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Care questioned after stab death

The death of West Midlands police detective Michael Swindells has thrust the issue of community care back into the public spotlight.

He was stabbed to death by paranoid schizophrenic Glaister Earl Butler on a canal towpath last May beneath Birmingham's Spaghetti Junction.

Butler was cleared of murder on Thursday but was convicted of manslaughter under the grounds of diminished responsibility.

At the time of Det Con Swindell's death, he was under the care of health officials whose job was to keep him stable and allow him to live a normal life in the community.

It is a philosophy that has developed over the past 20 years, but how well is it working?

In February, John Barrett stabbed former banker Denis Finnegan to death in a London park less than 24 hours after walking out of a psychiatric hospital.

Barrett, a paranoid schizophrenic, admitted manslaughter on the grounds of diminished responsibility.

In another well known case, Wolverhampton nursery nurse Lisa Potts was badly injured after she confronted a paranoid schizophrenic who attacked 18 children with a machete at St Luke's Church of England primary school, Wolverhampton, in 1996.

Those are just two high-profile cases where innocent people have suffered. But how great is the danger?

According to a leading charity Butler's case is the latest in a string of high profile cases which shows the "inadequacies" of treating some mental health patients in the community

Marjorie Wallace, the chief executive of mental health organisation Sane, said that vital signs in Butler's behaviour and case history appeared to have been ignored.

"It highlights yet again the inadequacies of supervising some patients in the community," she said.

"The greatest known predictors of tragedies like that of the killing of Det Con Swindells are living alone, failing to take medication, a history of aggression and delusions about people in authority and neighbours. It's a fatal combination."

In Butler's case, some 462 tablets, or 18 months' worth, of anti-psychotic drugs were found at the property where he stayed after Det Con Swindell's death.

When police called for information about his history, on the day of the killing, they were told he was not known to be aggressive or violent.

Mrs Wallace said: "The trouble with outreach and other teams is that they give a 'snapshot picture' of a person's mental state on which risk assessments are based, instead of 24-hour contact when deterioration of mental condition would become more evident."

The Herefordshire-based Zito Trust agrees.

The trust was set up in memory of Jonathan Zito who died after he was stabbed in the eye in an unprovoked attack by a paranoid schizophrenic while he waited for a Tube in London.

The trust's Michael Howlett said: "The pressure on the service is enormous, many people are discharged long before they are ready.

"Once in the community, the infrastructure and resources aren't in place to supervise them, to stop them relapsing."

But Dermot McGovern, consultant psychiatrist for Birmingham and Solihull Mental Health Trust, whose care Butler was under at the time of Det Con Swindells death, thinks the risks are slim.

"If you go out in the morning, you have 100 times more chance of being knocked down and killed by a car than you have by a psychiatric patient," he said.

In the past Northern Birmingham Mental Health Trust - which has now merged into the Birmingham and Solihull Mental Health Trust - were criticised for poor risk assessment, high suicide rates and in-patient deaths.

Mr McGovern said: "I think there's no doubt that resources have come into mental health and they have been targeted.

"But I think that it was a Cinderella service and that it is still a Cinderella service."

Mrs Wallace, from Sane, said that in the end, policy and treatment came down to cost.

"Providing supervised, 24-hour accommodation is expensive. Living alone is less expensive."

bbc.co.uk 19 May

Wife's killing was 'preventable'

A mentally ill man's fatal knife attack on his Devon mother was a "preventable tragedy", her husband said.
Stuart Penfold's stepson Philip Wayne, 20, was detained on Monday under an unrestricted hospital order at Exeter Crown Court.

Maxine Penfold, 49, was found stabbed with 10 knife wounds in the family home in Cullompton last November.

Paranoid schizophrenic Wayne admitted manslaughter on the grounds of diminished responsibility.

After the hearing Mr Penfold, 58, said: "Strangely enough I do not totally blame Philip for what has happened. I blame the medical profession.

"It was a preventable tragedy," he said.

All the advice he and his wife were given about their son's behaviour was to ignore it, he said.

Wayne was diagnosed schizophrenic in April last year and prescribed strong anti-depressants, but his relationship with his family deteriorated.

Prosecutor Sarah Munro, said: "The response from the medics was to prescribe yet stronger tablets."

On 21 November Mr Penfold called a GP asking if Wayne, who had taken his mother's car to Cumbria days before, could be detained under the Mental Health Act.

He was told not unless he was a danger to himself or others, said Miss Munro.

Mr Penfold said after the case he was told that because there was no physical violence his stepson could not be sectioned.

He said he was told the best idea was to "back off".

"I regret not doing something else," he said, adding that Wayne was a "loner who stayed in his room most of the time".

bbc.co.uk 23 May

SCHIZOPHRENIC ROBBER GIVEN CURFEW

A Robber has been given a curfew as his sentence for a street mugging.

Liam Jordan, a chronic paranoid schizophrenic, grabbed a woman's handbag in Trinity Square in the early hours of November 15.

Nottingham Crown Court heard the woman, who had been out with friends, chased after Jordan with the help of two witnesses. But he got into a Vauxhall Calibre. The car was found abandoned in a pub car park off Woodborough Road, Mapperley. The woman's mobile phone was behind the driver's seat, but the Sim card had been removed. The woman's purse and passport were missing.

Jordan returned as the car was being removed and was arrested. Sarah Knight, prosecuting, said: "Jordan was arrested and admitted the offence. He said he heard voices in his head."

Jordan, 21, of Querneby Road, Mapperley Top, has a previous conviction for theft after he took money from his girlfriend's handbag.

The court heard his second conviction was for robbery in March 2000 after he and two others stole someone's wallet in Carrington Street, The Meadows.

Defending, Andrew Easteal told the court that his client had been full and frank with the police.

Recorder Paul Sanghera put Jordan on home curfew for the next six months. He will report to the probation service for two years. Reports said he needed treatment.

thisisnottingham.co.uk 21 May

Father who was hit by train committed suicide

A FATHER-of-ten was hit by the early-service train in Borth late last year. At an inquest in Aberystwyth last week, coroner Peter Brun- ton heard how Anthony Tho- mas Bragg, 45, sat in the mid- dle of the railway track at Borth’s railway station and took his own life when the 05.28 train arrived in October last year. With a long history of alcohol and mental illness, Mr Bragg left his family near the train station in Borth and sat on the tracks around four feet from the end of the platform as the morning train made its way from Aberystwyth. The inquest heard that Mr Bragg had attempted suicide on at least six separate occa- sions and at the time of his death, he was heavily intoxicated, but had told no one of his intentions.

A month earlier, his wife Anna spoke of how Mr Bragg, or Tony as he was known, came back to the home and told her that he had “missed the train”. Whilst giving evidence, Mrs Bragg spoke of how her late husband had suffered from depression and had spoken to her about taking his life in the past. She also spoke of Mr Bragg hugging their daughter a month before his death, which she said was very unusual for him. On the morning of the colli- sion, Mrs Bragg woke up at around 5.30am and noticed that the front door was off the latch. She ventured down to the station and when noticing that the train had stopped, she started shouting “is it my hus- band” to the train driver, Andrew Tack. Mr Tack spoke of how visibil- ity was very poor on the day of the collision, only being able to see four to six feet in front of the cab. “I saw a glow arc in front of me when I was approaching the platform, which arced from centre to the track to the left,” he said. Travelling at 25 mph, Mr Tack slammed on the emer- gency brakes, but it was too late as the impact knocked Mr Bragg back 10-12 feet. Mr Brunton passed the ver- dict of suicide whilst suffering from a depressive illness. He added that there was no blame on the shoulders of Mr Tack and passed his sympathy to Mrs Bragg and the children Mr Bragg leaves behind.

aberystwyth-today.co.uk 25 May

Mother plans to combat the stigma of suicide

MORE should be done to stamp out the stigma attached to mental illness - this is the message from a determined mother whose son took his own life following a 12-year battle with mental illness.

Paul Andrews, 30, died in a psychiatric ward at the QE2 Hospital, WGC, last August.

Following the inquest into his death last week, Wendy Andrews spoke to the Hertford Times about her plans to change the way people perceive mental illness.

She said she hoped to kick-start a campaign to raise awareness and improve hospital facilities for sufferers.

"Paul was a very special guy," she said.

"I haven't got a problem with him taking his life. I want the stigma of suicide among the mentally ill to be taken out. It's not their fault, it's not like they got into debt.

"We've got to get across that these people who are mentally ill have an illness much like cancer. I want people to have the same compassion as they do for cancer. They should be more understanding."

If society was more understanding of mental illness then sufferers might find it easier to cope, she said.

"It was only this that held Paul back. If not he would probably have been a famous artist or something."

Mrs Andrews said her son was a very intelligent and popular young man and a talented artist.

He was also a dedicated Buddhist and had been hoping to go to a Buddhist camp in France around the time he died.

Paul's funeral, which his family referred to as his "farewell", took place at the Amaravati Buddhist Monastery in Hemel Hempstead. Two of his close friends scattered his ashes in the south of Ireland.

Mrs Andrews added Paul's school friends and brother Mark were in the process of setting up a trust fund in his name.

whtimes.co.uk 25 May

Tower block suicide fire horror

A MAN has died in a fire at a Leith tower block in a suspected suicide.

The 37-year-old man, who has not been named, was dragged out of his burning eighth floor flat in Cables Wynd House by firefighters at about 3pm yesterday.

Several items of furniture were piled up against the door of the flat, suggesting that a fire had been started deliberately in a suicide attempt, a fire brigade source said.

Paramedics pronounced the man dead at the scene, estimating he had lost his life up to an hour before his body was pulled on to the building's main landing.

Emergency services first received the call-out to the fire at 1.45pm. More than 40 firefighters were dispatched to deal with the blaze, which was especially severe due to the intense heat given out by the concrete structure.

As smoke and flames poured from the window, firefighters wearing breathing apparatus used thermal imaging cameras to locate the man inside.

Ross Wynn, divisional officer with Lothian and Borders Fire Brigade, said it was an extremely difficult operation for his teams.

"With the concrete structure, fires like this are always more intense and more dangerous for the firefighters, because such a strong heat is given out.

"And it was extremely difficult for the crews to gain access to the flat because there was a lot of furniture piled up against the door.

"Once they got in, the heat came up to meet them from the lower floor."

There were no other casualties in the blaze, which caused severe damage to the dead man's flat but was prevented from spreading to other properties.

Today, a friend of the deceased, Robert Cowan, told of his deep sadness at the death of a man "who cared about and helped everyone he knew".

Mr Cowan, 31, whose sister lives in Cables Wynd House, said: "He had the biggest heart, he cared about absolutely everybody.

"He would give you money or food if you were in need and he was devoted to his kids, who live in Fife. I just can't believe what's happened."

A police spokesman said: "As a result of a fire within a flat in Cables Wynd House, a 37-year-old male sustained injuries from which he died.

"Our inquiries into the incident are continuing."

scotsman.com 25 May

Man suffocated his daughter before committing suicide

A 40-YEAR-OLD man suffocated his daughter before hanging himself, an inquest heard.

