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Stark inequalities for people with mental disorders, WHO

The World Health Organization (WHO) is giving countries an important new legal tool to help address the often unacceptable conditions in which people with mental disabilities live.

There are more than 450 million people with mental, neurological or behavioural problems throughout the world. In many countries, they are among the most vulnerable and the least legally protected. Nearly a quarter of all countries have no mental health legislation, while many more have legislation that poorly protects the human rights of people with mental disorders, or does not reflect currently accepted mental health practices.

For example, in some communities, people with mental disorders are tied or chained to trees or logs. Others are incarcerated in prisons without having been accused of a crime. In many psychiatric institutions and hospitals, patients face gross violations of their rights. People are restrained with metal shackles, confined in caged beds, deprived of clothing, decent bedding, clean water or proper toilet facilities and are subject to abuse.

In addition, people with mental disorders often face social isolation and severe stigmatization which results in additional human rights violations, including discrimination in education, employment and housing. Some countries even prohibit people from voting, marrying or having children.

WHO is providing support to an increasing number of countries implementing progressive mental health laws that respect, protect and fulfil the rights of people with mental disorders, with the aim of improving their lives and well-being.

As part of this ongoing effort, today WHO announces the publication of a landmark book which will guide countries and support stakeholders in creating mental health legislation. The WHO Resource Book on Mental Health, Human Rights and Legislation includes input from consultations with hundreds of experts and stakeholders throughout the world, leaders in psychiatry, psychology, law, and human rights, as well as representatives from mental health service users, family groups and NGOs.

"We have a moral and legal obligation to modernize mental health legislation. WHO is ready to help its Member States fulfil this obligation with technical support and expert advice." said Dr. LEE Jong-wook, Director-General of the World Health Organization.

The book examines international human rights standards and shows how they apply to people with mental disorders, addresses the 'why' and the 'how-to' of drafting, adopting and implementation, as well as linking legislation with mental health policy. The book also includes a 'step-by-step' checklist for reviewing existing legislation and developing new laws.

The Resource Book illustrates how a human rights approach to mental health law improves the quality of psychiatric care and improves access. In Chile, for example, recent measures to protect and promote the rights of people with mental illness have resulted in investigation of abuses, changed therapeutic practices, and improved access to treatment and rehabilitation.

WHO has also established an international network of experts in mental health, law, and human rights trained in the WHO framework for mental health legislation. Currently, WHO and network members are offering technical advice and assistance to several countries throughout the world. The network stands ready to assist any country that wishes to modernize its mental health laws.

Dr Soumitra Pathare, a psychiatrist from Pune, India is a contributor to the Resource Book. He notes that "legislation can be an invaluable resource in promoting the human rights of people with mental disorders throughout the world. Respect for rights and provision of quality mental health services go hand in hand -- you cannot have one without the other. The WHO approach is flexible enough to be of use in countries with vastly different historical, social and economic contexts."

The information contained in this Resource Book, together with the technical expertise provided by the WHO and its network of experts are important steps in moving towards universal human rights protection and access to care for people with mental disorders.

Mental health issues will be the focus for WHO on Human Rights Day on 10 December 2005.

To access The WHO Resource Book on Mental Health, Human Rights and Legislation, please see: who.int/mental_health/policy/en.

medicalnewstoday 24 June

Mental health providers to set up their own "trade body"

Voluntary sector mental health providers are to set up their own “trade body” to push for a wider role in the delivery of services, Community Care has learned,

The Mental Health Providers Forum is expected to launch in the autumn with a primary brief to remove barriers preventing NHS services being commissioned from the voluntary sector.

Set up as an informal group of 13 large providers including Mind, Rethink and Turning Point two years ago, the group now wants to open itself up to a wider membership and it will begin to recruit staff and take on limited company status over the summer.

One of its chief tasks will be to tackle the perception that the voluntary sector can only provide social and not health care.

“Its main focus is to improve the interface with NHS purchasers and raise the issue of whether provision always needs to be provided from within the NHS. The goal of the group is clearly to expand the role of the voluntary sector in providing health services,” said Mind chief executive Richard Brook.

He argued that apart from compulsory treatment, the vast majority of mental health services could be opened up to the voluntary sector.

Brook said the forum had already completed work on developing the clinical governance and quality frameworks voluntary sector agencies would need to deliver health services.

Rethink chief executive Cliff Prior said he would not want the forum to simply help the sector bid for existing services but tackle how it might play a part within a changing service model, involving more non-hospital crisis settings and early intervention work.

He said Rethink wanted: “a reconfiguring of services so voluntary sector providers can bring in what they are good at”.

communitycare.co.uk 23 June

Dad killer sent to mental hospital

A SCHIZOPHRENIC has been locked away in a mental hospital for killing his father outside their Norbury home.

Sharan Katiyal, 41, chased Attamparkash Katiyal around the family Mercedes in Pollards Hill South before grabbing him around the throat.

He then punched the helpless pensioner twice in the head and hit him in the neck as he lay on the ground.

The 69-year-old died after suffering a fatal heart attack because of the stress of the argument on August 15 last year.

When he appeared at the Old Bailey on Monday, Katiyal was sent to a secure hospital for an unlimited amount of time under sections 37 and 41 of the Mental Health Act.

The court heard Katiyal, of Pollards Hill South, had suffered "aggressive outbursts" since he was a teenager.

He had often argued with his father at the family home.

While awaiting trial he put a fellow patient at his mental hospital in a headlock and later claimed he had intended to kill him.

On another occasion he punched a care worker.

The court decided last month that Katiyal, who has the mental age of a child, had been physically well enough to attend the Old Bailey after recently suffering a heart attack himself.

The judge decided, because of Katiyal's physical state, he was not fit to enter a plea or stand trial, but under the Criminal Justice Act the jury was still required to make a finding on the manslaughter charge.

They took just eight minutes to decide he had carried out the killing.

icsouthlondon.co.uk 22 June

New moves to spot mental illness

Health officials have launched a trail blazing drive aimed at spotting early signs of mental illness.
The Mental Health First Aid scheme is aimed at health service staff, job centres, colleges, voluntary groups, and the police and ambulance services.

The push, developed in Australia, was tested in Scotland last year.

NHS Health Scotland chief executive Graham Robertson said he believed it was a course that would be accessible to all.

He added: "It will assist with a better understanding of mental health problems and what people can do to support others.

"A key message that the trainees take from the training is that with the right understanding, empathy and support, people with mental health problems can and do get better."

Patient Linda Goslan said she had suffered from severe depression for about nine years and was unable to work for extended periods of time.

She explained: "My current employer is understanding and supports me by tailoring my working hours.

"It wasn't until a friend shared her knowledge from her training as a mental health first aid instructor that I realised that it would take more than doctors' appointments and medication to help make me better."

Ms Goslan added: "In fact, I had convinced myself that I would be living with depression for the rest of my life.

"My friend showed me otherwise. I know now that I can help myself with the right support to take more positive steps to recover."

Spokeswoman for the Australian National University, Betty Kitchener, said that Scotland was leading the way with mental health first aid in Europe.

She added: "I see this as the catalyst for mental health first aid spreading across the UK and Europe."

As many as 70 people have qualified as instructors this year and 300 will be trained over the next three years.

Deputy Health Minister Rhona Brankin said: "Good mental health underpins all health, and early support is vital for anyone experiencing mental health problems that affect their day-to-day lives.

"That is why this training is so important. It gives people the knowledge, skills and confidence to support their friends, family, work colleagues and others who may be experiencing mental health problems."

She went on: "The benefits of mental health first aid are priceless. There is no doubt about it, mental health first aid helps both improve and save lives."

bbc.co.uk 20 June

Review endorses daughter's care

Health and social care services have said there was nothing wrong with care given to a woman whose father died in a suicide pact in Tenerife last November.
Bill Ainscow, of Prenton, Merseyside, died in 2004 when he and his wife took painkillers and walked into the sea.

Wendy Ainscow said her daughter, Lisa, has Asperger's Syndrome and went on spending sprees at their expense.

Cheshire and Wirral Partnership NHS Trust said the family did not take up the support that was offered to them.

The couple had recently moved to Birmingham.

Mr Ainscow died in the pact but his wife survived. In April, she tried again to commit suicide but was rescued.

Lisa Ainscow, who lives in Birmingham, denies having Asperger's Syndrome or being mentally ill.

An internal review, carried out jointly by the trust and Wirral Social Services, looked at claims made by Mrs Ainscow relating to the care of her daughter.

She claimed health and social care services had not done enough to look after her daughter, leaving her and her late husband with the burden of responsibility and care for her.

Their report concluded many of the allegations made were not true, and Lisa Ainscow had no diagnosed mental illness.

Avril Haydock, Director of Nursing, Therapies and Patient Partnership at Cheshire and Wirral Partnership NHS Trust, said: "We are confident that services made every attempt to respond to the needs of Lisa and her family and to engage them in support."

bbc.co.uk 24 June

Concern over prison suicide spate

A spate of prison suicides is linked to a rising number of inmates, the chief inspector of prisons has said.
Ann Owers said the movement of inmates between prisons due to overcrowding was a cause of "increased anxiety".

Twelve prisoners have taken their own lives in as many days in England and Wales, the latest at Pentonville jail in north London on Wednesday.

The Home Office said prison deaths were "a tragedy" but clusters of suicides were unfortunately not unusual.

There were 95 prison suicides in England and Wales in the whole of 2004 - equalling the highest number, which occurred in 2002.

Ms Owers told BBC News there were so many new prisoners arriving at jails it was hard for staff to assess those who might be at risk from suicide or self harm.

She said the prison population was rising because more people were being sent to prison and being given longer sentences.

Many inmates were mentally ill, or had substance abuse problems, which Ms Owers said created a "volatile mixture" that could lead to suicide or self harm.

A Home Office spokeswoman said the level of self-inflicted deaths in April and May 2005 had been at its lowest since 1992.

She said tackling suicide and self-harm was a key priority for ministers and the Prison Service.

The spokeswoman added the Home Office did not know what had caused the recent spate of deaths but would try to find out and learn any lessons it could.

Ms Owers raised the topic at a briefing about her recent US visit, which looked at prison inspections.

She said there was a "groundswell" of support in America for an independent inspection system of prisons.

It follows allegations of ill-treatment by American guards at Abu Ghraib prison in Iraq, and Guantanamo Bay, Cuba.

