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Several unusual things here .
The mother of L. seems to have suffered from an active untreated schizophrenia illness throughout L,s childhood . Able to keep the children neat and tidy and regular at school - where they got meals, the Inquiry found many times when the children were not given motherly attentio .
The children had no child-centred social worker - although the youngest child was removed into care.
There was a 'family social worker ' in regular contact.
The father separated from the marriage when L was three ,and eventually the parents divorced. He had no base to offer the children as an alternative domestic option. He did challenge Social Services about the family conditions, was often dissatisfied and verbally aggressive.
Adolescence brought L to defiance and resentment. He left home. He kept in touch with his elder brother ( later ill himself ) but could never establish himself independently. He turned to theft for the means for this, was caught, and went to prison. There his schizophrenia illness was noticed and he received medication. He was assessed by forensic psychiatry who observed that his offences were likely to have been associated with his developing illness. Later the medication was reduced and his illness returned. A Mental Health Act Transfer Order was applied six months into his four year custodial sentence, and he was transferred to a small medium secure Unit serving his catchment area. Re-introduced, medication settled his illness quickly. Still under custodial sentence - so that he could not be resettled at once in his own neighbourhood - he was transferred to a private secure service at Kneeworth House some sixty miles away. His local Unit did not have the 'beds' to retain him in his natural area.
Some time during his stay at Kneesworth, the catchment area Forensic Psychiatrist who had first assessed him, visited and recommended that L. be returned to his catchment area general mental health services, to continue his preparation for reinstatement . Home Office refused this .
There were visits from his family, from the aftercare Social Services in his catchment area, and from the catchment area general consultant psychiatrist. Some months before his Court sentence ran out it was decided that he would be unlikely to maintain medication after discharge.There were side-effects. Medication was withdrawn. Seven months later some 'at odds ' behaviour returned - suggestive of a return of illness according to the ward - confirmed by other incidents later, but it was not considered sufficient to invoke a detaining MHA Section 3. Treatment Order under the Mental Health Act .When his custodial release date came up, all future help would have to be with his agreement. The catchment area general Mental Health Service consultant could not be present at the pre-release final Section 117assessment. She had seen L before this in the hospital when visiting other patients from her catchment area.
Because he was subject to a Hospital Transfer Order he required Section 117 after-care preparation and Social Services support after discharge. The final pre-discharge meeting decided that aftercare arrangements were to be supervised by a catchment area Social Service key worker .... [ key workers coordinate aftercare plans ] . Resettlement would involve rehousing, help with finances to setup a dwelling , help in taking up the threads of normal living. The support worker who had met him in hospital left his post .
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Pre-discharge contributions from his Ward Manager included ...'symptoms' ...'coming out of remission' ... 'increasing potential for reoffending' ... 'a danger to himself and others ... if he remains medication free'
... 'I feel the preferred option ... continuing rehabilitation via the psychiatric services' ( this writer italics )(*!)The local catchment area mental health Approved Social worker recorded from the meeting '...he has stopped all contact with his family, believing them to be against him....' He is not interested in participating in after-care .. i.e. ... with Outpatients appointments with Dr B .'
and the Inquiry Report ... 'No family members were present, at S.L's request.' At the ( pre-discharge ) planning meeting it was noted there were insufficient grounds to warrant his detention ...... The Inquiry Report notes ... 'No consultation with Dr B ( the locality general consultant psychiatrist who had last seen him in May1993, when he had been off medication for 6/12 and was shortly to be showing signs of relapse ) or his family doctor took place prior to S.L discharge and no date was setup for a future multi-disciplinary review ...' L was attached to support contact within a Local Authority Social Services Centre which had a homeless support service and an adjacent day centre. L was found a flat, very meagrely furnished with bare essentials by Benefit Agency money. He used the Centre as a drop-in contact, and a place to discuss any problems with support workers, one of whom visited his flat. One of the specific parts of the aftercare plan was to watch out for signs of more active schizophrenia illness.
The contact at the Centre did not reveal a change towards active illness, only confirming the basic level of illness noted at the time of his discharge .
L never attended Out-patient Health psychiatric appointments, sometimes because his address changed, and he did not receive the dates. He was reluctant to attend, known to have an antipathy with B., the catchment area consultant. The failure to attend Out-patients precipitated a Review, called in and conducted by the Health element of his care, who had not yet been able to see him. He did attend a this poorly constructed aftercare review meeting, led by a junior doctor who had not previously seen him, who made accurate observations at the meeting, but was not able favourably to engage L or the Social Service people who attended, before she was called away.
Soon after this, the Social Services representatives decided that their services to L were complete and recommended release from their aftercare supervision. This release from Section 117 aftercare provsion requires agreement by the Health Service involvement . This was signed by a locum Consultant who had never seen L.
L continued to drop in to the social Centre, and it was on one of these visits that he picked up a casual piece of talk from an attending patient, resonated this into delusion, and later attacked and killed the person to whom the remark referred.
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