Is there still such a thing as care in the community?

In 1992, Jonathan Zito was murdered by a stranger in an unprovoked attack. Yesterday, the man who stabbed to death Denis Finnegan was convicted. In both cases, the assailants were mentally ill patients denied the care they needed. In the years between these two tragic incidents, up to 40 people a year have died in similar circumstances

Maxine Frith,Social Affairs Correspondent
Saturday 26 February 2005 01:00
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Almost 13 years ago, when a 27-year-old musician, Jonathan Zito, was murdered on the platform of a London Tube station, a national outcry was sparked about how mental health patients are treated in Britain.

Almost 13 years ago, when a 27-year-old musician, Jonathan Zito, was murdered on the platform of a London Tube station, a national outcry was sparked about how mental health patients are treated in Britain.

His assailant, Christopher Clunis, 29, had recently been released from a psychiatric hospital, and had become a care in the community patient.

Yesterday another mentally ill man, John Barrett, 42, pleaded guilty to stabbing to death a former banker, Denis Finnegan, 50, in a random attack in Richmond Park last September. Both Barrett and Clunis had a history of violence and paranoid schizophrenia, both had deteriorated rapidly in the days before they attacked their victims - and yet, in both cases, doctors decided they were safe to be in the community.

In the 11 years between the deaths of Zito and Finnegan, up to 40 people a year have been killed by mentally ill patients. Each death has been accompanied by an independent inquiry into the failings of the system. Yet mental health campaigners warn that errors in the care in the community system are still failing patients and putting the public at risk. They accuse doctors of conducting inadequate risk assessments and allowing too many patients to go free, despite obvious warning signs that they are a risk both to the public and themselves.

Marjorie Wallace, chief executive of the mental health charity Sane, said: "We are becoming increasingly concerned at the number of extremely disturbed patients who are being allowed to discharge themselves, abscond or simply leave psychiatric wards, sometimes to their own deaths, with failing efforts being made to protect either them or the public, or give adequate warnings to families, police or those entrusted with their care.

"If the public cannot have confidence in the psychiatric services to make risk assessments and monitor those who may pose a risk to themselves or others, how can they retain their faith in the care in the community system?"

In the latest case, 41-year-old Barrett attacked Mr Finnegan as he cycled in south-west London. Barrett admitted manslaughter on the grounds of diminished responsibility at the Old Bailey and will be sentenced next month.

Mr Finnegan's brother John said: "I think the major fact of my brother's death is that there was a failure in the care of John Barrett. Everybody involved in this case should be ashamed of themselves. This should never be allowed to happen again. But I cannot honestly say that is going to happen."

Barrett had a long history of mental illness and was detained in a secure unit in 2002 after stabbing and seriously injuring a nurse and two patients at St George's Hospital in Tooting, south London. The gravity of his offence meant he became one of 4,300 "restricted" mental health patients, who are either held at secure hospitals or on "conditional discharge" under close monitoring in the community.

In October 2003, an independent mental health review tribunal ruled that Barrett should be released on conditional discharge from the secure unit at Springfield Hospital in Tooting, despite the opposition of the Home Office, which manages cases of restricted patients. A risk assessment by doctors set out several "warning indicators" which should have alerted Barrett's case workers to any problems. These included smoking cannabis, behaving inappropriately and being verbally aggressive.

All of these supposed safeguards had been introduced as a result of the Zito case to bolster public confidence in care in the community - yet, at every step, they appear to have failed.

On 1 September last year, Barrett's former girlfriend warned Springfield Hospital's crisis line that his mental health was deteriorating rapidly. He was smoking cannabis, hearing voices and had verbally abused a stranger in the street. That afternoon, Barrett attended Springfield voluntarily and was assessed by a forensic psychiatrist.

Despite the warning signs doctors decided not to section him - instead he was admitted as a voluntary patient and given an hour's leave. That evening, Barrett discharged himself from the hospital and bought a set of kitchen knives from a DIY store. He went to Richmond Park the next morning intending to kill someone. He told police later that voices in his head were telling him to kill a man, rather than a woman, child or elderly person.

