M ental I llness C oncerns A ll	This editor finds it impossible to summarise the Inquiry evidence in it's examination of the complicated care management of these two people. The Inquiry examines the same mental health service that looked after Shane Bath, someone also with an abnormal personality, and the Inquiry comes to the same conclusion. The mental health service offered is unsuited for the task it accepted When faced with a complicated aberrant behaviour pattern, outwith a sound and agreed basis of psychiatric illness, categorisation, formulation, and clinical management flounder and fail to find the way through. Multi-disciplinary interventions are too difficult to negotiate where there is diffusion of command, when no single leadership is given the authority to structure what the many contacts on the ward should realise, be given the time to go through all the reports, balance their import and come to a conclusion which can govern future interventions. Coombe is seen on remand in prison, aged twenty four, for a psychiatric opinion after a penultimate offence of theft and robbery. He has been previously before a court for minor offences A curious episode there is not given enough weight. He slashed another prisoner - found to be at the prsioner request - but still rather telling, The consultant psychiatrist called to advise the court recommends a period of admission for observation to fill out the picture. It extends to six months of interventions to define his situation, during which time no definition is reached. The breach of normative behaviour is never marked by any consequence.   This Inquiry team took on the examination of the care and treatment of McMahon in the same service and found that service floundering when faced with another abnormal personality, unfitted into the community around them. McMahon had been noted as violent in his past. growing up in the midst of paramilitary activity in which he took part, he had been injured during a punishment shooting in Northern Ireland, left that province to come to London, and subsequent alcohol abuse interfered with his living. There were two episods of violence . After one of these, he was given a sympathetic diagnosis - post traumatic stress disorder - without any consideration or assessment of what he was 'up to' before the 'punishment' was handed out by those who evidently knew something about him, nor what might have led to that punishment. Coombe was never registered as behaving violently, but was known to fantasise elaborately from his early teens onwards, about a twin, and about master criminal activity. He was unseemly and intrusive when addressing female staff, mant different womedn finding him uncomfortable to be with. In one group session when asked about his relationships with a female he said he would use her and the next day drop her. It turns out that this might have been a sign to be held in mind. Other comments are retrieved by the Inquiry pointing to uninhibition, especially after drink. Coombe would have escaped any actuarial account of future risk. If in that, McMahon would have been classified as in a risk potential. But that does not help when making an individual judgement. What is left is only uncertainty. Neither Coombe nor McMahon had a personalised CPA or a formal expression about future risk. Here, full family and social history was never obtained. Coombe's mother visited regularly. She found the setting of a team meeting intimidating. The system was unable to meet her on her own ground. That's a common feature in mental health system failures. The Inquiry Report finds the service offered to both well meaning, and not up to the job. It has no leadership, and no secure practice. It's relationship with the criminal justice system is misleading and unfortunate. The conclusion in this double Inquiry Report, together with that on Shane Bath earlier in the same service, is a profession and a service at a loss in what to do . A majority determined not to accept responsibility for what they expect will be failures in treatment. What treatment? - they say - and do not offer or undertake any. Better to let them go. Until those of them - which we cannot foresee - commit a serious crime. Then we may say they have a mental disorder, and should not go to prison, but to a special Unit or special Hospital which will keep them there until 'time and the hour' moves them on to some kind of recognition that they can mend their ways. Ward management, decent and worthy, but outwith authority, not inside any system for exploration and challenge and exposure, considerationis what both Coombe and Mcmahon got, and psychological assessments. Both men were sent to prison when they killed weaker people who did not know them, and who meant little to them. Coombe killed a female, a fellow lodger around some sort of sex. McMahon killed a dosser around drink What to do ?   back to Inquiry linking       E-mail reaction is welcome mica@didgy.freeserve.co.uk