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Takoushis (R on the application of) v Guys & Thomas Hospital NHS Trust

This is an application for judicial review. It arises out of the inquest into the death of a 64-year-old-man, whose body was found in the river Thames on 14 February 2003. There are essentially two grounds to the claim:
the Coroner erred in law by refusing to hold the inquest with a jury; and / or

the inquiry at the inquest was inadequate because the defendant refused to allow the claimant the opportunity to call expert evidence in relation to the care the deceased received from the Guy's and St Thomas' NHS Trust (the interested party) immediately prior to his death.

The claimant seeks an order quashing the inquest which was formally opened on the 24 February 2003, was resumed on 3 March 2004 and continued on the 4 March. She also seeks an order that a fresh inquest be held with a jury.

The claimant and the interested party have been represented before me by Ms Brander and Mr Daniels respectively. I am grateful to them both for the quality of their submissions. The Coroner was not represented. He has, however, helpfully provided a witness statement for the assistance of the Court.

The deceased, Pavlos Takoushis, was the husband of the claimant. He was a long-term schizophrenic who had been treated periodically in psychiatric hospitals, both voluntarily and involuntarily, since he was first diagnosed with the illness in 1974.
On 9 January 2003 he was admitted to Chase Farm Hospital as a voluntary patient. On 13 January, at approximately 11.15am, Mr Takoushis obtained permission to leave the ward to visit the day hospital within the hospital grounds. He did not return.

Full Transcript

FURY AT RELEASE OF MURDERER

A FATHER who stabbed his former partner to death hours after being sent home from a mental health check-up yesterday pleaded guilty to killing her.

Craig Sexton, 30, attacked Lynda Lovatt at her home as their two young children slept.

Hours earlier his parents, concerned about his behaviour, had taken him to see doctors.

But after being examined Sexton was discharged and told to come back the next day.

Yesterday, Lynda's family demanded to know why the hospital had released him.

Her mother Beryl, who is now looking after grandchildren James, seven, and four-year-old Amy, said: "It must have been obvious he should have been detained.

"He had a history of illness and his parents must have been desperate to take him to the hospital. That decision left a family without a daughter and a mum."

Sexton, from North Shields, Tyne and Wear, split with Lynda in February but began to subject her to a barrage of abusive calls.

On June 18, he was seen by a crisis assessment team at nearby North Tyneside General Hospital. But he was discharged and took the ferry to South Shields, killing 29-year-old Lynda in a frenzied attack.

Sexton pleaded guilty at Newcastle crown court to manslaughter on the grounds of diminished responsibility.

John Evans, prosecuting, said: "At the time of the killing the defendant was suffering from an abnormality of mind - a depressive illness."

Sexton was remanded in custody until January 21 for psychiatric reports.

Beryl, 57, from South Shields, said her daughter had complained to her of his "mental cruelty" during their 11-year relationship.

She added: "James has an idea what happened. He knows his father was a 'naughty daddy and killed mummy'.

"Amy wakes in the night and calls for her mum. Sometimes she tries to call me mum, but I tell her 'no, I'm your granny'."

The Newcastle, North Tyneside and Northumberland Mental Health Trust last night refused to comment on individual cases because of patient confidentiality.

But it said there would be a thorough internal review, adding: "In cases where there are very serious circumstances there is always an independent inquiry."

mirror.co.uk 23 Dec

MENTAL CARE OF KILLER REVIEWED

The South West Peninsula Strategic Health Authority is to carry out an independent review into the contact murderer Ian Hartshorn had with different organisations before he killed pensioner Flo Seccombe. The 'independent formal multi-agency review' aims to learn lessons from the contact he had with organisations such as mental health services in the city and Social Services, and to also assess the 'care and treatment' he received.

Plymouth City Council will also be putting together a multi-agency protocol for any similar incident in the future.

Yesterday the Herald reported that initial findings of an inquiry conducted by Plymouth Hospitals NHS Trust (PHT) revealed there were 'communication' problems between agencies but there was no 'clinical criticism'.

PHT began an internal investigation in October, which centred on the contact Hartshorn had with the Child and Adolescent Mental Health Service at Mount Gould Hospital before he murdered pensioner Flo Seccombe at Bretonside in October 2003.

The panel has now finished taking evidence and is due to meet again in January after which a public report will be published.

Plymouth Primary Care Trust (PCT), which shared responsibility for Hartshorn's care under a so-called 'multi-agency approach' has also carried out its own internal inquiry.

A spokesperson for the South West Peninsula Strategic Health Authority today said the authority would be setting up an independent review once PHT and the PCT had finished their own inquiries. She said: "Once the internal investigations, undertaken by Plymouth Primary Care Trust and Plymouth Hospitals NHS Trust, are concluded, the South West Peninsula Strategic Health Authority, in collaboration with other agencies, will be establishing an independent formal multi-agency review.

"This multi-agency review will look at the contact Mr Hartshorn had with organisations, and assess his care and treatment, to understand what happened and learn lessons from it."

A spokesman for Plymouth City Council, said: "It has also been agreed that Plymouth City Council will be putting together a multi-agency protocol for any future incident involving a young person that causes harm."

Hartshorn, aged 18, was jailed for life at Plymouth Crown Court in October for stabbing to death 69-year-old Mrs Seccombe. The inquiries now being carried out follow criticisms of the way in which Hartshorn was handled by mental health services, made by trial Judge William Taylor and Tory MP Gary Streeter in the House of Commons.

Sentencing Hartshorn to a minimum of 14 years in jail, Judge Taylor revealed the killer had seen a consultant psychiatrist at Mount Gould Hospital eight days before killing Mrs Seccombe and had asked for help with long-term mental health problems. The court heard Hartshorn had been a self-harmer, but a psychiatric report concluded he 'was not in need of psychiatric care'.

thisisplymouth.co.uk 23 Dec

ASBOS TARGET 'WRONG PEOPLE'

ANTI-social behaviour orders are being used to jail people who are vulnerable and mentally ill, a new report claimed last night.

There is growing evidence that courts are abusing the controversial system, said the National Association of Probation Officers (Napo).

The orders, introduced by Tony Blair, were no longer being used just to target small-scale yobs and vandals.

Instead, said Napo, they are being targeted at people who need medical treatment, or help from social services.

Victims include a prostitute locked up for carrying free condoms given to her by a drugs clinic.

Napo Assistant General Secretary, Harry Fletcher, said: "People with mental health problems are being made subject of anti-social behaviour orders when they need treatment."

The report also found there was a 'postcode lottery' in how the orders were used.

In Manchester, 155 were issued in the first six months of 2004, but only 27 in Merseyside.

In South Yorkshire there were 22, compared to 128 in West Yorkshire.

A Home Office spokeswoman said: "It only becomes a criminal matter if the order is breached.

"This is a powerful deterrent to those who receive orders."

mirror.co.uk 28 Dec

Killer will spend life in mental institution

A TILEHURST man who killed a neighbour in an horrific arson attack because he thought she was a witch, will spend the rest of his life in a psychiatric institution.

Angel Sanjurjo started an inferno by pouring petrol through the letterbox of former Battle Hospital nurse Angela Stanyer at 3am on March 18 this year.

Mrs Stanyer managed to help 16-year-old daughter Fiona to safety through a bedroom window as their Ogmore Close home was engulfed in flames.

But the 52-year-old, who had twice survived cancer, was trapped in the blaze, and died later from her burns at the Royal Berkshire Hospital.

Sanjurjo, 62, was arrested within hours but was found mentally unfit to stand trial for Mrs Stanyer's murder because a series of strokes have left his brain deadened and caused hallucinations.

He met Mrs Stanyer while they were working at the Mars Confectionery factory in Slough 10 years ago but, even though they barely knew each other, became fixated with her after he fell ill.

A Reading Crown Court jury concluded Sanjurjo was responsible for starting the blaze, and Mr Justice Treacy ordered him to spend the rest of his life in a mental institution.

Sanjurjo, who was treated for burns after the blaze, told hospital staff he thought Mrs Stanyer was a witch who was trying to kill him.

He said: "She has got spiritual powers and puts her voice in my head, she has been tormenting me for years. I see her everywhere I go. She says she still wants to harm me and kill me but that she still loves me.

"The witch woman is up there. She wants to harm me."

Nigel Daly, defending, argued there was insufficient evidence to prove Sanjurjo, now detained in a psychiatric unit in Thatcham, carried out the attack.

icberkshire.icnetwork.co.uk 23 Dec

Most mentally ill pose no threat

Campaigners say the overwhelming majority of mentally ill people pose no risk to public safety.
Some critics have suggested the modern approach of treating mental illness in the community may have increased the risk of violent incidents.

But experts say there is little statistical evidence to back this up.

They say violent attacks by strangers are relatively rare, and it would be wrong to deprive many people of their liberty when they pose little threat.

There have been a number of high profile cases of mentally ill people turning into killers.
These include Christopher Clunis, a schizophrenic who killed Jonathan Zito on the platform of Finsbury Park tube station in north London in 1992.

Clunis had stopped taking his medication.

However, cases of this ilk are not common.

Andy Bell, director of communications at the Sainsbury Centre for Mental Health told the BBC News website that around 30-50 murders a year out of a total of 800 could be blamed on mental illness.

"That is still 30-50 too many, but it is a very low risk when you compare it to the number of violent incidents involving alcohol," he said.

Mr Bell said around 500,000 people in the UK were suffering from a severe mental illness such as schizophrenia or manic depression, which required specialist treatment. In total one in six people has some form of mental illness.

He said the idea that all mentally ill people posed a threat to society was a stereotype which was not founded in reality.

"The policy of care in the community has allowed hundreds of people to live peacefully and normally as valued members of the community," he said.

"We don't want to go back to a Victorian policy of locking up people away from the community on the grounds that one day maybe they might be a risk.

"It is very, very difficult to predict violence, and so such a policy would require locking away hundreds, maybe even thousands of people in order to prevent one or two tragic incidents."

Violence is not a common symptom of mental illness. Most schizophrenic individuals, for instance, are not violent; more typically, they prefer to withdraw and be left alone.

Mr Bell said statistics showed that a mentally ill person was twice as likely to be murdered as anybody else.

He said support services continued to be under-funded. Mental health as a whole received a third of the increase in resources granted to the rest of the NHS this year, he said.

Marjorie Wallace, chief executive of the mental health charity Sane, said every violent incident involving a mentally ill person would inevitably call into question the policy of care in the community.

But she pinned any blame not on the policy, but on the lack of resources to fund it.

"Mental health services in some areas are struggling under such severe pressures that they simply cannot follow up patients, who may then become lost to the system.

