`Blunders' allowed schizophrenic to kill

Care in the community: Breakdown of communication is blamed in case where patient stabbed fellow inmate 82 times

Care in the community once again came under fire yesterday after a report about a paranoid schizophrenic who killed concluded that there had been a catalogue of "missed opportunities" and attempts at good social care had been undermined by inadequate health care.

The families of both victim and killer yesterday criticised funding in the community care programme, as the Woodley Team reported on the case of Stephen Laudat, 26, who stabbed fellow patient Bryan Bennett 82 times in July last year at the Worland Day Centre, Newham.

Laudat, who believed Mr Bennett to be one of the Kray twins, was sent to Rampton top security hospital in December after admitting manslaughter on the grounds of diminished responsibility.

While the report said the "ferocity" of Laudat's attack could not have been predicted and "the killing could not reasonably have been prevented", it spoke of a history of "missed opportunities" in Stephen Laudat's care beginning with his placement in prison in 1991.

"We think he should have received psychiatric care then, rather than a prison sentence," said Len Woodley, QC, chairman of the inquiry. Ethnic bias was also a factor. "When Stephen went to court in 1991 he was a young black man. Where as we now know he was showing symptoms of a serious mental illness, the court saw a young black man who was violent. The view that violence is linked to young black men prevails," he said.

The inquiry team also criticised the care given to Laudat at the private Kneesworth House Hospital, Cambridgeshire, in 1992 as "barely adequate". It is estimated the NHS paid between pounds 1,600 to pounds 2,000 a week for Laudat's care in the 18 months he was there.

The report describes the ward environment as "confined" creating an "inappropriate burden of tolerance" on patients. "The overall busy-ness and interference from other patients is also a concern."

But the most stringent reproach in the report is concerned with Laudat's return to the community. Mr Woodley said: "Our main criticism over the period of Stephen Laudat's care and treatment in the community is that attempts to provide good social care were undermined by inadequate health care."

Health workers and social workers did not know what the other was doing during Laudat's care. "It was a case of the right hand not knowing what the left hand was doing," he said.

He praised "the approach, commitment and sensitivity" shown by two inexperienced and unqualified social workers. "This was not matched, or supported by more experienced health colleagues," he added.

Laudat's prison sentence was due to end in December 1993 but by October concerns about his mental state had been raised by both his social worker and nursing staff. A couple of months earlier he had been transferred on to a more secure locked ward.

The ward manager wrote: "I fear he may well relapse in the future if he remains medication free, increasing potential for reoffending, a danger to himself and others."

But on 25 November 1993 an aftercare planning meeting came to the conclusion that there were insufficient grounds to warrant his detention beyond December.

Laudat was discharged to bed and breakfast accommodation, and in the six months leading up to the killing, he failed to turn up for two out- patient appointments. Despite knowing he was not taking any medication, and had a criminal record, his psychiatrist, Dianne LeFevre, took no action.

The report notes her "responses were those of finding reasons for not doing things, rather than reasons for doing. Dr LeFevre made no positive contribution to his care programme."

The consensus remained that Laudat was making good progress in the community and three weeks before the killing both health and social services professionals discharged their statutory duty to provide him with aftercare services.

The report says this decision was "wrong" and should have been deferred. "The clinical notes provide no evidence that SL was no longer in need of health services, there was no psychiatric assessment of his longterm needs, therapeutic support needs or risk assessment."

John Bowis, a health minister, commenting on the report, said: "Our thoughts must go to both families...The Laudat case starkly illustrates the need for health and social service authorities to work together to achieve effective care in the community.

"We need to ensure that mentally ill people receive the range of services they need and do not fall out of the care net. We expect health authorities to give these services a high priority," he added.

But Councillor Kevin Jenkins, chair of Newham social services committee, said it recognised "deficiencies" in support to the Laudat family but that the development of mental health provision "continues to be hampered by inadequate funding".

"The Newham Needs campaign calculates the borough is under-funded by pounds 48.5m per year. The social services department is striving to protect and develop mental health services whilst having to cut up to 9 per cent of its budget".

t Jason Mitchell, 24, a paranoid schizophrenic who killed three people in December fooled psychiatrists about his mental state before he was set free to murder, an inquiry heard yesterday.

The main recommendations

Bed and breakfast accommodation should not be used for homeless people with mental health needs. Prison service should seek psychiatric opinion about care of disordered people.

Large institutional day centres should be provided in areas where they have been cut.

Social services and district health authorities should work together on developing training and strategy for community care.

The Government should increase the level of funding for social grants to the mentally ill in the community.

Guidance over disclosing personal, confidential information concerning the risk of violence to the public should be produced.

Attempts should be made to retrieve existing family/personal history to assess those in hospital secure units. Health authorities should assist relatives to make long-distance visits.

Hospitals should develop and implement more positive action policies for patients from ethnic minorities and women. Single sex wards should be available in all psychiatric hospitals.