At 10am, Mr Finnegan, 50, cycled through the park gates. He had just returned from a year-long trip around the world after taking redundancy from his job as head of corporate banking at the Royal Bank of Scotland. Barrett ambushed him, stabbed him through the heart repeatedly and ran off.

Three passers-by contacted police and, within minutes, Barrett was caught in the park with the bloodstained knife near by. Mr Finnegan, who was unmarried, died three hours later in hospital before his family could reach his side.

The South West London and St George's Mental Health NHS Trust has launched an inquiry. It's chief executive, Nigel Fisher, said: "I am committed to ensuring that an in-depth analysis of the incident takes place to ensure we do all we can to prevent a tragedy of this sort happening in the future."

The care in the community policy began in earnest in the early 1980s, as Victorian-style institutions were emptied in favour of giving patients who had often committed no crime more freedom. However, increasing concerns were voiced that many former patients were being dumped in bedsits and hostels, without adequate supervision or care.

The Zito murder was the first high-profile case involving care in the community, partly because the murdered man's widow, Jayne, became a highly articulate critic of the system. The ensuing Ritchie report resulted in reforms, including independent inquiries into every killing by a mentally ill person.

Charities said the Finnegan case was a tragic example of the failings of care in the community. Michael Howlett, director of the Zito Trust, said: "[Spring-field] appear to have underestimated the seriousness of the signs that were emerging and were relying on him to come in when they suggested it. A lot of the risk assessments that are going on are very poor."

But Dr Tony Zigmond, vice-president of the Royal College of Psychiatrists, said a balance had to be struck between protecting the public and locking people up: "There has to be a recognition that we cannot predict who is going to go on and kill. Most of the time it is impossible to predict. We need a mental health system which is accessible and attractive and makes people want to use it when they are not coping, rather than locking people up."

CASES THAT ENDED IN TRAGEDY

Emma Brodie, 11, was stabbed by Carol Barratt in a shopping centre in Doncaster on 16 April 1991 after her killer absconded from the psychiatric unit at Doncaster Royal Infirmary the month before.

Katie Sullivan, 23, a voluntary worker at the Mind hostel in Kingston-upon-Thames, was stabbed 14 times by Erieyune Inweh on 30 October 1992. The day before the attack, Inweh stopped taking medication.

J onathan Zito, 27, was stabbed to death by Christopher Clunis at Finsbury Park Tube station on 17 December 1992. An inquiry revealed a catalogue of errors and missed opportunities in the care in the community extended to Clunis.

Anthony Kellman, a bouncer, was shot by the paranoid schizophrenic Wayne Hutchinson, in December 1994. He also stabbed Marie Hatton through the head. A report found a catalogue of errors from medical staff.

Carla Thompson, 57, had allowed Daniel Joseph, 18, to stay in her home when he beat her to death in 1998. An inquiry found a lack of communication between agencies responsible for his care. He had been diagnosed as psychotic.

Michael Martin, 56, was killed by his son Matthew, 25, with a pickaxe at his home in Almondsbury in 1999, three months after his son's release from Exeter prison. An inquiry found several blunders in Matthew's care.

Andrew Pennington, 39, an aide to the Liberal Democrat MP, Nigel Jones, was stabbed to death by Robert Ashman in Mr Jones's Cheltenham surgery on 28 January 2000. Ashman's trial heard he had an untreated paranoid disorder.

Tammy Little, 36, was throttled by Errol Leong, 38, in Hayle Towans, Cornwall, in November 2000. He had just been released from custody. Aninquirycriticised the health trust. A judge ordered him to be detained indefinitely.

Brian Dodd, 72, a grandfather, was stabbed to death by Paul Khan in Prestatyn in March 2003. A report into the stabbing identified a clear failure in Khan's care. He was jailed for life at Chester Crown Court.

Lenny Leak, 49, had petrol poured over him and was set alight by Mark Towell, 26, at a house in Gateshead. An inquiry said Towell had a propensity for violent antisocial behaviour and cared little for the consequences of his actions.

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