APPENDIX 8
Joint memorandum by Sandra Sullivan and
Wendy Robinson, Victims' Voice (MH 27)
We request amongst other things specific help, available
nationally, for those bereaved through homicide and that funds
be made available by the government to enable psychologists to
provide this specific help.
We further request a Memorial be created for
all those victims of homicide by severely mentally ill patients
as a result of "Care in the Community". This memorial
would take the form of a small plaque in the wall of the Department
for Health, approximately 12" by 12".
We wish also to see positive action taken with
regard to the families of victims of homicide by the severely
mentally ill through "Care in the Community" (FVH MPCC)
in the form of the right to be legally represented at MHRTs (Mental
Health Review Tribunals).
In addition, we wish action to be taken to prevent
criminals profiting in any way from the publication of details
of their evil crimes.
Perhaps most importantly we wish to see the
principle of accountability—which seems at present to be
completely absent—firmly established as a foundation for
all decisions surrounding the treatment and care of the severely
mentally ill.
FOR THE
ATTENTION OF
THE SELECT
COMMITTEE
We are two mothers who have each lost a daughter
who was working in the mental health area during 1992-1993. Our
daughters were brutally killed by patients receiving care.
We therefore consider it vital that care of
those who are severely mentally ill be viewed from the perspective
of care for all, not simply the particular patient/client alone.
Protective care would best describe the need
we see (and the challenge we wish to meet). We wish to see the
implementation of stringent practices and a realistic awareness
of potential risk factors.
We are both founder members of well-known organisations:
The Zito Trust and Justice for Victims, both affiliated to Victims'
Voice, and are therefore in daily contact with families of victims
of dangerously mentally ill patients.
We wish to be witnesses at any relevant Committee
meeting, and we strongly wish our information to be read and used—widely.
Duty of Care
The precise duty of care—to whom and by
whom—must be clarified and carefully scrutinized in order
to place responsibility in a reasonable setting. The present "duty
of care" is an amorphous platitude. Duty of care is a very
necessary function on which the basis of care must rest.
Accountability
Is a necessary requisite in order to gain maximum
effort and performance by professionals who work with severely
mentally ill patients. True accountability would structure an
approach of exactly who does what and why, when and where. Those
caring for users with unpredictable mental illness would seek
positive knowledge and awareness, and there would be strong reason
to act in a thorough way. Professionals must be seen to be accountable,
responsive and responsible. Accountability would apportion blame
when a user is not receiving adequate care, and where things go
wrong and someone is hurt or killed by a severely mentally ill
patient, who should be being protected from themselves.
At present, families who seek accountability
are pushed through the Courts—a cats cradle of confusion
and unfair discrimination.
Liaison
Good, open, consistent communication between
the various health professionals involved in the care of the severely
mentally ill is essential. Considerations of "confidentiality"
overriding all else is preventing the passage of vital information,
and hampers the development of good procedures for patient care.
It is both advisable and plain common sense to integrate information
between CPN, social workers, doctors and hospitals. Secrecy can
be both deceitful and dangerous, and not always in the patient's
best interests.
Training/Colleges
Universities are not at present teaching the
whole scenario in relation to mental health issues. Young people
venturing on a career in mental health are not being adequately
equipped with appropriate knowledge to work safely and effectively
in this vital area. Priority must be given to addressing this
omission. Students must be alerted to danger signals which they
should be able to recognise. It is not enough to trust to fate,
to allow "calculated risks" to be taken in ignorance.
Awareness and information through education leads to knowledge
armed with caution.
There is a shortage of qualified staff, approved
social workers with forensic training and of Occupational Therapists—despite
recommendations in a number of the Independent Inquiry Reports
calling for more to be employed in the community. More and more
Occupational Therapists are turning to research, being disillusioned
by their changing role in mental health and the fewer training
places available due to college closures.
Offending
For every act of violence there is a victim.