In September, Ms Owers will take a British prison inspection team to Canada to inspect two women's jails criticised by a commission on human rights.

She said it was "ironic" other countries were turning towards the specialised expertise offered by British inspectors at a time when plans were afoot to merge criminal justice inspectorates into one agency.

bbc.co.uk 15 June

Mental health care 'not holistic'

People with severe mental illness are still receiving worryingly sub-standard levels of physical care, a report says.
Experts believe poor physical care contributes towards a three times higher rate of premature death among those with severe mental problems.

This group is at greater risk of physical illness, often due to their mental illness and lifestyle factors.

Among those contributing to the report are mental health charities Rethink and Sane, and the Royal College of Nursing.

The report calls for a holistic approach to treating mental health, with physical and lifestyle factors playing an important role.

Figures show that people with severe mental illness have up to five times the risk of the general population of diabetes, and twice the risk of cardiovascular disease and respiratory diseases.

Government guidance recommends that people being treated for severe mental health problems should undergo assessments of their physical health.

But the latest study found 89% claimed not to have had a record of their health history taken, and seven out of 10 said they had not been offered lifestyle management advice.

Paul Corry of the charity Rethink said: "The report reveals that those affected by serious mental illness are being neglected and offered an unacceptable level of care, despite being more at risk of some of the most common physical illnesses than the general population."

Marjorie Wallace, chief executive of Sane, said adopting a holistic approach would help to improve the overall health and daily lives of many people.

The National institute for Mental Health in England said work was under way to spread good practice across Britain.

"We look forward to working closely with those involved in developing this report to address this serious issue."

Severe mental illnesses is usually defined as schizophrenia and bipolar disorder (manic depression).

Sue Carroll has benefited from the holistic approach on offer at the Brixton Wellbeing Support Programme in south London.

Sue has struggled with a range of severe mental illness since a breakdown in 1982 forced her to give up her work as a nurse.

She underwent drug and ECT therapy and was sectioned four times.

Two years ago, she was referred to the Brixton project and now attends three times a week, regularly joining trips to the local lido and gym.

"It gets me out of the house and helps me to meet new people," she said.

"Before I was quite isolated, and had very low self-esteem.

"The project has had a tremendous impact on my life."

bbc.co.uk 29 June

Hospital criticised after killing

An NHS mental health trust has been strongly criticised in a report for releasing a psychiatric patient 11 days before he stabbed a man to death.
An independent inquiry said Richard King's attack on John West in August 2004 could not have been predicted but could have been prevented.

Mr King, 36, was released four days after admitting himself to Hellesdon Mental Hospital in Norwich last July.

Norfolk and Waveney Mental Health Partnership has admitted errors.

Mr King, from Wells-next-the-Sea, stabbed his wife's stepfather, John West, 11 times with a kitchen knife.

The Independent Panel of Inquiry concluded Mr King, who had a violent history of paranoid schizophrenia, would not have been in a position to kill 61-year-old Mr West if he had been correctly admitted under the Mental Health Act.

The hospital has apologised to the family and admitted mistakes were made.

Pat Holman, of Norfolk and Waveney Mental Health Partnership, said: "The report focuses on the importance of really detailed risk assessment and up-to-date reporting on patients with all the family kept informed."

Mr King is now being indefinitely detained under the Mental Health Act but his controversial case is going further.

North Norfolk MP Norman Lamb is going to bring the report's finding before Parliament because someone died and his killer was failed by the health service.

He said: "We have to ensure the trust learns its lessons and those involved are brought to account.

"The patient was as much a victim in this case. He had a serious illness and the system to ensure his care and the protection of the public proved inadequate. They ignored warnings and that was tragic.

"We've all got to understand it costs money to protect the public and give proper care to patients like Richard King."

Mr King's father, who had expressed his misgivings before his son was released back into the community, said he feels let down by health experts.

Ivor King said: "I feel very bitter but now he's getting the psychiatric help the mental health trust failed to give him before.

"The report pointed out the inadequacies but that does not help our family."

Panel Report from the Inquiry into the care and treatment of Richard King - June 2005

Bunting v W 21 June 2005

This is an edited version of a judgment arising out of a hearing of an application ("The Application") dated 4th February 2005 issued by Christine Doris Bunting the current Receiver appointed under the Mental Health Act 1983 ("MHA 1983") in respect of a patient to whom I shall refer in this judgment as ("M"). The application was heard in private. This version may be disclosed and published, because it raises points, which may be of interest beyond the particular parties. The full version is subject to embargo.
By the Application the Receiver seeks an order against the Respondent, to whom I shall refer as ("Mr W") that the accounts he delivered in his capacity as Receiver of M for the year ending 21st April 1994 and thereafter annually until year ending 21st April 2002 be re-opened or set aside.

The application further seeks an order that Mr W deliver fresh accounts verified by affidavit, identifying (amongst other matters) the funds or assets of M used directly or indirectly for the personal benefit of Mr W or his family; that the Receiver be given permission to raise objections and further inquiries as to whether or not Mr W is to be entitled to charge remuneration for the services of himself and his wife in caring for or attending on M and an order that he should pay into the Court of Protection such sums as may be found due on taking the accounts and inquiries.

Full Transcript

Killing of mentally ill man was lawful

A mentally ill man shot dead by police near Heathrow airport after he aimed a replica gun at officers was lawfully killed, an inquest jury found yesterday.
But the jury strongly criticised "systematic shortfalls" in Keith Larkins' healthcare, which they said "may have contributed to his behaviour".

The former security guard, who had suffered a nervous breakdown, was involved in a car chase around the airport perimeter on June 6 2003. He threatened unarmed officers with a blank-firing copy of a police-issue 8mm Glock handgun.

Armed police who were called in asked Mr Larkin several times to put down the weapon, but he continued to brandish it and attempted to steal a police vehicle. Officers and other witnesses testified that they heard Mr Larkins fire it, though the dead man's family dispute this, and ballistics tests were inconclusive.
Mr Larkins, 33, of Feltham, south-west London, died after being shot in the chest and stomach.

Commander Phil Gormley, the Metropolitan police's head of aviation security, said: "We know now that the weapon possessed by Mr Larkins was an 8mm blank-firing weapon that was an exact replica of a police Glock handgun.

"This placed the officers in the virtually impossible position of having to make an instant judgment on whether the gun was real or not.

"This incident, and its tragic outcome, only serves to highlight the dangers realistic replica firearms present, and we fully support the measures currently before parliament to ban their manufacture and sale in order to make London safer and minimise the risk of incidents such as this occurring.

"Few of us can imagine what it must be like to lose someone we love in these circumstances and on behalf of the Metropolitan police service I would like to extend my sympathy to the family of Keith Larkins.

"This has also been a stressful time for officers involved in this incident, and for their families. This verdict confirms that they acted properly, both within the law and as they have been trained to do."

The 11-strong jury, which returned a majority verdict of nine to two, said Mr Larkins' mental illness may have been misdiagnosed, resulting in lack of correct treatment.

Earlier, the dead man's mother, Maureen Larkins, told the coroner's court that her son had been receiving care in the community but she had noticed a deterioration in his mental condition in the run-up to his death, and had repeatedly urged his social worker and local mental health team to help.

Mrs Larkins told a psychiatrist who turned up at Mr Larkins' home the day he went missing: "You're too late."

The inquest had been told that Mr Larkins was displaying signs of psychosis at the time of his death.

Jurors heard that he believed he could communicate with God and that he was also obsessed with Milly Dowler, the 13-year-old girl who was murdered in Surrey in 2002.

guardian.co.uk 28 June

IPCC Concludes West Midlands Mental Health Case

The Independent Police Complaints Commission (IPCC) has called for closer inter-agency working to ensure people with mental health problems in police custody receive appropriate care. It follows an IPCC investigation into complaints made by a woman against the West Midlands Police.

The IPCC launched its investigation following a complaint from a woman concerning her treatment and welfare from her initial contact with police officers until her arrival at hospital.

The incident, in August 2004, arose when West Midlands Police responded to a call from a relative of the woman. Officers attended the scene and arrested the woman in her home in relation to a public order offence. She was taken to Queens Road Police Station in Birmingham.

During her time in police custody the woman attempted to commit suicide on a number of occasions, ending up naked for a period as clothes that could act as ligatures were removed, and was held in police custody for around eight hours in total before being transferred to the Mental Health Unit at the Queen Elizabeth Hospital, Birmingham under section 2 of the Mental Health Act.

The IPCC’s investigation, led by Senior Investigator Tom Henry, found that:

Despite all custody staff acting in good faith, the woman’s treatment could, according to legal advice given to the IPCC, amount to a breach of Article 3 of the Human Rights Act 1998 (that ‘no one shall be subjected to [torture or to inhuman or] degrading treatment or punishment.’)

No criminal offences were committed by any police officers or staff involved.

There were shortcomings in police actions by some officers but these fell short of breaches of the Police Code of Conduct requiring disciplinary action.

Existing partnership work between the local police, NHS mental health and primary care trusts and social services should be built upon to address issues of concern that the case raises.

John Crawley, IPCC Commissioner for the West Midlands said:

“This case illustrates the inappropriateness of a police station as a safe or satisfactory environment for vulnerable people experiencing acute mental illness.

“It was an extremely difficult and challenging situation that the officers and staff found themselves in. Our investigation has found no evidence that any individual acted without good faith. For that reason, although we have identified shortcomings in relation to the Police Code of Conduct, I have decided that it is appropriate that those involved should receive advice from their local commander rather than formal disciplinary sanctions.”

Mr Crawley went on to say:

“I have already begun discussions with senior officials from the police, local NHS Trusts and social services to see how we can minimise the risk of a similar situation occurring in the future.”

Mr Crawley has also formally invited the Chief Constable and West Midlands Police Authority to review the implications of the legal advice provided to the IPCC that the circumstances arising in this case could amount to a breach of a person’s human rights and to set out the specific actions to be taken to avoid any repetition in similar circumstances in the future.

ipcc.gov.uk 9 June

People with learning difficulties moved from long-stay hospitals to private institutions

People with learning difficulties are being moved out of long-stay NHS hospitals into private institutions in the face of government guidance calling for people to receive community care.

Private provider Care Principles admitted this week it was planning 70 new beds and said some patients had come from long-stay hospitals.

Another provider, Castlebeck, confirmed it was “expanding existing provision” but refused to comment further.

A source close to the Department of Health also revealed a case where a local authority was “attempting” to refer an individual to a private institution following the closure of an NHS long-stay hospital.

