Schizophrenic's knife attack was `predictable'

Inquiry into therapist's death calls for Act to be scrapped and for min isters to review mental health law. Rosie Waterhouse reports `Successful care enables a patient to live as normal a life as possible'

THE REPORT The killing of Georgina Robinson by Andrew Robinson, a paranoid schizophrenic with a history of violence and obsessions with women, was "predictable and preventable", according to a damning report of the independent inquiry into the affair published yesterday.

The report pinpoints insoluble flaws in the 1983 Mental Health Act - which it argues should be replaced - and proposes a new legal framework for community care.

The independent inquiry, held last July, was told how Miss Robinson, 26, died in hospital in September 1993 after a horrific attack at the Edith Morgan psychiatric centre in Torquay, Devon. Andrew Robinson, 36, who was no relation, stabbed her a dozen times in the neck with a knife he had kept hidden in his room for a week.

The inquiry, conducted by a three-strong team led by the former Mental Act Commission chairman, Sir Louis Blom-Cooper QC, was commissioned by the South Devon Health Care Trust.

It concludes: "The homicidal attack on Georgina Robinson with a knife was, in the circumstance described below, preventable. That there was a likelihood of some dangerous conduct by Andrew Robinson, as a consequence of the removal of the restriction order on 19 September 1986 by the Mental Health Review Tribunal, was foreseeable for all those who thereafter became responsible for his care and treatment.

"It was entirely predictable that one day Andrew Robinson, if he was not maintained on medication under proper supervision, would attack someone (probably a young woman) and that steps should and could have been taken to prevent that eventuality."

The report says that Miss Robinson's mother was not overstating the case when she told the inquiry that her daughter's life was "sacrificed to the inadequate care and treatment provided by mental health policy and practice for the severely mentally disordered people in this country".

The report concludes: "Had Andrew Robinson been denied - as he should have been - both the freedom to go to Torquay on 25 August and to wander round London and Torquay for three days from 28-31 August, Georgina almost certainly would not have been fatally assaulted by Andrew on 1 September 1993. Georgina Robinson's death was in that sense preventable, the responsibility for which lies with the (South Devon Health Care) Trust's management and staff of EMC."

Expressing sympathy for both Robinson families, the report said: "Ever since Andrew Robinson was diagnosed as suffering from paranoid schizophrenia in 1978, [his parents] the Rev Peter and Jennifer Robinson have suffered the ... desperate worries of anxious parents. Their constant entreaties to doctors and social workers to respond to their experiences of their son's frequent mental breakdowns appeared to them to go unheeded."

The inquiry report says there are "fundamental flaws'' in the 1983 Mental Health Act's underlying philosophy. The first is the Act's underlying theme that care and treatment for people with a mental disorder of a certain severity require hospital treatment. The report argues that specific treatments, for example monthly medication, could be administered in a day centre or hospital surgery and the person obliged to live in a specified place such as a supervised hostel or their own home.

The second "philosophical flaw" is the "removal of medical treatment from the social context in which care must be delivered to be therapeutic". The report argues: "Successful care from the patient's point of view enables him or her to lead as normal a life in the community as possible."

The report calls for a legal power for the compulsory care of mentally disordered people, which would designate a place where the individual is required to live; confirm that a care plan had been agreed by the health and local authorities responsible forproviding care; specify any medical, nursing or rehabilitative treatments, and where it would be delivered; and name the key professional responsible for ensuring that a health care plan was implemented. It would also be a time-linked power, with op p ortunities for the patient to be discharged from the order after a certain period.

Explaining the need for a compulsory community care order the authors conclude: "We believe that the broader concept of a comprehensive care plan order ... would protect patients' welfare while they were receiving medication against their wishes. The time

has come to jettison an Act which neither protects the public effectively, nor provides the care which seriously mentally disordered people need to have a more fulfilled and happier life. There has been a ministerial commitment to a review of mental health law `sooner or later'. We think the review should start now."

The Falling Shadow: One Patient's Mental Health Care 1978-1993, Duckworth, £12.99.

Leading article, page 13