M ental I llness C oncerns A ll	The mixture means the illness cannot be controlled properly. It is never clear whether cannabis induces a relapse or the boredom and lack of will and direction in residual if controlled schizophrenia leads to cannabis. But he took to it soon after leaving school. Moffatt is a friendly person when well. When ill he soon is taken into morbid direction by delusional force. Separated from cannabis he can be greatly helped by medication - to what extent cannot be clear because away from closed off care he takes to either stopping his medication or starting cannabis or both in turn one after another. Which starts relapse cannot be decided. A problem is that the only medication that helps decisively is one which is not available by depot regimes. It also has its own side-effect consequences. We are not told that these are a problem. Over eighteen months at home where his parents find for him a structured day with activities, he manages well. For some reason not given, he is moved from there into a Hostel with a 'laisser faire' regime. That does not work for him. In that hostel he is seen reading about rifles. That is not disclosed to the mental health team dealing with him at the time. It is likely he stops taking his medication. Everything the local mental health service tries to do they have to do with less effective provision. A mental health Strategy has had to be abandoned some way through because the promised funding from Regional hierarchy and Health Authority, does not become available. Workface staff are uncertain. A historical sense of standards of behaviour and of local supervision is not felt to be replaced by the new regime. They have to reapply for their own posts. There seems to be a downgrade move in skillmix in an attempt to stretch the avilable funding. An OT service in the old buildings had extensive resource. In the new admission service it is constrained and constricted. In the old admission service there was space for natural movement watching and taking part. That made work feel easier. Individual rights meant single rooms and that meant difficult and anxious observation. Security was by close observation. In the new service it was claustrophobic. Moffat spent six weeks under close observation which was felt to be oppressive. The reason for that length of intimidatory observation is not made clear. The mental health team is admired and enthusiastic - the consultant hard working, available and practical in leadership. The circumstances of the provision undermine their effectiveness. The Trust Chief Executive writes an unsympathetic and insensitive letter whilst Moffat is in custody awaiting final disposal. The Inquiry raises one question about the clinical management. Could he not have been more succesfully supervised better outside hospital if he was there on Section 17 leave, when aftercare would have been under review and more active intervention may have been achieved at an earlier stage whenever provision turned out to be inappropriate? The use of Section 17 leave from hospital whilst under a Detention order - as a compulsory form of community supervision - is often a matter of adverse criticism by libertarian positions and of weak backing from the Royal college of Psychiatry. It is often uncertainly understood by Responsible Medical Officer psychiatrist because some have been taken to case law decisions with results unsurely understood in their consequence. The old certainties of - ' I did what was right and necessary and anyway I am backed up by management and my Defence Insurance ' - seem to have gone. Psychiatry is about the management of anxieties, and is not so easy when the psychiatrists themselvs are anxious and unsure. The lead position has been undermined. Sufficiently often to leave clinical teams disagreeing within themselves - that and uncertainty about the relationships with the parallel social services after-care standards. There is not always a common mores, nor a common purpose nor submission to one leadership. The adverse comments have postponed any introduction of a compulsory community Order in a New Mental Health Bill. Here is someone who did well under that kind of obligation to conform - at his parents home, with a structured week, and under confinement in a closed Secure Unit. The mental health nurse teams, both in the oppressive new admission wards ill designed for friendly observation and generous time in companionship, and in the community where purchasing authority is with the family doctor and they accrue mental health nurses into their base, find more and more duties and expectations put on them, so that people, like Moffat who are undemanding themselves but fall into difficulties, can get - forgotten. Schizophrenia can never go unwatched without risk. The National Confidential Enquiry into Homicide and Suicide recommends that schizophrenia always warrants the enhanced Care Programme Approach - unless the particular circumstance is documented otherwise. Back to Eldergill; Moffat back to Inquiry Links	E-mail reaction is welcome mica@didgy.freeserve.co.uk