Review; Lauder

 

M ental

I llness

C oncerns

A ll

L should not have been sentenced for a crime conducted whilst he was ill. The Court did not receive official reports on his mental condition. He should have been diverted to a local forensic psychiatric Unit under a Court Order; or to the local general psychiatric services. That would have made after-care more flexible, more local, and he would have remained in his home area.

His family would be available as observers, as links, as people who might intervene or support.

Social and psychiatric aftercare services would have been more easily gathered together.

The crime and its punishment governed what followed.

His care was circumscribed by the need to detain him until his sentence tariff ran out. That length of detention could not be managed in a local secure Unit . There were insufficient local ' beds'. It meant he had to be contained far away from his neighbourhood base which would have to re-engage him without any familiarity.


In aftercare the London catchment area health service is criticised .

This area of 90,000 people - twice the appropriate number , as indicated and confirmed by a new consultant appointment after the Inquiry , was then looked after by one consultant with trainee junior staff , whom she was supposed to be teaching , helping her . They had seen L. only briefly, and had neither engaged with him nor his family, and were not present when his aftercare services were arranged . L was discharged before an aftercare attachment to psychiatry was established, before his future address would be known and given a family doctor who did not know the recent events , the medication history, or the after-care arrangements.

There were three community mental health nurses working with the consultant in the local catchment area . One of these could have met L before his discharge from Kneeworth , and carried the health commitment , if that had been requested .

Where there is likely to be a relapse into a severe and enduring mental illness, as here when that had happened after previous treatment withdrawal, linking to a health service lead supervision is mandatory, and should be made before discharge. The key worker and community mental health nurse would already know of each other .



In fact, the lead aftercare services was chosen to be the catchment area Local Authority Social Services, who had only their own observation of his base-line mental status at discharge to go on, and did not know know his 'well' condition when treated. The Psychiatric services were not engaged until those services made contact after L. failed to turn up to an Out-Patient appointment.

The Psychiatric services asked for the Review meeting .

The 'pass the baton' problem was not properly addressed. That his illness would return was a probable event. Aftercare should have built in psychiatric observation from the beginning, especially after signs of the continuing presence of illness had been noticed before his discharge .


L accepted family visits in hospital but dismissed his family during the period after his medication was withdrawn. At the same time the social worker of the hospital noted other changes in behaviour. These pointers to relapse were a warning. Steps to give his family an entry point into after discharge could have been made .

A natural aftercare observation source that could instigate contact was lost.

In fact a brother spoke to the Social worker at Kneeworth, during the six months after discharge, to say that L. was talking about things which suggested a more florid illness.

The 'holding' position should have been maintained by Kneeworth until both elements of aftercare, health and social, were setup, had engaged L, and were working together.

The person to have held the arrangements together until those arrangements for reception were in place would be the Social worker from Kneeworth , whose contact was welcome to L, and who had already met with the family.
When the aftercare social service support, and mental health support were in position and functioning, then the baton could be let go .

As in most Inquiry reports this Inquiry finds an observer - here a close and supportive neighbour - in the Community - who had noticed the signs of increasing illness behaviour but had no preparation as to how and when and where to contact professional services.

It is difficult to foresee all the difficulties that can arise when someone with schizophrenia, becomes increasingly ill, whilst in the community. A survey this year ( 2000 ) shows ( in London ) that as many as a third of such people will move out of the catchment area where they are known, and become lost .

In such cases, the people most likely still to be able to find the ill person are members of the family, friends, or companions. ( Clunis, D.Joseph, Edwards )

The preparation of a full social history, at some point in a care programme initiative, will usually include ways to find family members, and give them a contact point, and encourage them to make contact when worried . It will often note the other significant people involved with the life of the patient /client who might be helpful in aftercare situation to pass on warning signs.

 

 

Inquiry Woodley; Laudat

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