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Mr P was born in Northern Ireland on 9 July 1971, the middle child of three. He has two sisters. His parents divorced during his teenage years and his mother moved to Sussex while his father remained in Ireland. Initially Mr P stayed with his father. In 1990 he came to England to visit his mother for a holiday. He decided to remain in the UK and settled with relatives in, Berkshire. During this year he was seen by a GP having allegedly taken magic mushrooms and alcohol. The GP noted that he was very aggressive and had been violent towards his mother. No treatment was given. In 1991 at the age of 20 Mr P met his future wife, they married six years later. But the marriage broke down after seven months and they divorced in 1998. They had two sons but since the divorce Mr P has had no further contact with them nor his ex-wife. During this period Mr P reported having taken an overdose and he was seen in the A & E department at Wycombe General Hospital. Later Mr 'P' killed a girl friend with whom he had a tempestuous relationship lasting seven months. At the need of that relationship the girl friend, left. 'P' took an overdose and was subsequently offered a place in a Voluntary sanctuary with input from a crisis team of the local NHS mental health service, who were in contact with him for a fortnight, until he killed the girl friend. He pleaded diminsished responsibility but was sentenced for life He was prescribed a new anti-depressant medication insufficently tested out clinically but with the usual commercial claims [ mirtazine an ssni drug affecting serotonin and noradrenaline ] which has not been treid out enough yet to appraise either efficacy or tolerance from side-effects. fident efficacy trials behind it. It did not have time to test any effectiveness The issues are:- those of supervision at all levels , a very high use of agency people in a crisis setting, the degree of psychiatric oversight that was possible in a voluntary service; the presence or absence of Mood illness as opposed to an adjustment reaction; and the expectation that any anti-depressant is relevant in a relationship breakdown. The ssri and ssni drugs are pushed for their support in common disappointments in life., as well as being safe in overdose, attractive to family doctor prescription - the drawbacks are decsribed but have less impact. Was there a coincidence between a bout of an endogenous illness – there would have to be evidence independent of the situation or characteristics present? the sleep pattern and loss of weight, previous episodes or family vulnerability are the things to be lloked out for The panel discusses domestic violence.and the mental health services list of Inquiries Home Page back to Home Page E-mail reaction is welcome mica@didgy.freeserve.co.uk