Select Committee on Health Appendices to the Minutes of Evidence


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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