M ental I llness C oncerns A ll	So much is not said by this Inquiry. The psychiatric admission ward seems to be in anarchic management . A drug is given by injection - presumably by a nurse - and the Inquiry can find no record of prescription or the name of the person who gave it. It has the usual over 100% occupancy and a general loss of structural application of record. ... there were more patients than beds on the ward so that some had to be discharged for the week-end to create space.... He is an adolescent in an adult Ward. The ward doctors started in work only three weeks previously. There is no named nurse system, and the intensive but belated introduction of the Care programme approach - aimed at the front line workers - has not reached this ward. It seems to have been nobody's routine to lead care. There is a team Social worker, but neither he nor the ward nurses see or notify the family. The social worker delares his team position as 'attached' rather than a team member. The LA Social Services mental health team tended to work with those patients assessed as medium to high dependency whereas those of low dependency would be dealt with if appropriate by the Social Service Access system. There was no procedure in place for getting a social work assessment to the Ward. St. was opposed to any contact with family. They have been told by St not to do so. "The Inquiry doubts whether absolute confidentiality is an appropriate goal when the welfare and safety of othes potentially is at stake". The laisser faire attitude to guidance from this Social Service contrasts with the compliance brought earlier by an 80 hours community Order and a Probation supervision for 12 months; both of which were completed satisfactorily. The consultant psychiatrist clinical lead and the nurses differ at the Inquiry as to why a discharge was delayed. The consultant thinks matters of clinical care, the nurses matters of social problems. He goes out after one week, into some anonymity. He is seen once or twice by the team social worker , but St. takes up nothing. Nobody recalls any apprehension about this. Even in retrospect the tragedy was inexplicable. Is it never to be given light? The Inquiries never recommend the value of follow up. Some give a post trial diagnosis whilst in Secure detention . It will surely be helpful to a future Mental health act mandatory community Order when those with schizophrenia who were not taking their medication 'outside'can be shown to respond significantly when obliged to do so in detention. It would also be helpful if the diagnosis or assessment arrived at over the longer period of detention could be set against that suggested 'in the community'. Inquiry Adams; Stemp Inquiries Listing	E-mail reaction is welcome mica@didgy.freeserve.co.uk