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M ental I llnessC oncernsA ll | Winship is an example where an early diagnosis of schizophrenia was possible and necessary, but never happened. Early and continuing awareness of the possibility of schizophrenia, as the broader picture of living style does not cohere, and a thorough reconsideration of all the observations that can be gathered in, is required. It is the 'off duty# behaviour and remarks that are likely to show illness. Early intervention and obtaining engagement with that is not an easy answer to preventing chronic illness, nor always possible. His early childhood sees his father depart into drinking problems,leaving him and an older sister,with his mother His schooling gives no problems until higher education when his application and attention deteriorate At sixteen he leaves home into his own digs. From then until the tragedy when he is twenty , there are many contacts with the psychiatric services, and some psychiatric admissions. Often he is affected by alcohol. One junior doctor queries 'alcohol hallucinosis'. He does raise 'pseudo hallucinations' ( talking of hearing voices and killing his father ) but his account does not convince a consultant. To his GP 'he felt his ears were attached to a power source with someone turning him on and off . Referral, to a physician later, this is attributed to a side effect of medication, but which is not stated. Winship is not hang out with peer groups or companion , or any particular life plan,and does not get into drugs. He drinks , sometimes injures himself, and sometimes overdoses. He is prescribed the major neuroleptics but only in their minimal dosage, sometimes a hopeful and ambivalent presciption for persistent anxieties and uncertainties, that are inexplicable and just may turn into psychosis. He is referred to an inexperienced clinical psychologist who holds him in weekly sessions for months, discussing what goes on, occasionally with the psychiatrist and her supervisor, but then leaves post, at that time she feels he is becoming fond of her. A community nurse then maintains contact in a supportive way. Consultants see him from time to time. There is never a full team discussion and review. The CPA process is not in vogue yet. ( 1997 ! ) He drifts along without any settling into work or higher education or social ties. He visits his father - by now in a sheltered hostel for alcoholism - from time to time, and his mother at home. He stabs his father who dies. Social workers are rarely involved except an occasional 'sectioning'. The family are never approached for any observation or opinion about his behaviour when out of reach of the structured style of the professional examination. Nor do the Inquiry Panel report on it's contact with them. There is no account of the tragedy, or the trial. The forensic psychiatrist from the medium secure Unit which holds Winship - for the Court - finds a clear account of schizophrenia and says that it is likely that it has been present fro the preceding two or three years. Winship goes back to the medium secure Unit . How he has got on there with full medication is not reported - w aweaknes of these Inquiry reports, for 'secure observation, trial of full medication point to what might have been possible The Mental Health Act has risk to own health, or to othe people. Somehow the latter is attacked by professiona opinion as being a dominant risk that the governemnt wants to put in as the prime reponsibility of the mental health professional. But the foundation of any sectioning is that there is a mental dsiorder of sufficient nature OR degree [ Blom Coper; Robinson. ] which promotes illness behaviour. Where that illness behaviour - points to a risk to others tha is in just that fact also a risk to the ourcome of the management of the health of the perpetrator for subsequent treatment will be at the disadvantage of the loss of reputation.
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