I llness

C oncerns

A ll

Clunis had many hospital admissions, often in different catchment areas in the metropolis, all of which should have been followed by full social and health aftercare, mandatory after a compulsory detention. None of the aftercare plans saw the importance of keeping in touch with his significant relative, the sister who was always in touch, throughout his many moves.

Placed out of sight, out of their catchment area, he went out of their mind as their responsibility. His own, affected by his schizophrenia illness, could not cope for long with his deteriorating social condition. This became predictable when he lost contact with medication regimes. He asked that his family be not involved. The professional care accepted that was his choice. Was he capable - in the presence of residual illness - of recognising that this might not be in his best interests.

As is the case here. It rather gets the professional sevice off the hook. Who else will be bothered enough and driven to find out whether the care is all that is a available or all that it should be? Who can act for the patient - 'as if he would want when well to have been done when he was ill?

The separate admissions were dealt with as separate episodes, not as a continuing illness.

Only one social worker report is referred to in the Inquiry, and the Report comments on no details.The final episode is covered with tragic ironies. He awaits a court appearance for a serious attack on a fellow hostel resident. Because there are no locally available secure beds where he lands up after the assault, they move him out of their hospital, and he awaits his Court appearance seventy miles away in a private secure placement. That hospital is told at the last moment that the victim , the witness , will not turn up at Court , and the proceedings are likely to be dropped. He is correctly believed to be too ill to be released into his own charge, which would be the consequence of the collapse of the Court case, so, his long-term continuing illness being recognised, a longstay Treatment Order is imposed, which will keep him over many months if necessary. Being a private hospital they have no obligation to make way for more urgent cases which is the problem with the NHS hospital which sent him there. So long as they get paid, he can stay as long as the payment comes. This will not do for the Health Authority which sent him there , and will have to continue with payment. Before a long term treatment schedule of depot administration can become established as an acceptable habit, the original sending Health Authority wants him back. He returns to Guy's Hospital, a different hospital from the one which arranged his transfer to the private hospital but in the same Health Authority, and serving the equivalent catchment area of this admission spell.

Clunis quickly obtains an alteration in his treatment conditions, keeps up a good presentation, the long-term Treatment Order is not considered necessary, is abandoned, and a discharge is arranged to yet another catchment area.

At a discharge meeting attended and conducted by a doctor in senior training who seems to have had most to do with him, the hospital social worker decides he is fit enough to go his own way without any further need for social work aftercare contact, and the doctor decides that health aftercare will be by a hospital staff doctor in the different catchment area, who has never seen him ,who has no knowledge of who will be his Gp, who does not have the help of any social aftercare arrangements in place, who has no contact point to hear from his family.
She is told, without her consent being sought, that she is his future key worker.

He does not attend any Out-Patient appointments that she makes for him. Her catchment area social work allies, have no prior knowledge of Clunis, and try and fail, to establish contact.
He is without medication, but in very good lodgings. He attacks some one in a street, is recognised but can never be found. He frightens some boys. A police station is advised but the incidents are lost in obscurity. A combined visit with police, doctor, and social work fails to meet him.

The next day the tragedy occurs; an unheralded and unprovoked fatal attack is made on a passing stranger.

The progression of Inquiries begins.

Ritchie;Clunis

Review and general comment on carer input

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