I llness

C oncerns

A ll

A rather unsettling childhood left JB unable to stick up for himself. He achieved A-level examination standards. He could not extricate himself from a childless marriage into which he felt he had been tricked.

The marriage foundered but the couple remained for ten years in the same household. When both became unemployed at the same time things got much worse between them with JB continually getting the thick end of many unfounded accusations from the wife.

During the ten years prior to his homicidal attack on the wife JB was referred to the psychiatric services, which never engaged sufficiently to provide a continuous supporting contact so that the situational troubles could be resolved.

The management had not fully accepted or practiced the Care Programme Approach - six years after its introduction by directive - perhaps never understanding that at this time it was also to apply generally to any contact, and therefore to Out-patients as well as routinely on discharge after a hospital admission.

The Inquiry notes only junior staff out-patient interview contacts with no mention of consultant involvement until a new appointment shortly before the tragedy. He never received a support system that couldhave helped him to dissolve the difficult and unrewarding marriage. He was recommended for the specific tri-cyclic anti-depressant medication suitable for endogenous mood illness, and these were prescribed by the family doctor in variable and inconsistent low dosage, as well as a sedative benzodiazepine for anxiety. It was not possible to assess any decisive influence on the depression that was present. There was insufficient continuity of psychiatric contact to establish a diagnosis of Affective Illness. There is one allusion to a possible 'hypomania shift' just before the final denouement.

A referral to the clinical psychology service passes him on to the marriage guidance service without seeing if that came to anything. It did not and could not.

There was a younger sister who never seems to have been approached.

The psychiatric services continued an old practice without realising that the old support services - like the previous mental health social worker in the old hospital - no longer existed and nothing had here adequately replaced them in a community service.

Social Services were never involved and it is not clear that a referral would have been taken up successfuly by JB or the Social Services .

The Inquiry explains a delay in publication as down to 'confidentiality' and the non-appearance of witnesses without explaining what this meant.

But there is no report about earlier consultant support, particularly no reference to the backing supervision for the junior psychiatric staff at out-patients, until a new Consultant arrives three months before the final tragedy.

JB seems not to have got the direction and companionship, professional or lay, that he needed.

A puzzling feature is that JB continued to be seen by mental illness services without JB mentioning that the dead body of his wife was in the house somewhere. It was six weeks before her body was found and JB was charged. Psychiatric evidence at the trial did not attribute any of the final behaviour to the influence of major psychiatric illness .

JB went to prison.

This Report is a very tardy release. Little chance for others to learn any lessons.

Event - Aug.1997.

Convicted- July1998.

Inquiry - Commissioned May1999.

Published - February 2001.

reviewed

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