M I C A	Inquiry Gledhill; Janes This is yet another poor care management of someone suffering from schizophrenia, by people who open their hands and say ill but not clear enough to warrant compulsory intervention. Usually nothing happens. Here, eventually, another sufferer is attacked and killed. There had been a previous axe attack which was intrinsically dangerous and insufficiently explained or accounted for. Janes had been ill since mid teenage, but it was not fully and conclusively declared that he was a sufferer from continuous schizophrenia. He took drugs and alcohol continually, and was never isolated and supervised enough to ever have an uncontaminated clearcut diagnosis. That might then have achieved full recognition and a reflective decision that what he required was a long period of containment somewhere , off street drugs completely; and then a full re-assessment of how much or how little the illness could be cleared away under medication, and what level of chance there would be of sustaining him, when in a community. Informal status was preferred, a position always difficult for ward staff, where there is doubtful understanding of that status by a patient with fluctuating capacity and an uncertain diagnostic categorisation, without any consideration as to whether this was to his longer term advantage. It was not. Ward staff found him a nuisance, unco-operative and unbiddable, when in fact he was probably unable to make a well relationship, because of his underlying continuing illness. That should have been addressed as the major psychiatric disorder, but gave way to recrimination about drug misuse on the ward - being treated in the modern way - assuming sufficient capacity to answer for his misdemeanours, and being told he should leave if misbehaving. 'Drug induced illness', and 'drug psychosis' does not obtain sufficient rigour from professional attitudes in admission wards under perpetual strain from active illness admissions and bed handling pressure. Ward staff do not get clear leadership from medical staff under these circumstances The ward staff saw only a passive if awkward degree of compliance in a ward setting. This led to an insufficient look back at the 'axe' story. Nobody thought to ask family whether there was a different story when he was out of routine supervison and structured living. His mother could have told a different story of active aggression and hostility when obstructed. As is almost usual now, the family account, experience, and viewpoint was never sought or valued. Neither the health contacts, nor the social service work, nor the hostel managers of the mental health charity that eventually accepted his discharge, that eventually allowed his placement, ever asked for the opinions of his mother, who was often in difficulties with him, and often anxious about the younger children in her family, when he was about. The consultant seems not to have declared any opinion about a risk assessment. Risk assessment escaped thorough review. That there was a CPA care plan seems to have been accepted by the non health people as sufficient declaration that there could not be any significant and overlooked apprehension for his eventual placement. Four days after moving into the Rethink Hostel, he was in an argument, went off and found a knife, and killed the other resident in the conversation. Rethink did a prompt think over what had happened and what to do another time. But so far as other inquiries, only a slow dragged out attention to the concerns from the mother of Janes , prompted continually by letters from his mother. She wanted an explanation and some satisfaction about the course events had taken, especially as her opinions had been much less sanguine than those of the various agencies dealing with her son. The 'Edwards' decision does not really help the concerns of the family of the perpetrator - although they and the perpetrator are equally victims in disasters like this, and some sort of account and reassurances is required. Review Gledhill; Janes Home page

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