The news comes despite government guidance calling for commissioners to place people “as far as possible in community rather than institutional settings”.

This followed comments from former community care minister Stephen Ladyman criticising councils for “reinventing the long-stay hospital by the backdoor” by placing people in private sector hospitals.

But Yvonne Cox, chief executive of Oxfordshire Learning Disability NHS Trust, said it would be “hard to find a primary care trust which had read [the guidance]”.

While she said commissioners were “beginning” to be aware of the issue, there was a lack of community provision.

Rob Grieg, director of the Valuing People support team, said he was concerned that the developments were occurring despite “categoric assurance” he had received from strategic health authorities that no people were being moved into private institutions when long-stay hospitals closed.

But Dr Simon Halstead, medical director of Care Principles, defended the use of private institutions, arguing that the Valuing People programme “skirted around” the needs of people who were “too dangerous” to be placed in the community.

He said: “Valuing People is full of constructive ideas for the vast majority, but there is a small group whose needs fall outside that frame of reference. We are taking up a client group that would previously have found a home in a long-stay hospital.”

But Greig added: “I do not accept that a significant number of people cannot be supported in the community.”

Dual diagnosis - Mental health and substance abuse: Networking Tool

Produced in partnership with Turning Point, the UK's leading social care organisation, this toolkit provides background information to the issues surrounding dual diagnosis and offers a practical guide to delivering services. It includes information about substance misuse, mental health and policy background and features current treatment modules along with case studies and exercises for individuals or group work.

Click Here

Independent investigation of adverse events in mental health services

This guidance replaces paragraphs 33-36 of HSG (94) 27 concerning the conduct of independent inquiries into mental health services.

Download Independent investigation of adverse events in mental health services (PDF, 123K)

Download HSG (94)27: Guidance on the discharge of mentally disordered people and their continuing care in the community (3.3Mb)

Inquiry held in razor killer case

Health chiefs have ordered an independent inquiry into the care of a schizophrenic who killed two friends.
Sean Crone, 26, of the Redhouse estate in Sunderland, stabbed Ian Lawson, 25, 24 times and slashed the throat of Simon Richardson, 27, in October 2003.

In January this year he was ordered to be detained indefinitely after admitting manslaughter.

He was being cared for by South of Tyne and Wearside Mental Health Trust before the deaths and a probe will take place.

Days before the deaths, Crone was referred for help to the authority and was awaiting an appointment for assessment.

But in the meantime, Sheffield Crown Court heard how he killed his friend Mr Lawson in a frenzied attack, knifing him through the eye and brain.

He then went to see his best friend, Mr Richardson and slashed him to death with a razor.

The court heard Crone, who admitted manslaughter on the grounds of diminished responsibility, had symptoms of mental illness dating back to his teens when he took a cocktail of drugs.

He was diagnosed as a paranoid schizophrenic after being sent to Rampton Special Hospital in Nottinghamshire following his arrest.

The inquiry has been ordered by Northumberland, Tyne and Wear Strategic Health Authority which monitors all local health trusts.

Under the law, crimes of murder or manslaughter committed by people who have been involved with mental health services must be investigated.

The findings of the independent inquiry will be made public.

bbc.co.uk 15 June

The Royal College of Psychiatrists: Response to the Bournewood Consultation

1.0 Introduction
1.1 The Royal College of Psychiatrists is the leading medical authority on mental health in the United Kingdom and the Republic of Ireland and is the professional and educational organisation for doctors specialising in psychiatry. The College welcomes the opportunity to comment on the Bournewoood Consultation issued by the Department of Health on 23rd March 2005. This response has been prepared in consultation with the College Faculties, particularly the two Faculties of Old Age Psychiatry and the Psychiatry of Learning Disabilities. The facts in this case are well known and therefore we have summarised below only the most significant points.

2.0 Background
2.1 On 5th October 2004 the European Court of Human Rights (ECtHR) ruled that in the case of H.L. v. the United Kingdom, H.L. had been deprived of his liberty contrary to Article 5(1) of the European Convention on Human Rights (ECHR) because his admission was not "in accordance with a procedure prescribed by law" and was contrary to article 5(4) of the ECHR because he was unable "to take proceedings by which the lawfulness of his detention shall be decided speedily by a court".

2.2 H.L. was admitted to a hospital run by Bournewood NHS Trust following an episode of disturbed behaviour at the day centre he attended, the staff at the Centre had contacted the hospital having been unable to contact his carers, Mr and Mrs E. He was known to have severe learning disabilities and autism and had no spoken language. Although not formally stated, it was presumed that he lacked the capacity to consent to hospital admission and he had been admitted informally on the grounds of necessity, under common law, having not dissented to such a course of action. Following admission his paid carers wished for him to return home but this was refused by the Responsible Medical Officer (RMO). The RMO also advised at that time that it was best that visits by the carers were limited.

2.3 His carers challenged the fact that Mr H.L. was being kept in hospital and hearings subsequently took place in the High Court, Court of Appeal, and the House of Lords. The High Court ruled in favour of the Trust. However, the Court of Appeal subsequently ruled that H.L.'s detention was unlawful and he was therefore placed on Section 3 of the Mental Health Act (MHA) 1983, as it was considered necessary that he remain in hospital. He was subsequently discharged following an independent psychiatric report that did not support the case for continuing detention under the MHA. A subsequent ruling by the House of Lords argued that the use of the MHA had not been necessary, providing that he was assenting. The grounds for this decision were that Section 131 of the MHA states that nothing should impede the possibility of a voluntary admission. The House of Lords however recognised that the lack of appropriate statute left a 'gap' in English and Welsh law.

2.4 Clinically, as well as in law, this case highlighted two particular issues of concern relating to the person with potential incapacity. First, how to ensure that there is due process when freedom is restricted, for whatever reason, for those lacking decision-making capacity given the likelihood that they themselves will not be able to challenge the decision. Secondly, how to ensure that there is a ready means of appeal if there is disagreement as to the best course of action. From the perspective of health care services, after the ruling of the Court of Appeal, a particular concern was that, if all those people with incapacity presently admitted to hospital informally (e.g., those with advanced dementia being admitted to hospital for observation or respite) had to be detained under the MHA, this would be both stigmatising and overly bureaucratic and potentially hinder access to treatment, when such treatment might in everyone's view be clearly necessary.

2.5 The Government issued interim guidance following the European Court ruling and since that judgement the Mental Capacity Act (MCA) has also received Royal assent. When that Act comes into force it will provide the framework for substitute decision-making with respect to those lacking capacity to make specific decisions. Two important principles of particular relevance that would then apply include; acting in that person's 'best interests' and the use of 'the least restrictive option'. The intention of the MCA is to enable people who may lack decision-making capacity to make those decisions which they are able to make and to ensure that the process to be followed when the person concerned lacks capacity, involves the person him/herself and other relevant people, and is the least restrictive option. It sets the standards by which those acting on behalf of the person lacking capacity should expect to be judged.

3.0 General comments

3.1 Although the judgement of the ECtHR is limited to the examination of specific issues - whether Mr H.L.'s admission and continuing stay in hospital amounted to detention and whether that detention was lawful – the College is of the opinion that this case encompasses wider issues. For people who lack capacity, actions by others resulting in restriction or deprivation of liberty, are not limited to just admission to hospital for psychiatric assessment but may also occur in other health settings (e.g., general hospitals) and also in private and voluntary nursing homes or social care settings. In addition, admission to hospital (whether general or psychiatric) is usually part of an assessment process and frequently includes the instigation of treatment, as was the case with Mr H.L. In the view of the College any solution has therefore to be able to address these broad issues that go beyond just the question of detention in hospital for treatment of a mental disorder.

3.2 In arriving at a solution the College is of an opinion that a careful balance has to be struck. This is illustrated by considering such a balance in the context of the ECHR. There are those articles concerned with the right to liberty, freedom and personal autonomy of a person, on the one hand, and the right to life and therefore access to health care, as and when appropriate, on the other. We do not see these as opposing rights but rather that good health (and access to treatment for mental or physical illnesses) is part of ensuring these other freedoms. Disproportionately burdensome regulation might impair day to day care and hinder access to treatment. With respect to people lacking decision-making capacity the problem is that there is not the safeguard provided by the process of consent and therefore additional measures are clearly required.

3.3 The judgement of the ECtHR made a distinction between restriction of liberty and deprivation of liberty. We consider this to be an important distinction. The former may include preventing a person leaving a building as it is in his/her best interests not to leave unaccompanied because he/she lacks the ability to cross roads safely or find his/her way around (essentially good and sensible care). The latter is more draconian and may include severe restrictions on freedom of movement and the denial of access to visits from or to family or other carers (as was the case with H.L.). We propose that additional safeguards are essential if a person is being deprived of his/her liberty, as opposed to having their liberty restricted.

3.4 The MCA, when it comes into force will provide the framework for making decisions on behalf of people who lack capacity. Importantly this Act sets out the standards by which health and social care practitioners and family carers should be judged when making decisions on behalf of a person lacking capacity (under the heading of 'Acts done for a person lacking capacity'). Under 'best interests' there is a responsibility to involve the person as far as is possible in the decision, including taking into account their previous wishes if known or advance statements/directives, together with the involvement of others, such as family, and to use the least restrictive option.

3.5 The present MHA and proposed future mental health legislation are not based on the same ethical principles. The College is of the opinion that it is the fact that there are differences in the principles underpinning these two statutes, which are in essence both about substitute decision-making, that makes the resolution of this issue problematic. In its evidence to the Scrutiny Committee considering the Mental Health Bill the College advised that similar principles should apply to both pieces of legislation.

4.0 Responses to specific questions

4.1 Question 1 (para 3.8 in the consultation paper): we are not able to place an accurate figure on the numbers of people with 'unsound mind' who lack capacity and who are deprived of their liberty each year. However, the numbers of those who are potentially liable to deprivation of liberty is undoubtedly very considerable as it includes those with long term mental disability (such as those with severe learning disabilities or dementia) who potentially have enduring incapacity (re: para 3.3 and 3.4 in consultation document). Almost universally there will be various levels of restriction placed on their lives, such as not going out unless with a carer. Front doors may be locked from the inside or the design of handles makes it difficult for confused people to open the front door. Whether, and to what extent, this restriction of liberty results in deprivation of liberty for some is uncertain. Whilst the above are likely to be the most significant groups numerically it may also include those persons with incapacity seen in Accident and Emergency or admitted to general hospital, for example, following head injury.

