DN had a strange start in life. His mother had her first child when 16 ( J, DN's elder brother ). He went to be brought up by his grandmother. DN was born later (1970) from the same father, and when aged 5 his mother abandoned him at a police station so that he was from then on in the custody of his father, but in fact came to be brought up by his paternal grandmother, the eventual victim. He was fed cannabis from early childhood, and took to that and other street drugs after fourteen. His father 'dealt' in drugs.
DN was convicted on a charge of Grievous Bodily Harm ( GBH ) in 1992. Whilst on Remand aged twenty his mother telephoned the young offenders institute to say she thought he had paranoid schizophrenia. The offence was strange in that the person he assaulted was the uncle of a child travelling with him. DN attacked the uncle and removed the child because DN felt the child was being abducted – by the man who was his uncle – the man assaulted by DN.
There had been two previous attacks –on his older brother, and an uncle, which DN told the Inquiry were set on by misbeliefs of a religious and paranoid certainty the details of which were not revealed to any psychiatrist who examined him for the later Court appearance of GBH.
The relatives probably withdrew any evidence.
For GBH offence he went to a private mental hospital which provided security, subsequently transferring the a Medium Secure Unit in the Hackney catchment service.
He received medication there and in prison awaiting transfer, medication which was that which would be given to someone suffering from schizophrenia. He was reasonably well on that. He decamped two weeks before he was due to be released. There was no proper release summary and accordingly neither family doctor nor the local catchment area general psychiatrist was copied with the information about the initial events nor the treatment responsiveness. When a discharge material did arrive it contained the designation borderline personality disorder.
Otherwise he was looked after for seven years, between the initial Psychiatric referral following the verdict of Grievous Bodily Harm and the final tragedy by two interested and concerned family doctors, who did have an understanding of psychiatry as illness, but less understanding of how to get an adequate response form the secondary psychiatric services. They referred him on to the local community mental health team when they felt things were beyond their service, only to have DN referred back to them without much progress in the care advised.
For a long time the key worker was an occupational therapist attached to the team.
The Community teams had the chance to take advice from an attached specialist Registrar in training but he was never approached in this case. The medical lead was in the hands of the family doctors, and it was from them that he received neuroleptic medication by depot regimes. The local consultant psychiatrist was addressed by letter only from the family doctor practice.
It seems that in the final days of his stay in the medium secure Unit he was reassigned to the diagnosis of 'borderline personality disorder' and ever afterwards as a 'personality disorder' he became a 'client' in the community team.
During a brief admission period, in june 1997, achieved by referring him to the a&e department who advised his acceptance, he was given a contract to uphold, one of the consequences of not sticking to it .. would be … discharge.
'he felt that spirits were controlling him and also entered other people –he could tell by looking into their eyes. He said that he and his wife had the spirit of the Holy Ghost in them and people with spirits in them were visiting his bed-sit in his absence to check up on him.'
Later that year DN was passed by magistrates to a higher Court, convicted for aggravated burglary and taking a car, the Court having reports about his mental disorder then sentenced him to eighteen months in prison.
The Mental Health community team closed his case.
In prison he received regular depot injections , three weekly, and his stay there was uneventful.
After release his family doctor resumed the depot regime. He had one injection at the surgery on time, and the subsequent one, eleven days delayed, seven days before the tragedy.
He had stopped taking the additional oral medication ( melleril) since leaving prison.
Seven days later DN killed his paternal grandmother whose flat he was sharing after release form prison.
During four weeks before the final and fatal brutal attack on his grandmother, DN inherited his share of the sale of his father's housespent 9000£ spending it on cocaine and a mixture of other 'recreational' drugs.
The Inquiry team became informed of several features which point to schizophrenia, especially in the detail of the attacks upon the elder brother and the uncle although this was always within a background of drug abuse. It seems that this information was never known to any of the professionals who were involved in his care.
[ Were the relatives never before approached in a way which would have allowed these revelations? At some stage under the old systems a social and family history would have been part of the team information. Not now, the 'user' - here the 'client' ! to the community mental health team, chiefly made up of nurses - is the the 'stop' in what is revealed in that relationship. ]
There-after, until the reports given to the Courts about the final offence, he never saw a consultant hospital based psychiatrist, that service, when he was eventually briefly admitted to the secondary hospital services, being represented by a junior doctor in training.
The consultant psychiatrist and the hospital team were never actually involved with the community teams.
[ "We are also concerned about the ‘them and us’ attitude that seems to exist between the
hospital-based and the community-based services, and in particular that there are poor links in
some areas between the consultant psychiatrists and the community professionals.
When we aired our concerns about DN being discharged by a junior doctor without consulting with
a more senior colleague and asked him about induction for junior doctors in respect of discharge
policies, the Medical Director, Dr Falkowski said:
“One would normally hope that the junior would seek advice, particularly from people in the community
or the ward staff concerned. If there is a mixed picture coming from the ward staff, one would hope for
more details from the CMHT. I would be interested to know whether there are any entries in the notes from
the CMHT that had been concerned with him all this time, or did they just dump him as an in-patient and
run? Sometimes the community teams expect the in-patient wards to sort all the problems out.”
Perhaps Dr Falkowski was speaking with his consultant psychiatrist’s hat rather than his Medical
Director’s hat on when he said this, but given that he is the current Medical Director, we are
surprised that his views appear to be out of step with the overall direction of modern mental health
services.
It is essential that it is recognised from the Medical Director downwards that specialist psychiatric
services must be more integrated across the community to reflect what is seen as normal practice
elsewhere. " ]
After the final offence he was examined and opinions obtained from six consultant psychiatrists. None were decisive in giving him a diagnosis of schizophrenia. They were seeing a partially treated patient, full presenatiion obscured, as well.
A hospital Court Order sent him, eventually , to Rampton Hospital. There his diagnosis remains confounded, the treatment for schizophrenia resumed, but an emphasis on the presence of remaining personality disorder .
The Inquiry Report will not have this and at some length decides against that diagnosis as being valid, and not the influence behind his crimes.
That lay with continuing schizophrenia, the care and treatment for which was inadequate in many respects.
Two recommendations (ed emphasis )which do not appear in the Press release from the Authority
: - The new Mental Health Trust should declare its commitment to MHT and the
promoting the importance of locality-based CMHTs with the active London Borough
involvement of consultant psychiatrists as an integral part of the total of Tower Hamlets
service.This involvement of the consultant should be consistent across all Trusts and will require leadership at executive team level..
: - For all new referrals to the CMHT there should be a generic MHT and the assessment which all members of the team should be trained to London Borough
conduct.This assessment should be discussed at a multi-disciplinary of Tower Hamlets
team meeting at which a senior psychiatrist should be present and
from which: ... a care plan should be developed ....