New rules to govern care of the mentally ill

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New guidelines on co-operation between agencies dealing with the mentally ill were issued yesterday to avoid the "tragic consequences" of a number of cases where patients have killed or attacked others.

The guide "Building Bridges" was begun in February 1994, after the publication of the report which identified major failings in the co-ordination of care of Christopher Clunis, a schizophrenic who stabbed Jonathan Zito to death in a tube station.

It will be sent out to all health and social services and voluntary organisations and attempts to clarify procedures for dealing with the mentally ill.

The guidelines concentrate on a commitment to joint working between health, social services and other agencies at all levels. Information exchanges should be set up between agencies.

"Responsibility for providing good community care for mentally ill people is not the job of one agency alone," the report said, "just as it is not the responsibility of one professional group alone."

Lack of co-operation between agencies has been a recurring theme over the last few years. In September, the Woodley Team report into the killing of Bryan Bennett by Stephen Laudat concluded there had been a catalogue of "missed opportunities", and good social care had been undermined by inadequate health care.In August two reports, by the Social Services Inspectorate and the Clinical Standards Advisory Group, condemned "Care in the Community" as "haphazard" and "confused".

The guide calls for agencies to target resources at those who have greatest need and to define who are the severely mentally ill. The guide's framework definition says that "people suffering from severe mental illness" are those suffering from sort of mental illness such as schizophrenia or dementia who are unable to care for themselves, sustain relationships or work, have suffered recurring crises and are a "significant risk" to the safety of themselves and others".

Patients who are at a "significant risk" of danger should be included on a supervision "at risk" register. The patient should be informed orally and in writing that they are on such a register. Such registers are confidential and the report also says that teams should have written policies on how such information should be disclosed and to whom.

The report also deals with the question of violent deaths caused by Care in the Community patients, whether homicides or suicides.

In cases of homicide, the district health authority must always hold an independent inquiry. Such an inquiry must cover the care the patient was receiving; whether that care was suitable; whether it corresponded with statutory obligations; how professional judgment was exercised; and the adequacy of the care plan and whether properly monitored.

Later this month, NHS chairman are due to report back to the Department of Health to describe improvements in supervision and treatment after being ordered to do so by Gerald Malone, Minister of State for Health, on 24 August.