4.2 Question 2 (assumption in 4.1 and 4.2 of the consultation paper): we agree that these sections set out the key issues. With respect to paragraph 4.2 of the consultation document we agree a) that the Bournewood judgement only applies to those who at the material time lack decision-making capacity; b) as described above there is potential for the restriction or deprivation of liberty to take place in many settings; and c) many people in such situations would not meet criteria for detention under the MHA either because they may not meet criteria for one of the four mental disorders need for Section3 or 37 or a Guardianship Order (e.g., people with learning disabilities are not necessarily mentally impaired under the meaning of the MHA because they rarely demonstrate abnormally aggressive or seriously irresponsible behaviour), or it may not be of a nature or degree etc. to warrant admission to hospital. .

4.3 Question 3 (section 5.5 of the consultation paper): the College agrees that action is required if deprivation of liberty takes place but proposes that this should be within the framework of the MCA. We believe that the requirements of the MCA (to be elaborated in any Code of Practice) would require that the nature of the decision and those making the decision are clear, and if detention for medical treatment is required then other safeguards in the MCA would be necessary (see below). With respect to second opinions it depends on the question being addressed. The opinion may appropriately be medical if detention is about medical treatment, however, advocacy may be more important under other circumstances. Whether in hospital or care homes central to the caring process is the care plan. This must be the focus for decisions about capacity and best interests, and in the context of the MCA, must record the reasons for why a particular restrictive course of action is, in the carer's opinion, in that person's best interests.

4.4 Question 4 (section 5.10 to 5.13 of the consultation paper): the College is concerned that possibly new tribunal systems are being envisaged. We have set out below what we believe is an acceptable and 'tiered' approach to protection. This approach is based on the assumption that many aspects of restriction of liberty of people with incapacity are for sound reasons and clearly in that person's best interests. However, we also recognise that such situations must be open to challenge and when restrictions become more marked or are associated with specific treatments, tighter safeguards are required. We set out in Section 5 below our ideas and reasoning. In essence the key aspects are the legal framework of the MCA and the process of care planning.

4.5 Question 8 (section 6 of the consultation paper): The College does not consider that an extension of the MHA, including the use of Guardianship Orders, is helpful. Whilst the MHA could be amended, at present its scope is too limited to cover all relevant situations and, as is argued above, not everyone would meet the necessary criteria as described above. In addition, this would be an overly rigid approach to what are often variable and complex situations. Rather with a strengthening of the MCA anyone supporting a person would be required to justify their actions and consultation is required and an appeal mechanism will be in place (extended Court of Protection).

5.0 College conclusions and recommendations

5.1 The College agrees that any guidance must address the relationship between any resolution of the Bournewood issue (such as the proposed concept of protective custody) and mental health legislation and the MCA. The general principles that the College has applied in considering our response are that the safeguards should be no less for people with incapacity than they would be for those with capacity under similar circumstances and that there must be absolute clarity as to when the MHA applies. This is both to avoid confusion and to ensure that the risk of double jeopardy (i.e., if the MCA does not apply because he/she has capacity then the MHA will be used) only occurs in those very specific situations where the MHA 1983 applies with respect to hospital admission for assessment or treatment of a mental disorder that is of a nature or degree etc.

5.2 We agree with the proposal in paragraph 4.3 that those people who lack the capacity to consent or not to admission to hospital for treatment for his/her mental disorder and are resisting, should be admitted under the MHA. This would give the protections available under the MHA to this group of patients. It is recognised that there remains a difficulty in ensuring those patients who lack capacity have equal rights to those who retain capacity (Re (MH) v Health Secretary 2004). However, we do not see any distinction with respect to the likely permanent or temporary nature of a person's incapacity. If a person who lacks capacity, for example, because of a severe psychotic illness, comes into hospital apparently voluntarily (even though on assessment he may lack capacity) this would be similar to present arrangements and in the future would be covered by the MCA. The MHA should not be used simply because the person is likely to recover capacity. However, having recovered capacity the options would be for that person to decide for him/herself whether to remain in voluntarily or to leave hospital. If the person wished to leave, whether capable or not, the doctor in charge of the patient's care would need then to consider whether the MHA should be applied.

5.3 Section 5 'Protective care': the College appreciates that the principles of protective care comes into force when deprivation of liberty is being considered. However, we are concerned that this approach is too narrow and we are unclear as to whether this concept adds more than could be achieved by strengthening the MCA. The concept that 'release' from detention could be ordered does not address the problems of restrictive practices in social care settings where people live. Given the varied situations and potential complexities the College remains of the opinion that any solution to the 'Bournewood gap' best sits within the legal framework of the MCA, but with added safeguards. The College would hope that with the strengthening of the MCA, this Act would contain sufficient 'procedures prescribed by law' to satisfy the ECHR.

5.4 The College is of the opinion that any solution that addresses the concerns of the ECtHR needs to be proportionate to the nature and severity of restrictions in the individual case. Whilst the resources in terms of available expertise is an issue, this is more a question of balance between ensuring a sound process that protects individual rights, on the one hand, and ensuring access to hospital and to treatment where appropriate and the maintenance of a safe environment for the person concerned, on the other.

5.5 With respect to restriction of liberty, set out below (5.6 onwards) are circumstances that might lead to different levels of legal protection. In all cases such restrictions would have to be justified on the grounds that they are in that person's best interests and the least restrictive alternative (under the MCA). As part of determining best interests the person's past and, where possible, present wishes should be ascertained and relevant others should be consulted. Those making decisions that result in some limitation on individual liberty should be expected to be able to defend their actions against the standards set out in the MCA and its Code of Practice.

5.6 Level 1: restrictions are placed on a person's movement in his/her place of normal residence on specific occasions where he/she both lacks the capacity to make the relevant decisions for him/herself and it is in his/her best interests on the grounds of his/her health or safety. This might include the person not leaving the house unaccompanied and being led back into the house if he/she wandered. Other freedoms, such as family visits and accompanied trips out, still occurred and were not controlled or limited. As part of the person's care plan these arrangements should be reviewed regularly. If relatives or other relevant parties disagreed there would be an attempt at local resolution and if necessary access to the Court of Protection.

5.7 Level 2: restrictions are placed on a person's movements in his/her normal place of residence that go beyond simple restriction of liberty and amount to deprivation of liberty, in that the person was confined to the house/hospital and visits out or visits by others were controlled and limited by the care staff. Under these circumstances we recommend that an independent mental capacity advocate should be appointed and he/she and others (such as relatives) would have access to the Court of Protection, if disagreements about the care plan and level of restriction could not be resolved.

5.8 Level 3: transfer from normal place of residence to hospital for assessment or treatment and any associated restriction of liberty should be undertaken under the auspices of the MCA, unless it was admission for treatment of a mental disorder and the person was resisting, then the MHA would apply. Under the above circumstances (and other than in emergencies) the safeguards would include the duty to consult under best interests, the right of relatives and/or advocates to have discussions with the clinical team particularly where there is disagreement, the rights of others to ask for a second expert opinion, and, if necessary, the right of appeal to the Court of Protection.

5.9 Level 4: where permanent transfer from the normal place or residence was to occur we recommend that the rights to a mental capacity advocate is not limited to those with no additional support. We recommend that a responsibility is placed on the local authority to satisfy themselves that the likely perspective of the person with incapacity has been fairly represented by carer, family member, or independent advocate. Where there is the potential for a conflict on interest on the part of a paid or family carer the local authority have a duty to appoint an advocate.

5.10 Detention in the context of medical treatment: as described above treatment for a mental disorder under specific situations will be covered by the MCA or MHA (if dissenting). However, the College, in its submission to the Department of Constitutional Affairs during the redrafting of the then Mental Capacity Bill, did recommend that additional safeguards needed to be in place with respect to certain treatment situations. We are still of this opinion and believe that the resolution of the Bournewood gap with respect to the ECtHR ruling on detention should also cover these situations. Such situations might include requirements for second opinions in the case of specific treatments listed in regulation or where treatment is outside recommended clinical guidelines.

Professor Tony Holland, June 2005

Lawyer rigged up rifle for suicide

A GUN-OBSESSED lawyer killed himself with a rifle after his marriage fell apart, an inquest heard.

Troubled gun club member Robert Williams, 48, shot himself with the weapon hidden in a kitchen cupboard after arguing with his wife in front of concerned relatives.

Carolyn Williams told the inquest: "On occasions there was a sinister side to his interest in guns.

"He had threatened to take his own life before and once I had to take a hand-gun from him and unload it.

"But I just regarded it as a horrible domestic obsession. I hoped that was what it was anyway, rather than him actually doing anything."

Mrs Williams, an NHS manager, said her dedicated husband sat law exams to become a solicitor while still working long hours as a paramedic, and even put in for his HGV driver's licence as well.

Their marriage had been in trouble for some time and 'he took the news dreadfully' when she moved out of their Runcorn home, she said.

The inquest heard how Mr Williams had owned powerful Colt and Magnum handguns before they were banned but continued to possess licences for rifles, which he used at two gun clubs.

His brother, Norman, said he had tried to persuade him to give up his hobby after becoming worried about his 'upset and disturbed' state following Mrs Williams's calls for a trial separation.

"I told him I was worried but he told me not to be stupid and begged me on his knees not to make him hand his licences over to the police."

Mr Williams shot himself at the family home in Windmill Hill in February this year. Concerned family members had rushed round fearing he was having a panic attack.

But after calming him down, Mr Williams went into his kitchen and shot himself with a 'military-style assault rifle' rigged up in a storage cupboard.

His sister Joyce Owens heard the bang but thought he had electrocuted himself.

"I didn't even know he had guns in the house," she said. "But then I saw the barrel of the gun hidden. It was only like a piece of pipe sticking out."

Recording a verdict of suicide, Cheshire coroner Mr Nicholas Rheinberg, said: "Robert Glyn Williams was a very hard-working individual, qualified in a number of different occupations, which showed great determination and ability. It is clear the marriage was in trouble but perhaps he didn't believe a separation would ever actually happen and it was a complete shock when his worst fears were realised.

"He was a very intelligent man," Mr Rheinberg added. "There can be no doubt he intended to take his own life."

RuncornWorld 15 June

Coronor blasts care home after patient's suicide

A coroner has criticised a lack of communication in a care home where a mental health patient committed suicide.

