M ental I llness C oncerns A ll	Mrs Kapte is cut off from representation. Even the interpreter speaks a different tongue from her native one - although Mrs kapte speaks good enough english. But the professional service never attempts to penetrate the ethnic habits, the system within whuiich she has to see herself, which rest heavily upon extended close family support, in this case on her own within the family of her husband, in amarriage about which she complains, with little neighbourhood or community display. The family believe the professional must know what they are doing - the condition is their speciality and never doubt that the professional service knows to what extent the family will go to adapt and bring in its resources. There is no natural channel for information and observation about in-between behaviour, a necessary source of any abnormal talk or intention. In some ways what channels that there are there officially, only serve for one unit to leave it to another, or for one who knows to fail to influence the other. There is no coherence although there is a structure for coherence - the CPA programme Approach - whcih the Report says is bureaucratically constricted. It needs a generous attendance and a consistent attendance; with someone, a believer, leading, to whom all will give account, and who in turn accounts to the team in public decision. These are some of the comments, apposite and relevant., at the end of the Inquiry Report.   1. Statutory responsibilities should not be overlooked because of cultural factors. Practitioners should not be afraid to carry out their duties, by perhaps involving themselves in family matters, for fear of being seen as racist. 2. If it is recognised that the family has little understanding of the psychological difficulties of their relative and that little or no emotional support is forthcoming, this MUST form part of the risk assessment process. It must not be assumed that, because a mentally ill patient has practical family support, the risk factors are low. If that family does not appreciate the concept of mental illness and feels, as in this case, the patient is "putting it on" then the situation can be made far worse. 3. Clinical managers should take responsibility for supervising and monitoring complex cases, so that failure of provision of services is identified at an early stage. The care plans, produced at these meetings, should be periodically reviewed by a clinical supervisor. Communication between Professionals 4. All key members of a client's care team must be present at review meetings, except in exceptional circumstances. Where children are involved, this should always include the health visitor. 5. If a worker cannot attend a meeting, a written report outlining their assessment of the situation, as at the date of the meeting, should be submitted. 6. Minutes of review meetings should be as detailed as possible and, in any event, should identify why specific decisions have been taken. 7. All members of the care team should receive a copy of the minutes and care plans and file them with their papers. 8. The key-worker should always be informed of any referral to child and families team and receive a copy of the paperwork. 9. If any professional within the care team (care team in the widest sense, meaning hospital and community staff at all levels) has concerns about a client's care or risk management, they should inform the key-worker and follow it up in written form (no matter how brief) to all members of the care team. 10. Concerns raised by any professional involved with the family should be discussed at review meetings, minuted and reasons given for any subsequent decision taken. 11. Those members of the care team who need to be informed when a client is discharged from hospital, should also be informed when interim leave is given. 12. Communication between clinicians when a patient is transferring needs to be by provision of detailed summaries and meaningful hand-over notes. Recommendations relating to Training (Findings pages 62 to 66) 13. Training in ethnic minority issues should be tailored to extend beyond its current composition, be ongoing and mandatory for all staff involved in the delivery of services (including supervisors, managers and board directors) 14. Lack of appropriate in-house trainers should neither delay nor prevent the above recommendation from being implemented. Appropriate trainers should be seconded in or staff seconded out wherever necessary. Wherever possible, when services are delivered jointly between Health and Social Services, there should be joint training. The Inquiry has much sense in its recommendations, but fails, as all Inquiries have done, to tell the delivering Trust what to do to achieve in working practice to bring about the the required chang in mores. Leaving it to management to learn the lessons has never worked so far . It also fails to describe the working practice of the area mental health service, although laying out its structure. It is the habit of working togwether which needs to be described. This editor is happy to make up for that. What managers should see is put in place, to record attendance, to see sustained, a regular weekly meeting of the catchment area mental health service at which senior representatives attend with the ability to respond to catchment area problems, uncertainties, and concerns with executive action. When the catchment area is familiar with the regularity of such a meeting, then they can find the route in with those matters that they feel need addressing, certain that it will come to a consideration by people sufficiently experienced and of sufficient longstanding presence , to respond with the appropriate resource for that area. Neighbour, district nurse postman friend, family, spouse, companion, police, local surgery can feed in their observations through whoever they know is connected with the meeting. Inquiry Kapte back to Inquiries linking	E-mail reaction is welcome mica@didgy.freeserve.co.uk