KG was brought up in North London by his mother, with a half-brother ten years older, his father having split off, but keeping some contact with KG. His jamaican mother was led by her religion. KG had a restricted childhood , without birthday celebrations and some 'belting' . He went into Social Services Care aged fifteen and into petty crime and youth indiscretions.

KG suffered from occasional fits .

Awaiting trial for theft KG was held in a second medium secure Unit - a temporary first medium secure Unit placement having started medication for schizophrenia. The second Secure Unit consultant suspended the medication, and at the trial, reported that a drug-induced psychosis was most probable. The Court preferred that diagnosis, sending KG to prison .

He again showed signs of persisting mental illness. He became floridly ill with grandiose delusions, but also extended pseudophilosophical perplexities. He believed a computer could speak to him. His demeanour in prison was frightening; often because he did not recognise his convicted position and conform to that.

The expression of mental illness in prison continued for some weeks. It again responded to medication for schizophrenia. The illness became recognised by visiting psychiatrists, resulting in a Mental Health Act (MHA) Hospital Transfer Order (Section47].

Then he moved to the general NHS mental illness services.

Because his prison sentence tariff was ending, the Hospital Order applied was the Section 47 Order, because this would continue as an ordinary detaining section of the Mental Health Act.

In effect it amounts to an ordinary MHA section except that the nearest relative could not discharge - the Responsible Hospital Medical Officer ( a hospital consultant ) could discharge and grant leave, or the Hospital managers, or an appeal Tribunal hearing could discharge. As after ordinary MHAct Detaining Section, after-discharge care support arrangements should be put in place between hospital and Local Authority social services, and the need for them reviewed between those services. The obligation to end aftercare has to be agreed by both Health and Social Services.

All this moving between care services may acount for the lack of confidence in naming the disorder that KG was expressing .

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KG was in hospital nearly two weeks, on a secure ward. He was visited by his mother.

Prison transfer orders are laid out in puzzling text. There is reference to any reclassification of mental disorder having to be in the same category.

This may have misled the receiving hospital consultant RMO into mistakenly adding a MHA Section 2 Assessment Section Order to the Hospital Transfer Order, on the day after KG arrived at Hackney hospital. As a consequence of that Section, a community social worker was involved and assessed KG, and saw his mother.

KG had settled sufficently, with medication appropriate for the treatment of schizophrenia, for the staff psychiatrist to anticipate that a Mental Health Tribunal would remove any Detention Order the next day. KG was released from his Hospital Order and moved to an open Ward by a hospital staff psychiatrist in senior training who did not have the rank to act as a Responsible Medical Officer ( Mental Health Act RMO ) with the authority to discharge. If KG had gone before before a Tribunal for the Tribunal verdict, it would have been necessary - to inform the Tribunal - to prepare a social work report on appropriate aftercare arrangements.

KG immediately absented himself from the hospital, and the system lost him . The Inquiry is critical of the absence of any subsequent aftercare activity. Discharge after detention - even after an absconsion - requires an aftercare procedure ( MHAct Section117 ) agreed between Local Authority Social Services and NHS mental health services, with an obligation to have a keyworker continue to try to achieve what could be done to retain contact . He spent a day or two with his mother but could not be persuaded to return to hospital. He left home and became 'homeless', but visited his mother 2-3 times a week. He returned to street available drugs.

A month later he accosted his mother at her home, argued with her about religion, and stabbed her.

Review Mishcom; Grey

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