"Once someone is discharged from the psychiatric services, it is often hard to get back in.

"Families and friends who may notice a deterioration in a person's mental state are often ignored, and there are not enough beds or staff to ensure a quick response.

"We need a huge increase in resources, and vigilance so that mentally ill people can live safely in the community and the public can have confidence that they are receiving reliable mental health care."

The draft Mental Health Bill currently going through parliament which would enable the forced detention of mentally ill people deemed to pose a risk to the public who refused to take their medication.

bbc.co.uk 23 Dec

Man held after one killed, five injured in stabbing rampage

A man who went on the rampage through the streets of London, stabbing one man to death and leaving five other people seriously injured, has a history of mental illness, police said yesterday.
The man drove across a six square mile area of north London at the height of the morning rush hour, stopping and stabbing victims at random in six locations.

The hour-long series of attacks left one man dead and three other people needing surgery after suffering life-threatening wounds.

The attacks ended only after police traced the suspect from the registered address of the car he was using. They went to the address where the car, a red Hyundai, was registered and arrested the man as he pulled up outside his home. Police said there were signs of blood on the man and in the car.

Last night police said they were holding a 30-year-old man in connection with the stabbings of five men and one woman.

One witness told how he battled to save the life of the man who died. The victim, believed to be a construction worker, was 58 and married with children. He was stabbed by a scrapyard on the edge of an industrial estate in Advent Way, Edmonton.

He staggered down stairs, bleeding heavily, and asked a security guard at an industrial unit. The man was taken inside where Dervish Dervish, 54, and a colleague fought to save his life.

Mr Dervish, a delivery worker, said as they removed his bloodsoaked clothing they saw the man had suffered three stab wounds to his front, and one to the back.

Mr Dervish said he asked the man, who was slipping in and out of consciousness, what had happened: "He said 'I was walking, a car pulled up and two guys got out and stabbed me. I said 'why' and he said 'I don't know'".

Police said only one person carried out the stabbing.

Mr Dervish said he and a colleague administered heart massage and mouth to mouth resuscitation after the victim's heart stopped three times.

He said: "It burns me up. I felt like crying. The bloke is going to work, the next thing they're phoning his wife to say he's dead."

Some of the victims received multiple stabs wounds and at least two were fighting for life last night, including a 20-year-old woman who was stabbed as she was cycling.

Police say the woman was so surprised by the random attack that she cycled on thinking she had been punched in the back, before collapsing.

The terrifying series of attacks started just after 8am, when a 29-year-old man said goodbye to his girlfriend, left his home and was stabbed. He staggered to Edmonton Green rail station before collapsing, leaving a trail of blood in the street.

Police were called to the first attack at 8.20am, and arrested a man at 9.24am.

The last victim was not reported until 80 minutes after the arrest at 10.45am, when a 76-year-old man walked into a hospital for treatment, apparently unaware how serious his injuries were.

At one time over 100 officers were involved in hunting the knifeman and helping the victims.

Chief superintendent Simon O'Brien said: "The stabbings were random and there appears to be no link between the victims.

"There was a man coming out of his vehicle, picking people at random. Some were cycling, some were walking. He was stabbing them, sometimes in the back, and then driving off."

Chief Supt O'Brien told BBC Online: "We could be dealing with a person who has mental illness. Certainly the person in custody has a history of mental illness."

Police said they had recovered a large kitchen knife, which they believed was used in the attacks.

The Barnet, Enfield and Haringey NHS mental health trust said it was checking its records to see if the suspect had been a user of its services.

Chief Supt O'Brien said the suspect was 29 and believed to be of Turkish origin.

Dr Yasmin Drabu, medical director of North Middlesex hospital, said the victims had multiple stab wounds, some "life-threatening", including in the stomach and abdomen.

guardian.co.uk 24 Dec

One dead after stabbing rampage

A man died and five people were seriously hurt after a knifeman went on the rampage in north London.
Police say the attacks, carried out by a man in a red car, took place over a period of an hour within a six mile area of Edmonton and Haringey.

The knifeman drove between the locations before springing out of the vehicle to attack random victims.

A 58-year-old man died of his wounds in hospital and police later arrested a 30-year-old man near his home.

A police spokesman said the victim, whose identity has not yet been released, leaves a wife and children.

The spokesman said the man being held in connection with the attacks had a history of mental illness.

Enfield borough commander Ch Supt O'Brien said the motivation for the attacks was not known.

He added: "It's very difficult to know what prompted this. The first victim was a man who was walking to the station to go to work.

"He had just left his girlfriend when he was stabbed a couple of times in the back. He thought he had been punched and carried on.

"The calls then started coming in thick and fast and we realised we were probably dealing with the same guy stabbing people."

A suspect was arrested by unarmed officers as he got out of a Hyundai near his home in Tottenham, north London. A knife has also been recovered.

Ch Supt O'Brien added: "We could be dealing with a person who has mental illness, certainly the person in custody has a history of mental illness."

He said 100 police officers were involved in the case.

"It seems the man was getting out of his vehicle, picking people at random, stabbing them and then getting back in his vehicle," he said.

A witness to one of the attacks told BBC News: "A man came inside the garage and he was bleeding and said, 'somebody just stabbed me in the stomach'.
"We gave him tissue and a wrapping and were holding tissues so the blood wouldn't come out. He was shocked and very nervous."

Police said they were first called out to the area at 0820 GMT to reports of a stabbing outside Edmonton Green train station and then attended four other incidents over the next hour.

A shopkeeper near to the first attack told BBC News: "This man came out of a car and then stabbed this person in the back. He then went off. I was really frightened."

The victim who died was the last to be found at 0927 GMT in Advent Way.

A spokeswoman for the North Middlesex Hospital in Edmonton said a woman, aged 20, had been transferred to the London Heart Hospital where she was undergoing surgery three men, aged 33, 49 and 76, have undergone emergency surgery; two were recovering and one was in the high dependency unit.

Another man, aged 50, was also in the high dependency unit. All four men are described as stable.

The incident comes one day after shopkeeper Mahmut Fahri was knifed to death in Wood Green, north London - just 1.4 miles from the first stabbing.

He was stabbed in the chest by two thieves who stole two bottles of spirits from his grocery store.

Mike Rye, the leader of Enfield Council, described the attacks as "most shocking".

He added: "There is a lot of concern in the community about extreme violent crimes at present."

bbc.co.uk 23 Dec

NEW TRIBUNAL RIGHTS FOR SECTION 2 PATIENTS

This special News Flash edition of Hempsons Mental Health News Brief discusses the decision of the Court of Appeal in the case of MH.

Hempsons' mental health law specialists are available to discuss the implications of this decision, and to provide expert advice and representation in connection with Mental Health Review Tribunal proceedings.

On 3 December 2004, the Court of Appeal gave a judgment that is likely to be significant for many patients detained under section 2 of the Mental Health Act. Although it won't have an immediate impact on the way NHS trusts, independent providers and clinical staff do their jobs, it will make a difference in the long-term.

Click Here

The full Judgement can be found here

National Programme for Improving Mental Health and Well-Being annual review 2003-2004.

Scottish Executive Dec 04

Minister's Foreword

The Scottish Executive's National Programme for Improving Mental Health and Well-Being has two fundamental aims: to help improve the way in which people think and act about their own mental health and that of others; and to improve the quality of life, well-being and social inclusion of people who experience mental illness or mental health problems. These two aims are fundamentally linked and achieving them requires understanding, commitment and action from everyone in Scotland.

For too long, mental health issues have been misrepresented, misunderstood, ignored or delegated to others to deal with. This is no longer acceptable in modern Scotland. To be the country we want to be, we need to focus more on our emotional mental health and well-being, and on how we feel and think as a country, as organisations, as families and as individuals.

In September 2003, we launched the National Programme's three-year action plan. Much of the progress over the last 12 months is outlined in this document. A particular challenge is to help make better connections for mental health and mental well-being into a wider range of policy and action areas. For example, making more explicit the links to physical health and activity while improving health in workplaces, employment, schools, colleges and universities, in local neighbourhoods and communities, with families, with our children and young people and with our most marginalised and vulnerable communities. In short, we need to continue to take action on improving the mental health and well-being of everyone in Scotland, target work at the people who need it most, and make wider connections to improvements in our overall health.

The most important ingredient in any programme of activity in public policy, public health and health improvement is people. Without their energy, commitment and enthusiasm the work you will read about in this annual review would not exist. So I encourage you to join with us in taking this work forward in Scotland and to making your contribution to a more mentally aware and more mentally healthy Scotland.

Click Here

Poorer Scots at risk of suicide

Deprived Scots are four times as likely to commit suicide than those living in more affluent areas, a study has found.
Researchers found suicide rates among poorer communities had increased dramatically since 1980.

The General Register Office for Scotland found suicides for 15-44-year-olds went up from 15.38 to 24.32 per 100,000 between 1980 and 2001.

The study suggested drug abuse, divorce and unemployment could be to blame as they are more common in poorer areas.

The results, published in the British Medical Journal (BMJ), found men in the most deprived communities were four times more at risk of taking their own lives than those in more affluent areas.

Across all parts of Scotland, the risk of suicide for males rose from 22.13 to 38.65 per 100,000.

The suicide rate for all women increased from 8.62 to 10.55 per 100,000 over the same timescale.

However, the figures noticed a sharp increase in female suicides between 1999 and 2001 when almost six times more women took their own lives while living in poorer postcodes.

The researchers also noticed suicide rates dropped for those aged 45 and over, dropping from 22.99 per 100,000 in 1980-82 to 16.73 in 1999-2001.

Despite the findings, the Scottish Executive, which has set a target to reduce suicides by 15% for 10-24-year-olds in the most deprived communities by 2009, said the rate had already fallen since the end of the BMJ study in 2001.

The director of the executive's national programme for improving mental health, Gregor Henderson, said: "Achieving this target will rely heavily on people all over Scotland becoming more aware of their own mental and emotional health and well-being and the difficulties facing others.

"We need to get across a message of hope for people.

"The vast majority of people who experience mental or emotional ill-health and difficulties can and do recover with the right support and help.

"People's attitudes also help and ending the stigma that still exists is also of vital importance."

The Scottish Association for Mental Health said the rising suicide rate among poorer communities came as no surprise.

Policy director Richard Norris said: "In Scotland we need to be more open about mental health problems, so that people are able to seek help before it is too late.

"This survey shows we need to focus on the importance of mental well-being and ensuring everyone, particularly among younger people, has a feeling of belonging.

bbc.co.uk 22 Dec

Statement by the Royal College of Psychiatrists in respect of the psychiatric problems of detainees held under the 2001 Anti-Terrorism Crime & Security Act.

