Leading Article: 'Care' that made killers

ON 30 OCTOBER 1992, Katie Sullivan, an idealistic 23-year-old worker at a Mind hostel in Kingston, Surrey, was stabbed to death by a woman resident. The resident, Erhi Inweh, was a paranoid schizophrenic with a history of violence - a few months earlier, it had taken five police to restrain her in Hyde Park. The hostel, a halfway-house for former mental patients, did not accept violent people. So what was Inweh doing there? The answer was that hostel staff had been kept in ignorance of her violent background by psychiatric social workers who were concerned about 'stigmatising' Inweh and wished to protect her 'civil rights'.

The story behind Sullivan's death is alarmingly similar to that behind Jonathan Zito's death less than two months later. Zito, a young musician, was knifed to death on a London Tube platform by Christopher Clunis, also a paranoid schizophrenic. An inquiry that reported last week found that Clunis's illness went back to 1986. He had been involved in dozens of violent, or potentially violent, incidents, many of them with knives. He had been discharged prematurely from hospitals - or not put in secure units - usually because of a shortage of beds. Social workers were dilatory in paying visits to him, even after public complaints of violence. Doctors removed him from their lists, hospitals failed to follow up missed appointments. The police repeatedly failed to charge him for seriously violent offences. On countless occasions, the medical and social services failed to keep or transmit proper records.

It takes the inquiry team, headed by a QC, some 40,000 words to tell this story, without embroidery and with the minimum of comment. It reveals a level of incompetence that almost passes belief. It gives us a tour of a preposterous bureaucracy that would have boggled even Kafka's imagination. It shows that 'care in the community' is worse than a farce. At least 50 professional people were supposed, at various times, to 'care' for Clunis; only a few are singled out for praise by the inquiry team. When Clunis crossed their paths, many seemed anxious, like Elizabethan parish officials ministering the Poor Law, to pass the buck to somebody else. Lack of resources can excuse many failings. But the report shows something far worse: that many professional people are failing to give the public adequate protection as a matter of principle, that the culture of the social services almost inevitably leads to deaths such as those of Sullivan and Zito.

Take just one example from the Clunis report. Clunis attacked another resident with a knife at a resettlement unit for homeless men in May 1992. The manager said that the unit was not equipped to deal with the mentally ill and that, had he known of Clunis's violent history, he would not have accepted him. But, he told the inquiry, even if he had known, he would not have told another hostel for fear of jeopardising Clunis's future. Repeat edly, the inquiry team found that Clunis's violence was glossed over because 'carers' feared to 'label' him.

There should be no argument that the mentally ill have rights. It is wrong to jeopardise people's future employment or housing prospects by labelling them as violent because of isolated incidents caused by a condition that may prove temporary or sus ceptible to treatment. But Zito had a right not to be stabbed to death on a station platform. The mentally ill themselves have the right to be properly diagnosed and properly cared for. As the inquiry team puts it, the failure to describe his behaviour properly 'ultimately served Christopher Clunis very badly'.

Politicians may have legitimate differences over the extent to which the state is best equipped to provide education or medical services or transport or even economic growth. But looking after the mentally ill and protecting the public from violent attack must be part of the irreducible minimum of government obligation, no matter what the ruling philosophy. In the past, governments have acknowledged this by locking away the deranged in asylums, if they presented the slightest risk to themselves or others. Allowing the mentally ill to live normal lives in a normal environment, with the aid of drugs and the support of families and social workers, is a better approach. But not if it means a chronic shortage of specialist beds and services, not if it means entrusting care to social workers who lack both funds and expertise, not if it means putting notional 'rights' above public safety.