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27 September 2013
Image caption The murder of a woman confronted by her husband with evidence of an affair from a private investigator was “not preventable”, a report has found.
The retired GP was jailed for at least 16 years in December 2010 for murder.
An NHS investigation said while areas of his care could have been improved the murder had been “unpredictable”.
The Hertfordshire Partnership University NHS Foundation Trust (HPFT) said there were “important lessons” to learn.
Jumaily, then 59, was referred urgently by a GP to the Community Mental Health Team in the HPFT on 15 December 2009.
Jumaily, who was identified in the report as Mr X, said he had suffered from “intermittent depression” but it had recently worsened due to his marriage breakdown.
He was assessed by a psychiatric nurse, a social worker and consultant psychiatrist in the days leading up to the attack on 23 December.
At his trial, the court heard Jumaily had employed private detectives to follow his wife and fit a tracker device to her car.
They also photographed her with a man.
When she came to the former marital home in Field Lane, Letchworth, to discuss splitting their property, Jumaily confronted her with the evidence and, during an argument, stabbed her 20 times with a kitchen knife.
An NHS independent investigation team heard Jumaily had a “complex history”.
Born and brought up in Baghdad, he said his father and two brothers were killed by the Saddam Hussein regime, and his mother had a history of depression.
He also had mental health problems that led to him leaving his job as a doctor.
Having reviewed GP records provided, investigators thought Jumaily might have benefited from earlier referral to secondary mental health care services in 2001-2002.
They also said it was “unfortunate” he had not received as full an assessment as he would have done at any other time of the year.
It concluded the murder was “not predictable or preventable” by health services.
An HPFT spokesperson said it had made “a number of changes” since 2009.
“We are reviewing the report in detail to see if there is more we can do to continue to ensure our services meet the needs of those who use them,” a statement read.
“There are important lessons we can learn.”
[But they missed the most important lesson of all – i.e. that SSRIs can cause violence – Ed (see below)]
To view complete report click here
An independent investigation into the care and treatment of a mental health service user (Mr. X) in Hertfordshire
Mr. X was a 59 year old man who had been referred urgently by a Locum General Practitioner (GP) to the Community Mental Health Team (CMHT) in Hertfordshire Partnership NHS Foundation Trust on 15th December 2009, nine days before he murdered his estranged wife, Y, at their home.
The referral from the GP to the CMHT stated that Mr. X suffered from intermittent depression but that this had worsened in the previous six weeks due to the breakdown of his marriage and splitting up with his wife.
Mr. X was seen and assessed by a Community Psychiatric Nurse (CPN) and a Social Worker (SW) on 17th December 2009 and by a Consultant Psychiatrist on 22nd December 2009.
The following day, on 23rd December 2009, Mr. X was visited at home by his estranged wife, Y, and their step-daughter. Mr. X confronted his wife with evidence he had gained from a private investigator that she was having an affair and an argument ensued. Mr. X stabbed his wife repeatedly with a kitchen knife. She later died from her injuries.
Mr. X was arrested and after assessment by a Forensic Consultant Psychiatrist he was transferred to a medium secure unit on Section 48/491 of the Mental Health Act.
It has been difficult for the independent investigation team to gain a full picture of the service users’ mental health history as the private psychiatrist who saw Mr. X on an ongoing basis in 2001 and 2002 did not wish to talk to the independent investigation team and was not able to supply copies of the clinical records pertaining to these consultations as they have since been destroyed. Additionally the GP who treated Mr. X between 2001 and 2009 also did not wish to take part in the independent investigation and was therefore not interviewed as part of the process. He did supply copies of Mr. X’s GP notes but unfortunately, these did not provide full information. Copies of correspondence between the private psychiatrist and Mr. X’s GP in 2001 and 2002 suggested that Mr. X left his job as a doctor at that time due to mental ill health. The independent investigation team attempted to obtain copies of occupational health records from that time in an attempt to gain a better understanding of Mr. X’s long term mental health history but unfortunately these were unavailable.
22 December 2009
Mr. X was assessed by the Consultant Psychiatrist from the Letchworth CMHT who noted the following:
Mr. X stated he had returned from a trip to Iraq to find out his wife was leaving him. He believed she was having an affair with the neighbour and was devastated by her departure. He became extremely distressed and developed a recurrence of severe depressive symptoms such as profound low mood, anxiety, agitation, tearfulness, disturbed sleep, reduced appetite and weight loss. He felt worthless and would ruminate about why his wife left him. He usually did not drink alcohol but in recent weeks had been drinking around three glasses of wine per day and his caffeine intake had increased greatly to around six or seven double espressos per day.
He had been married for just under 20 years and felt that the relationship was solid for most of it. They experienced problems about a year ago when she left him temporarily for another man. They reunited and went for marriage counselling and he worked hard on their relationship. He felt particularly embarrassed by the fact that she was having an affair.
He was started on Citalopram 20 mgs daily for four weeks and has been on 40 mg daily for the last 2 of those four weeks.
He grew up in Iraq and did most of his medical degree there but moved to Manchester for the final year of his degree. After completing his Membership of the Royal College of Physicians (MRCP), he worked as a physician for several years before moving in to the substance misuse field. He was medically retired in 2000 because of depression.
Letter Consultant Psychiatrist, Letchworth Mental Health Team, to GP, 23/12/2009
He did not receive any formal treatment for depression until the late 1990s when he was treated in primary care with Amitriptyline. He could not recall what dose of Amitriptyline he was taking and was unsure whether it really helped.
He presented as thin, tense and agitated and was tearful throughout most of the interview but calmed somewhat as the interview progressed. He described clear depressive symptoms but did not have any psychotic symptoms.
He said he felt worthless and alluded to having contemplated suicide but declined to go into detail about any suicide plans. He was looking forward to seeing his adult daughters on Christmas day. He was keen to engage with the staff and willing to accept help.
Mr. X described considerable trauma in his young adult life when several members of his family were assassinated which left him vulnerable to experiencing depressive episodes for much of his adulthood. He had to retire from working as a substance abuse doctor in 2000 because of depression.
For most of the last few years he stated he was reasonably well mentally. His depressive symptoms recurred markedly after his wife left him approximately six weeks ago. So far treatment with Citalopram had not helped but he had only been on it for four weeks. He experienced considerable adversity in recent months with two cancers and his wife leaving him. He contemplated suicide but resisted these thoughts so far mainly out of concern for his daughters.
His care plan following the assessment was as follows:
1. Allocated to a CPN for Care Coordination and support 2. Increase Citalopram to 60 mgs once a day and complete a six week trial of Citalopram before contemplating a switch of antidepressant. 3. Because of agitation start Diazepam 5 mg twice a day. 4. The Consultant Psychiatrist discussed with him a referral to the Crisis Assessment and Treatment Team (CATT) team but Mr. X was not keen on that option and had agreed to see the CMHT regularly instead. 5. Review with Consultant Psychiatrist in his clinic in a week’s time 6. Telephone numbers for the Trust helpline given to Mr. X and explanation that he could contact them or their duty worker if necessary explained to him.
23rd December 2009 Mr. X was visited at home by his estranged wife and their daughter. Mr. X apparently confronted his wife with evidence he had gained from a private investigator that she was having an affair and an argument ensued. Mr. X stabbed his wife repeatedly with a kitchen knife. She later died from her injuries.