This statement is made by the Royal College of Psychiatrists responding to public concern about the mental health of detainees held under the 2001 Anti-Terrorism Crime & Security Act. The College is aware that the Government needs to respond to the House of Lords' recent judgment that current legislation is unlawful. In the expectation that Parliament will consider this current legislation and may consider future legislation in response to potential threat from terrorist organisations, the Royal College of Psychiatrists asks legislators to consider the following points in respect of the potential impact on mental health of such legislation on detainees.

In considering the mental health of detainees, the College has taken account of the findings made public by a group of psychiatrists who have provided reports on those detainees currently held under the 2001 Anti-Terrorism Crime and Security Act.

Having considered available evidence the College is satisfied that detainees as a group do suffer from significant mental health problems. On balance, evidence does point to the particular circumstances of this group's detention contributing significantly to their mental health problems. Despite limitations to available evidence, our best estimate is that indeterminate detention, lack of normal due legal process and the resultant sense of powerlessness, is likely to cause significant deterioration to detainees' mental health We consider that the impact on mental health is an important factor that should be taken into account when reviewing present legislation or contemplating future such legislation.
The Royal College of Psychiatrists is satisfied that detainees have access, equal to that of other prisoners, to mental health services in prison and are able to access appropriate hospital treatment if deemed necessary. At the same time, the College believes that psychiatric treatment, however sophisticated it may be, cannot neutralise the deleterious impact on mental health of the particular nature of this group's detention. We are therefore particularly concerned that the Home Secretary should not suggest that provision of psychiatric treatment from high quality mental health services, can in itself prevent a decline in detainees' mental health that may come about as a result of their detention.
Members of the Royal College of Psychiatrists will continue to provide mental health services to this group of detainees and any others that may be detained under future legislation. The Royal College of Psychiatrists considers that it is the ethical duty of psychiatrists to provide psychiatric care to people irrespective of the circumstances under which they are held. Any special concerns that psychiatrists may have about the legality of detention would in no way impede psychiatrists from providing the highest standards of treatment possible under whatever circumstances detainees are held.
Tuesday, 21 December 2004

For further information please contact Deborah Hart or Thomas Kennedy in the External Affairs Department.

Telephone: 020 7235 2351 Extensions. 127 or 154
E-mail: dhart@rcpsych.ac.uk or tkennedy@rcpsych.ac.uk

http://www.rcpsych.ac.uk/press/preleases/pr/pr_633.htm

'More must be done' on suicide

Mental health charities have welcomed figures proclaiming the lowest suicide rate ever recorded in England, but warn of a worrying rise in cases of self-harm.
A report from the National Director for Mental Health found the suicide rate for 2001-03 was 8.6 per 100,000 of population, down from a peak of 11.4 recorded 14 years ago.

Professor Louis Appleby hailed the progress made in mental health treatment, saying the government aimed to meet its target of reducing the rate to 7.4 suicides per 100,000 by 2010.

He pointed to an increase in staff as well as better risk assessment as being behind the record drop.

Professor Appleby was also quick to acknowledge that more needs to be done, such as ensuring an even spread of funding across Britain and improving services for ethnic minorities.

But it would appear the biggest challenge remains that of removing the stigma attached to mental health problems.

Welcoming the report, Health Minister Rosie Winterton signalled the government's recognition of the problem: "We are determined to tackle and eradicate stigma, inequalities, discrimination and the social exclusion of people with mental health problems.

"Reform and investment of mental health services is beginning to make a real difference to the lives of people with mental health problems and their families."

Paul Corry, Rethink's director of campaigns and communications, outlined some of those reforms that have made a difference to people at risk.
"The means for patients to take their own lives on wards has been reduced - coat hooks have been removed off doors and shower rails are now much weaker. Out-patients are now targeted more after they have left hospital," he said.

The size of paracetamols had also been reduced, making it harder for people to take their own lives by means of an overdose.

Changes like these have improved the situation for many people with emotional problems, but the pain persists for others.

Marjorie Wallace, chief executive of the charity Sane, said: "While no one can question the well-meaning intentions and rhetoric, or the improvement for some mental health patients over the past five years, we have yet to see significant change in the lives of the majority of the 1,000 people who call us each week.

"The rate is still high, especially among young men and mentally ill people in prison. There is also disturbing evidence that the numbers of those self-harming are growing, and that they are doing so in increasingly damaging ways."

That was an immensely worrying trend, according the Sarah Nelson of the Samaritans.
"Self-harm is the biggest single indicator of a risk of suicide," she said.

"Just because someone self-harms doesn't mean they will definitely eventually take their own lives, but they are 100 times more likely to do so at some point."

And she said the rate of drug and alcohol abuse among young people, one of the main at-risk groups, showed a rise as well.

She said it was important to remember that suicide was the end point of a long line of distress, and that just because the figures were down at present it did not necessarily mean that the figures would remain so positive.

So long as the stigma attached to mental problems remained, she said, so too would the threat of these figures soon starting to climb once again.

bbc.co.uk 20 Dec

Sex attacker is sent to hospital

A man whose sexual attack on a woman was so violent she had to have reconstructive surgery has been sent to a mental hospital indefinitely.
Carlos Silva, 32, of Stockwell, took the 38-year-old to a south London park and ordered her to perform sex acts.

When she threatened to leave he strangled her until she was unconscious. When she awoke she had extensive head and neck injuries.

Silva admitted grievous bodily harm with intent at the Old Bailey.

Among the woman's injuries were a fractured cheek bone and eye socket.

Judge Christopher Moss said the victim was "lucky to survive" the three-hour ordeal.

He told Silva: "You subjected your victim to a dreadful attack with great violence and brutality"

bbc.co.uk 17 Dec

Suicide patient ‘let down by hospital’

A WOMAN found dead in the Hollow Ponds six weeks after attempting to commit suicide was seriously let down by a mental health unit, says her family.

A body found at the lake in Whipps Cross Road, Snaresbrook on Monday, November 29, has been confirmed as that of Selina Davidson, who had slipped out of the Naseberry Court mental health unit in Larkshall Road, Chingford.

Police said a post mortem revealed the cause of death was "probably from drowning".

The 47-year-old from Walthamstow was a voluntary patient at the unit and was being treated for depression after her boyfriend, Gareth Davis, fell to his death at Beachy Head, West Sussex, while on leave from Naseberry Court in August.

Ms Davidson was admitted as a voluntary patient soon after Mr Davis' death. She first went missing from the unit prior to her suicide attempt twice on November 4, believe her family.

Ms Davidson's sister Karen said Naseberry Court had "refused to believe Selina was a risk" to herself.

She said: "Naseberry Court called us to say Selina was missing at 6pm on November 4. Then Selina phoned from Naseberry Court at 9.20pm, and then she went missing again after that. We just cannot explain how we feel about that."

Karen Bellamy, who works for mental health charity PSS Together, said Ms Davidson had called her six weeks before her death from the forest area of Snaresbrook to say goodbye.

She said: "I managed to get her in time but she had already cut her wrists. When I heard about her death, I just broke down in tears. It seems such a waste of life.

"How many more suicides are we going to accept and say this is inevitable?

"Until that attitude changes, it will be more inevitable.

"Naseberry Court knew about her attempted suicide in October but still this is allowed to happen. There is no doubt Selina was let down. Investigations must and will take place."

Ms Davidson's family say they are planning to lodge a formal complaint.

North East London Mental Health NHS Trust (NELMHT) interim chief executive Judy Wilson said: "The death of any patient in our care is regrettable and I would like to extend our sympathy to Selina's family and friends. We are in the process of reviewing Selina's care and treatment to ensure that if there are lessons to be learned appropriate action is taken.

"Our staff are committed to providing high quality care to all our service users and since my arrival in the trust I have been impressed by their enthusiasm and professionalism."

wansteadandwoodfordguardian.co.uk 17 Dec

Mentally ill are left alone at Christmas

FATHER has slammed the charity that will leave his schizophrenic son alone in a Finchley Road hostel this Christmas.

Tim Salmon, whose 38-year-old son has been a resident at Burnett House for 14 months, is furious that no staff will be in the building over the festive period.

Mr Salmon, a travel writer from Belsize Lane, said: "The residents are not potential killers but they should not be left alone at a time which can be stressful enough for most people.

"If they don't take their medication or have a relapse, some can get aggressive or suicidal, and become a danger to themselves and a danger to others."

His fears were confirmed on Tuesday when his son was involved in a fight with another resident.

He said: "My son has a history with this man and he was knocked down after receiving several blows. If an altercation happened over Christmas, who the hell knows where it might end.

"My son has always found Christmas difficult and in fact he described the fight as the start of the Christmas saga."

Burnett House is home to 13 men who all have a history of severe mental health problems. There will be no staff on duty Christmas Day and Boxing Day, with residents relying on a 24-hour helpline.

Marjorie Wallace, chief executive of mental health charity SANE, said: "Christmas is the most stressful time of the year for people with mental illness or who may be recovering from a mental breakdown.

"Everyone in mental health knows just how vulnerable people can be and to leave them without support is tantamount to negligence. There should be more staff on duty to prove to them that at least someone cares."

Burnett House is run by mental health charity Mind. The housing support end of Mind in Camden is funded by the government and local health trust. Mind was forced to lose a housing team leader earlier this year after cuts in funding from Camden.

A source from the organisation said agency staff had been hired to work in Burnett House and cuts were making it difficult for everyone.

A Mind spokesman said: "The residents will have experienced mental health problems such as depression but all are now well enough to manage on their own day by day.

"Seven staff work across three projects in the borough during office hours (Monday to Friday, 9-5pm). As is the case during any other weekend period, on Christmas Day and Boxing Day this year, 24-hour telephone cover will be provided to Burnett House by two staff living nearby."

hamhigh.co.uk 17 dec

Police search routines criticised

Devon and Cornwall Police are changing search procedures for missing people after a strongly critical report.
Daniel Heard, 26, disappeared from the Cedars Mental Health Unit in Exeter in February. His body was found several days later.

The Independent Police Complaints Commission (IPCC) investigated the case. No misconduct was found but it has made a series of recommendations.

They include a single officer running such inquiries rather than a team.

Mr Heard, from Tiverton, was diagnosed as schizophrenic at 17. He was an in-patient at the Cedars unit in Exeter when he slipped out on 24 February.

The hospital's missing patient procedure was activated but it was several days before his body was found by a walker the following Sunday beside the River Culm, near Cullompton. It is thought he probably died from hypothermia.