The Orpington man, described as a "loving husband", pushed the five-year-old girl's face into a pillow, Croydon Coroner's Court was told on May 18.

Detective Inspector Colin Burgess said the mother came home to find the girl dead on a bed and her husband hanging from a garage beam.

He said all seemed to have been well in the family and it had been an "absolutely normal day".

A doctor's report spoke of the father's depression, for which he had been receiving treatment and hypnotherapy.

"There was never any indication he was violent or dangerous. Rather, he was a loving husband, " the statement said.

Pathologist Dr Vesna Djurovic said the father had several cut marks around his body, which all appeared to be self-inflicted but hanging was the cause of death.

Coroner Dr Roy Palmer recorded a verdict of unlawful killing on the girl and suicide on the father.

He said: "He left a note which gave some clue as to what he was going to do."

Dr Palmer made an order restricting the press from publishing any identifying details in regard to the December 30 tragedy.

newsshopper.co.uk 24 May

Appeal for funds to tackle suicide

More resources and funding are required to tackle rising levels of suicide and self-harm among Northern Ireland's youth, the Commissioner for Children and Young People said last night.

Suicide - particularly among young males - has become a major problem throughout the province in recent years, but it has proved particularly acute in north and west Belfast.

There were at least 15 suicides in west Belfast in a three-month period this year, with seven deaths in a single week.

Thirteen young men in the north of the city took their lives in a two-week period at the start of 2004, and just last week a north Belfast man committed suicide nine years after his brother took his own life.

Nigel Williams said there was a crisis in mental health services and called for further resources to tackle the problem.

He said: "I am extremely concerned that the mental health of our children and young people is provided with the right resources at the right time."

Mr Williams said he was aware of several voluntary and community groups providing valuable services but added that the lack of resources available was a major concern.

"Too many of the projects in the community, which deal with the real distress felt by children and young people, rely on short-term funding," he said.

"Each project waits every year to see if funding is renewed, and the people working to support the mental health of our young people worry that the lifeline they are providing may be cut off."

belfasttelegraph.co.uk 23 May

HORROR OF SUICIDE BY CHAINSAW

A WOMAN killed herself in a bloodbath at work by cutting off BOTH her hands with a chainsaw.

Joanne Leckey, 33, bled to death after severing her hands at the wrists with the electric saw which she had wedged between a desk and a wall.

Horrified cleaners found the body in a pool of blood when they arrived for work.

One shocked student said yesterday: "It was like something out of a horror movie. To think she died like this is just awful."

Joanne, an auxiliary worker in the medical centre at the University of Ulster in Belfast, got into the centre at the weekend when it was closed.

Shocked cleaners who arrived on Monday morning found the body with one hand severed and the other hanging by a thread.

Police, used to dealing with terrorist outrages in Ulster, were stunned at the blood-soaked scene.

One girl student said yesterday: "I still break down in tears thinking of the torment that poor woman must have gone through. It must have been sheer hell."

A number of shocked students attended Joanne's funeral on Thursday.

In a death notice her shattered family of Newtownabbey asked for donations to the Northern Ireland Association for Mental Health.

A university spokesman said: "It would be inappropriate to comment until a police investigation has been completed."

people.co.uk 22 May

FLAT FIRE WAS FAILED SUICIDE

A mentally ill woman has been given a three-year community sentence for setting her flat alight in a failed suicide bid. Rosalind Jenner caused £11,000 of damage, and a neighbour had to be taken to hospital, when she deliberately started the blaze with a cigarette lighter in her top-floor flat at Bridge Court, in Exe Street, Exeter.

Another neighbour ran through Jenner's flat trying to extinguish the flames with water.

Jenner, 30, has pleaded guilty to arson and being reckless as to whether life was endangered.

Judge John Neligan sentenced her to the community rehabilitation order at Exeter Crown Court on Friday.

He said she must undergo psychiatric treatment as part of her sentence.

Judge Neligan said he had taken into account that she had not intended to hurt anybody else in the arson attack last September.

The judge told her: "This is an extremely sad case and I approached it on that basis.

"I don't think anyone could be anything but moved by your situation, but there was considerable damage to your flat and other people's lives were at risk."

Prosecutor Peter Ashman said Jenner spent the evening with a male neighbour in her flat, which is owned by Devon Community Housing Association.

He returned to his own flat and later heard her calls for help. She was stood on the communal balcony with her flat ablaze.

"He saw the curtains in the living room and bedroom alight and the fire was fierce," said Mr Ashman.

"He tried putting buckets of water on the flames."

Other witnesses had gathered and alerted the fire brigade just before midnight. One of Jenner's female neighbours had woken to find fumes seeping through her flat.

She had to be taken to hospital with Jenner for treatment for smoke inhalation, and the defendant apologised to her while they were there.

Mr Ashman said the neighbour had been left frightened by the fire and now felt she had to lock her doors to feel safe.

The court was told Jenner suffered from a personality disorder but did not need to be sectioned under the Mental Health Act as she had recently been coping better with help from the neighbour who rescued her.

A fire service boss said it was unlikely that the fire would have spread to the rest of the complex, except for the smoke seeping into neighbour's flat.

thisisexeter.co.uk. 21 May

Three patients die at mental health unit

THREE deaths at a Little Hulton mental health unit are being investigated by police amid claims powerful painkillers were used to subdue patients.

The inquiry was triggered after the death last week of Robert Breeze, 77, who had been a patient at Woodlands Hospital for several months.

A whistleblower has raised concerns that patients on the hospital’s Kenyon Ward, including Mr Breeze, were given drugs to sedate them rather than help with genuine pain relief.

Three members of staff have been suspended during the inquiry, which will also consider the cases of two other patient deaths at the hospital.

The whistleblower wrote to Lezli Boswell, chief executive of the Bolton, Salford and Trafford Mental Health NHS Trust, which runs the hospital, expressing concerns about treatment given to Mr Breeze, and a patient, who died last year.

Four experts, assessed care given to Mr Breeze and changes were made to his treatment on May 16 and 17 to keep him as comfortable as possible. A management investigation into the allegations was started on May 18. Mr Breeze died on May 19. Concerns about the treatment given to a third patient two years ago were then raised.

Experts have concluded that, at the time of his death, Mr Breeze was receiving the correct medication in view of his worsening condition.

But the inquiry must establish whether he and the two other patients were given appropriate medication in the weeks or months before they died.

In a statement, the Trust said: “On May 12, a person provided details to the Trust about clinical concerns about patient care in Kenyon Ward.

“Immediate enquiries and safeguarding actions were taken by the Trust with the support of medical, nursing, and pharmacy advisors.

“Following the expected death of a patient, the trust informed the coroner of what may be unusual circumstances and the matter was referred to the Greater Manchester Police.

“The trust has taken the action to suspend staff; this is a neutral act to protect staff and the organisation. It does not imply guilt.”

A Greater Manchester Police spokesperson said: “Following a request from the coroner, detectives in Salford are currently looking into the circumstances surrounding the death of a 77-year-old man at Woodlands Hospital in Little Hulton.

“Officers have been made aware of concerns relating to patient care on the ward via the coroner and the health trust.

“A Home Office post mortem examination has been conducted and officers are currently awaiting the results.”

A HELPLINE has been set up for anyone with concerns about the treatment of relatives at the hospital on: 0161 772 3603 or: 0161 772 3610.

salfordadvertiser.co.uk 26 May

One third of staff accept they or colleagues have threatened to use medication or seclusion to control psychiatric patients' behaviour

Almost one third of mental health inpatient staff accept that they or colleagues have threatened to use medication or seclusion to control patients' behaviour, it has been revealed.

The findings were released yesterday in a national Healthcare Commission audit of violence on inpatient psychiatric and learning disability wards.

The audit also found that 78% of nurses, 41% of clinical staff and 36% of service users said that they have either been personally attacked, threatened or made to feel unsafe.

In addition, 35% of service users said staff 'winded them up'.

Almost half (45%) of mental health nurses said they had witnessed trouble on wards due to people drinking or taking drugs.

The audit, carried out for the commission by The Royal College of Psychiatrists' research unit, identified factors which the commission believes are contributing to a culture of violence on inpatient wards.

These include the unsafe design of wards, inadequate staffing, overcrowding, drug and alcohol abuse, high levels of boredom, and poor training in the prevention and management of violence.

For the audit, more than 6,500 anonymous questionnaires and 20,000 comments were received from staff, service users and ward visitors from 265 mental health and learning disability wards. The audit was carried out between December 2003 and March 2005.

The acute staffing problem within inpatient mental health services was reinforced today by a report by the Sainsbury Centre for Mental Health (SCMH)

It revealed that, on an average day, nearly half of 300 psychiatric wards in England surveyed lacked a lead consultant psychiatrist. Less than a quarter had a clinical psychologist, while 13% were without a ward manager or a senior nurse.

On an average day a ward of 16 beds had a combined shortfall of two full-time nurses and healthcare assistants, and used four full-time agency or bank staff.

In what has been a grim two days for everyone involved in mental health inpatient care, the audit and SCMH report expose, between them, a culture of violence, hostility and drug taking on inpatient wards.

Another mental health charity, Mind, also found last year that more than half of psychiatric inpatients had been verbally or physically threatened by other patients or staff.

Health Minister Rosie Winterton responded today by emphasising that since 1997 mental health services have witnessed a significant boost in the recruitment of key staff.

"The numbers of consultant psychiatrists and mental health nurses have increased by 45% and 21% respectively," she said.

Ms Winterton added that there are 74% more clinical psychologists, 125% more non-medical psychotherapists and 22% more art music and drama therapists.

"However, we are not complacent and in 2004 we published a National Mental Health Workforce Strategy which we are implementing in partnership with major stakeholders," she added.

The SCMH report - entitled Acute Care 2004 - covered 50 NHS trusts and was commissioned by the National Institute for Mental Health in England.

It called on the government to set national guidelines on appropriate staffing levels for acute psychiatric wards.

Ms Winterton said the government has developed an on-going programme of work to develop training for staff to prevent and de-escalate violence.

New National Institute for Mental Health guidelines on safer management of patients in psychiatric in-patient and A&E settings were released in February.

Snapshot of findings from The Healthcare Commission audit:
* 30% of nurses, 24% of clinical staff and 48% of service users felt staff threatened to use medication or seclusion to control service users' behaviour.
* 35% of service users said staff 'winded them up'
* 65% of service users were satisfied with their involvement in decisions about care and support. 29% were not.
* 45% of nurses said there had been trouble on wards due to people drinking or taking drugs
* 78% of nurses, 41% of clinical staff and 36% of service users said that they have either been personally attacked, threatened or made to feel unsafe.
* 23% of service users said they shared space with members of the opposite sex when they did not want to
* 75% of nurses and 79% of clinical staff said there was multi-disciplinary consensus on the clinical care of service users
* 86% of nurses and 82% of clinical staff thought that service users felt comfortable talking to staff
* 23% of service users said they shared space with members of the opposite sex when they did not want to
* 63% of service users said they did have enough time in private with family, friends or members of staff. 34% said they did not.
* 64% of service users said their complaints were taken seriously. 22% said they were not.

psychminded.co.uk 25 May

’Well back mental health campaign

MOTHERWELL FC has become the first football club to join the ‘see me’ campaign, tackling the stigma of mental ill health.

