Review - Chapman; Halewood

M ental I llness C oncerns A ll	The diagnosis is - yet again - founded on a point examination - a short in-patient admission which did not get a reflective psychiatric examination till two days after admission, by people who had only a partial and temporary contact with H. or his family. The conclusion did not address the question of why a psychotic breakdown became florid when it did. What was the background, and what was the preceding personal style? It is premature , wrong and too fore-closed. Information was available from the family which would have given thought to a more provisional conclusion, and the implementation of a waiting and watching aftercare brief rather than an over hasty conclusion that the admission need had accounted for everything. A key worker community mental health nurse was in place and visited very promptly after the early discharge. But, he is from a different catchment area team. It does not appear that he was well prepared for that visit - it would have been proper to reach the family, and hear from those who had a more intimate knowledge of H. than that which could be got from a necessarily 'official' visit. That would have been the occasion for a functional future contact system to be in place. In fact that should have been a matter for pre-discharge Care Programme Approach decisions, but insufficient in-patient time and the absence of pre-admission history, would seem to have prevented that happening. The aftercare service in place for H restricted his contact to H. His family, known to be good observers, and actively in contact with H. were not informed and did not know how to to call in lead clinical decision. The family tried, but could not get, a satisfactory meeting of H. with the relevant specialist mental health services. The family had not been given a satisfactory fall back contact system so that they could talk over subsequent behaviour, with those whose team would be doing any subsequent rapid intervention. There is, in the area, a mental illness intervention system, jointly funded, and in the hands of the local LA Social Services. There is no indication that either the family or the social services were made aware of its relevance to H. or his family, or the family doctor. The Report questions its relevance to the management of H. and finds the agreement that the social services should lead a crisis mental health team, likely to prove to be unsatisfactory. A rejoinder from the LA Social Services(LASS) points out that the LASS crisis team, was never informed or involved. A question mark still hangs over this arrangement. In the test of reaction to this mounting crisis, so far as this family and this patient are concerned, the arrangement did not get into the picture. It was not in the communication system. Why was it in place if it was not going to be used ? - used in practice - used as part of the overall mental health community provision. It looks as though social work about the mentally ill is not closely tied in with the mental health services - either in gathering in a social history from the family or receiving mental health discharge notes where a family was involved. These Inquiries have no knowledge of the good old bad old days, when the LA mental health social worker connected with the catchment area would have seen it as normal to be requested to visit and obtain a family history, and to be pointed by the family to - in this case - the close friend, who was involved with the admission. They might even have been based in the hospital service. It still seems odd to this page editor that none of the Inquiry Reports - although confirming that there is information in the community vital to decision making about the best care and treatment of the person who needs help, does not comment that the modern changes to line managing means that nothing from social services now gets sensibly into the mental health decision making. It is the patient that loses out This is management failure. A failure to get together by managers with different line management commitments who do not get together to agree their common obligation to the people they are there to serve. The diagnosis after the final tragedy, happening within days of discharge, during the second florid episode, settles to schizophrenia. (*)community 'teams' have accumulated a lot of different designations which appear to be descriptive, but need detailed specification as to composition and as to their functional working, to be able come to any clear notion of what they do, and what they can do. The name is not the thing	E-mail reaction is welcome mica@didgy.freeserve.co.uk

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