The police did not organise a full ground search until five days after he first disappeared.

Daniel's mother, Linda Kelly, said she believed police misinterpreted what his condition meant for them.

She said: "The core mistake was that they didn't realise how vulnerable he was. The emphasis was put on the concept that he was dangerous when he was actually very vulnerable.

"And there were too many people passing too many messages which became distorted."
The IPCC report made a series of criticisms of Devon and Cornwall Police.

It said the risk assessment process used for missing people was not considered "best practice" as it did not help evaluate the true risk of their vulnerability.

It said that, for efficiency, an individual officer should take charge of the inquiry, rather than a team; and the use of the police helicopter should be considered for such searches.

Devon and Cornwall Police said in a statement the force had already commissioned a review into the policies and practices adopted in relation to missing persons.

The force said: "We will study the report into Daniel Heard's death and include its recommendations into those new practices."

On the whole, the IPCC report says the police's ongoing supervision on the inquiry was appropriate and no misconduct was found.

bbc.co.uk 16 Dec

Stalker will serve only 12 years for murder

A jilted lover who knifed his former girlfriend to death as she tended her horse was jailed for life yesterday.

Stephen Griffiths, 41, refused to accept that 35-year-old Rana Faruqui wanted nothing more to do with him.

He stalked her for weeks before repeatedly stabbing her with an eight-inch serrated hunting blade.

Griffiths was arrested five days after the attack. Police found a "stalker's tool kit" in the back of his Mercedes, including rat poison, syringes, knives, binoculars, an axe, saws and a truncheon.

Griffiths is expected to serve only 12 years of his life sentence. The victim's family criticised the jail term. Her mother, Carol, said in a statement: "In our opinion the sentence is far too lenient.

"He has shown to us no remorse throughout this time and in our opinion should never be freed.

"Rana was a beautiful girl who had a true love of life and was loved by so many people whose lives she touched.

"Today Griffiths begins the first day of his sentence. For Rana's family and friends, today is the first day of our life sentence. But for us there is no parole."

Reading Crown Court was told that at the time of the attack Miss Faruqui was calling police on her mobile phone, reporting Griffith's approach in defiance of an order banning him from contacting her. Her body was found close to her horse, Toby, on which she competed in dressage events.

Michael Lawson, prosecuting, said Griffiths, a surveyor, stalked his victim after she ended their relationship.

He spied on her at night, taking secret photographs of her. He once posed as an equestrian photographer to gain access to the Royal Windsor Horse Show, where Miss Faruqui was competing.

Two weeks before her death he cut her BMW brake pipes.

The pair met in October 2002 when Griffiths gave a presentation at the offices of a company in High Wycombe, Bucks, where Miss Faruqui worked as an IT manager.

They struck up an "intense" relationship. Griffiths moved into her cottage in Farnham Common, Bucks. But the relationship soured because of his possessive character and uncontrollable temper. She told him to leave.

In August last year, Miss Faruqui was tethering her horse in a paddock when Griffiths approached her. She dialled 999 and during the call she was heard to say: "You're not supposed to come anywhere near me, Steve." Seconds later she could be heard screaming.

The judge, Mr Justice Silber, told Griffiths: "This was a vicious and sadistic attack."

Griffiths, of no fixed address, admitted murdering Miss Faruqui at an earlier hearing. He has already spent the last 16 months in custody.

telegraph.co.uk 14 Dec

Mental hospital 'is like Prisoner Cell Block H'

A TILEHURST woman whose daughter made several escapes from Reading's state-of-the-art Prospect Park Hospital claims Berkshire's understaffed mental health services are a shambles.

Kath Tebbutt, 43, says daughter Natasha was sectioned under the Mental Health Act and repeatedly told staff she planned to kill herself, but was still able to walk out at will.

Miss Tebbutt, of Usk Road, also alleges that while an in-patient at Prospect Park her 21-year-old daughter regularly smelled of alcohol, tested positive for cannabis and had a "totally inappropriate" love affair with a male nurse.

Her claims are backed by another mother who says Prospect Park is so under-resourced staff have no time to care properly for patients.

The woman, who asked to remain anonymous, said: "The patients just have nothing to do. You have to be self-motivated to do something in there. But how many mentally ill patients are self-motivated?"

Shortly after Prospect Park opened last year a patient who was free to walk out, murdered his former girlfriend at her home in Theale.

Miss Tebbutt, whose daughter is now being treated at Oxford's secure Littlemore Hospital alongside convicted criminals, said Prospect Park's over-use of prescribed drugs simply masks patients' symptoms.

icberkshire.icnetwork.co.uk 16 Dec

Security ‘lapses’ at mental health unit spark concerns

LAX security at a Chingford mental health unit is a danger to patients and the public, a relative has claimed.

Andrew Ramsden, 46, said his wife Susan, sectioned under the Mental Health Act, is given free rein at Naseberry Court.

She suffers from bipolar disorder, a severe form of manic depression, and Mr Ramsden said he was scared of the consequences after his wife walked out of the hospital unhindered several times.

He said security needed to be drastically improved.

"They do have a very open policy at this particular hospital," he said.

"They should be more aware of what patients can do if they get out. They do not seem to care. They take everything that goes wrong with a very blase attitude. Patients come and go when they like, they then disappear and the hospital has to call the police which is not right.

"The whole thing is a complete sham and complete chaos and they say they are under-staffed which is a lame excuse."

Last month the body of Selina Davidson, 47, who was a voluntary patient at the unit, was found at Hollow Ponds in Leytonstone. She was being treated for depression after her boyfriend Gareth Davis fell to his death at Beachy Head, West Sussex, while on leave from Naseberry Court.

North East London Mental Health NHS Trust (NELMHT) which is responsible for running the hospital said security was a top priority for staff.

Interim chief executive Judy Wilson said: "All members of staff at Naseberry Court are vigilant about the safety and security of service users and their visitors. Service users are given leave when the clinical team responsible for their care assesses that it is appropriate.

"Naseberry Court provides acute mental health inpatient services and in keeping with all modern mental health services this is within an essentially open environment.

"Service users are free to leave the unit to go shopping or visit friends. In many cases it is an important part of their care and treatment.

"We are extremely vigilant and careful about ensuring that there is appropriate security, but it is not in the interests of the majority of service users to keep them behind locked doors. Intensive care is provided in a separate unit for which patients are assessed on an individual basis."

But Mr Ramsden said he wanted more action to release his wife from a vicious cycle.

He said: "If you knew her when she is well, she is a very kind, warm-hearted lady, who wouldn't hurt a fly.

"I have also seen her up for 38 hours without eating or talking. She completely loses track of time and blurs reality with her own fabrication and she has to go back into hospital.

"When she is released she gives up the medication thinking she doesn't need it any more, then she gets ill and has to go back into hospital.

"But then I know within two months she will be allowed out to do her own thing."

walthamforestguardian.co.uk 16 Dec

In-patients formally detained in hospitals under the Mental Health Act 1983 and other legislation, England: 1993-94 to 2003-04

This bulletin is an annual publication which summarises information about people detained under the 1983 Mental Health Act in NHS facilities, including high security psychiatric hospitals, and independent hospitals. It includes figures for the period 1993-94 to 2003-04.
Key facts:
The number of detentions under the Act fell slightly to 45,700 in 2003-04 from 46,500 in 2002-03. Formal admissions fell to 26,200 in 2003-04 from 26,400 in 2002-03, having reached a peak of 26,900 in 1998-99
95% of all formal admissions in 2003-04 were to NHS hospitals. 89% of all formal admissions were NHS under Part II of the Act
In 2003-04 there were 18,200 detentions after informal admission to hospital. This compares with 19,000 in 2002-03
The number of Place of Safety Orders involving assessment in hospital increased by 8% from 4,100 in 2002-03 to 4,400 in 2003-04. This followed a 20% rise in 2002-03 and a 16% rise in 2001-02
Court and prison disposals were up 7% in 2003-04 compared to 2002-03 but have fallen by over a quarter since 1993-94
The rate of detentions in NHS hospitals under the Act (including detentions after admission) in 2003-04 in England was 88 per 100,000 population
At 31 March 2004, there were 14,000 patients detained in hospital, of which 11,700 were in NHS facilities and 2,300 in independent hospitals

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Inspection of mental health services, Stoke on Trent City Council (July 2004)

This inspection of Stoke on Trent City Council’s services for people with mental health problems took place between 13th and 23rd July 2004. The inspection was undertaken by two inspectors assisted by a lay assessor.

The objective of the inspection was to evaluate the implementation of government policy relating to the social care needs of adults of working age who experience difficulties with their mental health.

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Carter (2) Hall v London Borough of Wandsworth 17 Dec

These two appeals from the Wandsworth County Court raise similar issues relating to the review of decisions as to "priority need", under the homeless persons legislation. Priority need is important in determining the extent of the duties imposed by the Housing Act 1996 for the benefit of those found to be homeless. Section 189 defines certain categories of priority need. These cases are concerned with section 189(1)(c):

"A person who is vulnerable as a result of old age, mental illness or handicap or physical disability or other special reason."

In this case we are concerned with applicants claimed to be "vulnerable as a result of mental illness". Guidance on the meaning of this phrase was given by this court in R v Camden London Borough Council ex parte Pereira [1998] 31 HLR 317, 330. Hobhouse LJ said:

"The council must consider whether Mr Pereira is a person who is vulnerable as a result of mental illness or handicap or for other special reason. Thus, the council must ask itself whether Mr Pereira is, when homeless, less able to fend for himself than an ordinary homeless person so that injury or detriment to him will result when a less vulnerable man would be able to cope without harmful effects."

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D v (1) Secretary of State for the Home Department (2) National Assembly for Wales 16 Dec

The Claimant was born on 24 October 1985 in Wales, where he resided at the times material to these proceedings. On 19 January 2003, when he was aged 17, he was arrested and charged with taking a motor vehicle without consent (he had driven a stolen vehicle over a police officer), assault occasioning actual bodily harm, obstructing a police officer, and criminal damage. On 21 January 2003, he was remanded in custody to YOI Stoke Heath. While in custody there, he inflicted harm on himself, and exhibited symptoms that were indicative of mental disorder. Over the period from January until August 2003 his case was considered by a number of psychiatrists, and there was considerable discussion of his condition and of his care, and of his possible transfer to an appropriate hospital where he could be treated. However, nothing was achieved before these proceedings were commenced on 19 August 2003.