Manager Terry Butcher signed the ‘see me’ pledge on Thursday, May 19, at Fir Park - three days before his team defeated Celtic in the final match of the season on Sunday.

Terry said: “This is an issue that is certainly close to my heart as I know people who have experienced mental health problems and how difficult that can be for them.

“Unfortunately, the problem itself can be made much worse by the attitudes of other people. Sometimes we all say things that lead to stigma without realising the damage it can cause. Anyone with mental ill health needs our support and understanding – not outdated labels and prejudices.

“I’m delighted that Motherwell FC can play a part in reminding people to see the person and not the label.”

As a symbol of their commitment to tackling the stigma, the Motherwell players wore ‘see me’ t-shirts during the warm-up for Sunday’s home game against Celtic and ‘see me’ armbands during the game.

Young volunteers pitchside also wore ‘see me’ t-shirts and all Motherwell staff wore ‘see me’ badges on the day.

’See me’ Campaign Director Linda Dunion said: “Prejudice against people with mental health problems is just as unacceptable as racism or sectarianism.

“Motherwell FC’s support for ‘see me’ sends out a signal that stigma and football do not mix.

Just like the rest of the population, one in four of the club’s supporters, players and staff will experience a mental health problem at some point in their lives.

“When they do, they need support and understanding; not ridicule and isolation.

“We hope that other clubs will follow Motherwell’s lead in stamping out this kind of stigma.”

Although Motherwell is the first club to join the campaign, ‘see me’ has previously used football to challenge people’s attitudes about mental ill health.

One of its best-known adverts features a goalkeeper with ‘Schizophrenic’ on the back of his jersey and states, “I’m a person, not a label.”

The advert appeared in the match day programme on Sunday and will also appear in the first home games of next season.

Motherwell were approached to join the campaign by the Lanarkshire ‘see me’ Partnership which was formed by 16 organisations including NHS Lanarkshire, North Lanarkshire Council, South Lanarkshire Council and voluntary sector and campaigning organisations.

All have signed a pledge to defeat stigma through taking action in their own areas, and collectively through the ‘see me’ partnership.

Around 102,000 adults in Lanarkshire will experience a mental health problem at some time.

One of the Lanarkshire ‘See me’ Partnership’s aims is to work with local community organisations and businesses to promote the ‘see me’ message and raise awareness about mental health issues.

The Lanarkshire ‘See me’ Partnership is also planning to give awards to the organisations, community groups, workplaces, schools or young persons’ agencies that show the greatest commitment to reducing stigma and discrimination.

The Fir Park side’s commitment to tackling stigma will help the Lanarkshire ‘see me’ Partnership to reach young people locally.

The local initiative complements the national ‘see me’ young person’s campaign which includes an innovative TV advert on Channel 4 and MTV.

Striking animation is used in the ad to highlight the fact that one in 10 young people in Scotland experience a mental health problem and that the behaviour of other young people can make things worse.

The cartoon ad is the first of its kind in the UK to tackle issues of self-harm, alienation, depression and anorexia in young people aged 12-18.

For more information visit www.justlikeme.org.uk

http://iclanarkshire.icnetwork.co.uk 25 May

Crisis-hit mental units 'harm patients'

Mentally ill patients admitted to psychiatric hospitals are becoming sicker in wards which are so short of staff that only minimal treatment is offered, a survey has found.

A critical shortage of staff and bed occupancy rates of 100 per cent mean most wards only offer treatment with powerful sedative drugs. Just one in five provides the psychological treatment, cognitive behaviour therapy.

The first national survey of in-patient mental health wards, commissioned by the National Institute for Mental Health and published by the Sainsbury Centre, paints a bleak picture of an overstretched, under-resourced service. It is based on the views of managers in 50 English NHS trusts, who could be expected to paint the service in the best possible light. Patient surveys suggest the service is even worse.

The findings come a day after the Healthcare Commission, the NHS watchdog, reported that one in three patients on mental health wards had experienced violent or threatening behaviour, mostly from other patients. Nearly half of medical staff and four out of five nurses also said they had been verbally or physically assaulted.

Nearly half of the wards had no consultant psychiatrist in charge and one in seven had no ward manager. One in seven nurse posts was vacant.

independent.co.uk 25 May

Major overhaul of mental health wards needed, says King’s Fund

The King's Fund today called for a major overhaul of adult psychiatric inpatient wards following the publication of an audit showing high levels of violence in mental health and learning disability services.

Speaking in response to the study conducted for the Healthcare Commission by the Royal College of Psychiatrists, King’s Fund chief executive Niall Dickson said: “This audit adds to the growing body of evidence of serious problems on many mental health wards up and down the country. There are still far too many patients, front-line health professionals and members of the public experiencing violent or threatening behaviour, which is unacceptable. It is not only distressing for the individuals involved, but reflects shortfalls in the way care is provided.

“We know it can be hard providing good quality care to patients in psychiatric wards, but both patients and staff need to know they are in a safe environment. Much of this is obvious and we know what needs to be done to improve mental health services - we need more staff, better training, more activities for patients and a clampdown on people bringing illicit drugs and alcohol on to wards. This has been well highlighted in the King’s Fund’s mental health inquiry in 2003, as well as in other subsequent reports.

“Mental health trusts now need to take a long, hard look at how they provide inpatient psychiatric services - in cases where violence and aggression are rife, trusts should be undertaking urgent reviews of their services. We very much hope this audit leads to real improvements in mental health wards and staff training.”

Violence and aggression on acute psychiatric wards linked with mental health and substance misuse problems was a key finding of the King’s Fund’s 18-month inquiry into London’s mental health care, published in November 2003. It found that:

• many nurses on mental health wards had been personally threatened or had witnessed threatening behaviour
• service users are equally affected by violence and aggression on wards
• patients with drug or alcohol abuse problems, as well as mental health problems, were behind most violent confrontations; some nurses had been threatened by drug dealers.

The King’s Fund inquiry recommended that:

• mental health trusts review conditions, staffing levels and skill mix in acute inpatient wards
• mental health trusts prioritise training for ward staff on dual diagnosis and complex needs
• the Government commission an independent, systematic review of acute in-patient care provided for black and minority ethnic service users to address concerns about safety.

The King’s Fund is now part of a major collaborative with the London Development Centre for Mental Health to devise and test out new ways of improving patient and staff safety on psychiatric wards in the capital. The collaborative expects to conclude its work in December.

kingsfund.org.uk 24 May

Violence widespread in NHS units

Violence against patients and staff is widespread in mental health and learning disability inpatient units, research shows.
A national audit found one in three inpatient service users had experienced violent or threatening behaviour while in care.

For clinical staff the figure was 41%, and for nursing staff a massive 80%.

The study was carried out by the Healthcare Commission and the Royal College of Psychiatrists.

It also found that 18% of visitors to the units had experienced violent or threatening behaviour.

The researchers defined threatening behaviour as anything from raised voices to threat of attack with a weapon.

The Healthcare Commission has pledged to push for improvements in inpatient services.

The audit identified drug and alcohol abuse as a key factor behind many violent incidents. It says staff need more help dealing with this issue.

It also found that units are having to rely too heavily on temporary staff due to difficulties filling vacant posts. This was leading to problems creating cohesive and experienced teams.

It calls for the status of inpatient nursing to be raised to at least that of community nursing to help recruit and retain staff.

Other factors highlighted in the report include:

Flaws in the design of many wards and units, which fail to meet basic safety standards

Overcrowding

Boredom among service users, who are not being offered structured and therapeutic care

The audit also highlights examples of good practice across the country, including the use of personal alarm in one trust to help make visitors feel safer.

"But we must do more to protect the people who use and work in our mental health services.

"We will build on the findings of this report by refining the way we assess the performance of mental health units.

"There is plenty of good work going on. We've got to ensure best practice becomes standard practice."

Professor Paul Lelliott, of the Royal College of Psychiatrists, said: "The audit confirms just how challenging it is to work in mental health residential settings."

However, he said there was now a recognition in all parts of the NHS that action was needed.

NHS action

Alex Nagle, director of NHS Security Management, said a dedicated team had been established to spread best practice, and to encourage a consistent approach to tackling the problem.

"Their aim is to create a safe, secure and therapeutic environment for staff and service users so that the highest standards of clinical care can be achieved."

A course in how deal with violence in a non-physical way was also to be offered throughout the NHS following a successful pilot.

"Its aim is to give staff the skills required to confidently and lawfully recognise, prevent, de-escalate and manage potentially violent situations."

Niall Dickson, chief executive of the independent King's Fund, called for a major overhaul of adult psychiatric inpatient wards.

He said: "This audit adds to the growing body of evidence of serious problems on many mental health wards up and down the country.

"There are still far too many patients, front-line health professionals and members of the public experiencing violent or threatening behaviour, which is unacceptable.

"It is not only distressing for the individuals involved, but reflects shortfalls in the way care is provided."

Around 6,500 questionnaires were submitted as part of the audit, including respondents from 265 units.

Anna Walker, chief executive of the Healthcare Commission, said: "These figures are deeply worrying. No one is saying these issues are easy to deal with

bbc.co.uk 23 May

(See Articles section of this site)

HELP FOR MENTAL HEALTH FOCUS OF BIG LOTTERY FUNDING

Rethink severe mental illness is set to expand its work through a BIG Lottery Fund grant of £287,210. The Lottery funding will help to develop a user and carer involvement project which aims to enable service users and carers to make their voices heard and get involved in the provision of local services.

Rethink can now progress a project to establish eight regional networks of user and carer influencers and provide them with training and support to get involved in mental health planning and also be more involved with Rethink itself.

The main outcomes of this project are to empower users and carers to influence both mental health services and mental health policy, locally, regionally and nationally and to help change people's attitudes about mental illness through increased communication with the media. The grant will also fund three user and carer involvement officers.

Rethink is a campaigning membership charity involving people with severe mental illness and carers, with a network of mutual support groups around the country. Rethink is also the largest voluntary sector service provider in mental health, helping 7500 people each day.

Sir Clive Booth, Chair of the Big Lottery Fund, said: "We are delighted to award funding to Rethink. Working together we can help many thousands of people affected by severe mental illness to recover a better quality of life. The services they provide will help people take more control of their own lives by building their confidence and strengthening their skills."

Cliff Prior, Rethink Chief Executive, said: "The money received by the Lottery Fund will make a substantial difference helping us tackle the three biggest mental health problems in Britain today; prejudice, ignorance and fear. Our members and service users tell us time and again that misrepresentation of mental illness is incredibly distressing and adds to the stigma and can be worse than the illness itself. We believe that supporting people who wish to speak out will help to challenge the prejudice, ignorance and fear that blights so many lives."

These are among 9 grants totalling £2,209,838 awarded today from the Fund's Strategic programme. So far, this programme has funded 1,410 projects with grants
worth more than £286 million.

gnn.gov.uk 23 May

Errors by mental health workers led to death of a brave detective

A catalogue of blunders by mental health workers allowed a paranoid schizophrenic to stab a policeman to death.

