M ental I llness C oncerns A ll	Someone who has had a long illness with schizophrenia , must be presumed to be vulnerable to a relapse into more florid illness in the future : at times of stress . In Dyer-McFadden the change of address only weeks prior to the event which followed a fire , and the accident to the elder brother two years previously, would have been vulnerable times , and would call for a review of the support services , if the events had come to the notice of a professional care system . The crux is who should recognise that , at the time of stressful incident , and who should be informed . At such times , closer observation , and support to the potential sufferer , and to the supporting care system , is part of a community care programme . In 2000 , a community mental health team would be in place , with a working attachment to the family doctor service ; not so in 1995. When professional care is withdrawn , and the likelihood of illness persists , some contingency and fail-safe procedure should be left in place . Here it was the final letter to the family doctor service which ended the Adolescent Service involvement . That was the practice then. Any future initiative would come from there . It would have been helpful to an eventual referral to the adult services - which could have been anticipated - if in the last stages of the adolescent contact, the maintaining depot regime was introduced and handed over to be delivered from the family practice base. Any lapse would then have quickly come to notice at the family doctor end, and contingency intervention put in place; such as replacement monitoring, and keeping contact with the family carer. When one professional support system finds contact difficult to sustain , it should introduce to the 'holding' carer , a 'watchover ' figure , with the procedures and the named people that will be required to bring in future assistance . Especially if that will be from a different service , with whom the carer and potentially ill person has no experience of contact behaviour . Someone must receive the baton . The continuing figure for McF and the family would be the Practitioner nurse at the family doctor surgery , who had already met ,and been acceptable to , the family . It would be up to the family doctor to initiate further contact from that end . It need not be left to the carer to keep contact . In Ritchie-Clunis the hand-over from Guy's hospital was to someone whom the final clinical meeting at Guys designated as 'the key worker' , a hospital psychiatrist in a different area ,who had never seen Clunis , and was not asked if she could be the key worker . The family carer contact was never told who would next be the key worker , or how to link in with future service . In the case of McF there are allusions to his mother not easily making contact with services when things were going along in a 'manageable' way in the family . He had been well enough for six months or so , before the final two months . It might have been hoped that early signs of illness would pass . It all depends on what was told to a lay carer about the course of an illness . Clunis forbade professional approach to his sister - the one person to keep in contact with him throughout the course of his illness It is difficult to see what more could have been done .The situation is comparable to the circumstances around the beginning of serious mental illness . Who makes the need for attention known when the ill person will not do so , or cannot , without 'insight' , do so ? To whom ? The one person whom the mother - or another member of the family - might have approached more readily to discuss the options for extra help , and what to do in a future problem area , would have been the Practitioner nurse at the family surgery . She could have been connected up to the family after the Adolescent service handed McF over to the responsibility of the General Practitioner Service , if the family Practice had been advised of the necessity to keep in touch with the carin situation . General Practitioners at that time were not familiar with the problems of reining in community care support , and may not have thought that being active about keeping a link was necessary , unless they were directly told so by a professional mentalhealth team that knew the ill person , previously . The tragedy could not have been foreseen . That the family might be faced with trouble could have been , and a prepared position introduced before florid illness , for intervention at an earlier stage . Back to Dyer; McFadden Inquiry list	E-mail reaction is welcome mica@didgy.freeserve.co.uk