M ental I llness C oncerns A ll	RW manages in a semi fou kind of way submerged in the underworld of the dispossessed, between schooldays and until he is thirty, when he kills his sister and nephew. So he has been left to get on with it, because he did not want institutional contact. His own comment - avoid institutions,destroy labels. They have not helped me. Because he would not be helped, they did not offer to put in their professional structure. When they did not help, he decided they had no help to offer. The initial psychiatric assessment - that he was likely to be ill with schizophrenia, but that should not be addressed by admission, in case it turns him off future professional cooperation and help, seems to have been followed by exactly that. He does not engage so we will not engage him with the professional service. That would stigmatise him. So the community mental health team makes the attempt to engage - and failing lets him go. Do they contact the family with the suspicions about the diagnosis ?Do they ask the family, to be aware of the possible diagnosis, to talk amongst themselves, and note anything strange and let them know? The Report says nothing so that we have to presume nothing is done to follow up th suggestion that this might be an untreated illness of schizophrenia. The other welfare services seem to take their own contribution along those lines also. The help from the family doctor service dabbles in psychiatric medication, for anxiety, or for depression. Not for schizophrenia. The Inquiry does not comment on what the family doctor service was advised by the initial psychiatric opinion. Oral medication appropriate to the condition could have been started by the family doctor, and managed by the community team, with the help of the family observations. What is missing - in this Inquiry report - as in many others, is any understanding or awareness or description of the family involvement and experience, or any help and support to them. Particularly from the LA Social Services whose interest in the family is barely referred to. If he was likely to turn into schizohrenia, how was the community to know what to do then, if not given some source of contact or advice as to contact, by the mental health community service. And what to do, if that service did not respond-was not able to engage RW. This is not a good Inquiry Report, narrowly restricting itself in commentary, to finding that when the service was engaged, it did do the right prescribing and gave the right future appontments. But the Inquiry does not say whether the family was seen in any advisory way, particularly about risk protection, or whether the family had succeeded in getting any reservations they had about RW , into the professional consideration. Perhaps some general assistance in monitoring medication. The Inquiry Report says nothing about any residual medication found after the event. Assessing compliance is part of learning the lessons. It is relatively easy to estimate compliance when, as in this case, medication has just started - the estimate by subtracting the residue from the regime can be made Nor does it examine what led to the absence of any psychiatric attention in the intervening years - what accounted for that - how receptive and reactive was the service seen to be in this neighbourhood? The initial clinical judgment was 'wait and see' But who was then to do the 'seeing' and what guidance was the lay community given as to when the psychiatric service could be brought to intervene? Inquiry Winter; Wills	E-mail reaction is welcome mica@didgy.freeserve.co.uk