Inquiries were under way yesterday into the case of Glaister Earl Butler, 49, who suffered from a severe mental illness that he hid from the experts who were supposed to be monitoring him.

It transpired that they assessed him only intermittently, did not realise that he was not taking his medication and even allowed him to keep a large knife at home because he said he was interested in martial arts.

They failed to log a number of violent incidents on his risk assessment sheet - given to police when they went to arrest him - which claimed that Butler was verbally, but not physically, aggressive.

Because of this, officers who were chasing Butler after he had threatened to kill a council worker were not given a proper warning about the threat that he posed.

Dc Mick Swindells, 44, who was unarmed and wearing no protective clothing, approached Butler, who stabbed him. Butler had a "deep-seated" 10-year paranoia about the police and MI5.

Butler was ordered yesterday to be detained without limit of time at a secure unit after a two-week murder trial. The judge ordered the jury to return a verdict of manslaughter on the grounds of diminished responsibility, which Butler had admitted. Passing sentence, Mr Justice Calvert-Smith said he could not envisage a time when Butler would not pose a "serious danger" to either himself or the public, and especially the police.

He said while the "outward manifestations" of his condition might be able to be controlled through treatment, the underlying illness remained and was "liable to erupt dangerously at any time".

The judge said Dc Swindells had shown "immense courage" in trying to tackle Butler. He added: "He joins a large number of police officers who have given their lives as public servants.

"The grief of his family, colleagues and the citizens of Birmingham can, and I hope will, be mixed with pride for his selfless devotion to duty."

Birmingham Crown Court heard that Butler's mental illness developed after he was made redundant from his job as a design draughtsman with Rolls-Royce in 1982.

He was first sectioned in 1994 and, after spells in and out of hospital, was released into the community in 2001 and placed under the supervision of the Small Heath Assertive Outreach Team, run by the Birmingham and Solihull Mental Health Trust. A psychiatric nurse delivered his mood-stabilising pills every fortnight and was supposed to assess him.

But Butler's obsession about privacy meant the "assessment" normally lasted a few minutes on the doorstep.

Yet Hilary Reid, a community psychiatric nurse, said Butler, who has a degree in mechanical engineering, appeared to be taking his medicine and "running his everyday life very well". The reality was very different. Neighbours reported him screaming to himself and banging doors in the night.

It turned out after the stabbing that Butler had not taken his medication for at least 15 months. When officers searched his house they found 462 mood-stabilising pills.

Butler also tricked his consultant psychiatrist, Dr Thilak Ratnayake, who saw him only "three or four times in the space of four years". Dr Ratnayake told the court he "didn't have any concerns" about Butler.

The month before Dc Swindells's death, Dr Ratnayake and Mrs Reid visited Butler and noticed a large knife on his sofa as well as numerous stab marks in his living-room door. Butler said he was practising martial arts, which they took to be "usual" behaviour and therefore did not log it.

A risk assessment sheet attached to Butler's medical file and read to officers by care workers minutes before the stabbing lacked crucial incidents that had not been logged, including that Butler had burned down his own house, thrown a brick through a neighbour's window, kicked another neighbour in the head, been found in possession of a knife and spat in a police officer's face.

On May 21 last year Butler threatened to cut Michael Wood's head off after the council worker arrived at his home in Nechells Birmingham, to fix his gate. Mr Wood called the police. Nine officers, one with a dog, went to Butler's home. When Butler saw them he ran down a canal towpath underneath Spaghetti Junction.

During the chase he pulled a knife and tried to stab a number of officers and the police dog.

After an appeal went out on police radio, Dc Swindells, a father-of-two from Burton-upon-Trent, Staffs, joined the pursuit and was the first to reach Butler.

After missing with an initial swipe with the knife, Butler plunged it into the officer's stomach, tearing through his chest and penetrating his heart. He ran off again but was cornered a short time later by armed police.

After the trial, Det Chief Insp Glenn Moss said Dc Swindells "demonstrated terrific courage". Mr Moss said Dc Swindells was "a dedicated and committed officer who responded to the local community and his colleagues".

Dc Swindells's wife, Carol, who sat through the trial, declined to comment, but Det Ch Insp Moss said she and his family were "content" with the outcome.

He added: "They accept that Mr Butler clearly had an illness and needs treatment."

Butler's brother, who declined to give his first name, said Butler should not have been released into the community. He said: "He has been let down by the system and that's it. There's nobody done nothing for him. He should have been in care."

Sue Turner, the chief executive of the Birmingham and Solihull Mental Health Trust, said there would be two inquiries into the case, one internal and one independent. She said Butler was assessed regularly and had shown no signs of relapse.

Marjorie Wallace, the chief executive of the mental health organisation Sane, said of the case: "It highlights yet again the inadequacies of supervising some patients in the community."

Freed to kill

Other cases where mental patients have been freed and gone on to kill include:

• John Barrett, 42, admitted in February stabbing Denis Finnegan, 50, in Richmond Park, London, the day after being released from Springfield hospital, south London. Barrett bought a set of knives and stabbed Mr Finnegan after "hearing voices in his head". He was jailed for life.

• Peter Bryan, a paranoid schizophrenic and self-confessed cannibal, was jailed for life in March after a "manifest failure" in his treatment. He was under the supervision of East London and The City Mental Health NHS Trust after a fatal attack but was deemed safe to live in the community. Police found him cooking a victim's brain in a frying pan.

• Dale Pick, 35, a violent schizophrenic, was allowed to discharge himself from Bradgate Mental Health Unit in Leicester. Soon after leaving, Pick killed Michael Doherty, 47, stabbing him seven times in the head and once in the heart.

telegraph.co.uk 20 May

Charity pleads for tolerance as autistic youngsters face Asbos

Children with autism and other serious psychological conditions are being targetted by the government's controversial anti-social behaviour orders (Asbos), according to mental health charities and professionals.

In one case in the South West, a 15-year-old boy with Asperger's syndrome, an autistic disorder, was given an Asbo which stated he was not to stare over his neighbours' fence into their garden.

The young man concerned had no previous criminal convictions, but if he breached the order by 'continuing to stare' he faced a custodial sentence.

The young man concerned had no previous criminal convictions, but if he breached the order by 'continuing to stare' he faced a custodial sentence.

guardian.co.uk 22 May

Religious knife maniac feared 'judgment day'

A KNIFE wielding maniac who stabbed his social worker and a police officer believing they were stopping him from spreading the Islamic faith has been sent to a mental hospital indefinitely.

His social worker, Penelope Milsom, and rookie police constable Mark Plitsch are lucky to be alive following the horrific episode at Abbott's flat in Hanson Court, Cambridge, in March last year.

Experienced social worker Mrs Milsom and probationary police officer Pc Plitsch, in the job for only seven weeks, were calmly trying to persuade Abbott - a Muslim-convert obsessed that he was a messenger from Allah - to be admitted to hospital because of his deteriorating mental state.

The pair, who had back-up from other health workers and officers waiting nearby, fled as Abbott drew two large kitchen knives from his trousers and chased them from his flat.

Pandemonium reigned as Mrs Milsom was stabbed in the back, the knife narrowly missing her vital organs, and Pc Plitsch - the only officer present wearing a stab-proof vest - was cornered on the landing as he shouted warnings for everyone to run.

Abbott slashed at Pc Plitsch "with a chopping motion", scything through his ear and face and relentlessly continuing the onslaught even after the officer - bleeding profusely - kicked him in the groin and another officer sprayed the demented assailant with CS gas.

Abbott's friend, Cihan Bashan, 30, who had moments earlier warned that Abbott had armed himself with knives, jumped on his back in a bid to stop the attack.

Abbott was then brought to his knees by a police officer wielding his baton.

Mrs Milsom - who realised she had been stabbed only after blood seeped through her cardigan - and Pc Plitsch, were both taken to hospital. Both say they are scarred mentally as well as physically by the incident and feel lucky to have survived.

Abbott's mother was also at the scene and was distraught at what happened.

A jury on Monday returned a verdict of not guilty by way of insanity on Abbott - who has suffered mental health problems since he was a teenager but has never shown violent tendencies in the past - on charges of wounding Mrs Milsom and Pc Plitsch with intent to do grievous bodily harm.

The same verdict was returned in relation to assault on another police officer, Stephen Ellis, who was hurt as efforts were made to restrain Abbott.

Psychiatrists said Abbott, ruled by the "supremacy of his religious delusions" by voices in his head and by "supernatural visions", was aware of his physical actions that day but lacked the capacity to know that what he was doing was wrong.

He feared because "judgement day" was approaching he would be badly judged by Allah as he would not have completed his task of spreading the religious message.

Judge John Sennitt ruled that in order to protect the public Abbott, who has been remanded to Kneesworth House mental hospital, near Royston, since soon after the attack, be confined in a mental hospital without limit of time until deemed fit for release by the Home Office.

cambridge-news.co.uk 17 May

Also:

'I believed he would kill me'

BRAVE Pc Mark Plitsch has told how he "fought for his life" after schizophrenic James Abbott attacked him with a knife.

Pc Plitsch said in a harrowing statement read out at Cambridge Crown Court: "I would describe myself as fighting for my life.

"I believe he was intent on killing me. I was desperate. Blood was pumping out of my wound. The sight of me covered in blood had not stopped his attack. I knew if he got close enough he would stab me again."

Speaking to the News after his attacker was sent to a secure unit for the mentally ill, Pc Plitsch spoke of the horrifying moment that he realised his struggle to restrain Abbott was a fight for his life.

He said: "We went to what seemed like a routine call, to assist a social worker in a very straightforward situation, but as soon as we got to the flat it became clear that things weren't right.

"When we went in Abbott pulled two rather large kitchen knives on us, and as we tried to calm the situation down he started to run towards us, forcing us to back out into the stairwell.

"It was a tight, confined space, and he came at me with both knives - I feared for my life.

"He was slashing and stabbing at me and when he was hit with CS gas it seemed to have no effect at all.

"Then he struck one of the knives across my face. It cut my ear in half and opened up my face, but it happened so fast that I didn't have time to think about it or feel the pain.

"There was blood, but he still had the knives and was still attacking me, so my focus had to be on tackling him and saving my own life as well as the other people in the flat.

"This sort of incident is something we as police officers can come up against on any day in service.

"My only thought was to get the man restrained, and the pain came later when they started to pull the wound about in hospital." Pc Plitsch, 32, was wearing a stab-proof vest under his shredded fluorescent jacket, and was able to muster the strength to bring Abbott down, along with colleague Pc Matt Keep, 26, before backup arrived.

Both officers were commended for their bravery after the incident. Speaking after receiving the Chief Constable's Commendation for bravery at a special ceremony last July, Pc Plitsch said: "I would just like to say thank you to Matt for saving my life."

Pc Keep, 25, who was tutoring his colleague, said: "It is a real honour. We never expected it - we saw it as the normal course of duty."

Now transferred to Ely, Pc Plitsch was open about the impact the attack has had on him, but said he had no intention of letting it affect the job he loves.

