M ental I llness C oncerns A ll	Like Blom-Cooper; Mitchell- and Coonan; Edwards/Linford - a well established previous diagnosis - by equally qualified professional colleagues - which is made to bring careful attention to a serious illness, is rejected, and future clinical supervision and field management loosens in consequence,and does not gain respect. As in those cases the family doctor - traditionally the person of final say for the best interests of their patient and as their protection from harm, is here not in the picture. Sometimes it seems they want it that way. He is not held under review or contact by the professional team supporting his hostel placement. Field workers lose clear guidance and relevant direction. The 'care manager' of C. is a social worker who has no regular place in this final outreach team. Alone, she is not able to bring C. to the belief that care in the community has been to his advantage. Her reservations about his progress do not get a clinical review. A built up alliance leading to part success has lost its impetus and the professional withdrawal loses its value for any future appeal by C. There is nobody among his community contacts who is sufficiently known to the professional services to be a source of information as to what is going on in his life 'outside' and to point him back to agency intervention. There have been changes in locality mental health management boundaries. The clinical lead who has removed the clear diagnosis disparages the guidance of the Care Programme Approach. His immediate Trust Board are not in the picture about that. Neither he nor the method of team work are held in account and his outreach group goes its individual own way. The Inquiry Report recommends it be disbanded and its people come into the fold. Touchiness and irritability and aggressive reaction are held - without the original diagnosis - to be passing ephemera not requiring professional review. When C leaves, the out of area hostel maintains its helping point of contact for him but it is now without its professional backup, and when stretched about him, do not make contact with the withdrawn outreach team - their normal support. The hostel was originally staffed for stabilised enduring mental illness but their clientele is now younger and more volatile without any corresponding staff upgrade or support system change. A final aggressive attack on a passerby leads to his detention in a close admission ward with a diagnosis of 'psychosis'. There have been a number of escapes from there, and C. gets away. The retrieval arrangements are not rehearsed and prepared with the local police and when C. escapes it is not clear from where or from whom, an urgent reponse should come. Government guidelines are followed but in effect were inadequate in themselves to make up for individual Bell; Conceiaco ( Phillips )   back to Inquiry links Inquiry Bell; Conceicao	E-mail reaction is welcome mica@didgy.freeserve.co.uk