On 1 October 2003, St Andrew's Hospital offered a place to the Claimant. It had no free place at the time, and initially the offer was for a place from 12 November 2003. The Hospital subsequently brought that date forward to 24 October 2003. The Claimant was due to be released from custody on 14 October 2003. On 3 October 2003, on his application for interim relief, a consent order was made by Silber J. In it the Home Secretary "in the form of the prison service" undertook to use his best endeavours to obtain two medical recommendations in support of the Claimant's transfer to a hospital under section 47 of the Mental Health Act 1983 ("the MHA") on an interim basis until his intended transfer to St Andrew's hospital in November 2003; and "in the form of the Mental Health Unit of the Home Office" the Home Secretary undertook to act expeditiously upon receipt of those medical recommendations to direct the transfer of the claimant to a hospital under section 47 until his intended transfer to St Andrew's Hospital. The order contained other provisions which it is unnecessary to refer to.

Following the making of that order, the Home Secretary stated that, notwithstanding his best endeavours, it was not possible to find an interim place for the Claimant in a hospital until the place at St Andrew's became available. With the Claimant's release from custody imminent, the matter came before Davis J on 13 October 2003. Wrexham Local Health Board was then a defendant to the proceedings. It undertook to use its best endeavours to provide the Home Secretary that day with two medical recommendations in support of the Claimant's transfer to a hospital under section 47. On the basis of that undertaking, Davis J. ordered the Home Secretary, on receipt of those medical recommendations, to direct the Claimant's transfer to a hospital under section 47 before his release from Stoke Heath Young Offenders Institution on 14 October 2003.

Doubtless as result of the pressure created by this order, St Andrew's managed to offer an immediate place, and the Claimant was transferred there on 14 October and detained under the MHA under the classification stated in the section 47 reports of "mental impairment". At St Andrew's, the Claimant has ceased self-harm and has engaged with a two-year treatment programme. It is not in dispute that his transfer to St. Andrew's and his treatment there have been beneficial.

At the times relevant to these proceedings, the Second Defendant was responsible for commissioning specialised child and adolescent mental health services in relation to Wales.

The Claimant's claim relates to the period of his detention at Stoke Heath between 21 January and 14 October 2003. He seeks:
(a) declarations that the Defendants delayed in securing his transfer to an appropriate hospital and thereby infringed his rights under Article 8 of the European Convention on Human Rights. The claim against the First Defendant was for a declaration that he had unlawfully failed to seek medical recommendations for the transfer of the Claimant to a hospital and failed to make the necessary direction under section 47 of the MHA; the claim against the First and the Second Defendant was that they had unlawfully delayed the making of referrals to hospital for the Claimant.
(b) damages for breach of his Convention rights.

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National Director for Mental Health's Review of Implementation of the NSF for Mental Health

Extra £30 million funding for general psychiatric intensive care units

Louis Appleby, National Director for Mental Health, today published his update report on mental health services in England, and Health Minister Rosie Winterton announced an extra £30million capital funding for psychiatric intensive care units.

Main findings of the report include:

suicide rates are at their lowest recorded level;
most users of services report that their experience of mental health care has been positive;
staff numbers have substantially increased and modern treatments are in widespread use; and
specialist community mental health teams have been set up across the country, offering home treatment, early intervention or intensive support for people with complex needs.
Welcoming improvements in mental health services, five years into a 10-year period of transformation, Louis Appleby said:

“My update report is a record of progress and achievement that I believe is unprecedented in the history of NHS mental health care. In reviewing the impact of the NSF, I have been struck most of all by the huge amount of activity that it has generated, the benefits of which are now becoming apparent. An impressive range of policy initiatives has been triggered in an area of health care that was previously neglected.

"Although services have become increasingly responsive to the needs and wishes of the people who use them, more changes are needed. For instance there still needs to be improvements in the experience of black and minority ethnic patients.

"We now need to plan the next five years in a way that re-casts our NSF in line with the direction that the NHS as a whole is taking towards patient choice, the care of long-term conditions, and improved access to services. We need to broaden our focus from specialist mental health services to the mental health needs of the community as a whole."

Health Minister Rosie Winterton said:

“I welcome this update from Louis Appleby. He rightly highlights areas in mental health provision that are progressing, helped by a 20 percent increase in spending on mental health services by the NHS and local authorities, and areas that need to improve if we are to deliver better in-patient care.

"This is why I’m pleased to announce today an extra £30 million this year to improve local, general psychiatric intensive care units. We are asking SHAs to tell us what pressures they are under and we will work with them so that money is targeted accordingly. SHAs, working with PCTs, will be taking a strategic view in allocating capital funding where it will be of the greatest benefit to mental health patients.

“Over the next five years, with the introduction of new roles for key staff, better information systems and working with the National Institute for Mental Health, we will be able to give even greater support to health and social care professionals to deliver services for people with mental health problems.

“We are determined to tackle and eradicate stigma, inequalities, discrimination and the social exclusion of people with mental health problems. Reform and investment of mental health services is beginning to make a real difference to the lives of people with mental health problems and their families. "

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Cell toilets change after suicide

The design of toilets in Northants Police cells have been changed after a 29-year-old man committed suicide while in custody.
An inquest jury in Kettering ruled on Thursday that Neil Dodd hanged himself from a toilet fitting.

Mr Dodd, of Turnbury Close in Wellingborough, had a history of drug abuse, but had been on a successful rehabilitation course. He died after being arrested for drunken behaviour in March this year.

The inquest heard that Mr Dodd had been training to become an electrician on a college course.

But on the 1 March, he came home drunk and began behaving aggressively to his parents, who called the police.

He was arrested and taken to the police station just after midnight.

But at a 0345 GMT he was found hanging in his cell. He had torn up his combat trousers to use as a ligature.

A health and safety adviser to the police said the toilet flush was designed to be flat into the wall, but had been worked loose.

It allowed Mr Dodd to use it to kill himself. Changes had since been made in all police cells.

bbc.co.uk 16 Dec

300 trained to spot the early suicide signs

TWO Glasgow psychologists have trained more than 300 people to spot the signs that someone is contemplating suicide.

The psychiatric 'first aid' scheme called Applied Suicide Intervention Skills Training is part of the Scottish Executive's £100,000 Choose LIfe campaign, which is one-year-old next month.

Scotland has twice the suicide rate of the rest of the UK - last year 540 Scots took their own lives and young men aged between 16 and 24 have one of the highest suicide rates in Europe.

The training programme aims to reduce these figures by 20% by 2013.

The project will come in especially useful at this time of year as suicide rates traditionally rise over the festive season.

Chartered psychologist Moira Sugden and David Murray, a chartered educational psychologist, carried out the training.

They are based in Glasgow's Notre Dame Centre for children with psychological and behavioural problems and between them have trained more than 300 people, some 100 of whom work in Glasgow.

Among those now equipped to detect the early signs of suicide are youth workers, community police officers and school receptionists.

Moira said: "We were interested in becoming ASIST trainers because a lot of the young people we work with are very vulnerable and we are aware they have had thoughts of suicide."

David added: "The better-prepared we are as a community to be able not only to talk about suicidal feelings but to have other people ask and listen, the less likely it is people will actually kill themselves.

"The skills we teach means they are more ready, willing and able to intervene and make a difference."

The scheme has been such a success Renfrewshire Council launched its own Choose Life campaign in September.

And last night workers at the local authority's project watched a screening of the classic film It's A Wonderful Life, which deals with suicide. The film sees Jimmy Stewart contemplate taking his own life when his personal fortunes crumble during the festive season.

It was screened at a special event for workers whose clients self-harm or who have attempted suicide in the past.

eveningtimes.co.uk 16 Dec

Discharge rules from medium secure units in Wales to be reviewed after stabbing

Arrangements for planning discharges at medium secure units in Wales are to be reviewed after an investigation into the case of psychiatric patient, Paul Khan, who fatally stabbed a stranger. The investigation identified a series of system failures—including a failure to apply a "12 hour missing" rule, which would have alerted the Home Office to the disappearance of 35 year old Mr Khan.

The inquiry team also said that they had difficulty understanding how Mr Khan, who had been admitted to Ashworth Maximum Security Hospital, Merseyside, seven years previously for an unprovoked knife attack, could have been transferred from medium secure accommodation to independent living within a few months.

Eighteen months ago Khan killed 72 year old Brian Dodd in Prestatyn, north Wales, by stabbing him at least 28 times. At the time, Mr Khan, who had been diagnosed with paranoid schizophrenia at 26, was under the care of the community forensic psychiatric team at Whitchurch Hospital, Cardiff, and was living in independent accommodation.

After the fatal stabbing in north Wales Cardiff Local Health Board was asked to commission an independent external review of the care management arrangements and the events leading up to the killing. The report identifies a number of areas of concern and makes a series of recommendations.

About accommodation it says, "The team found it difficult to understand how [Mr Khan] could essentially transfer from conditions of medium security to independent living within a total period of only nine months. Given [Mr Khan’s] offending history, the seriousness of the offence leading to him being detained in Ashworth Hospital, the inadequate hostel supervision and the relatively short period of time [Mr Khan] spent in the community, it felt his transition to independent living was not only completed too quickly but also without sufficient time based evidence of successful rehabilitation, in particular when considering the seriousness of the previous offence committed."

The team also highlights the failure to implement an arrangement which would have raised the alarm after Mr Khan was missing for 12 hours. "Notwithstanding the offence had already been committed, the failure to notify the police or the Home Office until three days later was a significant failing resulting in a situation where [Mr Khan] was effectively out of the area whilst presenting a serious risk to public safety and without instructions to recall him being considered or put in place," it says.

Ann Lloyd, Head of the Welsh Assembly Government’s health and social care department, said, "Health Commission Wales has been asked to undertake an audit of discharge planning arrangements from medium secure units across Wales. They will be supported by Healthcare Inspectorate Wales who will simultaneously undertake a clinical governance inspection. This will get underway before Christmas."

The report, Independent External Review into a Homicide at Prestatyn, Wales, is available at http://www.wales.nhs.uk/lhg/documents/PKReport.pdf (pdf file)

SUICIDE TIPS BY JAIL DOC

A PRISON doctor gave graphic suicide tips to a vulnerable inmate, a tribunal heard yesterday.

Wassim Malas was said to be angry at being called in the night to treat him.

The prisoner, Mr B, had cut his arms and injuries that needed staples, the General Medical Council was told.

But Dr Malas, 34, said: "If you want to do it properly, deep cuts to the arms and throat, lie on the bed and don't ask for help."

He also swore called the man a "f***ing little s**t", it was said.

It was the latest in a series of incidents involving him and inmates at Manchester prison - formerly Strangeways.

He had been found guilty of serious professional misconduct at the prison in 2002.

Since then he has worked under supervision. Yesterday's hearing ruled that must continue for another 12 months.