"It's one of those things that I have to deal with, and, yes, it will stay with me, but I enjoy every bit of my job and nothing's going to change that," he said.

Det Sgt Al Page, who led the investigation, said Pc Plitsch has shown "immense courage" in the way he dealt with Abbott, and the trauma of such a vicious attack so early in his police career.

"I would like to say how remarkably brave Pc Plitsch was and how well he acted for someone so young in the service," he said.

"I would also like to commend how well he has done to continue and flourish in his police career after something like this happened to him.

"He has done really well to come back from this, it was a life-threatening situation and his actions really were of the highest

cambridge-news.co.uk 17 May

B (R on the application of) v (1) Haddock (2) Rigby (3) Wood. 20 May

The claimant, whom I shall refer to as B, is now 27 years old. He is detained at Ashworth Hospital pursuant to a Hospital order under s.37 of the Mental Health Act 1983 ('the 1983 Act') coupled with a restriction order without limitation of time under s.41 of the 1983 Act. These orders were made following his conviction for offences of affray and causing actual bodily harm. This was in September 1995 when he was just 18. He has remained in Ashworth Hospital since then and is still regarded as too irresponsible to be released into the community because of his lack of co-operation with those who seek to treat him and his continuing threats and acts of violence.
2. That view is challenged by a psychiatrist and a psychologist who have submitted reports on his behalf. Professor Sashidharan, a consultant psychiatrist, maintains that the claimant is not suffering from mental disorder but that his problems are a result of "long standing emotional difficulties, dating back to his childhood, which remain poorly understood and largely unresolved, in spite of almost ten years of close psychiatric supervision and treatment". Professor McGuire, an eminent psychologist, is of the same view and concerned that B is fundamentally a case of "psychiatric injustice"...

By May 2004 Dr Haddock, the first defendant and the claimant's responsible medical officer (RMO), decided that treatment with anti-psychotic medication would alleviate the claimant's condition. Confirmation in the form of a certificate authorising the treatment was obtained from the second defendant. Treatment commenced on 13 May 2004 and comprised forcible administration of intra muscular depot injections of an anti-psychotic drug. Following the lodging of this claim at the end of July 2004, Dr Haddock undertook not to administer anti-psychotic medication to the claimant without his consent until further order of the court and that formed part of an order of the court when permission was granted on 20 August 2004. It was hoped that the claim might be heard in September, but that did not prove possible and the certificate issued by the second defendant, whose existence was an essential prerequisite to the administration of the challenged treatment, was withdrawn. The claimant's representatives were informed that the RMO was still satisfied that the treatment was needed and that another doctor was being instructed to consider whether to grant a certificate that it was. The third defendant was instructed, read the documentation and interviewed the claimant. On 30 October 2004 he granted a certificate; but restricted the type and the amount of the medication. The claim was amended to add the third defendant and to take account of this development.

Two grounds were relied on in the claim. The first alleged that to administer the medication without consent was a breach of the claimant's human rights. This can be subdivided into a number of issues. These, briefly, are: -
(1) Is the claimant suffering from mental disorder?
(2) Does the claimant have capacity to refuse consent to the proposed treatment?

(3) Is the proposed treatment necessary?

(4) Is the proposed treatment likely to be in any way effective?

Full Transcript

Diaby v Secretary of State for the Home Department 12 May

The appellant was a citizen of the Ivory Coast. He was a member of the RDR Party and of Malinki ethnicity and feared persecution. The appeal considered whether the Special Adjudicator had erred in law in considering psychiatric evidence that the appellant was not able to present evidence after the hearing without submissions from either party and after making an adverse credibiilty finding on evidence given at the hearing.

Outcome: Appeal Allowed, Application Allowed

Full Transcript

First national survey of acute inpatient wards

The first national survey of acute inpatient mental health wards was today (25 May) published by the Sainsbury Centre for Mental Health (SCMH).

Acute Care 2004 surveyed over 50 NHS trusts and 300 wards across England to provide a benchmark to measure change over the coming years.

Acute Care 2004 found that:

There is an over-reliance on bank and agency staff. On an average day, a ward of 16 beds would have a combined shortfall of two whole-time nurses and health care assistants and use four whole-time agency or bank staff. National guidelines are needed to inform appropriate staffing levels on wards.

Nearly half of wards lack a lead consultant psychiatrist, while 13% are without a ward manager or senior nurse above grade F. This indicates that mental health trusts need to give more focus to strengthening clinical leadership.

One quarter of wards had lost staff to community teams in the year before the survey. This highlights the need for trusts to look at how all their services are managed and improve the career prospects of acute inpatient staff.

Many wards are unable to offer therapeutic activities such as cognitive behaviour therapy (CBT, available in just one-fifth of wards). Less than a quarter of wards had the services of a psychologist. Ward staff need more opportunities to improve their skills and to practise what they have learnt.

The survey also found that, as a result of the successful creation of new community teams, many ward managers reported their clients had increasingly severe mental health problems and high levels of need. Yet one-fifth of wards lacked access to a psychiatric intensive care unit (PICU).

The survey was commissioned by the National Institute for Mental Health in England (NIMHE).

Paul Rooney, NIMHE Joint Programme Lead for the Acute Inpatient Care Programme, said: "This report is timely, as acute inpatient care has been identified as a key priority area for action in the recently published National Service Framework for Mental Health – Five Years On Department of Health document. This document acknowledged the number of initiatives already underway to improve the physical and therapeutic environment of inpatient wards and additional capital spending provided for new units and ward refurbishments – but recognised that much more needed to be done.

"Acute Care 2004 provides a valuable snapshot of a service that faces many challenges in order to offer people the quality of care which they have a right to expect. We hope this survey will stimulate local dialogue between service providers, users and commissioners and act as a spur to inform future service improvement priorities."

SCMH chief executive Angela Greatley said: "Acute inpatient mental health care is in need of urgent attention. There is no doubt that mental health services have improved in recent years, but in many places progress has been slowest in inpatient services. Our survey shows the scale of what remains to be achieved in acute wards to offer the quality of care service users want, need and deserve. In particular we need to tackle the urgent staffing problems many wards face and to make the many good practices that do exist much more common across the country."

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MHAC:

Concordat Between Bodies Inspecting, Regulating, and Auditing Health and Social Care in Wales.

External review bodies inspecting, regulating, and auditing health and social care in Wales have developed and agreed a set of principles and practices (a Concordat) to support the improvement of services for patients, service users and carers and to eliminate any unnecessary burdens of external review.

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Moore & Ors v Care Standards Tribunal & Anor 24 May 2005

Alternative Futures Limited (Futures), is a not for profit company limited by guarantee and is a registered charity. It was established in 1992, primarily to assist the retraction of the NHS institutional hospitals by providing care in the community. This took the form of small registered residential homes, nursing homes, and supported living services. At first, Futures provided both housing and personal services. In March 2001, Alternative Housing Limited (Housing) was established as a separate not for profit company to facilitate the move towards supported and assisted living. It is also registered as a charity. Futures and Housing are part of the Alternative Group.

Section 11 of the 2000 Act provides that "any person who carries on or manages an establishment or agency of any description without being registered under this part … shall be guilty of an offence". The care homes owned and operated by Futures were registered as such under the Registered Homes Act 1984 and remained registered under the 2000 Act when it came into force on the 1st April 2002 . Futures applied under section 15(1) (b) of the 2000 Act, on 15th May 2002 to cancel the registration of their houses as care homes. Four of their houses were considered by the Commission to be suitable for deregistration, but eleven were not. Futures appealed against the decision to refuse to cancel the registration of the eleven houses.

Full Transcript

J v Secretary of State for the Home Department 24 May 2005

This is an appeal against the decision of the Immigration Appeal Tribunal ("IAT") dated 22 September 2004. The appellant is a citizen of Sri Lanka and an ethnic Tamil. He alleges that he would commit suicide if he were returned to Sri Lanka, and for that reason he claims that the decision by the Secretary of State to remove him to Sri Lanka violated his rights under articles 3 and 8 of the European Convention on Human Rights ("ECHR").

The IAT dismissed his appeal against a determination by Mr D A Radcliffe as adjudicator, which was promulgated on 13 August 2003. The adjudicator rejected an appeal against the Secretary of State's refusal of his claim for asylum. He also rejected his appeal on human rights grounds under section 65 (1) of the Immigration and Asylum Act 1999.

Full Transcript

Lewis v Gibson & Anor 19 May 2005

An appeal by a mother (B) from a decision of Mitchell HHJ, sitting at the Telford County Court. B was responsible for the care of her 34-year-old daughter (M) who suffered from Down's syndrome. Unable to cope with this burden, in an application to the local authority, B had referred to euthanasia for M, not as a direct threat, but as a last resort. However, the local authority decided that M did not meet the criteria required for euthanasia under s.1 of the Mental Health Act 1983 (the 1983 Act). Soon, B was unable to maintain her daughter's well-being and M's condition consequently deteriorated. A warrant was issued under s.135 of the 1983 Act and M was removed by the police with the help of social workers and admitted to a mental hospital. Later, the local authority assumed guardianship over M when its application to displace B as M's nearest relative under s.29 of the 1983 Act was granted. B appealed. The court was required to determine whether the interim displacement order had been correctly made.

M had satisfied the requirements for guardianship under s.7(2) of the 1983 Act. The local authority had also established their entitlement to the order sought under s.29 of the 1983 Act. Further, M had been received into guardianship in her best interests and for her protection. Hence, B's objections to the local authority's application for the interim displacement order were unreasonable. However, it was open to B to apply to a Mental Health Review Tribunal for the discharge of the guardianship direction.

Full Transcript

Seal v Chief Constable of South Wales Police 19 May 2005

The issue in this appeal is the effect of s.139(2) of the Mental Health Act 1983 ("the 1983 Act"). That subsection provides a filter for proceedings arising in respect of acts purporting to be done under the mental health legislation. In the case of civil proceedings the leave of the High Court is required. When proceedings are brought without the leave of the court, as required by the subsection, what is the consequence? Are the proceedings a nullity or can the situation be remedied by a subsequent grant of leave, possibly with the proceedings being stayed in the meantime?

This is a second appeal but, because the issue raised is an important one of principle, permission to appeal has been granted.

The essential background facts are as follows. On 9 December 1997 Mr Seal, the appellant, went to his mother's house in Merthyr Tydfil but could not park his car because of other vehicles. He went into his mother's house having been unable to alert the owners of the other vehicles by sounding his horn. He decided to telephone the police and complain about the obstruction. His mother tried to stop him, but somebody contacted the police and a few minutes later three police officers arrived.

There is a dispute about what happened, both inside and subsequently outside his mother's house. Mr Seal was arrested inside the house for breach of the peace. He disputes that there were lawful grounds for arresting him. He was taken outside. The police apparently intended to take him home, but as a result of what happened outside they decided to remove him to a place of safety under s.136 of the 1983 Act. He was detained for some days under that Act.

Full Transcript

Violence in Mental Health Settings

Healthcare Commission calls for action on inpatient services 24 May 2005

High levels of violence in mental health and learning disability inpatient facilities in England and Wales are revealed today in a national study conducted for the Healthcare Commission by the Royal College of Psychiatrists.

