At the time of the tragedy the depot medication regime was at the next level up from the low dosage which had previously failed and been followed by a return of symptoms.The blood levels would be at their lowest - at their lowest influence - on the day of the monthly injection - the day of the tragedy . Blood levels begin to rise two to three days after an injection and then fall gradually.
The low level would coincide with the challenge of hospital admission.
The striking thing here is the absence of clear support and engagement with the elderly carer. RV resented any attention of that sort and was suspicious of it .
Following the Inquiry a Carer Support worker team was funded by the Local Authority Social Services , its independent stance established by letting out the agency management to the carer organisation, the National Schizophrenia Fellowship; whose local self help carer group meetings the mother had tried to attend, but had been obliged to give up because she was harangued by the 'user' about what she had said and why she had been . ( 'user' here -and elsewhere in these Inquiries seems hardly the appropriate term . )
Mental Health management has to remember that lay people, carers and 'users' , although not readily joining 'them' - the institutional service - often feeling patronised and ignored, but will respond, to what they see as more friendly meetings for support, led by people familiar with their problems , independent of the health professional hierarchies.
Carer support workes will do this. They will see carers in an environment chosen by the carer, and will share with the carer, matters which the carer support worker will have learnt about from their contact with other carers of people with severe and enduring mental illness, and and from the carer groups they encourage to share directly mutual concerns and mutual support.
It is what old-fashioned social workers used to do - bring in to the professional loop what were the circumstances of care in-between. Somehow contact has to be made at the level of the carer.This is easier when carer/user have weekdays to themselves, using meaningful activities in which the dependent 'user' feels welcome and rspected.
Drop-in centres in accessible locations familiar to the 'user' - with activity interests, information sources, are more likely to touch the 'hard to reach' 'user'people. It will be their home ground and professionals can see them there by agreement. ( Clunis : Davies ; Rous ; Lauder ) People attending willingly can learn of the activity interests they may want to join in with elsewhere.
Where there is only one official service day centre it tends to develop its own clique, its own mores which enclose and isolate, attracting some but repelling others. Just providing one such centre is token engagement .
There is a need for variety in alternatives. Carers and users need their own independent pursuits, and aims, discovered and allowed for. Those seeking day activities and a need to be with and near people, can fit in their own distance, as the caring day suits them .
The only 'respite' turned into action, was the eventual hospital admission. The tragedy occurred that night .
Another criticism in this Inquiry Report is the absence of any support for his own quite persistent attempts to get rehoused .
The professional support is criticised for not working together in a
team
effort, but each element was separately engaging and asessing the care, and then leaving.
The 'team' was a nurse team only.
The neighbouring catchment area - in the same Trust management, had a team with the three core elements - psychiatry , nurse , and social work - in the same meeting together and working together team .
Where was the management leadership here?
Service springing from the personal situation of carers and 'users' works best; rather than obliging their circumstance to fit in with what is the provison in place; and leaving them alone when they do not engage. It is another lesson to be learnt from these Inquiries .
E-mail reaction is welcome
back to Inquiry Holwill; Viner
mica@didgy.freeserve.co.uk