The tribunal heard that Dr Malas, of Eccles, Greater Manchester, no longer works at the prison and has attended an anger management course.

mirror.co.uk 15 Dec

UK Government offers last minute concessions to avert rebellion on Mental Capacity Bill

Last night, in a chaotic attempt to save legislation which has been fifteen years in the making, the UK Government offered assurances that amendments in the Lords would not allow the Mental Capacity Bill to "authorise any decision where the motive is to kill". The concessions, which were successful in limiting a revolt by Labour MPs, were the result of last minute discussions with leaders of the Roman Catholic Church.

'It is very difficult to have confidence in the Government's last minute assurances that satisfactory changes will be made to Mental Capacity Bill,' said Julia Millington of the ProLife Alliance. 'While we understand that many of the provisions in the Mental Capacity Bill are welcomed by people caring for relatives who are mentally incapacitated, the fundamental flaws that make this Bill so dangerous, and which we have highlighted for such a long time, still remain.

'One of our main concerns is that this Bill gives proxy decision-makers the power to make healthcare decisions, including the withdrawal of nutrition and hydration with the intention of killing the patient. Why were Report Stage amendments, which would have gone some way in allaying our primary concerns, rejected? Clearly the Government's sole purpose in offering concessions at this late stage was to secure victory.

'We can only hope that the Lords will indeed make the amendments necessary to safeguard the lives of patients with mental incapacity. It must be made absolutely clear that the Bill gives no statutory authority to any decision made with the intention of bringing about the death of the patient.'

medicalnewstoday.com 15 Dec

House of Commons debates: Mental Capacity Bill 14 Dec.

The Government want to ensure that there is sufficient time to debate the important issues that arise in the Bill, and we recognise the need to allow adequate time to debate the amendments relating to best interests and advance decisions. That is why we have provided for the debate to last until 3.30 pm on all the amendments in the first group. It is also important that we allow time to discuss the other important issues—independent consultees and research. A number of amendments have been tabled on those subjects, which concerned hon. Members on Second Reading and in Committee. I hope the time allocated this afternoon will allow us to debate all the amendments and the technical arrangements in the three groups...

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Under what circumstances can you ask to die?

The Guardian Q&A

Why is the mental capacity bill needed?
It gives legal backing to advance directives, or "living wills" under which patients can demand the right to die by refusing treatment when facing a terminal decline.

Any concern by a doctor over the validity of a particular living will would be judged in court, with doubts resolved in favour of preserving life.

The bill also gives patients the power to appoint a friend or relative to tell doctors to withdraw treatment if they themself are no longer capable of doing so, and to make decisions on finance. Those with no friend or relative to speak for them can have an independent consultee.

Who supports the bill?
The government, and charities such as the Alzheimer's Society, Age Concern and Mencap. They stress that living wills are used in common law but this legislation gives them statutory force.

Why is the bill opposed?
MPs are concerned that the bill introduces "euthanasia by the back door", and also could enable unscrupulous friends or relatives to order an incapacitated patient's death.

Critics also argue that people do not recognise that the legal definition of treatment includes food and water: by saying they do not want medical treatment, they could be dehydrated or starved to death. Another argument is that those who sign a living will often change their mind if they become incapacitated - and have no means of conveying this. And MPs also criticised the fact that, as the bill initially stood, living wills need not be written down or witnessed but could be based on conversations.

Any concessions offered?
Two: Living wills would have to be written and witnessed to constitute law; and where withdrawing "life-sustaining treatment" is concerned, the decision-maker must not be motivated by a desire to bring about death, irrespective of whether that is in the person's best interests.

What happens next?
The bill goes to the Lords for second reading on January 10 for the concessions to go before peers. The Department of Constitutional Affairs expects it to be on the statute book in the spring.

What can I put in a living will?
Patients cannot request the treatment they want (a decision for doctors), but only what they do not want.

You could request no antibiotics or resuscitation, but could not say you still wanted food and hydration, particularly since in some cases of terminal cancer, this can feed tumours. Doctors would have to look at any positive requests, but would in no way be bound by hem.

Campaigner's disquiet at passing of Mental Capacity Bill

Pro-lifers have expressed "deep disquiet" at the passing of the Mental Capacity Bill, which campaigners say would introduce 'euthanasia by the back door', through its Third Reading in the House of Commons.

The Society for the Protection of Unborn Children (SPUC) said the Government had "refused to reverse the euthanasia nature" of the Bill and had used the whipping system to force it through "a sceptical House of Commons".

There was a stir during the debate when government officials circulated correspondence between the Lord Chancellor and Catholic Archbishop Peter Smith of Cardiff in which the Archbishop claimed that the Government has made a crucial concession on the Bill’s legal effect of permitting euthanasia by omission.

The Government attempted to unveil this correspondence in the middle of the debate in order to trump objections to the Bill say pro-lifers. However many MPs were unable to obtain copies of the correspondence.

Lord Falconer has written to the Archbishop of Cardiff, Peter Smith, saying the bill is not meant to authorise any decision where the motive is to kill as opposed to relieve or prevent suffering or ending treatment where the patient is in an irreversible coma. But Archbishop Smith said he wanted to see the details of any changes but told BBC News: "In principle, I think they have conceded the point. There was a lot of misunderstanding."

MPs complained of "farce" because they had not seen the letter as they prepared to vote on a series of backbenchers' amendments.

Paul Tully, SPUC general secretary, commented: "The vote of 118 against the Bill at Third Reading reflected the reluctance of MPs to accept the Government's assurances about an alleged understanding with Archbishop Peter Smith of Cardiff that the Government would amend the Bill in the House of Lords to exclude euthanasia.

"The Commons was in uproar during the Bill's Report Stage when Government officials circulated correspondence between the Lord Chancellor and Archbishop Smith in which the Archbishop claimed that the Government has made a crucial concession on the Bill’s legal effect of permitting euthanasia by omission.

"The Lord Chancellor's letter to Archbishop Smith gives no indication of the text of any proposed amendments. It's all smoke and mirrors. The Lord Chancellor's ambiguous proposal crucially refers to excluding decisions only "where the motive is to kill" rather than intention to kill. What matters in the eyes of the law is the intention to kill - motive is simply what moved the person to kill, which might be a misguided notion of compassion."

The Government rejected Report Stage amendments, backed by 200 MPs, which represented concerns that the Bill would allow and even compel the denial of ordinary treatment, as well as basic care such as tube-feeding, from patients who can’t communicate.

Mr Tully concluded: "In the light of today's farcical proceedings in the Commons, we urge the House of Lords to give the Bill and any new amendments by the Government strict scrutiny, with a view to rejecting the Bill unless the euthanasia nature of the Bill is reversed."

ekklesia.co.uk 14 Dec

Mental Capacity Bill passed amidst chaos in the Commons

The Government's Mental Capacity Bill has cleared the Commons, but only after the Government offered reassurances to MPs that the bill would be clarified to demonstrate that it was not meant to authorise any decision aimed at ending life.

MPs were concerned by the section of the bill on living wills, which would allow individuals to decide before they became mentally incapacitated that certain treatments - for example tube feeding - should not be administered.

They would also be able to appoint a third party to have "power of attorney" over medical decisions if they were unable to make them.

Ministers insisted that the bill would not change the current laws regarding the decision to refuse medical treatment, and in fact would improve safeguards on the welfare of mentally incapacitated individuals.

An amendment to the bill, tabled by former Conservative Party leader Iain Duncan Smith, which would have explicitly stated that the bill did not allow decisions aimed at resulting in death, was eventually defeated 297 votes to 203.

In the course of the debate it also emerged that the Lord Chancellor had written to the Archbishop of Cardiff offering reassurances that the bill would not legalise euthanasia.

Text of this letter began to circulate among Labour backbenchers as the Government worked to stave-off defeat - but it was not initially read to the whole of the House. This led to protests, notably from the opposition benches, and Constitutional Affairs Minister David Lammy, conducting the debate, was eventually handed a copy of the letter to read out.

Lord Falconer also promised that he would try to make it explicit in the bill that there is no question of authorising the taking of life, but it is aimed at relieving suffering or ending treatment when a patient is in an irreversible condition.

The Liberal Democrats branded the conduct of the debate "shambolic", with health spokesman Paul Burstow saying later: "For the Minister not to have told MPs that the Lord Chancellor had given undertakings to Archbishop Peter Smith is treating Parliament with contempt and keeping MPs in the dark.

"The Government managed to persuade Labour backbenchers to support them now with promise of details later. That is not the right way to make good law."

The bill will now go to the Lords.

politics.co.uk 13 Dec

Deaths in Custody

House of Lords, House of Commons, Joint Committee on Human Rights
Third Report of Session 2004–05

When the state takes away a person’s liberty, it assumes full responsibility for protecting their human rights. The most fundamental of these is the right to life. Each year, however, many people die in custody. This report examines the causes of deaths in custody, and considers what may be done to prevent these deaths, and to better protect the right to life, and other human rights, of vulnerable people held in the custody of the state. The report begins by considering the human rights standards which apply. Article 2 of the European Convention on Human Rights guarantees the right to life and places duties on the state to take steps to prevent deaths of people in detention, and to establish
independent investigations into deaths in custody. The freedom from inhuman and degrading treatment also protects detained people from violence or serious neglect. These rights must be guaranteed, not through excessive control, but in the context of a system which also respects rights to privacy, personal identity and physical integrity.
The report assesses the scale of the problem, and the numbers of people dying in each form of state detention. It looks at the wider system in which these deaths occur, and concludes that measures to reduce deaths in custody are being implemented within a system where there are many acutely vulnerable people detained, especially in prison, who simply should not be there. Overcrowding in the prison system further hampers efforts to reduce deaths in custody. The principal reason for the increase in the prison population is sentencing practice, and the report considers the availability and recourse to alternatives to prison for vulnerable offenders, in light of the Article 2 right to life.
In the long-term, increased resources and a reduction in the use of imprisonment is needed to address the problem of deaths in custody. However, significant improvements can be made within the context of the present system. The report considers risk assessment of detainees, especially on admission to custody. It also assesses the provision of physical and mental healthcare in detention, and the human rights implications of inadequate healthcare. The report stresses the importance of maintaining a standard of healthcare equivalent to that available in the community. The provision of adequate treatment for drug and alcohol addiction in detention is essential in order to protect the rights to life and to freedom from inhuman and degrading treatment. The report also raises concerns about the detention of mentally ill people in inappropriate forms of detention, whether in prison, in police cells, or in immigration removal centres.