The National Audit of Violence in mental health and learning disability services found that one in three inpatient service users have experienced violent or threatening behaviour while in care, this ranges from raised voices and verbal aggression to the much rarer use of a weapon to threaten or attack.

This figure rose to 41% for clinical staff working in these units and nearly 80% of nursing staff. Eighteen percent of visitors to the units had experienced violent or threatening behaviour.

The Healthcare Commission has pledged to use the findings to drive much needed improvement in inpatient services, saying "best practice must become standard practice".

The Audit highlights areas of good practice across the country. For example, the use of personal alarms in one trust helps to make visitors feel safer. Other positive results show that a high percentage of staff, service users and visitors feel that violence between service users is dealt with well. The majority of service users also feel able to speak to staff when they need to.

Around 6,500 questionnaires were submitted as part of the audit - respondents were drawn from 265 units and included over 1,500 service users.

The Audit makes recommendations about how to reduce the causes of violence on units and wards in the following areas:

Substance misuse - this was cited by the Audit as the number one trigger for violent or threatening behaviour. The Audit recommends that more must be done to support staff teams to address the problems caused by alcohol and illegal drugs.

Staffing - The Audit found staffing issues to be the second most frequent trigger of violence. Many units are operating with substantial staff vacancies and are overly reliant on temporary and agency staff. Experienced staff are being drawn into more prestigious community posts and inpatient units are having difficulty creating cohesive and experienced teams. The Audit recommends that the status of inpatient nursing is raised to at least that of community nursing.

Security - The design of many wards and units fail to meet basic safety standards. For example, 35% of nursing staff feel that the alarm system where they work is unsatisfactory. The Audit recommends that greater efforts should be made to upgrade existing wards in ways that optimise safety.
Service user concerns - Service users experience high levels of boredom and many wards and units are unable to offer a structured and therapeutic system of care. Overcrowding and service users with more than one condition also prevent the delivery of good services. The Audit calls for ways to be found to help staff to spend more time in face-to-face contact with service users.

Training - Training to handle violent incidents must be more focussed on prevention rather than management.
Professor Paul Lelliott, Director of the Royal College of Psychiatrists' Research Unit said:"the audit confirms just how challenging it is to work in mental health residential settings. However, it is encouraging that, after 20 years of relative neglect, there is now recognition in all parts of the health service that something must be done. The National Institute for Clinical Excellence, the National Patient Safety Agency and the National Institute for Mental Health for England have all made in-patient services a priority and this Audit demonstrates the Healthcare Commission's commitment.

"Despite the problems illustrated by the Audit, we were struck by the dedication and enthusiasm of front-line staff of all disciplines and the extent to which they were committed to working with service users to improve safety. This must be built on: Unit managers must be given back the authority to manage their wards, and the support and resources required to improve the physical environment, and nurses must be freed from unnecessary paperwork so that they can spend more time on the ward working face-to-face with patients, providing better care and creating a safer environment."

Anna Walker, chief executive of the Healthcare Commission said: "These figures are deeply worrying. No one is saying these issues are easy to deal with. But we must do more to protect the people who use and work in our mental health services.

"This Audit gives us hard evidence on an area of growing concern. It suggests that while community services have been really important, more attention must be given to inpatients. Nobody must take their eye off this ball."

"We will build on the findings of this report by refining the way we assess the performance of mental health units. There is plenty of good work going on. We've got to ensure best practice becomes standard practice."

For further information, or to arrange an interview, phone Creina Lilburne at the Healthcare Commission on 020 7448 9339 or after hours on 07941 156 827. Alternatively, contact Thomas Kennedy at the Royal College of Psychiatrists press office on 020 7235 2351.

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SCARE IN THE COMMUNITY

WE should have known things would go disastrously wrong when the people meant to be monitoring schizophrenic Glaister Earl Butler were revealed as the Assertive Outreach Team.

Such aggressive titles usually hide hopelessly inefficient organisations, and so it proved.

Nobody checked Butler actually took his medication. Nobody assessed him regularly and there was an enormous black hole in his records so when police went to arrest him they were told he was not physically violent. Proving this ramshackle bunch of carers from the Small Heath Mental Health Trust wasn't assertive, failed to outreach and couldn't manage the most basic teamwork.

For that DC Mick Swindells paid with his life. Now we know what will happen. Lessons will be learnt, guidelines drawn up, the rulebook revised and carers retrained. Nothing will change and sooner rather than later another poor sacrifice will be offered up on the bloody altar of care in the community.

Nobody either at Butler's trial or afterwards could answer why he was released into the community by a three-man independent panel only seven months after being "sectioned" for the third time. During those seven months he headbutted a nurse, was frequently verbally and physically violent towards staff and fellow patients, wouldn't accept he was mentally ill and refused to take his medication regularly.

Yet somehow he was judged safe to be released into the outside world. This is incomprehensible and will remain so unless the tribunal that set him free is called to account. Surely you don't need to be Brain of Britain to know that a schizophrenic who won't take his medication and gets violent when he feels his privacy is threatened is not someone who should be free.

There is no doubt the Small Heath team has a lot to answer for, but they were handed one hell of an explosive cocktail by the assessment panel. In rugby it's called a hospital pass and is a story that has been repeated too often over the years as a result of disastrous Care in the Community decisions. It is tempting to blame it all on useless care workers and carry on with the hectic business of life, forgetting those who have to pick up the pieces, like the family of DC Swindells.

Care workers do jobs from which most of us would run a mile. We hear only of the tragic errors and incompetence. But they are the weary, hard-pressed, under-staffed, under-paid and under-resourced foot soldiers of an ill-conceived policy. "They call it Care in the Community," said DC Swindells' mother. "There should be more attention to caring for the community."

She's right. At the back of this, and every other Care in the Community tragedy, is the question of cash. It's cheaper to look after the mentally ill on the outside than it is in an institution. But the community doesn't have the resources to do it and the vast majority of us don't have the inclination either.

Butler wasn't properly monitored because to do so would have taken much more time than the team had to spend on him. That's why interviews were short and took place on his doorstep. That's why nobody knew he wasn't taking his medication. That's why a psychiatrist and nurse who visited him and saw a knife and gouge marks on a door accepted the absurd explanation that he had been "martial arts training". This explanation was not unusual, said psychiatrist Dr Thilak Ratnayake, who was in charge of his case.

"I thought he was taking his medication, progressing well and living a good life. We didn't have any concerns," he said. Hardly surprising as in three years in charge of Butler's case the doctor had seen his patient only four times for a total of two hours. If he had spent longer on it a very different picture would have emerged, from the simple expedient of talking to neighbour Iris Rose. "I would hear banging doors, swearing and talking to himself. Even when I knew no one else was in his flat I would hear him scream 'Leave me alone, leave me alone'," she said.

Yet even after Butler was convicted of DC Swindells' manslaughter on the inevitable grounds of diminished responsibility, those responsible for this debacle were busy rearranging the Titanic's deckchairs. Yes, there would not be one but two inquiries into what happened, said Sue Turner, chief executive of Birmingham and Solihull Mental Health Trust. But, she insisted, Butler had been regularly assessed and showed no signs of relapse.

Tell that to his neighbours. Tell that to DC Swindells' mother. Tell that to Butler's family, who insist he should never have been released. "Leave me alone," screamed Glaister Earl Butler as his fragmented personality tore him apart.

The tragedy was, too many did.

sundaymirror.co.uk 22 May

'POLICE VENDETTA' PROMPTED SUICIDE

A solicitor who spiralled into alcohol abuse and depression, after police pressed charges against him, went on to kill himself, an inquest has heard. Martin Sparkes, aged 50, committed suicide on September 9, 2003, at Observation Point, Lodge Hill, near Castle Cary, by hanging himself.

The inquest in Wells heard that Mr Sparkes, a father of three from Petersfield, in Hampshire, had been living rough for several days and was of no fixed abode.

The suicide was triggered after an eight-year battle with alcohol and depression, which his brother claimed was triggered by a "police vendetta".

Christopher Sparkes, Martin's brother, said that before 1995, when he was arrested and charged with money laundering and perverting the course of justice, his brother had no history of depression or alcoholism. The charges were dropped two years later.

Mr Sparkes said: "The day after Martin's arrest you had a man in front of you who was different. Within six days he was drinking heavily." Mr Sparkes stated that although his brother had always been a heavy social drinker, sometimes drinking two glasses of wine for lunch and several pints in the evening, he had never seen him drunk.

After his arrest, it was not unusual to find him drinking vodka in the morning.

Within eight days of his arrest he was talking about taking his own life, and a period of self-harm and suicide attempts followed.

Martin often referred to the period of his life after his arrest as "the chaos".

At the time of his death Martin was pursuing a compensation case against Hampshire police, and according to his brother he was confident he would win the claim.

His widow Jenny, who he separated from in 2002, is now pursuing the claim.

Coroner Tony Williams recorded a verdict of suicide.

He said: "Martin became consumed by the court proceedings that he had become involved in.

"He had become a broken man during this period."

thisissomerset.co.uk 19 May

Suicide farmer shot wife first

AN elderly Broadway farmer blasted his wife with a shotgun before turning the weapon on himself after becoming depressed during the sale of his smallholding, an inquest was told.

Fred Jobson, aged 75, was also worried about his health in the weeks before he killed his 74-year-old wife Nancy and shot himself at their farmhouse, Worcestershire Coroner's Court was told.

The couple, who had lived at Brooklea Farm, near Broadway, for 47 years, died last year. They had both suffered a single gunshot wound to the chest and their bodies were found between the side of the house and a fuel bunker.

Giving evidence from the witness box, the couple's daughters, Janette Rowlatt and Pamela Jarvie, both told the hearing on Friday how their father had spoken of ending his life with a gun.

Mrs Jarvie told the inquest at Stourport: "Daddy became increasingly fed up and he wanted to move."

The inquest heard that the tragedy happened shortly before Mr and Mrs Jobson were due to move to a bungalow because Mr Jobson found it difficult to maintain the farmhouse to his high standards.

Mrs Rowlatt said: "My father found it very difficult growing old and as he got older he found it more difficult to keep the property in a condition to which he was accustomed. The house was very modest, but the grounds and gardens were his pride and joy."

A statement from Mr Jobson's GP revealed he had been prescribed anti-depressants, although he had had stopped taking them at the time of his death. The farmer was also convinced, wrongly, that he had a heart condition.

The assistant deputy coroner for Worcestershire, Nigel Garbutt, said he was satisfied from the evidence that Mr Jobson had unlawfully killed his wife and taken his own life while the balance of his mind was disturbed.

thisisevesham.co.uk 19 May

Large Variation In Amount Of People On Incapacity Benefit For Mental Conditions In Different Parts Of Britain

London is highest with 42.3% - East Midlands is lowest with 34.4%

6,500 of the 11,100 persons on incapacity benefit in Camden London are claiming this benefit because of mental and behavioural disorders. That is 58.6% of the total number in Camden claiming incapacity benefit for any condition. This is well above the national average of 38.6% claiming for mental conditions.

