Bottomley rejects national standards in community care

NEW Government guidelines on looking after the mentally ill in the community will be published today, but they will stop short of the compulsory national standards demanded by doctors and the mental health charity, Mind.

The guidelines, to be issued by the Secretary of State for Health, Virginia Bottomley, are a response to the case of Christopher Clunis, a paranoid schizophrenic who stabbed a musician to death at a London Underground station after being discharged from hospital in 1992.

Mrs Bottomley's guidelines will say the existing procedures are sufficient to ensure that former patients are adequately monitored, and that what is needed is for the best working methods to be adopted all over Britain.

The guidelines will recommend that potentially violent patients be put on 'supervision registers' and given 'the highest priority for care and treatment'. However, a spokesman for the British Medical Association said the Government had ducked the problem. It would not be solved by guidelines while there was a shortage of accommodation, social workers and places for the mentally ill to seek help. Not enough money was available. 'They (the Government) will not agree national standards because they would then have to face up to the lack of resources. Being on a supervision register will not stop a patient stabbing somebody,' he said.

A private inquiry found that Clunis, 30, now in Rampton special hospital, had a history of violence. Several London hospitals had looked after him, but each time he had slipped through the net. The inquiry did not blame any one organisation, but criticised the police, doctors, social services and the Crown Prosecution Service.

Clunis was diagnosed as a paranoid schizophrenic in Jamaica in 1986 and was first admitted to hospital in England in 1987. From then on he was in and out of hospitals, living in the community and failing to take his medication.

In 1992 he was accused of a stabbing but the case against him collapsed. Eight days before he killed Mr Zito, he ran amok, threatening people with a screwdriver and a knife. He was out when an emergency mental health team called at his home.

Mrs Bottomley will tell a conference at the Royal College of Psychiatrists today: 'Care in the Community should be about practical action, not textbook theories . . . Now is the time to get practical and ensure that the high standards set in many parts of the country are established throughout the service for all our patients.'