M ental I llness C oncerns A ll	This 'odd man out' Inquiry ( March 2002 ) combines an examination of what was offered as protection of a minor - 'A' - a Part 8 review - with the function of an Inquiry after Homicide, 'A' being stabbed and killed by 'FD' , someone who had been in contact with the local mental health services, and had a past history of such contact, elsewhere. The Inquiry team is an Independent social work consultant whose previous experience included inspecting Social services work, and a consultant psychiatrist. It would have been better to deliver the two Reports separately The Report of the Inquiry into the care given to FD is cursory in comparison,and overwhelmed by that devoted to teasing out the obligations of those protecting 'A'. It was known that 'A' was being menaced but not that the threat would progress into killing. It was known that FD was odd but not that this warranted sufficient suspicion of an underlying schizophrenia. FD was not thought to be in such an uncertain position about his diagnosis that his mental disorder required further resolution, although he was in custody and could have been remanded for more specialised and longer observation FD was often homeless and not often sufficiently under observation to give the kind of observational detail that living with companions would afford. The family of FD were far away, and this Report gives little reference to them and their view of FD. FD is recorded in his ultimate locality as at one stage telling the family doctor that he suffered from schizophrenia. From one hostel to a duty mental health social worker ( who did not see him ) he is 'bizarre' and 'angry'. The Report says nothing about the recorded material from previous mental health service contacts - except to summarise their conclusion as a diagnostic uncertainty. There was one episode of detention, but the weightier observations within that period of observation are not disclosed here. It was probably from that time that the Report is able to say - ... when FD was taking anti-psychotic medication ( but not what that was ), then he was better. The professional assistance to the protection agencies, classifying the current behaviour of FD, rested on the conclusion of a community nurse who has no clinical supervisor behind him. He correctly reports caution about uncertain danger, [ 'dangerous', but 'definitely not sectionable' ] but can give no diagnostic assurance or instruction on what steps to take to get a better opinion. A subsequent examination in custody is with a 'diversion forensic team'. By a trainee junior psychiatrist, who again does not seem to have made contact with a more experienced clinical supervisor, although it is a forensic team representation. Somehow the team is unaware that FD is a name adopted by him fairly recently - 'deed poll changed' to that of a famous occultist. The Report records certain phrases from this examination that should have demanded the time for a thorough review of whatever was previously documented about FD. Take [ 'he said he was 'the path of least resistance' .. ' ] which to this editor is odd enough and points towards schizophrenia, and that is sufficient - taking into account the basis for the custody of a threatening relationship, where the question of paedophilia was raised between a poorly supervised minor and a homeless drifter with a history of mental disorder and social failure - to warrant a strong recommendation to remand in a forensic Unit. If there was a bed. The diversion team sees its role only as one of diverting into mental health care those who are not able to meet the requirements of a Court appearance - and in this case they reported .. ' he is fit to plead .. ' and there are no psychiatric recommendations for the Court ... 'we have been unable to complete a full assessment '.. and ... ' FD did not allow us to see the charge material ..' In the good old bad old days conclusions in this kind of situation would not have been left to the abilities of lesser qualified people, but would have, in the working mores of the time, have come to the decision of a hospital consultant psychiatrist, about admission. Neither the victim nor the perpetrator were able to sustain contact with sufficiently experienced care providers. Inquiry Arkle; FD&'A' back to Inquiry links	E-mail reaction is welcome mica@didgy.freeserve.co.uk