In total in Great Britain, 2,687,000 people claim incapacity benefit for all conditions. Of these, 1,036,300 or 38.6% claim because of mental and behavioural disorders.

There are considerable regional variations. The region with the highest percentage is Londonwith 42.3% of claimants suffering from mental problems. Next is Scotlandwith 41.5% with South West third on 40.4%. The East Midlandsand Waleshave the lowest percentage with 35.1% and 34.4% respectively. The full list of all regions and areas in Great Britainis shown on pages 2 & 3 of this release.

Eight of the top twenty areas are in London. The twenty areas with the highest percentage on incapacity benefit for mental conditions are 1) Camden 58.6%, 2) Westminster 53.1%, 3) Bournemouth 50.6%, 4) Brighton and Hove 50.0%, 5) Dundee City 50.0%, 6) Islington 49.6%, 7) Bristol 49.0%, 8) Aberdeen City 48.6%, 9) Lambeth 48.6%, 10) Glasgow City 47.8%, 11) Southwark 47.8%, 12) Hackney 47.7%, 13) Kensington and Chelsea 47.6%, 14) Manchester 47.1%, 15) West Dunbartonshire 47.1%, 16) Salford 47.0%, 17) Wandsworth 46.9%, 18) Merton 46.5% 19) Kingston upon Thames 45.9% and 20) Clackmannanshire 45.9%.

The areas with the lowest percentage of claimants with mental problems are Orkney Islands16.7%, Anglesea 24.6%, Bexley 24.4% Rutland28.6% and Carmarthenshire 29.1%.

These figures are from a new analysis by GMB of the incapacity benefit claimant data from the Department of Work and Pensions in the period to November 2004.

Sharon Holder, GMB National Officer said, "The mental health service has long been a Cinderella neglected service. This analysis by GMB shows just how vital this service will be in any concerted effort to get people who can be helped to get well and fit for work.Any review of persons claiming incapacity benefit must be centered on the health needs of the people not on the cash needs of the Treasury."

gmb.org.uk 19 May

Suicide sparks review at mental health unit

Health bosses have promised to tighten up practices at the mental health unit of Chase Farm Hospital after a patient killed herself while on suicide watch.

The pledge follows the inquest into the death of Caroline Baynes who died at the hospital in July 2003. A jury ruled Ms Baynes' death could have been prevented if staff had carried out their observation duties properly.

Ms Baynes' family received an undisclosed compensation package at the end of 2004. Yesterday, the family's lawyer David Kerry, of Attwater and Liell Solicitors, said Caroline's case was not an isolated one.

He said: "I think there is a problem in this country with the care of psychiatric patients generally. In the last 12 months, our firm has settled two suicide cases and I am now looking at another case where a psychiatric patient suffered a very serious injury."

The Barnet, Enfield and Haringey Mental Health Trust yesterday insisted it is dealing with the problem, despite the discovery that patient Beverley Purcell had committed suicide, one day after Ms Baynes' inquest in April.

A spokeswoman said the trust had undertaken a thorough internal review. She added: "We take this issue very seriously and are investing in prevention of suicides by minimising areas of risk in inpatient areas and having robust observation procedures.

"There is also new investment in our community services which will improve contact with people after they have been discharged from inpatient care. We are constantly reviewing our services and we wish to give reassurance that good standards in care and practice are a high priority for the trust."

She continued: "We would like to express our deepest sympathy to the family and friends of Caroline Baynes at this difficult time. While Caroline's death was in 2003, the continued discussion must at times be very painful for them."

enfieldindependent.co.uk 19 May

Police killer held indefinitely

A paranoid schizophrenic will be held indefinitely under the Mental Health Act after killing a police officer.
Det Con Michael Swindells, 44, was fatally stabbed last May, below Spaghetti Junction in Birmingham.

At Birmingham Crown Court, Glaister Earl Butler, 49, was cleared of murder but convicted of manslaughter on the grounds of diminished responsibility.

An independent inquiry is to examine how Butler was considered suitable to receive care in the community.

After nearly two weeks of evidence, prosecutor Timothy Raggatt QC said the medical evidence was "all one way" and it was their view Butler was suffering from an abnormality of mind at the time of the killing.

Butler had denied murder but admitted manslaughter on the grounds of diminished responsibility.

Mr Swindells, a married father-of-one from Burton-on-Trent, Staffordshire, had been a policeman for 14 years.

Mr Raggatt paid tribute to the 44-year-old West Midlands Police officer's "conspicuous bravery".

But he questioned the wisdom of treating Butler in the community, echoing the apparent concerns of the jury on Wednesday.

The jury asked the judge in a note read to the court: "By what process does a three-person (mental health) tribunal decide if he's safe to be released into the community?"

The judge said it was a "what if?" and "if only?" type of question that many people would raise, but he explained it was not an issue with which the trial was concerned.

Mr Raggatt said on Thursday: "The question the jury asked has been asked many times by those behind me and the police service.

"There is an enormous amount of concern that someone who, on the face of it, was as dangerous as this man was at large in the community.

"We are at a loss to understand how that situation came about."

Consultant psychiatrist Dr Neil Duchar, medical director of Birmingham and Solihull Mental Health Trust, said an independent inquiry would be carried out by another local health authority.

Sue Turner, the trust's chief executive, said an internal inquiry would also be carried out to determine what lessons could be learnt for the future.

"The trust is extremely concerned that such a tragedy occurred and involved a person who was receiving mental health care services from the trust," she said.

She said Butler, of Long Acre, Nechells, Birmingham, had been under the trust's care since 1995.

"This means that he was under our care and supervision with regular assessments of his condition being made while he continued to live in the community."

Outside the court, Det Ch Insp Glenn Moss said the family of Mr Swindells were content with the outcome of the trial.

"They accept that Glaister Earl Butler clearly has an illness," he said.

"They are as content as they can be and have asked to bring closure to the situation.

"Detective Constable Swindells demonstrated terrific courage. He was a dedicated and committed officer who did remarkable work in protecting the local community."

bbc.co.uk 17 May

Vital warnings ignored over killer's mental health

The case of Glaister Earl Butler shows the "inadequacies" of treating some mental health patients in the community, the head of a leading charity said.
Marjorie Wallace, the chief executive of mental health organisation Sane, said that vital signs in Butler's behaviour and case history appeared to have been ignored.

"It highlights yet again the inadequacies of supervising some patients in the community," she said.

"The greatest known predictors of tragedies like that of the killing of Det Con Swindells are living alone, failing to take medication, a history of aggression and delusions about people in authority and neighbours... It's a fatal combination."
An interest in martial arts - which was noted by outreach workers but not flagged up as a cause for concern even after they noticed Butler with a kitchen knife - had been a factor in a number of other similar cases.

"We're also concerned about the way in which people with a history like Glaister Earl Butler are released by tribunals or lay boards," she said.

During the trial, the jury raised a similar point in a note to the judge, Mr Justice Calvert-Smith.

The note, which was read to the court, asked: "The medical experts in this trial have all given opinions that Mr Butler has a lengthy history of paranoid schizophrenia.

"It has been documented that he has been hostile, threatening, potentially violent and actually violent to neighbours. He showed continual paranoia to police/authorities, there were difficulties during periods of enforced hospitalisation and he has no insight into his problems.

"By what process does a three-person (mental health) tribunal decide if he's safe to be released into the community?"

The judge said it was a "'what if?' and 'if only?"' type of question that many people would raise, but he explained it was not an issue with which the trial was concerned.

He added: "In the end, what happened did happen. He was in the community and he did kill DC Swindells and I don't think it's going to assist us to relive these questions whether the mental health tribunal system in this country could work better."

In fact, the court was told that a mental health tribunal twice refused to release Butler from hospital during his detention.

Who authorised his subsequent releases into the community is unclear but some followed home visits where his condition was noted to have improved.

In Butler's medical records, he apparently posed few problems for his outreach team and consultant psychiatrist throughout 2003, although from January 2004 there were concerns he was not taking his medication and repeated, failed, attempts to visit him at his flat.

Following DC Swindells's death, some 462 tablets, or 18 months' worth, of anti-psychotic drugs were found at the property.

When police called for information about his history on the day of Det Con Swindells' death, they were told he was not known to be aggressive or violent.

Mrs Wallace said: "The trouble with outreach and other teams is that they give a 'snapshot picture' of a person's mental state on which risk assessments are based, instead of 24-hour contact when deterioration of mental condition would become more evident."

In the end, policy and treatment came down to cost, she said.

"Providing supervised, 24-hour accommodation is expensive. Living alone is less expensive."

Hospital stay may up suicide risk in elderly

NEW YORK (Reuters Health) - The likelihood of and elderly person committing suicide is significantly higher if he or she has been hospitalized for a medical illness in the previous 2 years, according to Danish researchers.
However, the suicide risk in this population is still lower than that in middle-age people.

Dr. Annette Erlangsen, and colleagues from the University of Southern Denmark, Odense, evaluated the effect of hospitalization for medical illness on the risk of suicide in 1,684,205 people at least 52 years of age living in Denmark during 1996 to 1998. The subjects were divided into three groups: older than 80 years of age (oldest old), 65 to 79 years (old), and 52 to 64 years (middle-age).

A total of 1184 subjects committed suicide during the 3-year study period, including 779 men and 405 women, the investigators report in the Journal of the American Geriatrics Society.

The oldest-old men who had been hospitalized during the previous 2 years had an increased risk of suicide, at 113 per 100,000 versus 80 per 100,000 in the general population of men of the same age.

The oldest-old women who had been hospitalized also had higher suicide rates than their peer group.

"Comparing the relative risk within each age group showed that hospitalization was associated with a lower increase in risk in the oldest old than in the middle-aged," Dr. Erlangsen's team writes.

The risk for the oldest-old men doubled and the risk for the middle-age men tripled, they note. "The risk for the oldest-old and the middle-aged women who had been hospitalized recently quadrupled and quintupled, respectively."

"Considering that hospitalization with medical illness often precedes suicide in the oldest old, hospitalization may play an important role in identification of suicidal ideation in older people," the researchers conclude.

SOURCE: Journal of the American Geriatrics Society, May 2005.

Reuters 18 May

Jailed asylum seeker threatens suicide

AN IRAQI asylum seeker living in Wales yesterday claimed he would kill himself after being sentenced to eight months in jail.

Marewan Salledin Abdulstar, 31, of Park Street, Wrexham was found guilty of indecent assault by a jury at Mold Crown Court last month.

Leaving the dock after sentencing yesterday, he shouted: "I kill myself in prison, okay? I promise."

He was led away to the cells by security guards shouting in Kurdish.

Judge Merfyn Hughes QC, sitting at Caernarfon Crown Court, was told the former firefighter was suffering post traumatic stress disorder from his experiences in Iraq before he moved to Britain five years ago.

A psychologist's report described Abdulstar as "overloaded with trauma" and "highly suicidal". Defence counsel Arlene Milne urged leniency.

But Judge Hughes said: "It is a serious offence to touch a woman without her consent in a sexual way. It would be less serious if you had admitted what you did and shown remorse.

