description of the low grade persistent delusional material would have cleared up matters. She penultimately had continuous medication from a depot injection regime, usually used for continuing schizophrenia but used much less often, if sometimes effectively, to prevent or lessen the return of excessively uplifted euphoric moods. She remained at home during the five or six years she kept to this depot regime. She then asked for and succeeded in getting these abandoned two years before her death. Various replacement modern oral medications for schizophrenia were then offered to Eunice and tried over sufficently long time spans during the last two years, but none gave acceptable returns. Her last bout of illness, as ill as she had ever been, presented and continued for weeks before her final compulsory admission, and the final tragedy. Eunice was agreed by all who knew them to be the one who kept the home - her house - together, the carer, and, when she was ill, husband Christopher was known to show strain and be more obviously ill. Recently he returned again and again to suspicions about the unfaithfulness of Eunice, accusing her of resuming a sexual affair, founded on a time when the Watts'and another couple had spent a weekend away together in uncertain control of their alcohol consumption. Finally some weeks before the tragedy she was noted by people who were with her to be excitable again, thus eventually being admitted on a Treatment section (section 3.) of the Mental Health Act three weeks before the tragedy. Four days before this, her final admission, Christopher Watts, still an in-patient before his Appeal , took Eunice to the Centre duty doctor who thought she was 'hypomanic'. The examining doctor noticed that she showed apprehension in the presence of her husband,and recorded that in her notes. " It was clear to all present observers ( two nurses were present ) that Eunice's wish to stay was motivated by fear of Chris' and his potential to be violent. (she ...) Admitted to it by shouting at him while standing in a corner" She was offered admission which she declined. The day before her last admission the Inquiry report states...' Both had telephoned the on call worker at the Day Unit'. 'There was a report that one of them had a knife'. [ The Inquiry Report does not say whether this was explained - who reported it, to whom and for what reason. ] The psychiatrist asked to visit about this noted..." Police have been, both are drunk. no evidence of a knife . Police not overly concerned...." During the last period of Eunice's hospital admission there was an abusive exchange he pushed a stool about the ward. Previously out for short period, at the time of her death Eunice was still a hospital patient on an overnight leave at home with her husband Christopher. She was believed to have sufficently settled down on medication - not described. When she did not return to time, the police were informed and entered the house. Eunice was dead, strangled and stabbed with scissors; Chris was unconscious. He died later. He had toxic quantities of a variety of medications in his blood sample. The lethal one probably the tri-cyclic anti-depressant medication which he had accumulated in the house over a long time. There was no evidence of any medication at all in tissue samples from Eunice. The Police found and removed over 10,000 tablets from the house, mostly from old tablet regimes, but some of the last preparation (clozapine) , which Chris was supposed to be taking - but which he had earlier talked about stopping. Because of these doubts he was being given at least one supervised dose a day at the day centre which he attended regularly. Some five weeks earlier two social workers, visiting the home whilst Eunice was in her last hospital admission, seeing tablets loose and exposed to view, had searched the home, and found, collected and removed, a smaller but very large amount of medication (half a plastic bag ) which was not listed by type, but destroyed. Was the family doctor informed of this ? The letter to the Chair of the Authority which instigated the Inquiry has this to say. " You will see that we have concluded that the care and treatment provided by the services for these patients was thorough and of a high standard, meeting all the expectations of central NHS policy and guidanceon the management of people with persisting mental disorders. And yet the outcome was the one all these policies seek to avoid. To us this means that there are times when trying to find someone to blame for unpredictable events is not only wrong but may be very damaging to the people involved". [ italics - this editor ]	E-mail reaction is welcome mica@didgy.freeserve.co.uk

Review Dick; Watts