There is a reluctance to prosecute a mentally ill person, despite
a serious act of aggression involving an innocent party. The offence
is often either minimised or not recorded at all, and therefore
the seriousness of the offence is not taken into account in the
risk assessment and management of the mentally ill person concerned.
This often leaves the victim vulnerable against further acts of
aggression.
In collaboration with the police, the mental
health team responsible for the patient should be made aware of
the concerns of the victim and the circumstances which surrounded
the offence. Analysing the mentally disordered offender's behaviour
regarding the victim and taking into account all contributory
factors can only be good practice.
Secure Accommodation, Hospitals
At present provision of secure accommodation
for dangerously mentally ill patients is scant and haphazard—it
seems not enough serious consideration has been given to this
important area of patient care. As a result, patients are being
treated in hospitals that are poorly designed and in an environment
that is neither therapeutic nor safe. All too often patients are
being admitted to open hospitals that have limited, or no, security
with observation of patients and safety of staff being a major
problem, as patients are able to leave and re-enter the premises
very often unchallenged. Patients have been known to return to
hospital with alcohol, drugs or concealed weapons. Attacks, attempted
suicide, suicide and, at worst, the fatal stabbing of a member
of staff or fellow patient, have been the result. Patients have
also left the hospital premises and committed suicide or attacked
a member of the public.
In the absence of sufficient secure accommodation,
the safety measures within the hospital can be improved.
Patients seem to understand very well how long
their "section" runs for, what medication they are on,
and their right to confidentiality. They should therefore be able
to understand that if they choose to break the "house rules"
they will have restrictions placed upon them, eg body search,
one to one supervision, escorted leave etc. Evidence shows that
the majority of fatal attacks are pre-meditated. The opportunity
to have access to weapons, alcohol and drugs should be prevented—also
access to the victim, where there has been a specific threat.
All staff—paramedics are often not included—should
be kept informed of a patient's potential to violence and have
training in managing dangerous and threatening behaviour. There
should be adequate alarm systems in place, and a working policy
on health and safety under the guidelines laid down by the Health
and Safety Executive. Any hospital that fails to comply should
be prosecuted. There must be accountability where there is negligence.
Potential perpetrators of homicide must be heeded
and, if necessary, securely locked away from the community. To
allow someone to be stabbed 14, 30,78 times is a barbaric acceptance
by the government of the "calculated risk". When one
human being is killed by another under the "Care in the Community"
system, we are all responsible for failing the victim. Acceptance
is to be part of the death of the victim. Under present standards
of "care", patients who are already identified as potential
killers are presented with the choice of killing. There is no
accountability; "Care in the Community" does not control
or contain violence. Please end this bad means to a bad end—which
is causing too many suicides and loss of innocent life, through
homicide.
Hostels
Firstly, in the setting up of hostels it is
vitally important to clarify who is responsible and who will therefore
be accountable for the running of the hostel.
Confidentiality in the running of hostels has
gone too far. No one is aware of the past behaviour of patients.
Carers and patients alike are at risk in this environment. Security
measures such as alarms, locks, automatic doors and many other
schemes could and should be compulsory. Such measures could well
save life.
Patients with a known history of violence should
be placed in 24-hour supervised accommodation with trained staff,
who have a full knowledge of the patient's history, a summary
of police reports of any criminal offences and statements of victims.
Full support should be given to the staff at the hostel, and adequate
facilities should be provided for the residents for therapy, occupation
and leisure activities. Research has shown that being involved
in areas of occupation or therapy greatly reduces the risk of
violent incidents. Also, a settled staff allows for the building
of trust and understanding between staff and patients.
There is a lack of day care facilities for these
patients living in the community, and respite care for the families
and carers of the mentally ill. It is appalling to learn that
in 1998 a nurse in Oxfordshire had to walk the streets with a
client who has violent episodes, in order to give the parents
respite. There was nowhere for the nurse and client to go.
Medication
Haphazard appliance of medication in place of
appropriate sensitive care is dangerous. Because the law, as it
now stands, does not back up the consistent use of medication,
there is no force or reliability in this procedure.
