M ental I llness C oncerns A ll	Which was the way he wanted it. An only child, he seems not to have acquired any significantly influential companions. His network of church contacts are not interviewed . His mother and her family were never completely in the care situation. They were not partners in care, members of the caring loop.They were not shown the grounds for intervention, nor whom to contact , nor when to do so, nor to whom to appeal nor where and how to report in to the community services. He seems to have related best to his family doctor, but this may have been because he was not challenged to accept medication. He was allowed to take charge when his illness was untroublesome. He did not accept psychiatric help because he did not recognise he was ill. He may have seen some aspects of his illness as a matter of religous belief. But he was admitted, under Section of the Mental health Act, five times. Some of this should have led to Care Programme Approach reiews and a reconsideration of his care circumstance if he became negative and out of touch. This society has yet to put in powers of authority into supervision of mental illness in the community. Because in some aspects and over periods of time, people with schizophrenia can and do behave appropriately , the fluctuations in that illness when it is left without treatment and the sensitivity to misdirected inner connections which are not disclosed, raise problems of individual liberty which society has not yet resolved. Is the autonomy of the individual still there when an illness lingers on in a lesser degree - an illness whose nature is known to be able to hide misbeliefs until some thing brings it all out in delusional activity. That irresolution inhibits professional attitudes. He was detained five times , and as a consequence was subject to statutory after-care supervision. He could have been on very extended leave whilst still under Mental health Act Hospital Treatment Order, but the stigma of that may well have lost him whatever social position he still had, and his mental health advisors may not have wanted to lay that upon him. Psychiatrists have become unsure about their extended use of extended leave from hospital still under detention. What the doctor advised carried an authority which the family carers could use to exercise their persuasion, or justify their placing an obligation upon the family member to remain well. Now a family carer would be lucky to be able to discuss the caring position with anybody. The confidential relationship with the professional comes before gathering in information from lay obsevers. The professional sytem here let him go when he did not or could not make that therapeutic alliance. The family were left to do what they thought they owed to their family member. How far should the professional system go ? The answer should come out of a judgement from the level of best behaviour whilst under medication treatment. Was it at a level of performance that would return him to public respect and enable him to cope ? Would the public reaction to - still having medication - mean the public would not accept and deal with the treated person as they would have treated his previous self. A decision may come to be easier when the clear benefits of treatment can be seen, but are not so easy to project when all that the treatment and the side-effects can do is to make it easier and more acceptable for the person to be cared for in the ordinary public realm, without particular individual or social benefit to be felt by the person being treated.	E-mail reaction is welcome mica@didgy.freeserve.co.uk

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