Laurence Black, a 57-year-old psychiatric patient, was found dead at Davigdor Lodge halfway house in Hove after taking an overdose of around 150 paracetemol tablets.

His family have blamed failures in mental health services for his death and claim he felt suicidal after he discovered he would lose his place at the home.

Mr Black had a history of depression and schizophrenia but was thought to have been recovering before his death at the home on March 23.

His sister, Corrine Black, of Kemp Town, Brighton, claims he was pushed over the edge when he and other residents were not informed when they would have to leave or what alternative accommodation was on offer.

At the inquest at Brighton Magistrates Court yesterday, Coroner Veronica Hamilton-Deeley said: "It does strike me that if somebody had actually sat down and explained to Laurence that he wouldn't be moved straight away that might have given him more peace of mind.

"But I don't think the staff knew what was going on either.

"It seems to me that a bit of communication might have made life easier for everyone."

Gary Ryan, community psychiatric nurse for the South Downs Health Trust, told the inquest: "In retrospect maybe there could have been more communication with him about what was going to happen."

Privately-run Davigdor Lodge in Tisbury Road provides temporary accommodation for people with psychiatric problems.

It said Mr Black always knew he would have to leave. But his sister says he was under the impression his residency was permanent and he regressed after being told last October that he was to lose his place.

He was admitted to Millview Hospital in Nevill Avenue, Hove, before being moved to Asher Lodge hostel in Wilbury Gardens, Hove, in early 2002.

After eight months he moved to Davigdor Lodge. Robert Rawat, owner of Davigdor Lodge, said residents usually stayed for two years but this was "not written in stone".

Miss Black described her brother as a quiet, shy man who deteriorated after their mother died in 2000. Mr Black stopped eating and attempted suicide.

Recording a suicide verdict, Miss Hamilton-Deeley said: "I am quite sure that Laurence knew when he moved in there that it was temporary accommodation.

"The people involved in his day-to-day care were no doubt very dear to him, and he was to them. It is a complicated business to move people and provide them with independence but it is important to keep them involved with what's happening."

theargus.co.uk 15 June

New mental health units 'at risk from fire,' says report

A LEAKED report has revealed serious flaws in Leeds's three major new mental health units, built with private cash.
The Becklin Centre in Burmantofts, The Mount near Leeds General Infirmary and the Newsam Centre at Seacroft Hospital are all plagued by a number of fire hazards, whilst staff have complained that the buildings' layouts make it difficult to keep tabs on patients.
Leeds City Council is now being asked to back calls for a full public inquiry into the issue amid claims that corners were cut in the construction of the centres, built under the Private Finance Initiative.
The fire safety study commissioned by the Department of Health found that all three Leeds mental health centres failed to meet minimum standards for such units.
A Leeds councillor claims the trust had known of the problems for months and had tried to suppress the information.
The reports were handed to the YEP by a Leeds Mental Health Trust employee who asked not to be named.
He said: "One of the main risks in any mental health unit is of people setting fire to things, so the last thing you would want is to have the environmental fire hazards these buildings have got.
"Surely the safety of the patients and staff has to be paramount at all times."
Fire safety inspector Colin Newman carried out a thorough check of the three sites.
In each case he concluded: "The design of the premises falls short of the standard expected ... for those with mental illness or learning difficulties." He added that "several design issues" had been raised, including the "poor provision for patient observation."
Other concerns included the difficulty of evacuating bed-ridden patients and a lack of adequate fire protection.
The trust has been rocked in recent years by high-profile patient suicides includingBecklin Centre patient Kevin Hackney, 46, from Rodley, in May 2003, and the following month Geoffrey Martin, 56, of Tingley. Coroner David Hinchliff challenged the open-door policy of the centre.
In August last year, Becklin Centre patient Stephen Caird, 53, of Roundhay, threw himself in front of a train.
Now Coun Robert Finnigan (Independent, Morley) has tabled a motion calling for the Department of Health to hold a full public inquiry into failures by the Trust to implement the required fire safety standards. It will be voted on at a full council meeting on June 22.
Coun Finnigan told the YEP: "The reports I've seen suggest a clear link between a PFI build and lower standards, certainly lower safety standards.
"We understand that Leeds Mental Health Trust has been aware of these problems for months, we suspect for years, and we have great concern that there has been an attempt to try to suppress this information from coming out.
"We believe a full public inquiry is necessary."
The Becklin Centre, The Mount and the Newsam Centre opened in 2002 and 2003 as part of a £47m scheme. PFI involves private consortia, usually involving large construction firms, being contracted to design, build, and in some cases manage new projects.
The Accent Group of Shipley, formerly Bradford and Northern Housing Association, which built the centres, said it had not seen the full reports and did not wish to comment at this stage.
Peter McGinnis, director of nursing and clinical governance at Leeds Mental Health Trust, insisted safety of patients was always treated as a priority.

Leeds today 14 June

A mental unit for threat GP

A doctor who carried out an eight-month campaign of threats, intimidation and sexual allegations against a Church of England vicar has been sent to a psychiatric hospital.

GP Desmin O'Callaghan, 47, was sectioned for assessment under the Mental Health Act following his campaign of harassment with his lover Ann Draper, 32, to terrify and discredit a parish vicar.
The clergyman from Northamptonshire, who cannot be named for legal reasons, was left fearing for his life after receiving repeated threats by letter, email and phone as well as having the wheel-nuts of his car loosened.
The pair appeared at Northampton Crown Court on Friday where Draper did not speak to or acknowledge her former lover.
She was also granted permission not to sit in the court dock beside him.
The judge, Recorder Sam Mainds, granted a defence application for the doctor to be sent for a 12-week assessment at a psychiatric hospital in London.
Draper was released on bail until July and will be sentenced with her co-defendant.
The judge refused to sentence Draper separately and adjourned the case until later this summer.
He added: "I formally make the order as required under the Mental Health Act 1983 for an interim hospital order."
Recorder Mainds advised the prosecution to commission its own psychiatric report as O'Callaghan had mis-administered prescription drugs and showed himself "capable of manipulation".
Draper, an undertaker for Hollowell and Sons in Brafield-on-the-Green, admits harassment while O'Callaghan pleaded guilty to putting a person in fear of violence through harassment and conspiracy to pervert the course of justice.
The eight-month campaign of hate began in September 2003 when Draper told O'Callaghan she had had an affair with the married vicar.
The clergyman vehemently denied these claims in court.
The pair had bombarded the priest along with his wife, his neighbours, parishioners, bishop, colleagues and the Chronicle & Echo with letters alleging he was both a paedophile and having affairs with his parishioners.

northamptontoday.co.uk 14 June

Mental health check for pet neglect

A WOMAN who admitted keeping her pets in an animal house of horror was yesterday told to undergo a psychiatric examination.

A judge wants reports about the mental state of Hazel Marian Jones from a consultant psychiatrist.

The 55-year-old was due to be sentenced for keeping a neglected dog and cat locked up in cages at her home in Llys Nercwys, Mold.

An earlier court hearing was told Jones' springer spaniel Ellie had nails so long one curled in through the pad of the paw and had come out of the top, causing swelling and great pain.

The cat, and another one seized out-side, had to be put down.

Yesterday district judge Andrew Shaw adjourned the case until next month, while reports are drawn up.

The judge said as he was concerned about Jones' state and her attitude towards the case.

"I note the condition the animals were kept in and there were animal carcasses found in the house as well," he said.

He said a consultant psychiatrist's report would address any mental health problems, and present him "with a bigger picture" of Jones, who works in a care home for the elderly in Ellesmere Port.

Chris Jessie, defending, said Jones was anxious the case should be dealt with.

She was suffering from clinical depression and was taking medication for it.

The house of horror was discovered when police officers were called to check on the welfare of Mrs Jones, who lives alone.

Neighbours had become concerned mail was piling up and they had not seen her about.

She was at work, but police contacted the RSPCA.

Jones admitted two charges of causing unnecessary suffering to the dog and the cat between December 1 last year and January 22 this year.

John Wylde, prosecuting, said inside the officers discovered ceiling-high rubbish.

icnorthwales.icnetwork.co.uk 14 June

Stalker sent to mental hospital

STALKER Azeem Malik - whose obsession with a fellow Cambridge undergraduate has blighted her student life - is to be detained in a mental hospital for psychiatric assessment.

Malik, jailed time after time for his obsessive pursuit of King's College physics student Natalie Soule, is currently back behind bars after being recalled to jail for breaching a ban on contacting her or coming to Cambridge.

Just days after being freed in February from a two-year prison sentence imposed for harassing her, he returned to the city and was emailing her.

Twenty-four-year-old Malik, now of no fixed address and sent down from Cambridge University where he was studying maths, appeared before the city's crown court this week to be sentenced for the breaches.

A consultant psychiatrist who has seen Malik since he was re-arrested had recommended a 28-day detention order at George Mackenzie House, Fulbourn Hospital, for an in-depth assessment.

Now Malik must await a decision by the prison authorities on his release into psychiatric care, as the Mental Health Act order cannot take effect unless his recall to jail is suspended.

Judge Jonathan Haworth recommended that the serial stalker be transferred to a psychiatric hospital.

But if the prison authorities decide Malik must serve the remainder of his recall first, his case will have to come back to court before an order under the Mental Health Act can be renewed.

The judge is concerned that the court is given a full picture of Malik's mental health, the chances of reoffending and his possible future treatment before he is sentenced again.

In the past, Malik has refused to co-operate with psychiatrists but was ready and willing to do so this time, the court was told.

Bearded Malik was first convicted of hounding Ms Soule in December 2002. She had tried to shrug off his attentions but he continued to bombard her with letters and visits and was to be found constantly loitering near her lodgings.

A restraining order had no effect and he was then jailed for three months. Freed, he continued his relentless contact, and was imprisoned for another six months. He was released in March 2003 - and, subject to a new order banning him from coming to Cambridge, he turned up at Ms Soule's home in Exeter, Devon.

Jailed again, then released in November 2003 provided he lived at a bail hostel in Peterborough, he failed to turn up and was later spotted by King's College staff loitering in King's Parade.

At the end of March last year he was jailed for two years and, when freed in February, was breaching the restraining order within days.

Cambridge Evening News 10 June

Mental patients forced out as hospitals close

Seventy-three mental health patients who attend two day hospitals in Wandsworth are set to lose their places by the end of the month as the trust which runs them plans to close the facilities.

