M ental I llness C oncerns A ll	It took some time to get this External Inquiry in place. It was unclear that Hotson (MH) was mentally ill and unclear that he was in direct contact for that with specialist secondary mental health services. A homosexual man, he had just left a long period of steady companionship, and was going through difficult personal times. The contact between the perpetrator and the providing mental health Services was at such distance as to be difficult to ascribe to it a responsible involvement within the guidelines of the Department. There was no direct line in herarchical supervision or accountability. In fact, this difficulty also categorises the fault lines within what was offered to Hotson. Nobody was able to make a line of help decision which brought him into the kind of engagement with continuous mental health care that had a future commitment within it. In large part this was because Hotson had not established himself in any independent way. He had no secure base, and no settled companionship, and no settled employment. By the time he came to the notice of mental health services, other than in passing after overdosages and self harm, he had moved from a hinterland he understood and in which he had sustained a long personal companionship, if one that eventually gave way, into homelessness in London, attracted there by a 'gay' march, and then soon into a Hostel for the homeless and unsettled. This Hostel had recognised that a certain proportion of its customers had mental disorder, and to help deal with problems that might arise from that, they had a support service from an agency and within the agency team which gave this service, a community Mental health nurse and a clinical psychologist.That was the strength of the mental health service involvement. That, and an incomplete psychiatric assessment by trainee medical psychiatry following an accident & emergency attendance after cutting himself and an overdosage, was the specialist mental health service. [ The Department of Health held that was enough to engage its general Guidance - that where someone with a mental disorder has recently engaged with specialist service and there has been a homicide - there must be an External Inquiry. Here this was not at first recognised by the commissioning Health Authority, and both the Internal Inquiry and this External inquiry was delayed and potential witnesses left in uncertainty. ] The Inquiry recognises this and justifies its acceptance of the remit, because it finds that lessons can be learnt for the greater service, and because those lessons include that the Providing Trust - who did not seek this Inquiry thinking their contribution too little - provide a proper pathway for supervision, accountability and responsibility, even in services to this world of the demi-monde. It also wants to emphasise for others that a risk assessment should always be made and should be given enough of an airing. It finds insufficient persistence in the staff relationship with MH The Hostel had adopted some of the routines of a helping institution - each resident had a key worker with whom they could work out solutions to personal problems - but when it came to passing on a problem beyond their resource there was no confidently established link or route in, and in due course nobody stayed the course. Neither the community psychiatric nurse in the backup team, nor the clinical psychologist were able to keep MH engaged. MH was a problematic resident, sometimes aggressive and prickly, and he did not stay with 'professional contacts' so as to relate his style and reveal his position in current relationships. It seems these were at a level of sado-masochism. MH has lost the companionship of one friend - the eventual victim - whom he did find whilst living at the Hostel, then replaced this relationship with a new arrival at the Hostel, who has possibly previously been in the care of mental health services elsewhere. The week before the tragedy MH is offered a flat. The day before the tragedy MH has a fisticuff exchange within the Hostel. He gives up the offer of the flat and quits the Hostel with his newfound friend. They visit the victim - previously a friend - at his flat, attack him after drinking, bind him, then MH robs and uses th credit card to obtain money. The pair return to the flat. The victim is stabbed in the neck and killed. They remove some possessions. The next day they collect their belongings from the Hostel and move back together to the locality where MH grew up. The police make contact with MH when they find a telephone contact in the flat of the victim. MH confesses his being on the murder scene to the Samaritans. MH and the new friend are arrested, tried, found guilty of murder, and go to prison. Home page Comment Price; Hotson.	E-mail reaction is welcome mica@didgy.freeserve.co.uk