M ental I llness C oncerns A ll	The change from inpatient based service to community resource was never achieved. The pieces never came together again. Who was then in charge? Quite often - and finally - it was left to the patient to report illness had taken over and come in for help. Different parts and different people within the mental health service were left with L, often to their own devices. There may have been a mental health team but it is not described a a working system, no evidence that it met , was led, and reviewed progress and community care problems together, watched out for each other, or talked together on any regularised basis. There seemed to be no expectation that this should happen. There were weekly meetings but they were without the structure that brings to the attention of the whole team all changes of interest. He should have been subject to aftercare plan, scrutiny and assistance after discharge from a Section 3. MHAct Detention Order. Neither Health nor LA Social Services did that. If the weekly team meeting meant a serious look at movement between hospital and community , or movement between bits of a service , then that would have been the place to do that. There cannot be any mutual supervision or leadership without this happens. This editor is surprised that the Inquiry Reoport recommendations do not single out for emphasis working practice recommendations on this aspect - the opportunity for continual team meeting , documented and regularly attended by all the three cores of the mental health service - the same people at a senior enough level to make decisions - builds in an expectation that all matters of concern and uncertainty will get attention, and be brought into appropriate care arrangements. The natural lead is the potential Responsible Medical Officer, secure in permanent post - who is delegated by the family doctor to act in the best interests of the patient, and is not curbed in their employment by different drums - promotion and patronage. The Care Programme Approach was a name only. Nobody monitored it. Led under a structured regime - under orders - he went along with that. L was well enough whilst on depot medication.Then when ill he was expected to come for help. He did this at times but his approach was inopportune and he was not received back into patienthood. His family, the natural 'movers' were never welcomed into the professional caring regime. They had no idea about schizophrenia. They were never in the picture and had no point of contact. Back to Eldergill; Longman	E-mail reaction is welcome mica@didgy.freeserve.co.uk

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