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Children and Young People's Mental Health

Scottish Executive Dec 04

Since publication of the Scottish Needs Assessment Programme (SNAP) report on Child and Adolescent Mental Health in March 2003, the Scottish Executive has been working with the expert advisory Child Health Support Group to promote implementation of its recommendations. The key focus has been the development of Children and Young People’s Mental Health: A Framework for Promotion, Prevention and Care, to assist local health, education and social services in planning and delivering integrated approaches to children and young people's mental health across the continuum of promotion, prevention and care.

Earlier this year, the Child Health Support Group national SNAP into Action conference brought together professionals from all over Scotland currently working in a wide range of agencies and contexts with children and young people, to discuss approaches to supporting mental health and wellbeing. Around 30 young people also participated in the conference. Many of the views and comments expressed on the day have helped to shape the attached draft Framework.

The draft Framework is being published today for a three month consultation. We would welcome your views on the draft, and in particular, your response to the specific questions that have been identified in the document. All comments received will be analysed and the final document will be revised before issuing in final form.

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Beast freed from psycho ward chopped my mum into pieces

A DAUGHTER is demanding to know why a crazed killer was set free—to hack her mother's body horrically into 16 pieces.

newsoftheworld.co.uk. 12 Dec

Evil Glyn Dix, who was released from a prison psychiatric wing, slaughtered his 54-year-old wife Hazel then chopped up her body using a power tool and a hacksaw after returning from a romantic walk.

Her daughter Tracie Gower, 34, said her mum married the maniac after he convinced her he was innocent of a previous slaying — in which he tied a 33-year-old woman to a tree in the woods before raping and shooting her.

Distraught Tracie said: "Someone decided to let this man out to kill again. What he did to my mum was straight out of a horror film.

"I've written to the Home Office asking why he was allowed out. I want to know why nobody warned us of his past."

Dix, 50, who has pleaded guilty to Hazel's murder, had served the last few months of his life sentence in Bristol jail's psycho ward before being set free.

Hazel met Dix in the jail after he befriended her son Adam six years ago, while both were in Gloucester prison.

The couple married before Dix's release. But Tracie boycotted the ceremony at Redditch register office, Worcs, five years ago.

She fought back tears as she explained: "I couldn't stand the idea of having a killer as a stepdad. But Mum wouldn't listen.

"I'd never met him but felt it was a terrible mistake. The family asked questions but got no answers. He convinced Mum he wasn't guilty.

"Despite our warnings, she married him believing he'd been wrongfully jailed. Yet it was clear he was a menace to society.

"I asked Mum just before the wedding, ‘Do you know what you're doing?' and she replied, ‘He's the man for me'."

What neither woman knew was that in 1980 Dix murdered mum-of-two Pia Overbury in a copse at Hartpury, Gloucs, and given a life sentence.

Tracie said: "I only met Dix after mum married. At first he struck me as devoted to her. There were never any telltale signs of what he'd do.

"That's why we think it was a ritual killing, he'd planned it all."

Her brother Adam, 27, was serving six months for driving offences when Dix befriended him.

He stumbled across the killing scene last June, finding his mum's remains scattered across the kitchen of her home in Redditch

Dix was still crouched naked over her body, which he had mutilated using 17 weapons.

Now Adam is tortured because he introduced his mum to her killer. "I have sleepless nights," he said. "If I'd never gone to jail I'd never have met this animal and Mum would be alive today.

"I knew he was in for murder but couldn't find out anything about his past.

"He told me he was ex-SAS and had been fitted up after a woman hired him to kill her violent ex-partner. He also conned my mum. By marrying her, he was able to get out of jail on licence — he repaid her by butchering her."

Recalling the murder scene, Adam said: "I raced to a neighbour's home to raise the alarm.

"When I went back Dix looked at me with evil eyes and said, ‘Now we can be one.'

"I grabbed him and punched his head. I wanted to kill him.

"He tried to stab me but then the police burst in. My mum gave him everything and he took her life—and ruined mine."

The family say that after her marriage, ex-college janitor Hazel changed from a happy-go-lucky person into a haggard figure.

They revealed that demented Dix daubed murals on walls showing a scantily-clad woman on her knees and a hooded knifeman. And Tracie said: "I'm convinced he was into the occult. I think he killed mum in some kind of sick, satanic sacrifice."

Dix, who admitted murder at Worcester Crown Court, has had his sentencing deferred until next month. The family will be there to see justice done.

But they want the Home Office to assure them that sick killers like Dix are never freed again.

The Parole Board said the case would be referred to a review committee. A spokeswoman added: "Regrettably, no matter how much care we take, a few people will re-offend.

"When they do we try to look at what lessons can be learned."

Tracie said: "This man has destroyed the lives of two families. Unless action is taken the same mistake will happen.

"And other innocent lives will be taken by evil men like him."

Health probe by disability body

Healthcare provision for people with learning disabilities and for people with mental health problems is to be investigated by the Disability Rights Commission (DRC).

The body - which oversees the rights of disabled people in the UK - is concerned that people with learning difficulties and mental health patients have significantly worse health than the rest of the population.
Its investigation will focus on primary care - access to GP's, health screening services and health improvement initiatives.

The DRC says that initial research shows that:

People with learning disabilities are four times more likely to die as a result of a preventable condition
People with diagnosed schizophrenia die, on average, nine years before the rest of the population
Fewer than 20 percent of learning disabled women attend cervical screening
People with learning disabilities are 58 times more likely to die before the age of 50
The DRC is anxious to determine the causes of these health inequalities and will make recommendations about how they can be reduced when it reports in 18 months' time.

Among its areas of investigation will be whether healthcare professionals are failing to recognise problems, or diagnosing them too late.
This is known as 'diagnostic overshadowing - whereby a patient's physical symptoms tend to be seen in terms of their mental health condition or learning disability.

The DRC will also be interested to determine whether some people experience difficulties registering or remaining with a GP practice.

"The government's commitment to improving the nation's health could risk leaving out significant groups in our population," said DRC chairman, Bert Massie.

"Unless the inequalities between people with learning disabilities, people with mental health problems and non-disabled people are seriously addressed, we could find the gap widening."

Mr Massie said the investigation was a positive opportunity to share concerns and best practice.

The Royal College of General Practitioners says it welcomes the DRC's inquiry.

"It is an important function of GP's to iron out health inequalities - we are committed to promoting excellent care for all patients what ever their needs," said Royal College chairman Mayur Lakhani.

The DRC will be gathering evidence from individuals and organisations about access to primary healthcare in England and Wales.

In addition to examining information already available, it says that four primary healthcare bodies will be independently monitored to identify the barriers confronting people with learning disabilities or mental health problems.

It is also opening a dedicated website where anyone with an interest in the issue can register their views.

Health Minister Stephen Ladyman said: "The Department of Health is aware that more work needs to be done in reducing health inequalities experienced by people with learning disabilities and people with mental health problems and have already agreed a framework with the Disability Rights Commission to shape the formal investigation."

Mr Ladyman said the department was also working with Mencap on a number of ideas for improving the health of people with learning disabilities, including the need for primary care services to proactively identify people's health problems.

A guide had also been issued to primary care professionals to share best practice.

bbc.co.uk 10 Dec

Council 'failed autistic patient'

A council has been told to pay £30,000 to an autistic teenager who spent one-and-a-half years sedated because it could not find him suitable housing.
Bolton Council admitted its mistakes after the local government ombudsman found it guilty of maladministration.

The man spent 18 months in a psychiatric unit where he spent much of his time under sedation.

He suffers from epilepsy and Fragile X Syndrome, a form of autism which means he needs ongoing support.

Bolton Council has agreed to review its procedures following the case.

The man's mother complained about the council's social services department after the Mental Health Tribunal decided in February 2002 that her son should be transferred out of a secure adult psychiatric ward.

But the council did not provide a suitable placement, causing the ombudsman, Patricia Thomas, to find it guilty of maladministration causing injustice.

The man's mother said there were no facilities in the hospital for patients with a learning disability while staff were not familiar with the needs of people with an autistic spectrum disorder.

She added that her son was denied his right to liberty because he was frequently heavily sedated.

bbc.co.uk 8 Dec

Three-year inquiry led to suicide of popular GP

A three-year inquiry that led an "extremely popular" village GP to commit suicide because he felt he was being persecuted should have taken only a few weeks, a report said yesterday.

telegraph.co.uk 10 Dec

Dr Stephen Farley was being investigated over claims that he was referring too many patients to hospital. The pressure of such a long investigation led him to suffer deep depression, taking six weeks off work and eventually hanging himself in a barn behind his home.

The report said the inquiry took far too long and failed to recognise the seriousness of Dr Farley's own illness. It recommended that future inquiries into GPs should take no more than a year.

Dr Farley, a GP in Ibstock, Leics, for 25 years, had felt humiliated and undermined by the investigation by Charnwood and North Leicestershire Primary Care Trust.

After his death in January, friends said Dr Farley felt persecuted and was being attacked for his old-fashioned approach to patient care while working within a "computer-monitored money-conscious Blairite system".

Three months before, Dr Farley met with officials from the trust to show them evidence of why he had referred many of his cases to hospital. He was later told to undergo extra training, shattering his confidence and self-esteem.

Charles Jones, the surgery manager, said: "The man had nearly three years of this from when it was first brought up. The finger was always pointing at him - it was this continuing pressure. It was virtually a witch hunt."

The report said Dr Farley was an "extremely popular local GP" who was "exceptionally committed".

Yesterday David Sissling, chief executive of the Leicestershire, Northamptonshire and Rutland Strategic Health Authority, said: "My view is that it [the investigation] should have been concluded in a matter of weeks or months, but never a period of years. It went on far too long."

The report recommended that any trust investigation into a GP should take no more than a year, that the GP's health should be put first, and that there should be mutual agreement over how the inquiry is carried out.

Dr Farley's widow, Marion, 54, said she and her solicitor would now consider the report in detail before deciding on any further action.

She said: "I believe that it is clear from the PCT's audit report for 2003/04 that the Charnwood and North West Leicestershire Primary Care Trust is under considerable pressure to cut costs significantly and to observe tight budgetary constraints.

"This fact, taken together with the shortcomings in and failures of the system in which my husband worked, leaves me to question the circumstances and pressures he was under when he died."

Is section 2 of the Suicide Act being ignored?

A judge lifted a ban on a terminally-ill woman from going abroad with her husband to help her to commit suicide. By doing so is the court allowing the husband to commit an offence under s 2 of the Suicide Act 1961? Dr Sheila McLean, Director of the Institute of Law and Ethics in Medicine at Glasgow University discusses the dilemma with Stephen Ward…

Lexis Nexis 10 Dec

A judge last week allowed the husband of a terminally-ill woman to help her to travel to Switzerland to commit suicide. But the judgment avoided the key question of whether spouses should escape criminal prosecution in the United Kingdom, according to Dr Sheila McLean, Director of the Institute of Law and Ethics in Medicine at Glasgow University.