Community Psychiatric Nurses who fail to give
prescribed medication should be prosecuted if the patient then
goes on to commit a violent act towards another person or themselves.
It has to be accepted that the CPN is responsible for subsequent
behaviour of the non-medicated patient who has been prescribed
a particular medication.
In 1983 MIND were successful in bringing about,
through a judicial review, the position that unless a patient
kills or maims another person, then that patient does not have
to take their prescribed medication. In the light of subsequent
acts of violence and homicide, as a direct result of "Care
in the Community", this act must surely be reviewed.
Statistics show that if the law had been able
to back compulsory medication, the numbers of deaths and acts
of violence would have been considerably lower, eg as experienced
in Scotland. Instead of providing genuine care, reliance upon
repeat medication (the taking of which is itself unreliable),
is actually costing lives. The lives of these victims are being
sacrificed to those who, although severely mentally ill themselves,
are at liberty to decide whether or not they take prescribed medication—without
any corresponding responsibility.
Many patients are reluctant to take prescribed
medication because of the unwanted side-effects produced. New
style drugs are now available, however, which produce fewer side
effects. These drugs are not being used in many cases because
they are too expensive. Investment should be made to make these
new style drugs more readily available, as this would undoubtedly
alleviate the present position and, moreover, reduce the number
of cases of in-patient care. This would inevitably release pressure
on hospital beds and more importantly, stabilise behaviour.
As things stand at present, there have been
no significant changes. The Register of dangerously mentally ill
patients seems to underline the fact that there are indeed unstable,
dangerously mentally ill patients in the community. These people
will only be dealt with after committing a dangerously
violent act. Surely, in such cases, where a very real danger
has been identified, prevention of violence becomes a human rights
issue? There is, after all, no cure for murder.
Government seems to be paralyzed in the analysis.
They are reneging on their duty to every member of the community
with regard to the issue of safety. "Care" in
the community is unsafe—for the severely mentally ill themselves,
who should be securely accommodated, and for their potential victims,
who can be any human being. There is no cure for murder.
Tribunal Rights for Families of Victims (Mental
Health Review Tr.)
The choice of legal representation must be offered
to families of victims. Patients who are facing a tribunal are
doing so for a reason. The reason is because there is a cause.
Aristotle named the cause as the "because". Because
a person has killed, a victim has been caused. Because a killer
has killed, the cause must be discussed at the tribunal.
At present, notification to the family of the
victim that a Mental Health Review Tribunal is to take place is
entirely at the discretion of those in authority. Only rarely
are families informed or given the opportunity to represent the
victim at the Tribunal, or make a contribution to the proceedings.
Example: Family "A"
Family "A" are informed each time
a tribunal is imminent and they are required to re-live the horror
of the killing of their loved one in order to give a written statement
to the tribunal. This done, they receive no indication of whether
or not this information is even considered by the acting tribunal.
This "touch and go" approach is extremely distressing
and frustrating for the family. The perceived indifference to
the family amounts almost itself to victimisation. Legal representation
for the family at the tribunal would alleviate great suffering
and very real emotional and mental anguish.
The family faces a dilemma: they know of an
impending tribunal and of the haphazard part they are expected
to play, but they have not actual rights. They are also aware
of mothers who have literally bumped into their child's murderer,
in the street, without even knowing the killer and had been released.
This is utterly unacceptable: it can and must be prevented.
Example: Family "B"
Family "B" wrote to the Tribunal Office
requesting to be informed of any tribunal date concerning the
killer of their daughter. They were refused. As the killer had
contacted them, via a third party, from hospital, they felt an
urgent need to inform the tribunal of their concerns. The family
have no way of knowing if any information they send to the Tribunal
Office at the Department of Health will be forwarded at the relevant
time to the acting tribunal.
Not knowing if the killer is still in hospital
or not; not knowing if or when the killer will contact them again
is causing needless distress and anguish to the family. They feel
powerless over their own safety and mental well-being.