"I accept this was not a premeditated offence but the duty of the court must take account of the victim as well as you."

The jury had previously heard Abdul-star had visited a solicitor's office on July 12 last year to see a lawyer after a court date for his asylum application.

He was told to return later in the day but instead pressed his hand against the woman's throat, and indecently assaulted her.

Abdulstar's asylum application is still being considered.

icnorthwales 18 May

School cleared of blame over suicide of girl, 13

A schoolgirl's suicide which has been at the centre of national concern about bullying had more complex causes, a coroner decided yesterday, in a verdict which effectively cleared her school of blame.

Dr David Osborne highlighted expert evidence that Laura Rhodes, 13, and her 14-year-old friend, who survived a death pact, were primarily influenced by an intense terror of being separated and the prospect of "a perfect afterlife" together.

He also underlined the view of a consultant child psychiatrist that Cefn Saeson school, in Neath, should not be blamed for her death. He recorded a verdict of suicide by Laura.

The school welcomed the findings as a relief after "misrepresentation in some parts of the media", but Laura's parents disagreed and released part of a letter in which their daughter spoke of not being able to take her pain any longer.

The inquest, in Neath, heard that Laura and the friend, who cannot be named for legal reasons, both suffered weight problems and had no other friends. They had formed a passionate attachment after meeting through an internet chatroom.

They first met secretly on St Valentine's Day last year and later laid plans to elope together, buying disguises while on holiday in Crete with Laura's parents.

They ran away together on their return, staying in Newport, Bristol and Bath, before being found by police. The suicide pact was agreed on the journey back to Wales.

It was the second time Laura had run away, the inquest heard. She had previously gone to London.

Michelle Huws-Thomas, a psychiatric nurse who helped to look after Laura's friend after the tragedy, told the inquest: "I would not think that this was a cry for help. This was a definite pact with a volition and the hope of succeeding."

Dr John Talbot, a child psychiatrist commissioned by the coroner to examine the relationship between the two girls, said that they had become "extremely close emotionally", with an intensity which would have made it difficult to get help and support.

He said the girls' dread of separation would have been compounded by other fears of homophobia and punishment.

The inquest was told that Laura had been bullied at school about her weight of almost 14 stone and her secretly telling a friend that she was a lesbian, which the girl passed on.

But the school had acted promptly against the bullies, the inquest heard. The headteacher, Alun Griffiths, said: "We have scoured our consciences and I have to say that they are clear. We really could not have done more to support Laura and her family."

In a statement after the hearing, Laura's parents, Yvonne and Michael Rhodes, said: "We do not accept that Cefn Saeson school did all they could to deal with the bullying. We hope that lessons will be learned from our tragic loss so that others do not have to suffer."

Stuart Evans, acting director of education at Neath Port Talbot council, said: "We endorse the view of the school's recent inspection that the quality of care, support and guidance is outstanding.

"Grief and shock at Laura's death has been compounded by distress caused by speculation and misrepresentation of the school in sections of the media."

guardian.co.uk 14 May

Suicide agency to film deaths

A Swiss agency which helps people to commit suicide has begun to film the deaths of its clients to avoid future prosecution.

The Zurich based group, Dignitas, which was founded to help people with chronic diseases 'die with dignity', has introduced the measure on the advice of lawyers.

The agency's new insistence on filming deaths came to light when a 30-year-old Irishman, Martin Barry, was asked to sign a form agreeing to be recorded as he was helped to die last month.

Barry, from Cork, suffered from an advanced form of multiple sclerosis which left him in constant crippling pain. Volunteers from Dignitas recorded him as he assented to a physician administering a lethal dose of drugs to end his life.

Barry had provoked controversy in Ireland last October when he announced on radio that he would end his life with the aid of Dignitas. The freelance journalist and broadcaster said his suffering was almost intolerable.

'MS is a neurological illness and happens in 10 stages,' he said. 'I went from stage one to stage seven in less than five years. I do not want to endure a painful, cruel death propped up with morphine.'

It emerged last week that, with his condition deteriorating rapidly, he travelled to Switzerland less than a month ago. His family and close friends are understood not to have known of the trip.

When contacted this weekend, Dignitas director Ludwig Minelli refused to comment on the recording of clients' deaths or the case of Barry.

His death brings to five the number of Irish people who are believed have used the services of Dignitas. Approximately 30 Britons are thought to have died with Minelli's help and about 700 more are registered with the agency.

In the past, Dignitas, which claims 4,500 members worldwide, has been investigated for its part in the deaths of at least three foreigners, including a British couple and a 76-year-old Frenchman.

Although assisted suicide is legal in Switzerland, the law states that the person being helped must have a terminal illness and be of sound judgment.

guardian.co.uk 15 May

Widow plans to sue prison bosses over suicide

The widow of a driver who committed suicide after being jailed for killing three people in a road smash is planning to sue prison bosses who she claims could have prevented his death. Scott Currie had been trying to overtake another car on the A96 near Aberdeen but pulled out at the wrong time causing the crash.

Four young children are facing life without a father, a father whose gross error of judgement had already cost three lives and his freedom. Now it has also cost him his life. At home in Inverness his widow and children try to carry on with life. But it is tough, especially for the youngest who can't understand what has happened.

Sarah Currie said: "I have to go through the whole thing again where Daddy is in heaven and he is not going to be coming home again and I took them to the cemetery and they were looking around to see where he was and they were knocking on the grass."

Scott was sentenced to four years for dangerous driving last July. But he found prison tough to cope with along with the guilt and remorse. His family believe he was an obvious suicide risk and should have been checked on. Instead he was able to hang himself with his own belt in a toilet.

Lawyer Cameron Fyfe said: "He made three previous attempts to kill himself and the fourth of course was successful so there was evidence there that he was a risk and precautions should have been taken."

A Fatal Accident Inquiry into Scott's death gets underway in Inverness next month. His family believe it will show the Scottish Prison Service should have done more. Sarah will then sue for compensation. She says she has to. Scott was the breadwinner of the family and she needs the money to bring up his children.

She said: "An absolute accident with tragic consequences for all of us. Scott was punished and now we are being left with the punishment for the rest of my children's lives."

scotlandtoday 16 May

Trust guilty of neglect over suicide woman

A Grieving family today accused a health trust of failing to care for their vulnerable daughter, who committed suicide.

Caroline Baynes killed herself at a mediumsecure mental health unit on the

Chase Farm Hospital site despite the fact she was supposed to be checked by staff every 15 minutes.

An inquest found the 38-year-old former civil servant was not properly checked for hours. Her parents Beryl and Michael today accuse Barnet, Enfield and Haringey Mental Health Trust of treating her as a " second class citizen". Mrs Baynes, 68, from Enfield, said : "The trust let our daughter-down badly. If everything had worked as it should, then this would not have happened but the failure to properly watch her was only the final one she suffered.

"The conditions Caroline had to live in were cramped and often filthy. We called the cubicles she was given horse boxes, they were so bad.

"On several occasions she was given the wrong medication. Once she went missing and was found on a station platform two miles away, preparing to jump under a train.

"Our daughter was not the only patient to suffer. The whole mental health system is a mess."

Mr Baynes, 72, added: " Caroline was a independent woman with a long-term relationship, a healthy sense of humour and a family who loved her.

"The fact she suffered from

mental health problems does not lessen the value of her life." Mr and Mrs Baynes decided to speak out after it emerged a second patient had taken her own life while being cared for by the trust.

Miss Baynes, who had a history of attempting to take her own life, suffocated herself with a plastic bag in July 2003.

Staff only found her body when she did not get up in the morning, by which time rigor mortis had set in.

But the day after the inquest last month - when the jury found her death might have been prevented - staff at the Enfield unit discovered 58-yearold Beverley Purcell had also committed suicide while in their care.

Police are investigating the death but it is not thought Ms Purcell, of Palmers Green, was under an observation regime when she was found hanged.

Mrs Baynes said: "We had been assured by the trust it had put in measures to prevent in-patient suicides."

Clinical negligence solicitor David Kerry, for Miss Baynes's family, said: "For at least a portion of the night nobody checked she was breathing. It appears nurses simply popped their heads around the door."

The inquest jury stated: "Established procedures do not appear to have been adhered to. Had procedures been implemented in a timely manner the outcome may have been different."

The trust, given the lowest possible rating for its suicide rate by the Health Commission, fired the nurse in charge on the night of Miss Baynes's death and has tightened up its supervision practices.

A spokeswoman said: "The trust has met with Mrs Baynes's family to discuss their concerns.

"However, we will meet them to resolve any further complaints."

thisislondon.co.uk 15 May

Landlord loses compensation claim

A landlord has lost his fight for compensation after claiming he suffered a heart attack from the stress of working at a Greater Manchester pub.

Edward Harding's claim was thrown out by the Court of Appeal on Wednesday.

He took control at The Antelope pub in Salford, Little Hulton, in 1997 but 18 months later suffered a heart attack which ended his career.

Mr Harding, who now lives in Chorley, Lancashire, had his claim upheld by a County Court judge last year.

However, Appeal Court judges in London have overturned that ruling.

It means the former pub manager, 59, will not receive any compensation and is facing large legal costs.

Mr Harding, of Freemans Lane, Charnock Richard, had claimed that the stress of working 70 hours a week behind the bar in an area of high crime meant he was entitled to compensation from his employers, The Pub Estate Company.

Lord Justice Baker accepted the pub "was in a very rough area and there were problems with different kinds of criminal activity".

However, it was ruled that the employer could not be held legally responsible for the landlord's heart attack.

bbc.co.uk 11 May

Remand prisoner 'hanged himself'

An inquest jury has returned a verdict of suicide in the death of a remand prisoner found hanging in his cell at Gloucester Prison.

Thomas Burns, 24, from Belmont, in Hereford, was facing rape charges at the time of his death in February 2004.

The jury at Shire Hall, in Gloucester, heard he hanged himself from window bars in his cell using torn bed sheets.

A note was also found in the cell. Mr Burns had previously been monitored after a self-harming incident.

The jury were told it was thought that his state of mind had appeared to improve.

William Perks, the prison officer who found Mr Burns, described how during a routine check at 0600 GMT he found him with the sheets wrapped around his neck.

Gloucestershire Coroner Alan Crickmore told the jury they were not entitled to consider neglect by the prison as a cause of his death.

bbc.co.uk 12 May

HIV-case man to be detained in clinic

A MAN who passed on the HIV virus to his girlfriend was yesterday ordered to be detained in a psychiatric hospital.

Christopher Walker, 34, had been charged with repeatedly having sex with the woman and not caring about the consequences, but he was found to be insane and unfit to stand trial.

At a previous hearing at the High Court in Paisley to establish the facts of the case, the judge, Lord Philip, said he was satisfied the woman had been infected by Walker, a haemo-philiac, who repeatedly had sex with her at his former home in Bellshill, Lanarkshire, between May 1999 and December 2002.

The charge of culpable and reckless conduct stated that Walker knew or believed he was infected with the human immunodeficiency virus (HIV) and that it could be transmitted during sexual contact. However, with total disregard for the consequences, he had culpably and