South West London and St George's Mental Health Trust has put forward a proposal which recommends it stops providing day care within Wandsworth. This means closing Cottage Day Hospital on the Springfield Hospital site in Tooting and Parkgate Day Hospital, based at Queen Mary's Hospital, Roehampton.

If the proposals go ahead, 109 places for people with mental health problems will be lost and the 73 patients currently attending the hospitals will have to go elsewhere for treatment by June 17.

The trust is currently reviewing its specialist services in light of its £8.4million deficit. As well as the planned closure of the two day hospitals, it has already closed Yew Ward at Springfield Hospital, which had 13 unoccupied beds.

Despite the massive cuts, a report to the council's health committee from the trust stated: "It is envisaged the impact would be minimal."

However, Wandsworth Council chief executive Gerald Jones countered this argument.

In a report paper to the council's health committee, he stated: "The closure of the two day hospitals, with only limited information so far available about the proposed replacement services, is seen as a significant service change."

He went on to recommend the health committee warns the trust that consultation on the proposed closures will be necessary and that there should be no moves to decommission these hospitals until this has taken place.

Trust chief executive Nigel Fisher said it wanted to change the way day services were provided in line with Government modernisation requirements.

He said it was "envisaged that support currently provided by the day hospitals will be reprovided in community settings by June 17".

A senior figure in Wandsworth's mental health voluntary sector, who did not want to be named, said: "We are concerned that with the closure of two day hospitals the number of places available for therapeutic day care within the borough will be reduced without adequate consultation with the voluntary sector providers, carer groups and user groups."

He added there should have been greater transparency regarding the deficit and if changes must be made to plug the gap they should be planned and developed within a partnership context.

Another worker in the voluntary sector said he had only heard about the possible closures a couple of weeks ago and was amazed.

Wandsworth Borough News 10 June

Insufficient mental health schemes for offenders

There are insufficient schemes to divert offenders with mental health problems out of the criminal justice system and into appropriate health services, according to a report by Nacro

The research by the rehabilitation agency found that many areas in England and Wales had no service provision at all while others relied on one lone worker.

“The government needs to introduce a robust nationwide network of diversion and criminal justice mental health liaison schemes with ring-fenced money for the creation and maintenance of these schemes, and guidance on how to set up and run them,” said Lucy Smith, mental health policy officer for Nacro.

The survey found that:-

• 72 per cent of schemes cited a lack of beds as a barrier to their scheme operating successfully

• 34 per cent were using a police station as their sole “place of safety” for people detained

• A quarter had seen a decrease of staffing levels within the last year

Under-funding and a lack of clear guidance in this area was leading to serious gaps in service provision, the report concluded.

communitycare.co.uk 9 June

Full Report

Man at mental unit hanged himself

A man hanged himself by his tie at a Norwich mental unit after twice escaping from his ward.

Forty-five-year-old Mervyn Oldfield, who was being treated at the Hellesdon Hospital, had twice threatened to commit suicide, an inquest heard yesterday.

Skilled craftsman Mr Oldfield, of Clifton Street, Norwich, was found the day after going missing for the second time, in a shed on the hospital site hanging from the roof.

His suicide came after being told two days before that he needed medication by injection — which he was particularly afraid of — and that he would have to receive treatment at the hospital for up to six months rather than being allowed to go home.

The inquest heard Mr Oldfield went to one of the outbuildings at the hospital, where he had enjoyed taking part in carpentry and activities for 10 years, but which was about to close.

Mr Oldfield, who suffered from paranoid schizophrenia and alcohol problems and who was admitted in July, had escaped on August 10, 2004 but was talked into returning the following day when he escaped again. He was found dead by a police officer on August 12.

Mr Oldfield had written in dirt on a table: "Have a drink on me" and left a note which said "I said you leave me no option, I don't go back on my word – I had the last laugh this time."

A jury inquest at City Hall in Norwich returned a verdict of suicide.

Coroner William Armstrong said: "Nobody can be criticised for what happened, what has been highlighted was that there were areas of good practice, acknowledged care and treatment was implemented which was well informed and carefully considered and regularly reviewed.

"Just because Mr Oldfield died does not mean it was anyone's fault."

The findings come after much debate between the Norfolk Mental Healthcare NHS Trust and campaigners calling for a tightening of procedures. More than a dozen people took their own lives at the hospital between 1999 and 2002.

Earlier this week, Norwich North MP Ian Gibson called for an investigation into procedures at the hospital.

After the inquest, Mr Oldfield's 21-year-old son Liam, who lives in Norwich, said: "I am satisfied with the verdict but I would like to have known more about what went on in Hellesdon Hospital."

Mr Oldfield had made at least three suicide attempts previously.

After the hearing, Nicola Brown, Norfolk Mental Healthcare NHS Trust spokesman said: "People detained under sections two and three of the Mental Health Act (like Mr Oldfield) are not prisoners – the medieval days of locking people up and throwing away the key are, thankfully, gone.

"Mr Oldfield was on a six-times-an-hour observation basis, which means that a member of staff would have noted his presence on an average of every ten minutes."

Norwich Evening News 8 June

Husband jailed for killing wife

Last Updated: Wednesday, 8 June, 2005, 13:27 GMT 14:27 UK

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Husband jailed for killing wife
A Suffolk man who said he could not remember fatally stabbing his 42-year-old wife in the stomach has been jailed for manslaughter.
Gareth Lewis, 43, of Fitzgerald Walk in Bury St Edmunds admitted killing Amanda Lewis due to diminished responsibility.

Ipswich Crown Court heard Lewis had a history of depression and attacked his wife after an argument last October.

Judge John Devaux sentenced Lewis to three years and four months in jail, of which he should serve at least half.

The court heard that Lewis had had trouble finding work and his wife had told him she wanted him to move out of the family home.

Lewis had been preparing a meal in the kitchen when the attack took place.

The mother-of-two was treated in hospital for stab wounds to her stomach, but died later.

In sentencing Lewis on Wednesday Judge Devaux said he was not a danger to the public.

bbc.co.uk 8 June

Judge overturns his own sentence for schizophrenic killer

The family of a former banker who was stabbed to death by a mentally ill man expressed their dismay last night after learning that a judge has halved the tariff imposed at the original trial.

John Barrett, who had a history of violence and paranoid schizophrenia, admitted the manslaughter of Denis Finnegan, 50, as he cycled through Richmond Park in September. Claiming diminished responsibility, Barrett, 42, was sentenced to life imprisonment at the Old Bailey in March and given a tariff of 15 and a half years - the period before which he becomes eligible for parole.

But in a private hearing at his chambers at Lewes Crown Court 17 days after the trial, Judge Anthony Scott-Gall reduced the tariff to seven-and-a-half years. Mr Finnegan's brother John, who attended all the court proceedings, said he was only informed of the reduction in the tariff by a probation officer.

He said last night : "I want the CPS to get in touch with us and explain why the judge changed his mind. I don't think 15 and a half years is too much for the crime he committed."

The judge was using a little known power called the Slip Rule, which allows for a sentence to be altered by the trial judge within 28 days of the original trial. After that time, any alteration must go though the Court of Appeal. Last night the Crown Prosecution Service said it was unlikely to contest the judge's ruling with the Attorney General's office. A spokeswoman said: "We do not regard this reviewed sentence as unduly lenient." The CPS said informing the family was a matter for the police.

However, the Home Office expressed disquiet that the decision had been taken in private, at a four-minute hearing with only the presence of a prosecutor and the defence lawyer.

As he disclosed his decision to lessen the "excessive" tariff, Judge Scott-Gall said that his actions were "academic" but conceded that they would come as a surprise to Barrett.

When handing down his original sentence Judge Scott-Gall described how Barrett had purchased a 12-inch blade the day before. "This was a planned attack on a completely innocent member of the public, a family man who was a complete stranger to you chosen at random."

Barrett is being treated at Broadmoor. Because his condition is so severe, it is expected he will never be released. But at the trial the judge said that society would have to "think long and hard whether it is safe to release [Barrett] back into the community."

The case prompted mental health campaigners to warn that systematic errors in the care-in-the-community scheme were still failing patients and putting the public at risk. Barrett was a voluntary patient, and had been granted "ground leave", allowing him to walk out of Springfield Hospital in Tooting, south London, before killing Mr Finnegan.

At his sentencing, the court heard that on the day before the stabbing, a consultant forensic psychiatrist, who was not named, in consultation with a senior nurse, had taken the decision to grant Barrett leave.

Shortly after the killing, John Reid, the then Secretary of State for Health, ordered a review of proposed changes to the draft Mental Health Bill in the light of the case, which raised questions as to whether doctors should be given powers to detain patients, such as Barrett, who volunteer for treatment for mental illness and then discharge themselves.

Campaigners have accused doctors of conducting inadequate risk assessments of patients and allowing too many to go free, despite obvious warning signs that they constituted a risk both to the public and themselves. The Government has already ordered an independent inquiry into the case.

Th Independent 14 June

Mentally ill man in Jenkins road

A mentally ill man was seen acting strangely yards from Billie-Jo Jenkins' home at the time the 13-year-old was killed, an Old Bailey jury has heard.
Former deputy head teacher Sion Jenkins denies murdering his foster daughter at the family home in Hastings, East Sussex on 15 February, 1997.

Guest house owner and neighbour Brian Kent said on Tuesday a mentally ill man had knocked on his door that afternoon.

The defence claims the mentally ill man was Billie-Jo's killer.

"The conversation was rather confused," the defence witness told the court.

"He was asking all sorts of questions about whether the ferries went from Hastings to France.

"He was then questioning the rating of my guest house.

"It did become evident that he wasn't after accommodation and I wouldn't have considered him anyway.

"He obviously had mental health problems."

Mr Kent said he later identified the man in a police cell, where he was still acting strangely.

A second witness, Samantha Mott, told police she had seen a "very suspicious" man in a nearby park at a similar time.

She told the court: "I saw a chap sitting on a bench. He had a red mark on his forehead and carrier bags by his feet.

"He was unkempt, unshaven and generally dirty.

"It made me feel uncomfortable, because we had a small child with us."

The defence alleges the mentally ill man - known only as "Mr B" - killed Billie-Jo with a tent spike and stuffed a piece of black bin liner up her nose.

Police arrested Mr B two days after the killing and found a black balaclava at his home with a piece of plastic.

Mr B was later found to be psychotic and admitted to a mental hospital.

Mr Jenkins, 47, who now lives in Aberystwyth, mid-Wales, was convicted of murdering Billie-Jo and jailed for life in 1998 but is facing a retrial ordered by the Court of Appeal.