The system is unfair because there is an overriding
reason for the whole situation and that is homicide. Contact between
the killer of a loved one and the family should be avoided at
all costs. A duty of care to the family of the victim is vital.
Where a mentally ill person who comes before a tribunal has violent
history, in which someone's life has been threatened, the victim
should be given the opportunity to give evidence and be informed
of the tribunal's decision regarding release of the patient.
Those sitting a MHRTs should be required to
ascertain certain knowledge of all relevant information pertaining
to the patient's violent history. A tribunal should not, repeat
not be allowed to convene without all relevant information to
hand.
Example: The release of one Jason Mitchell into the
community after just such a tribunal culminated in three horrific
killings.
Who can guarantee that the person being released,
having already killed someone, will not kill again. Who will be
responsible for a second homicide?
There have been—and are still—too
many "calculated risks".
Should the decision be made to release the patient
back into the community, Social Services and the police should
be in contact with the surviving victims or the secondary victims,
in order to prepare them and support them through this very difficult
time. Confidentiality, exercised by the patient (under the Mental
Health Act) is at the moment causing the "victims" to
be re-victimised, the consequences of which can be devastating
to a family already extremely vulnerable and powerless. Consideration
must be centred on the family at risk.
Approach of Doctors, Psychiatrists and Psychologists
to the Families of Victims of Severely Mentally Ill Patients
The basic approach to the families of victims
is poor, and the trauma suffered by these families goes unheeded.
There is an urgent need for the medical profession to listen seriously
to those people who do actually know what help is needed, and
who can interpret seemingly "odd" behaviour by traumatized
families.
Treatment at present is clumsy and can be woefully
insensitive—even though this may not be deliberate. There
can be a tendency to blame families for their experience.
This can be traced back to the writings of certain criminologists,
barristers and the like who have stated that a "victim is
the cause of their own death". A ludicrous suggestion,
but one which serves to illustrate the gulf which can develop
between grieving families and the health and law professionals
with whom they come in contact. Often families are distanced and
they are categorized to the inadequate Victim Support system.
Many families are further damaged by the inappropriate care of
psychiatrists.
It must be acknowledged that it is the dangerously
mentally-ill patient who is in the wrong place at the
wrong time.
In the light of the many victims of Care in
the Community, it should now be accepted that the needs of victims'
families should be recognised and served; indeed to ignore such
needs will put a further strain on the "purse strings"
of the government. After a homicide as a result of care in the
community one can expect:
— suicide in a victim's close family
or of a friend;
— total inability to hold down a job;
— total collapse of the victims family
structure—and the family may well then become a burden on
the state;
— mental illness of various members
of family or friends.
The catastrophic reaction can be long lasting—perhaps
for life.
With the right help many of these awful effects
could be avoided. There is a need for good, coherent research—with
the participation of the families themselves. Otherwise many worthwhile,
productive lives can become negative. Many examples can be provided,
if required.
We now approach a sensitive area in this report,
in as much as "Care in the Community" is a human rights
issue for us all.
At present the rights of the patient override
those of the person who is not ill. We see this as positive discrimination.
Georgina Robinson B.A. killed 1993
A 27 year old Occupational Therapist was killed
by a patient in a hospital where she worked. Georgina's death
was totally avoidable. She was stabbed 14 times. Georgina died
slowly, she lay dying for five weeks her lungs damaged, her neck
severed. She knew there was no hope, as did her family. She had
three brothers and a sister.
The killer had made it clear that he would hurt
a woman, and he had a ten year history of violence. Because of
the lax attitude reflected in this report, he was allowed to kill
Georgina. He left the hospital to buy a knife and was not searched
on his return. Please see the "Falling Shadow" for further
information (Sir Louis Blom-Cooper).
