M ental I llness C oncerns A ll	The victim is a young woman with limited intelligence, who experiences personal and emotional difficulties during puberty and adolescence. She feels anxious and vulnerable when on her own in a flat amongst other flats, but is unhappy under the restrictions of home life with her mother. There is something to which she refers often when 'down' - someone was to be prosecuted at her insistence for possible rape and at least non-consenting intercourse, but the alleged perpetrator committed suicide before charges were progressed. She expresses some responsibility for this at times of depression. She is described as having a pattern of depression which fits that of the endogenous type, with substantial diurnal variation, but there is not the expected response to appropriate specific anti-depressant prescriptions.The response and the duration of treatment is not recorded. Instead she overdoses on these tablets at times.There is one reference to pre-menstrual difficulties but these are not specifically described. She has an implant of a contraceptive substance for this. There are social difficulties , but the LA Social Service interprets national guideines as stating that restricted funding means the service should be directed to the most in need. A young woman at the top range of learning disability is not one of these and Social Services involvement and attachment is firmly resisted. The emotional vagaries bring into prospect a possible categorisation of mental illness, and the learning disability NHS consultant refers her to the NHS adult mental health service who admit her for appraisal. In this Unit she is seen to build up a relationship, which leads to sexual relationships, with Arnold, a older fellow in-patient who is there after continued and mounting alcoholism, topped up with benzodiazepine sedatives. In some respects the relationship is seen as a positive one for both Arnold and his eventual victim. He has a scattered record of violence, when drinking, not available to the in-patient service. nevertheless if that service was condoning the friendship, it is something that should have led to an appraisal of whether it was sustainable without intrusive support. Then the background of violence potential might have come from a social worker investigation of his network - his immediate living neighbourhood observations, and perhaps his family. Social services were not involved in his in-patient assessment. The eventual victim is disappointed when attempts to find her a more companionable domicile fail, and an intention to have her attend the day centre adjoining the in-patient Unit gets lost. She is discharged back to where she came from. There is confusion as to who is her aftercare key worker - a learning disability line manager decides that staff used to accompanying simple learning disability would be inappropriate. She is still receiving medication, initiated and prescribed from the mental illness service. No actual hand back was arranged with the learning disability consultant who had obtained the admission to the mental health services in-patient Unit. That should mean that the aftercare remains with the mental health services until another service has engaged with their care. In the event she finds no one person to stand up for her, and she continues her casual unfocussed community companionship with Arnold. He does get to the Day centre adjacent to the in-patient Unit , and attends for a while , but less and less effectively. There is no one clinical lead charge at the day centre. Arnold drifts back into his drinking habit and networking. December arrives. Nobody delivers a full commitment from the caring services at those times. Arnold and the young victim go to their family homes over Xmas, but resume friendship immediately after that Help may arrive in the New year. But by then the victim has ended up in the flat with Arnold at a time when he falls into some sort of alcoholic furor. He shouts and beats her over some time on that evening- not apparently an untoward experience for the neighbours, who do not react at once. The police are called in by neighbours at 2am, and the tragedy is revealed. Review	E-mail reaction is welcome mica@didgy.freeserve.co.uk