M ental I llness C oncerns A ll	The fourth Inquiry Report to be issued on the Internet. In hindsight this Report tells us that - whilst waiting during remand from the Court, under observation for this at Rampton Special hospital - he showed no signs of mental illness ; although schizophrenia would have been especially looked for. That may explain the difference in judgement between Warren Court - the LA Social Services hostel and hospital admission Units - the latter finding no significant illness - that would be meaning little or nothing to point to active schizophrenia - the former seeing much evidence to be frightened about. He therefore received a jail sentence for the crime of manslaughter. It could be that his use of amphetamine was relatively curtailed in Health supervision, but that it went on more unchecked in the Hostel. Not all amphetamine abusers develop an associated schizophrenia, but where this does happen it will be wise to detain under a long-term segregation from drugs,and make especial arrangments for after-care supervision. One such case has been a significant law case. [ An amphetamine addict was released from hospital on sec 17 leave whilst retaining a Mental Health Act year long Section 3 hospital Treatment Order. That Order imposed a weekly return to hospital to be observed and to have a urine test for drug testing. This use of extended hospital leave was challenged, but the Appeal judgement was that it was legal in the circumstances - return to hospital for that purpose or something like it - would be a hospital based detention scheme and allowed. ] Without that level of control it is difficult to see how DW could have been kept steady. [ ... It also accounts for the statement of the Judge in Court - after receiving psychiatric Reports that DW suffered from a personality disorder and paranoid schizophrenia - as recorded by the Inquiry - ... ...... the report indicated that the condition was not treatable in a mental hospital and that he had no alternative other than that of life imprisonment ... ] What a comment upon mental health service provision - that there are no health facilities that will treat paranoid schizophrenia ( there are secure mental hospitals ) - I see a Human Rights legal challenge here . The degree of tolerance to challenging and strange behaviour, to rent arrears, and clear evidence of poor self management skills, beggars belief. Resolution seems to have foundered on the separation between LA Social services and Health Trust services. At one stage there was a difference within LA Social Services between the Hostel management and the social work running with the mental health team. Care Programme Approach Reviews did not resolve the differences. The family might have made an appropriate intervention, supported by advocacy or a Carer Support Worker. But the family seem to have been excluded - as usual It is dificult to see how even a common Care trust ( Health and LA Social Service mental health workers merged ) would have negotiated some agreement. In future this level of disagreement will have to involve higher powers - an outside view of the overall care would have to be brought in early when the developing schism became known. Trusts do this by inviting in external reviews from appropriately senior people. Perhaps the Royal College would have a list of people available to be called upon. The Commission for Health Improvement is making a beginning at regulatory inspection where service is questionable and the new National Patient Safety Committee, announced and now in place, encourages whistle-blowing and earlier intervention - looking at structural management rigidity, and at both latent weaknesses that can fail, and predisposing climates that allow these failures to occur. There is no particular reference to the resource side of the Trust services apart from criticism of the level of observation - partly because of the structure of the Unit and partly because of the miscalculated respect for privacy and individual rights. There is no comment about any pressure of admissions, nor about the absence of segregatng facilities for drug misuse. The decisive position of the responsible medical officer is limited by the variety of opportunities for close observation available to his team, and by the absence of any segregating routine retricting drug misuse. A new Mental Health Act may include drug misuse as grounds for both detention and for community Orders. It is long delayed by professional resistance to the poorly thought out attempt to include dangerous personality disorder as a definable group of people, and by the libertarian movement generally, and by the difficulty in drafting the limits to mental disorder which allows for detention and subsequent Community Orders. It is assumed that family carers will continue to exercise oversight and oblige a degree of compliance and constraint - but families are not now going to do this any longer. Caring families involved in caring for their relatives who have schizophrenia want compulsory community powers to back up early intervention and aftercare but the Charity representing them ( the National Schizophrenia Fellowship ) gave that little publicity. An interesting aspect of this Report is the application of a Potentially Dangerous Offender register and its review meetings, which recognised the difficulties but had no power of influence beyond giving advice.	E-mail reaction is welcome mica@didgy.freeserve.co.uk

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M ental I llness C oncerns A ll