Catherine Sullivan BA killed 1992
A 23 year old graduate in Psychology, she had
three brothers and was working towards her PhD when she was killed
by a patient in a hostel run by MIND. The patient's history of
violence was concealed by confidentiality and, although Katie
was consigned to rehabilitating this patient, she was not told
of the many previous attempts made by this patient to kill. Katie
was stabbed 14 times. Her death was totally avoidable. She lay
dying, alone—the ambulance was non-existent, and the air
ambulance took 40 minutes to arrive, by which time it was too
late. One hour later three ambulances arrived. There were no last
rites. Katie's hands and arms were also cut as she tried to protect
herself. The patient struck from behind and was crouched on her
back, stabbing at lungs, kidney and all the vital organs of her
body.
Our daughters' deaths reflect many other such
deaths in the community—as you all no doubt know—and
each death has caused untold deep suffering to families and friends.
Siblings are no longer "whole" people as the result
of the murder of a loved one; subsequent suicides have occurred.
As a result of our daughter's death our own lives have changed
totally— and all this is unnecessary and cruel. It is also
calculated by Government.
We now call for this catalogue of suffering
to stop.
Why do we concentrate on premature babies, and
prolonging the lives of the elderly, whilst yet allowing our young,
talented people to die needlessly in this way?
Why is this situation accepted by Government?
Why is liberty—without responsibility—given
to dangerous mentally ill patients, allowing them to kill?
The treatment of victims' families, subsequent
to the homicide itself, is nothing short of atrocious. There are
no guidelines, Courts are powerless and, in our own daughter's
case, when we sought to prove negligence and establish professional
accountability, we found there is no legislation in place for
this.
The Coroner called seven times for a Judicial
Inquiry into the circumstances surrounding our daughter Katie's
death, and we have been actively seeking this since 1992—all
to no avail. We have not seen justice done. Our grief is unable
to run its natural course because "things are not settled".
Our daughter's suffering has never been recognised
or considered by the authorities, instead it seems our attempts
to seek justice for our daughter have led to our being seen as
"the enemy", we feel very much that we have been punished
and ostracised for our experience. This amounts to secondary wounding:
there are no rights for families who suffer, no respect in Courts
or through any channels of the bureaucratic system. This is why
we seek changes—and acknowledgement.
Georgina's mother is no longer able to work.
Her worthwhile occupation working with disturbed children is no
longer possible because of the trauma of her daughter's death—and
subsequent events. She has, however, had to face interviews with
psychiatrists on numerous occasions to prove her suffering. Mrs
Robinson watched her daughter die over five weeks. The psychiatrists
investigation was harsh, intensive and insensitive towards a vulnerable
person; no dignity was afforded her.
She has been through an Inquiry into her daughter's
death. She has seen recommendations turned out and go unheeded.
Accountability has been non-existent. And yet she had a union
behind her.
We seek statutory procedures for families whose
loved ones are killed in the Health Service—common-sense
guidelines, if you will.
Is the Health Service above the law?
We seek an end to such treatment of victims'
families. Action is needed now.
We have found the Ombudsman "powerless
and inadequate in such cases" (his words).
A Ministry for Families of Victims is needed,
with clear guidelines for the treatment of such families.
Information relating to the death of our daughter
should be our right.
Katie Sullivan's family have sought the running
record of the Hostel in which she died. These have been denied.
They have received no communication from MIND at all. They have
received no approach from the Psychiatrist, Social Worker or Psychiatric
Nurse at all. The policy of "don't blow the whistle"
clearly works here.
Both Georgina and Katie worked in the Health
Service, this is the reason they died. Surely there is a duty
of care owing to them?
The prevailing wall of silence has produced
many hundreds of deaths like those of our daughters. We urge Government
reaction to this situation.
SUMMARY
We urge the Government to address the needs
outlined in this report.
We openly offer our testimony as witnesses in
the next Select Committee hearings.
We do everything we can to work towards an open
and safe Mental Health Service.
Dangerously mentally ill patients must be given
secure accommodation in asylums. At present, these people are
given liberty, yet they cannot cope with this responsibility—putting
the safety of individuals in the community at risk.
Why should the rights of others be less important
than those who are severely mentally ill and dangerous? Why is
the safety of the public a matter of "calculated risk"?
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