The trial continues.

bbc.co.uk 14 June

Mental health 'must be priority'

Maintaining good mental health should be considered to be as important as keeping physically fit, a report says.
The Institute for Public Policy Research said progress was being made with how it was treated and perceived.

But researchers said the issue needed to be brought more into the mainstream if it was to escape the stereotype of mentally ill people being dangerous.

The Department of Health said mental health was one of its top priorities along with heart disease and cancer.

The IPPR study called for specialists to be placed in GP surgeries, children centres and even libraries as part of its vision for mental health services in 2025.

The think-tank also called for less dependence on expensive medication to tackle common mental health problems and the creation of walk-in centres that deal with all aspects of a healthy life - mental and physical.

Report author Jennifer Rankin said there needed to be a greater emphasis on common mental health problems.

"There has been real progress in government approaches and public attitudes to mental health issues such as depression.

"However, mental health services have not kept pace with demand or improved as much as the rest of the NHS.

"They remain concentrated on a small group of people who are acutely unwell.

"This does not adequately help all those with long-term mental health problems or people with more common experience of depression and anxiety."

Figures suggest one in six people have had a mental health problem and nearly a third of GP consultations relate to mental health problems.

Cliff Prior, chief executive of mental health charity Rethink, said there were promising signs of change, but a "step change" in leadership and commitment was needed.

"For too long, mental health has been neglected and stigmatised, or overlooked by policy makers."

And Andy Bell, of the Sainsbury Centre for Mental Health, said the report was a "direction of travel" for everyone working in the field.

A Department of Health spokeswoman said the government was already focusing on primary care to deal with mental health.

"The report acknowledges significant changes have been made in mental health.

"There is a renewed focus on primary care and that is something we are looking at.

"The Public Health White Paper set out our view of creating a wellbeing service, not just a sickness service. It is something we want to achieve."

bbc.co.uk 14 June

Changes demand after pub shooting

An independent report into events leading up to a pregnant pub landlady being shot dead makes more than 30 recommendations for improving mental health services in west Wales.
William Davies, who was being treated for depression, killed Caroline Evans, 27, in Llangadog, Carmarthenshire.

The farmer, 59, turned a gun on himself after the incident in February 2003.

The report concluded although there was no evidence the tragedy could have been prevented, changes were needed.

It also said Pembrokeshire and Derwen NHS trust failed to properly assess the danger Davies posed to Ms Evans.

The NHS trust, which provides mental health services for Carmarthenshire, said it was already acting on many of the recommendations.

The farmer was referred to the trust when he attempted to hang himself while in police custody for threatening to kill Ms Evans with a shotgun in October 2002.

Tuesday's independent report for Carmarthenshire Local Health Board (LHB) states an initial assessment of Davies found he had "no ideas to harm others" but this analysis was never revisited during the subsequent four months.

However, he made further threats towards Ms Evans and a male customer at the pub.

The team responsible for his care and treatment accepted Davies' false claims that he was having an affair with Caroline Evans, but never corroborated his story.

The review panel also said no consideration appeared to have been given to the possibility that in addition to his depression, Mr Davies might also have been harbouring jealous or delusional ideas.

It puts forward ways to improve the risk assessment in such cases but it says that it was satisfied that the staff involved did their best to manage and treat the farmer, who it said, presented "specially difficult problems".

The report states: "There is no evidence that this unfortunate tragedy, which has seriously affected the close-knit neighbourhood and the whole of the mental health services of Pembrokeshire and Derwen NHS Trust, could have been prevented with certainty.

"Nevertheless, this independent, external review process, has identified some important recommendations to be addressed".

The report team was chaired by Alan T Jenkins, a solicitor and included representatives from the Royal Society of Psychologists, Royal College of Nursing and the local health board.

An inquest last year heard from a friend of Davies, who said he had stopped taking his psychiatric medication in the days leading up to the shootings because he was suffering from headaches and was drinking heavily.

In ruling that Ms Evans was unlawfully killed, the inquest jury questioned whether more could have been done to protect Ms Evans from Davies.

Ms Evans' father, David, said after the publication of the report: "The evidence was there if the psychiatrists has looked behind the spoken word, the replies given by Davies during his examination.

"They should have been more perceptive and realised not to take his word as being purely the whole truth.

"They should have corroborated his fantasies of having had an affair with my daughter."

Ann Lloyd, head of the Welsh Assembly Government's health and social care department, said on Tuesday that "a number of lessons need to be learnt and actions taken".

She said that said all relevant organisations had been asked to prepare action plans.

The LHB and trust said it would look at all the report's recommendations in detail.

LHB chief executive Alan Brace said: "What the report says is that there were a number of areas that needed attention and I have already seen a number of these being addressed."

Mary Hodgeon, acting chief executive of the trust, said: "All the mental health service staff have fully embraced the changes that were put in place after this tragedy.

"We give an assurance that all necessary further action will be taken."

bbc.co.uk 14 June

Full Report (pdf)

Hempsons News Flash: JD (FC) (Appellant) v. East Berkshire Community Health NHS Trust and others (Respondents) and two other actions (FC) 21 April

Download file

Full Transcript of case HERE

E v Channel Four & Anor 01 June 2005

In these proceedings the Official Solicitor, joined by St Helens Borough Council, seeks an interim injunction to restrain the broadcasting by Channel Four Television Corporation of a film and the publication by the Sunday Times of an article about Pamela. She is a woman of 32, who they assert lacks the capacity to consent to what Channel Four and the Sunday Times are proposing. They invoke the inherent jurisdiction of the court.

Pamela

Pamela was born in 1972. From a very early age she suffered from neglect and emotional abuse. She was taken into care by the local authority. Whilst in care she met Judy, who at that time was employed as a play therapist at a children's hospital which Pamela attended. From 1984 to 1989 Pamela was placed at a Rudolph Steiner school. In 1987, following the breakdown of her previous foster placement, Pamela was placed with Judy and her then husband as foster carers. From 1989 until 1999 Pamela was placed by the local authority in a residential establishment. In 1999 she was removed by Judy who took her to live in her own home. She remained there until her current package of care was set up, following extensive negotiations with the local authority, initially by Judy and subsequently from February 2002 by the Official Solicitor. Pamela now lives in her own house, supported by a large round-the-clock care support team. I have not been told exactly how the team is funded and managed, but as I understand it the funding comes from the local social services and health authorities under the community care legislation - the National Assistance Act 1948, the Chronically Sick and Disabled Persons Act 1970 and the National Health Service and Community Care Act 1990. Although she does not live in Pamela's house, Judy continues to play what is on any view a central role in Pamela's life.

Pamela has a learning disability (mental impairment within the meaning of the Mental Health Act 1983) and has additionally been diagnosed as suffering from DID - dissociative identity disorder. DID, in the view of the Official Solicitor's expert, Dr Milne, is an extremely controversial diagnosis which is probably best considered to be a disorder of personality rather than a mental illness.

Full Transcript

Intoxication 'rife among doctors'

The British Medical Association has called for action over alcohol and drug abuse among medics after a BBC survey showed the problem was widespread.
BBC One's Real Story found over the last 10 years 750 hospital staff in England had been disciplined over alcohol and drug-related incidents.

The BMA estimates one in 15 medics have a problem with drugs or alcohol at some point in their life-time.

Ethics Committee chairman Michael Wilks said the profession was in denial.

Doctors are known to be at least three times as likely to have cirrhosis of the liver - a sign of alcohol damage - than the rest of the population.

This is second only to publicans and bar staff.

Dr Wilks said: "You've got a profession that doesn't want to face up to the fact that it's got a problem in the ranks.

"You've got levels of denial that make it virtually impossible for an alcoholic doctor to be helped.

"With a fairly modest investment we could set up a programme that could intervene effectively, train people to buy the right treatment and set up a monitoring system," he said.

He estimates this would cost government £10million and would save money in the long run.

The BBC figures are based on replies from one in three hospital trusts in the UK and reflect only those cases that the employers knew about.

NHS Employers said the figures were probably an underestimate.

At Maidstone and Tunbridge Wells NHS Trust, three consultants in three years had been referred to the General Medical Council for alcohol problems.

At East Kent NHS Trust, seven doctors and two nurses had been disciplined over drink and drugs in the last 10 years.

The biggest figure came from the University of Leicester NHS Trust where 17 clinical staff, including one consultant, four nurses and two operating theatre practitioners were disciplined over the past decade.

The British Association of Oral and Maxillofacial Surgeons said a survey of 150 consultant surgeons revealed more than a fifth said they knew a colleague who they believed to be impaired by alcohol while on call.

Yet unlike other professions responsible for public safety, such as airline pilots and tube drivers, the NHS does not have strict rules on drinking before duty.

Newcastle Upon Tyne NHS Trust has guidance that staff should not drink up to eight hours before they are on duty. None of the others in the BBC survey had such rules.

Alistair Henderson, director of operations for NHS Employers, said even when policy was in place it did not always safeguard against the problem.

"Sometimes it is easy to assume that having a policy is the same as dealing with it.

"I would hope and expect that all organisations are able to deal effectively with drug and alcohol abuse."

He said random alcohol and drugs testing of staff, which has been suggested by some as a solution, would not solve the problem.

Dr Vivienne Nathanson, the BMA's Head of Science and Ethics, said: "Doctors respond extremely well to treatment when they have the appropriate services available to them. Research has shown that the vast majority of doctors will make a full recovery."

She also called for more government investment for such services.

A Department of Health spokeswoman said: "We expect all NHS Trusts to have in place drug and alcohol misuse policies."

She added that all trusts were required to provide access to occupational health services for staff and that NHS Employers had made good progress to ensure staff were being provided with appropriate support.

The Medical Defence Union, which provides medico-legal support and advice to UK doctors, said those with drug and alcohol problems should seek help early.

Dr Thomas Kenny, a surgeon who is recovering from alcohol addiction, said: "Patients have suffered and it's something I have to put up with every day of my life."

Natasza Lambert from Folkestone told Real Story she had been seen by a doctor who was under the influence of alcohol.

