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M ental I llnessC oncernsA ll | So many words produces no satisfactory answers. The commissioning body did not want the Report made available. Some elements in his trial pointed to a leak from a clinically confidential record. These things annoyed Stone and his sister, as they were used to underlie media presentations, and what they saw as hyperbole in the prosecution barrister statements, prejudicing his defence. Nobody gave an authoritative clinical lead with an authoritative clinical diagnosis, which stuck and guided psychiatric reaction. Nobody wanted him under their direct continuing responsibility for a long term, because, although actually fairly well behaved on the ward, he had a history of violence - indeed the fact that he had used or claimed to have used a hammer, threatening violence, was a factor in the final outcome. During hospital admission periods, he was largely conforming and acceding, even affable and likeable. He visited or contacted his mother almost daily. She often accompanied him but was not often seen on her own, her views on what was wrong with him not recorded in any detail , nor is much of his behaviour detailed from her experience, or that of one sister out of five (half) siblings, who was also in contact. Stone had a previous surname G .... which came from the man who was thought to be his father. Stone was difficult to bring up during childhood. He may have witnessed serious aggression by the step father. He had a truculent later childhood, going into care, and moving from then into street drug culture, and criminality. He had criminal convictions and a record of violence. He said in clinical confidence that he felt an impulse to kill children. He declared himself fearful of attack from criminal associates. He said he had wired his house against this, and owned a gun. He claimed a high income. He took street drugs and became addicted. He accepted help for that both as an inpatient and with a regular supply of a narcotic substitute, but was not for long clear of heroin and cocaine with which he used and dealt. He was not arrested during the last four years when he was engaged with psychiatric services He visited several doctors to get prescriptions for benzodiazepines. The general psychiatric admission service did not want him, exprssing staffing shortage, and the history of violence. The old mental hospitals would have had no difficulties. There, the many wards - one usually locked and with seclusion practices, meant that extra nurses could be summoned up readily in critical times. During an earlier period of prison custody the diagnosis of schizophrenia was applied. Medication for that condition was continued thereafter, but maybe not continuously; subsequently by depot until and after the final event. Subsequent management was less for schizophrenia, more for the variable drug abuse. The clinical lead was towards substitutive maintenance drugs. But the question of 'mental illness' arose around the psychiatric management before the tragedy, particularly very soon before the event when a community nurse who knew him well described his conversation with her as bizarre - without the Panel telling us how that was assessed - which raised again the diagnosis of schizophrenia. Some backing for this diagnosis is the return of uneasiness during the days just before the next depot injection was due. The day after he spoke, ordinarily. Psychiatrists never said clearly - going to prison will not damage the prospects for any treatment. Sometimes with the addition - we are not provided with the service provision nor the resources to cope with this, nor do we have access to treatment which can keeop him over a long enough time away from his unsettled community life style, so we do not accept him. People who are socially inept and do bad things can be called 'a person behaving badly' or they can be called 'behaving from an abnormal personality' In both cases the basic provision for changing the behaviour is limit setting and challenging beliefs, in a contained setting The Dutch 'inderminate sentence' is one model. The present system of early release from prison is not dependent on any self analysis or future change of ways. It is not enough to state that this person has an abnormal personality, and we have no treatment for this. The sine qua non of starting treatment - where going without it leads to repeatedly adverse consequences and that is shown by previous experience, is confinement. Long enough, under authority, that is an adequate observation for a full assessment, followed by a care plan, which establishes where the lead to future decisions then lies, and provides the only context under which the patient knows it can proceed. That to be achieved, the next decision is where future containment can be accomplished. It does not matter treatment-wise whether that is in a prison which allows for a situation like Grendon Underwood, or secure psychiatry, or a joint placement, from then on in, the person is contained under some rules and consequnces laid out, able to be carried out , until a consensus emerges and a programme is confirmed. This publication is now in the public eye six years after it was completed. Stone continued to see the NHS services for a year after the event without anyone associating anything he said with the killing. Nor was any change in attitude seen. Stone and his family do not accept the verdict. The Court finally accepted the observation of a prison inmate that he heard Stone making statewments that pointed to his knowledge of the tragedy at the time of the tragedy.go to final comment
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