M I C A	SH largely remains anonymous. His closest observer during his illness life is his wife seven years younger - an arranged marriage, herself raised in England, SH split between Bangladesh and England; the East end of London, Eastham.'. This area previously served by a hospital thirty miles away, Runwell mental hospital near Southend, which still holds the local 'intensive care psychiatric Unit - PICU - whatever that means. The local mental health service is now based on three sectors, supported by out community mental health teams which seem to be LA Social services led - at least when they are mentioned here it is social workers who speak for them. with admission ward in-patient beds at the local hospital with a day centre attached. The local community is half non-white. SH has a younger brother, known to the local service, who suffers with active schizophrenia, sometimes 'violent' and and he is known to the community team, who curiously subsequently never hear about SH, although at one time the two brothers quarrel extensively brandishing knives, an incident to which the police are called five times. SH is also involved in an incident at a police station when he is unable to get satisfaction about irregularity with his driving licence and the address it shows. That develops into a scuffle, and seems to have occurred around the time that SH starts with his active illness. There is another personal circumstance thatn the |Inquiry does not reveal which pertains to the relationship between SH and a business partner, leaving SH with persistent paranoia in some form, and also guilt . A GP family contact crescendos and SH is admiited quickly though a referral to community mentalhealth team - the constituion of which is not made clear. It is decided at the admission Unit that he had better be observed under an Observation order. Neither medication nor diagnosis has any mention. There is one risky but never executed suicidal attempt. Paranoia is noted but not quoted, or described further. The Consultant downgrades a ward doctor discharge letter to the family doctor. It contains no clear diagnosis. There has been no substantial opportunity in the in-patient stay for an exchange of views with the wife, nor any advice to her, nor any future offer of support or contact, or help offered to her. [ criticism of the attitude to carers ] The GP is satisfied the diagnosis is schizophrenia and is left to continue to manage by himself when a folowup out-patient appointment is not taken up by SH. There is no handing back to the original community mental health team. The family doctor accepts that. He is on his own. He prescribes haloperidol 5mgms once daily, which it is known to hom that SH takes it irregularly. This goes on for two years It seems SH goes regularly to the surgery when his wife attends there on her own behalf. She says nothing untoward about SH. After the tragedy, a sister-in-law does decribe domestic violence based upon unfaithfulness. SH has by now become pre-occupied with islam, and makes a pilgrimage to Mecca with a london sufi islam advisor, whom he sees daily. SH strangles his wife. He is declared mentally unfit to be charged at the police station. A Section 2 is created but cannot be proceeded with because the local hospital named has no security and declines to accept him. A bed is negotiated. There are two in-transfers for the price of this one out-placement.with the distant 'intensive care unit', and - surprise - the local nearby medium secure Unit unusually now finds a place within seven days. Altogether a bad show. Another carer failed, and killed. Comment Holwill; SH

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