. Mischcom; Hampshire
Mishcom; Hampshire

 

 

 

M ental

I llness

C oncerns

A ll

 

A middle class school head of department married to a teacher ; four grown-upchildren in professional careers .

An illness developed late, and at the time of the tragedy was being managed as an out-patient , with a community mental health nurse visiting .

It seems at first the the Regional NHS executive decided that it was not necessary to hold either an internal or an external Independent Inquiry .

Angry pressure from the grown-up children may have brought about the Inquiry thus held two years after the event .

Although admitted to hospital twice , the Inquiry does not describe a working diagnosis, and spends two pages going over what it might have been, and itself coming to no satisfactory conclusion. One admission was to a 'better' hospital decently away from the catchment area where he would have been 'known' .

The Inquiry says nothing about the conclusions drawn in that in-patient admission other than quoting from a discharge summary ...' relapse is likely if medication is not maintained'. Yet this conclusion - after a spell of in-patient observation - is the crucial period of psychiatric assessment which should govern whatever follows. The succesful medication ought to be described. The progress of the illness describes nothing but schizophrenia . The course is nothing like autonomous affective depression with its clear-cut intervals of normality. There was none of that here, even if self neglect and inertness were features.
IIlness trajectories are important in a dignostic conclusion, and looking back over a longer period,ofteh clearer than when in the middleof the condition and its context.

Those dealing with him later, without the map provided by a decisive diagnosis, faced with a respectable citizen using his authority and his subservient and dutiful wife, found it impossible to intervene, with what was the only possible way to obtain control over this illness ; a hospital admission - detention and Treatment Section of the Mental Health Act. They could not - from their own observations find an adequate basis. Whether they took the trouble to look for the significant observations of others, is a matter which might point to the lessons that have to be learnt.

Some of the irresolution lay at the conditions detention would have led this middle-class patient into enduring . The Inquiry visited the likely admission ward , and found the working conditions a disgrace . Also leading to indecision was the belief that not enough illness activity was being disclosed to prevail and define a 'sectionable' illness .

It was appreciated that the spouse was in difficulties, but no precise observation was ever given that could have clinched a reaction. The victim could have spoken. She was often with the visiting nurse on her own.

In the final year the children are described as having withdrawn - innured to nothing having been doen going on to nothing can be done. The Inquiry thinks they could have done more, could have entered the observation arena more. It is hard to see how. They were not approached directly , or given an entry procedure agreed upon, or told how to intercede with something which they were asked to look out for.

The Inquiry condemns the Health Authority for not going to look at what service they had purchased ; and reproaches the providing HealthCare Trust for the conditions they obliged patients to endure and within which they expected the professional staff to work .

The catchment area was 80,000 , served by one consultant. The mental hospital which served them was archaic, and being run down to prepare for community care .

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Review: Main-Hampshire