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OS was convinced his wife was or had been unfaithful with the husband of her sister. The conviction persisted over years, fluctuating in severity of preoccupation, sometimes aggravated by alcohol, leading to disharmony within the marriage, with a tendency for OS to be critical of the wife in her leel of appreciation of him, in comparison to her appreciation of others. One of their three children was severely disabled from birth. The disharmony led to the wife considering divorce and separation, but nothing came of that. He also acknowledged that he had 'dreams'which showed OS standing over the brother-in- law in a pool of blood. He had also assaulted his wife ,sometimes after alcohol,There may as well or may not have been some indications of depression about this time He gave an explanation as to how he thought the conviction arose; he believed because he had called his wife 'fatty' on occasion, that this would have pushed her into a relationship with someone else. On one occasion the wife thought he had tried to smother her. A forensic opinion was sought and agreed this was an obessively overvalued idea rather than a delusion. Following an attempt at reconciliation with the brother in law during an extended family celebration - that the matter could now be put behind them - the brother in law asked that OS should ackowledge to the brother in law, that there had been nothing between the brother in law and OS wife - so that there never had been anything to be put behind them - OS became enraged , expleted and lunging at his throat , with a broken glass, injured the brother in law so that he needed 30 sutures. He went to trial for this and served 200 hours community service in a charity shop, but was not put on Probation. Continuing in a rather fragmented attendance with the mental health service from which the psychiatrist eventually withdrew - thinking enough had been done, following a referral and an acceptance of and attendance at sessions with a clinical psychologist, the contact rather petered out without any fallback situation being established. During one session OS commented that he had phone calls when nothing proceeded. OS was probably prescribed an anti schizophrenia medication - olanzapine is referred to - in small dosages. The psychiatric service is criticised for not getting 'collateral accounts - that the false accusations wee continuing - and for not seeing the wife/partner separately to get the same observations. The mental health Trust is criticised as a whole for inadequate leadership and poor supervision, and for relying too much on locum appointments. Some weeks after the completion of sessions with the Psychologist , OS stabbed his wife many many times. His sentence was lifted to 'for life' Psychiatric Reports to the Court put in mitigation on account of his mind being disturbed for that, but without recommending any hospital consideration - there was no established medical mental illness, that could be dealt with. OS was sentenced for homicide to eight years in prison, extended on appeal to life imprisonment. Comment Abnormal jealousy has always been a difficult diagnosis to apply or manage. One is always apprehensive about the outlook for the wife . A consultant here ruminated in hindsight that he might have told the wife - this degree of jealousy never goes away - so leave . The first thing is to eliminate any underlying 'medical mental illness' - schizophrenia or affective illness, usually depression. It is not clear that this was achieved here. The progress of the jealousy needs to be matched against what is going on otherwise. If it waxes and wanes with sleep disturbance affective illness is to be tried as a working diagnosis. Poor sleep is reported. Here the GP initially gave OS a tricyclic prescription, but as often with GP management of psychiatric conditions the dosage was tentative and insufficient for proper trial. A proper and appropriate trial is an adjunct to deciding about diagnosis. A consultant tried medication for schizophrenia but also in a less complete regime. in insufficent dosage or duration to call it a diagnostic trial. Making a connection between calling his wife fatty as the start of her alleged extramarital goings on seems more like schizophrenia and in some support there is a hint of a more elaborated paranoid outlook when he commented to a clinical psychologist that he had received phone calls with a background noise but no voicing, on occasion. Many of the Inquiry Reports fail to settle a diagnosis, as though this is a lesser consideration; diagnosis does underpin a basis conclusion for what work would come up in continuing care; without one there is no general clinical lead. If this had been labelled 'pathological jealousy' - that it was 'pathological' would have been a worry to be borne in mind It would be proper and useful, following an Inquiry of this sort, for the Trust to keep up a follow up contact , to know the outcome of the further obsercation in custody. The Panel spoke with OS, were not impressed that he wasbeing open, and their 'quotations' do not suggest anenduring illness; but they note his continuing misbeliefs, also the lack of remorse, only regret; some thing in their summary suggests there is maybe underlying paranoid schizophrenia. They do not seem to have obtained observations or a diagnostic feeling, from the prison staff. The Panel appreciates the difficult and unsettled setting within which all had to work, but is still surprised at the absence of any mutual support or coherence in team working and cross relationships within this institution. It is rightly surprised at the absence of any continual risk appraisal and correct in concluding that the wife ( and others ) should have been seen on their own more . Perhaps an absence of social worker activity in this institution. Nevertheless, nobody really knows what there is to do or to be doing with people who have this enduring condition. Back to Home Page Back to Inquiry List