M ental I llness C oncerns A ll	" The family were very angry and upset that the doctors had not contacted them to ask for their input ." " The doctors told us that they were surprised that the family had not been in touch with them" Unless they are told what to look out for ? Until they are told straightforwardly something like - "we cannot judge from an interview situation how ill someone is with mental illness - what capacity they have - what they can do to cover up their illness - if that is the case - how frank they are being . Patients may hide a real situation from us - and we will not know ." "If a patient tells us we are not to approach a relative , or friend , for information , or to give information , our lips are sealed by confidentiality from making an approach . We have to leave it to you . But you can always contact us . We will keep the source of the information to ourselves ". Until lay people are told these things , lay people know nothing other than that 'we should leave it to the professionals - 'they know what they are doing and will ask us if they want anything more' . A 'serious incident' Inquiry which addressed this predicament and also reprimanded 'the community' for not getting in touch with the professional services is Phillips Inquiry . The patient had been receiving depot medication but had dropped out of contact , and was eventually found dead in the street .( at post-mortem .. from a heart attack ). He became the subject of a coroner Inquiry , without the relatives being found and informed . They were outraged . The Report says ... "although RPh dropped out from staff (contact) he was by no means lost to the community ...he was seen .. here and there ...friends were greatly concerned about his appearance and mental state .... Therefore we feel obliged to point out that some of those who feel that the authorities should have been more active in trying to trace RPh. - had information about his whereabouts , his condition , and his plight , which they could have passed on ..... ... If humane policy of community care is to work then it will at least require the participation of the community .... we consider therefore that those who knew..of RPh. whereabouts and condition ... were mistaken in not coming forward earlier to assist the authorities in his care" . * Neither that Report nor the Hampshire Report suggest how , or to whom , 'the community' should do the informing . So that a response is made . One service in Norway has a mental health telephone number - well publicised - waiting to respond to 'call-outs' from the public about just such uncertain matters - already set up and fully advertised to the public , waiting to hear calls and then to send out mental health personnel - particularly to those outside wandering , looking to be neglected , or acting oddly . Something like that service should be in place in a catchment area mental health service so that the 'community' can feed in information , easily . What professionals do not know is how hard it is to be living with someone who can be in two worlds , and not know any connection between them . How impossible it can be for the sufferer themselves to remember and describe - convey - the illness involvement , when their recall is separated by time , from the experience recorded in the ill phase . The situation is vividly described by the father of Robinson. The carer/companion experience of 'gaps' in recall is a frequent one, if usually on a lesser scale. The experience of not being given the opportunity - away from the patient - of putting information forward, is a very common experience and will often be to the disadvantage of the patient and to the judgement being made on his behalf by the psychiatric professional team. A very significant conclusion from this Inquiry, insufficiently raised in successive Inquiries, is the debilitating effect that awful structural service provision has upon the working decisions in mental illness. There is nothing to offer. no meny which meets the situation. The old asylums were improving after their own Inquiries about institututional abuse, but the improvements stopped and chaos followed as a move into community resourtce was started withoutthe systems there in place to sustain the change. The gatekeepers were very reluctant to admit H. They knew of the disgraceful conditions awaiting him and the effect that would have upon any future relationship with H. During the time phase of these Inquiries the mental health services have been compressed and ward occupancy approaching 100% has become a general problem facing consultant psychiatrists. Simplistic management, unqualified in clinical work, concerned only with actuarial efficiency , given too great a hierarchical pressure , has achieved this, and destroyed the heart of mental health services. ($) The way the admission services in Cornwall have been arrived at illuminates the superficiality in management decisions . To arrive at a basis for what would be the future requirement for places in new admission units , the management did a point sampling of the current position at the time. They counted who 'needed' to be in a 'bed' at that time. Finding a count of eighty-four they decided this would be the figure for future admission Units. Calculation on this basis represents an admission ward which is always full - a situation the Royal College of Psychiatry has declared to be incompatible with good practice, safety, adequate pre-discharge preparation, good working standards of observation and assessment, and timely relief for community 'carers'. The figure also discards those who are - in the management view - occupying beds because nowhere else could be found for them . It cannot be right to make forecasts on the basis of a solution to this issue, which has never previously been succesfully achieved. Management still insists that it knows better than the two groups who give personal care to those with the severe and enduring mentally ill - the professional care staff , and the family and lay carers . A mean service will get a mean and resentful performance. A mean and inhumane service under pressure will be felt by patients. Their response is to reject medication and drop out of it all into illness. 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