Health chief insists that system was not at fault

Diagnosing mental illness is an inexact science. Nicholas Timmins reports

David Morgan was not another Christopher Clunis, nor were the horrific scenes in Rackhams a failure of the mental health services, NHS managers and psychiatrists insisted yesterday.

Their vigorous defence came despite Morgan having a history of schizophrenia and psychosis and despite Adrian Fulford, QC, his defence lawyer, telling the court that if Morgan had been given anti-depressants during a visit to his GP two months before the attack, "there is a real chance these offences would not have occurred".

After a normal childhood, Morgan, who became a loner with a grudge against women, was admitted in 1988 to All Saints Hospital, Birmingham, aged 23, following his father's death. The stress led to a diagnosis of schizophrenia, hypomania and depressive psychosis. But after treatment he was discharged, and while he had undoubtedly been mentally ill six years ago, he had then made "a complete recovery," John Mahoney, chief executive of the Northern Birmingham Mental Health Trust, said yesterday. He added that 50 per cent of people with mental illness recover completely and remain symptom-free.

Mr Fulford told the court: "It appears from the records that effectively there was no follow-up at all" - a view rejected by the trust.

In 1992 and 1993, Morgan was conditionally discharged after attacking women in the street, but the psychiatric services had no further contact with him until September 1994 when he visited his GP, complaining of difficulty obtaining benefits.

Mr Mahoney said the GP referred him to a community psychiatric nurse who arranged for a consultant psychiatrist to examine him after he spoke of aggressive thoughts towards women. It was judged, however, that he was not mentally ill, a view that Mr Mahoney said had been upheld by psychiatrists at Ashworth special hospital - where Morgan has spent the last nine months - and backed by the judge.

"Numerous psychiatrists who have seen him before and after these attacks could find no evidence of mental illness or a recurrence of his earlier symptoms. We can only stand by our original conclusion that there were no grounds to treat David Morgan, compulsorily or not, and that he is not suffering from mental illness," Mr Mahoney said. While the trust extended its sincere sympathy to Morgan's victims, he said "the mental health services cannot be held accountable".

Having aggressive thoughts and attitudes did not necessarily mean individuals were mentally ill, Mr Mahoney said. Morgan had not been suffering from delusions, anxieties, phobia, hearing voices, or displaying other signs of mental illness.