"He had come in straight from riding. He was absolutely paralytic. He was all over the place, stuttering and slurring."

bbc.co.uk 13 June

NATIONAL STANDARDS FOR MENTAL HEALTH OFFICER SERVICES

1. RESPONSIVE SERVICES

All persons affected by mental disorder (which includes learning disability), either in their personal or professional capacity, who require a Mental Health Officer can expect an efficient and helpful response and comprehensive service following a request for a Mental Health Officer to undertake duties in accordance with the Mental Health (Care and Treatment) (Scotland) Act 2003 (the 2003 Act), the Criminal Procedure (Scotland) Act 1995 ( the 1995 Act) and the Adults with Incapacity (Scotland) Act 2000 ( the 2000 Act).

2. REFERRAL, ASSESSMENT AND ADMISSION PROCEDURES

Service users, carers and others making a referral to the Mental Health Officer service can expect that the local authority makes clear arrangements for the assessment of individuals under the 2003 Act, the 2000 Act and the 1995 Act and instigates action to meet assessed needs.

3. CARE PLANNING AND CARE MANAGEMENT

Service users who are subject to statutory measures under the 2003 Act, the 2000 Act or the 1995 Act can expect that they will benefit from care management and/or Care Programme Approach systems which provide support through keyworking, monitoring and review.

4. INTER/INTRA-AGENCY COLLABORATION AND CO-OPERATION

Service users who are, may be, or have been subject to statutory measures under the 2003 Act, the 2000 Act or the 1995 Act can expect that the local authority social work service works closely with other agencies and other departments to ensure a co-ordinated approach to implementing the legislation and securing required services.

5. EQUITABLE PROVISION AND ANTI-DISCRIMINATORY PRACTICE

Service users and carers can expect that the local authority implements systems and processes for referral, assessment, care planning and service provision which respect the rights of people, especially those who are, have been, or may be subject to statutory measures under the 2003 Act, the 2000 Act or the 1995 Act and which are provided in an anti-discriminatory way.

6. STAFF TRAINING AND DEVELOPMENT

Individual MHOs can expect that their local authority provides appropriate opportunities for continuing professional development and structured specialist professional advice and guidance, as needed, from an experienced MHO.

7. ORGANISATION AND MANAGEMENT

Individual MHOs can expect that their local authority provides proper managerial, administrative and technical support which enables MHOs to fulfil their statutory duties under the legislation in accordance with the principles of the legislation and the associated Codes of Practice.

Download file

Approved Medical Practitioners - Mental Health (Care and Treatment) (Scotland) Act, 2003 Training Manual

The 2003 Act will come into force in October 2005. It will affect all professionals in Scotland working in mental health.

This booklet is designed to complement the training programme through which psychiatrists can receive Section 22 accreditation as approved medical practitioners ( AMPs)

Section 22- AMPs are those doctors who have undertaken requisite training in the 2003 Act. They must be fully registered medical practitioners who are either:

Members or fellows of the Royal College of Psychiatrists, or

Have four years' continuous experience in the specialty of psychiatry and are sponsored by their local medical director.

Download file

Mum waits for force to apologise

Devon and Cornwall Police have been told to apologise for their mishandling of the disappearance and death of a young schizophrenic man.

Daniel Heard, 26, was found dead in freezing weather several days after he disappeared from the Cedars Mental Health Unit in Exeter last year.

The Independent Police Complaints Commission (IPCC) recommended changes in their search procedures.

But now it says the force's proposed response is not appropriate.

It says all officers should be trained in mental health awareness.

Supervisory officers involved in Daniel's case should also receive extra advice and training.

Devon and Cornwall police said they fully accepted the IPCC's recommendations and were in the process of writing to Mr Heard's family, setting out their position.

But Mr Heard's mother Lynda Kelly said she felt "insulted and disrespected" by the force's response.

She said: "It is really frustrating that it takes so much to get any kind of change.

"I have worked really hard on this and feel I am getting nowhere fast.

"I would also like an apology for the mistakes that have been made, but have received no sign of regret or apology."

bbc.co.uk 8 June

Suicide prisoner taken out of care

A father of four who hung himself in a prison toilet was taken off a programme for vulnerable inmates before he died, a court has heard.

A case conference held at Porterfield Prison in Inverness the day after Scott Currie attempted suicide concluded he was not at risk of self-harm, despite a psychiatrist noting he had suicidal tendencies.

Mr Currie, 31, was found dead in a staff toilet at the prison on September 20 last year.

icscotland.icnetwork.co.uk 8 June

Mental health body move dropped

Ministers have been forced to drop plans to relocate the Mental Welfare Commission to Falkirk.

The Scottish Executive reversed its decision to move the body from Edinburgh because it has no legal power to tell the commission what to do.

The lease on the organisation's office ends next spring and ministers felt the move would fit in with their policy of sharing government jobs in Scotland.

The news was met with controversy when first announced in March.

The commission warned that its service would be "seriously jeopardised" by a significant loss of expertise from its staff of 76, some of whom would not want to make the move.

When Scottish Natural Heritage raised similar complaints about its relocation, ministers overruled the agency.

But because the executive has no power to direct the commission in the same way, the Deputy Health Minister Rhona Brankin has backed down.

However, the executive says she may revisit the issue in two years time.

The relocation policy requires that in the case of new bodies being set up, there will be a presumption that they should be located away from Edinburgh.

In the case of existing bodies, a rethink on location is required when leases expire.

The relocation of Scottish Natural Heritage from Edinburgh to Inverness, which caused anger among some staff, led to a Holyrood inquiry into the policy.

The commission said it had recently emerged that the organisation held "a uniquely independent position" because of mental health law in Scotland.

A spokesman said: "This has led the Scottish Executive to invite the commission to make the decision on whether to relocate at this time.

"At a recent meeting, commissioners unanimously endorsed our consistently held position that the best interests of service users would not be served by relocation from Edinburgh at a time of great change in mental health and learning disability services.

"Consequently the commission will be remaining in Edinburgh for the foreseeable future."

BBC Scotland political correspondent Glenn Campbell said it seemed there had been a "blunder somewhere".

He added: "The executive has a well-established policy of relocating government jobs across Scotland - trying to share out the benefits of there being a Scottish Parliament.

"It is a widely supported policy but in the last couple of years it has become a bit more aggressive.

"Ministers have in the case of SNH, against that organisation's judgement, issued a direction to move its headquarters from Edinburgh up to Inverness.

"But in the case of the mental welfare commission, ministers didn't appear to know that this is an independent body over which they don't have that kind of power - when it dug in its heels and said no, ministers had to back off."

However an executive spokeswoman insisted that Ms Brankin was still committed to the relocation policy and the "wider benefits" it provided.

She said: "It is now three months since ministers announced the Mental Welfare Commission (MWC) should move and although the MWC, with Scottish Executive support, has been working towards the move we have not made as much progress as we wanted to.

"There are some key issues, such as staff retention, which we have been unable to resolve and time is running out if the move is to be successfully completed by March 2006.

"Given the unique nature of the MWC and its relationship with Scottish ministers, the decision is for the MWC to make.

"We have therefore agreed that the MWC can defer their relocation until the new Mental Health (Care and Treatment) (Scotland) Act 2003 is bedded in. After this we may look again at this issue."

bbc.co.uk 8 June

The Public Guardianship Office

The Public Guardianship Office provides financial protection services for people who have lost their mental capacity. It’s responsibilities cover England and Wales, separate arrangements exist for Scotland and Northern Ireland.

Government response to National Audit Office report [8 June 2005]
DCA welcomes the NAO response and that The NAO has recognised the considerable improvements the PGO has made to the overall quality of its service delivery since it reported on the Public Trust Office, the predecessor of the PGO, in 1999.

National Audit Office report on the Public Guardianship Office [8 June 2005]
The National Audit Office (NAO) report on the effectiveness of the Public Guardianship Office (PGO), protecting and promoting the financial affairs of those who lose their mental capacity. The report examines the PGO’s targeting of risk, the steps taken to improve service quality and to raise the public's awareness of it's role.

Framework Document for the Public Guardianship Office [8 June 2005] [ PDF 129KB]
This is a framework document for the Public Guardianship Office which was established in 2001. It provides services which were previously provided by the Public Trust Office (PTO). The PTO no longer exists.

The Strategic Investment Board
The Strategic Investment Board is an advisory non-departmental public body set up in 2001 to advise on the investment activities of the Public Guardianship Office, the Official Solicitor & Public Trustee Office and the Courts Fund Office.

Quinquennial Review of the Public Trust Office [November 1999]
The Public Trust Office is the predecessor of the PGO.

Killer in jail suicide bid

TORMENTED murderer Brian Kearney has attempted suicide in prison, his lawyers have revealed.
The 21-year-old, who dressed up in a "killing suit" and bludgeoned a grandad to death in one of the most shocking murders Sunderland has seen, is less than a month into a 20-year jail term.
He was due back at Newcastle Crown Court yesterday, where a judge reduced his sentence by 20 days.
But Kearney, formerly of Morgan Street, Southwick, who has been diagnosed with a personality disorder, waived his right to attend in person after a failed suicide bid on Friday at Frankland Prison.
It is understood he did not require medical treatment and yesterday's hearing was not related to the incident.

Kearney had overheard unfounded claims on a drinking session on December 1 last year that Barry Sewell was a paedophile – then hunted him down.
He donned a dark, hooded jacket and a joiner's belt filled with deadly weapons before cycling to a deserted barn near the River Wear in Low Southwick, where he launched the "unimaginable" attack on the 49-year-old.
Kearney admitted his crime and was jailed for life last month by Judge David Hodson, who told him it was the most savage killing he had ever encountered.
At the sentencing hearing defence barrister Patrick Cosgrove QC told the court that Kearney had been abused as a child and was the victim of a sex attack just a few weeks before the killing.
After downing seven or eight pints at a social club, Kearney was misinformed Mr Sewell was a paedophile then hunted him down.
He battered Mr Sewell's head with hammers, used a bar to smash his kneecaps and shins and dropped 15kg breeze blocks on his head before ramming a metal pole so hard into him it almost came out of his abdomen.
A post-mortem examination revealed Mr Sewell's skull had been fragmented by at least 25 separate blows, he had fractures to his legs and ribs as well as massive internal injuries from the metal pole.
Yesterday's hearing was told that the amount of time Kearney should serve had been miscalculated by 20 days, and his sentence was reduced to 20 years and 209 days.
Mr Cosgrove told the court: "The defendant attempted to take his life over the weekend and has waived his right to attend court."
A Home Office Spokesman said: "We would not comment on an individual prisoner. We can confirm that there was an incident of self-harm at HMP Frankland on Friday, May 27."

sunderlandtoday.co.uk 2 June