After reading the judge’s reasons, which were issued three days after the decision, she says: “Although there’s a welcome nod in the direction of basic human rights it just avoids the central question which is whether or not the court is turning a blind eye to what is technically the intention to carry out an act which is potentially criminal in this country.”

Mr Justice Hedley lifted a temporary injunction banning the trip and left it to the police to decide what action to take under criminal law. The judge, who ruled that the couple should not be identified, said: "The court should not frustrate indirectly the rights of [the woman,] Mrs Z. The role of Mr Z is now a matter for the criminal justice agencies BLD 0612045154.”

Mrs Z was fully capable of making her own decisions, but was too ill to carry them out alone. The case had been brought by her local authority, which had learned that her husband was preparing to take her to a Zurich clinic which specialises in helping people end their lives. The authority had obtained the temporary injunction pending a ruling from the High Court on whether it had a duty to act to stop the trip.

The judge ruled that in making arrangements to go to Switzerland Mr Z had “arguably committed an offence under Section 2 of the Suicide Act 1961” which forbids aiding suicide.

He said the local authority did have a duty to establish that it was Mrs Z’s true intention to commit suicide, and that she was competent to make and carry out that decision. It also had to consider what might be influencing her decision and consider asking the High Court to determine her competence, and where there was a suspicion that a criminal act might take place, to notify the police. But if she was competent, it should allow her in any lawful way to give effect to her decision.

McLean says of the judgment: “The judge has found a legitimate route to avoid the bigger question and has hinged the entire thing on the issue of the competence both of the woman and the local authority. As ever it falls back on the criminal law to decide whether to do anything about it, which presumably they won’t. The civil law is taking a position which is more tolerant than the criminal law purports to adopt.

“It says to me that Section 2 of the Suicide Act is completely unnecessary. We know from past experience the chances of the prosecution happening are slim. There is no value in having a law which everybody simply ignores or doesn’t use.”

Without the Act there would be the law of murder or manslaughter which could be used if suicide was assisted in cases without clear consent, she says.

Mental health care is 'grossly under-resourced'

PATIENTS claim alcohol and cannabis use is rife at Reading's cash-strapped state-of-the-art Prospect Park psychiatric hospital and the system is letting them down.

And they say they get more support from voluntary organisations than they do from Berkshire's mental health care services.

At a meeting of the West Berkshire Mental Health Forum last week the blame was placed firmly on the lack of staff and resources.

Patients are angry at the shortage of beds at Prospect Park. And they claim the trust's Community Mental Health Team, launched last year, is not an adequate substitute when chronically ill patients should be in hospital.

Many forum members also attacked the hospital's treatment methods - claiming staff are too quick to mask symptoms with drugs - and describe themselves as "revolving door patients".

Prospect Park is run by the Berkshire Healthcare NHS Trust, which was forced to make savage service cutbacks last year after running up a £12 million debt.

Forum chairwoman Verity Murricane said: "There are some excellent and very dedicated staff but they are grossly under-resourced.

"I am a service user and there is a common perception among users that it is very difficult to get into hospital when you need to.

"Last time I was ill I was told cognitive therapy would help me but it was more than a year before I received it."

icberkshire.co.uk 9 Dec

DoH: ADVICE ON THE DECISION OF THE EUROPEAN COURT OF HUMAN RIGHTS IN THE CASE OF HL v UK (THE “BOURNEWOOD” CASE)

This note is to provide further information for NHS bodies and local
authorities about the implications of the judgment of European Court
of Human Rights in the case of HL v UK (the “Bournewood” case). It
covers:
• a summary of the case and the key points of the judgment
(paragraphs 2 – 29)
• steps to be taken by the Department of Health to develop
proposals for new procedural safeguards (paragraphs 29 – 30)
• steps that might be taken in the interim by NHS bodies and
local authorities pending the development of those new
safeguards.

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Caution urged in Payment by Results for mental health

The Government should extend Payment by Results to mental health services but with caution, according to a policy paper published today by the Sainsbury Centre for Mental Health (SCMH).

scmh.org.uk 9 Dec

Payment by Results can work for mental health services but will be a leap in the dark

The Government should extend Payment by Results to mental health services but with caution, according to a policy paper published today by the Sainsbury Centre for Mental Health (SCMH).

The policy paper, Payment by Results: What does it mean for mental health?, shows that a workable system is some way off. A major programme of work is needed to ensure the potential benefits of Payment by Results in mental health services outweigh the risks.

Payment by Results is a new system to pay for NHS services using a national tariff for each procedure carried out. It is designed to increase activity and efficiency and to ensure that services are commissioned for patients on the basis of quality rather than price. Most acute hospital care will be paid for through it from April 2005. Mental health (and some other) services will initially be exempt, but the Government plans to apply the new system to the whole of the NHS by 2008.

The policy paper shows that Payment by Results has been used to pay for other health services in The United States, Australia and other countries for some time, mainly for the good. None have yet extended it to mental health care.

This is because it is harder and riskier to apply Payment by Results to mental health services. Payment by Results is best used for short-term procedures like routine surgery, where the costs do not vary very much from one patient to another. Mental health care is often provided over long periods, using a complex mix of services, and in quite different ways from one person to another.

In the NHS, a further obstacle to Payment by Results in mental health services is the poor quality of information. Without high quality IT support and recording of activity, it would not work.

The policy paper concludes that Payment by Results should be introduced gradually into mental health services while a robust way of classifying mental health care into groups can be found; improvements are made to IT and other managements system; and the effects of the regime are monitored elsewheer in the NHS.

Angela Greatley, SCMH chief executive, said: "Payment by Results was not designed for mental health care. It is untried and untested for these services, anywhere in the world. But that does not mean it should be rejected. Rather that we need to proceed with caution.

"Payment by Results could help to improve the quality of mental health care, to offer greater choice to service users, and to improve efficiency and value for money. To reap its benefits, much work will be needed, on the part of commissioners as well as providers of services. But to simply reject it because it is too difficult would be to make mental health services, and the 600,000 people who use them, yet again a Cinderella within the NHS."

Payment by Results: What does it mean for mental health? is available from the Sainsbury Centre for Mental Health on 020 7827 8352 or can be ordered online in our publications section, price £5.

R (on the application of MH) v Secretary of State for Health: DoH Briefing

Judgement

On 3 December 2004, the Court of Appeal handed down its judgment in this case, which concerned the rights of certain patients detained under section 2 of the Mental Health Act 1983 to have their detention reviewed by the Mental Health Review Tribunal.

Background

The case was brought on behalf of MH, a single woman in her 30s with severe learning disability as a result of Down's syndrome. She was detained for assessment under section 2 of the Mental Health Act (MHA) 1983 on 31 January 2003. Her doctor recommended that, upon discharge, she should be subject to guardianship under the Act. However, no application for guardianship could be made because her nearest relative (her mother) objected. The mother also sought her discharge under section 23 of the Act, but this was blocked by her doctors under section 25.

The local authority applied to the county court to displace the mother as nearest relative under section 29 of the Act. Sections 2 and 29(4) operate so that detention under section 2, which would otherwise end after 28 days, continues until the application for displacement of the nearest relative is determined.

A case was brought on her behalf in the High Court claiming that her rights under Article 5 (right to liberty) of the European Convention on Human Rights had been violated. The two key questions in the case were (broadly speaking):

whether patients should have a right to apply to the Mental Health Review Tribunal when their detention is extended under s29(4) pending resolution of an application to displace a nearest relative

whether the case of patients who lack the capacity to make their own applications to be discharged from detention under s2 of the Act should automatically be referred to the Tribunal.
On 22 January 2004, the High Court found against the claimant, who then appealed.

Outcome

The Court of Appeal overturned the High Court’s decision. It found that there had been a violation of MH’s rights under Article 5(4) and made a declaration of incompatibility under section 4 of the Human Rights Act 1998 as follows:

“(i) section 2 of the Mental Health Act 1983 is incompatible with article 5.4 of the European Convention on Human Rights in that it is not attended by adequate provision for the reference to a court of the case of a patient detained pursuant to section 2 in circumstances where a patient has a right to make application to a Mental Health Review Tribunal but the patient is incapable of exercising that right on his own initiative;

(ii) section 29(4) of the Mental Health Act 1983 is incompatible with article 5.4 of the European Convention on Human Rights in that it is not attended by provision for the reference to a court of the case of a patient detained pursuant to section 2 of that Act whose period of detention is extended by the operation of the said section 29(4).”

Implications of the judgment

The Department is considering what action to take in response to the judgment, including the possibility of an appeal. However, pending an appeal or any remedial action, the declaration of incompatibility does not affect the continued operation of sections 2 and 29 of the Mental Health Act. NHS trusts, local authorities and others should continue to act on the basis of the Act as it stands.

9 Dec 2004

Safeguarding Children and adolescents detained under the Mental Health Act 1983 on adult psychiatric wards

The Mental Health Act Commission.

Report on the notification and visiting programme by the Mental Health Act Commission between April 2002 and September 2003.

The Mental Health Act Commission (MHAC) has voiced concerns about the treatment of children and adolescents under the Mental Health Act within adult mental health facilities in each of its past four Biennial Reports1. A survey of all relevant providers during the period 1999-2001 found that 62% of all children and young people under 18 admitted to inpatient care under the Act were placed on adult wards.

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Patients' Information Leaflets

An extensive range of Patients' Information Leaflets in different languages are now available.

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Developing Mental Health Services for Older People in Wales: A Follow-up to Losing Time

Mental health problems are common among older people, and more people are living to old age. An estimated 41,000 people living in Wales have dementia, and depression is more common among older people than in any other age group.

This report provides a review of progress in the development of mental health services for older people in Wales during the two years since the publication of Losing Time – Developing Mental Health Services for Older People in Wales (Ref. 1). It examines each of the areas considered in the original report and, based on recent work carried out across Wales, draws conclusions about the extent to which services have moved forward. It has been written to provide a stocktake for the Welsh Assembly Government and local agencies to help them to prioritise actions and investment. We also hope that it will inform the Welsh agenda in the context of the forthcoming National Service Framework (NSF) for Older People in Wales, which is due to be published in June 2005.

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Scandal of society's misfits dumped in jail

Up to 70% of inmates in Britain's jails have mental health disorders.

On the evening of Thursday A