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SSRI Stories summary: An unfortunate man, Garry Taylor, gets into trouble with the law at a young age and ends up treated with neuroleptic medications. He resists this treatment, so his mother covertly administers the medication. He does not do well on it and suffers serious withdrawal effects when he stops. As usual, this is treated as “relapse”. At the end of Nov, 2003, Gary and his mother attend an appointment, and he leaves, but is prescribed 75 mg of Effexor (venlafaxine) in absentia. His mother is slipping the medication in his food and drink, but she is not able to give it steadily over the Christmas period 2003. When she starts to administer it daily in the new year, 2004, he reacts badly and stabs a friend to death on Jan 17. Mental illness is blamed, not the medication (let alone the circumstances of ingesting it), and the meds are not mentioned in the news.
Last Updated: Tuesday, 27 September 2005, 16:38 GMT 17:38 UK
A man is to be detained indefinitely after admitting hacking a father-of-two to death with an axe on Wearside.
Colin Johnson, 40, was virtually decapitated in the attack at his home in Pickering Road, Pennywell, Sunderland, on 17 January last year.
Garry Taylor, 39, of the Royalty in Sunderland, admitted manslaughter due to diminished responsibility.
Newcastle Crown Court heard how Taylor was motivated by jealousy, brought on by a psychotic illness.
Mr Johnson was alone at home when Taylor let himself in and attacked him, the court heard.
His body was found on the living room floor by his fiancee, Shirley Cooper. He died of multiple injuries.
Colin Johnson was axed to death in his Sunderland home.
Taylor was arrested a fortnight after the attack after forensic samples taken from the axe linked him to the scene.
Det Insp Tim Walker, of Northumbria Police, said: “This was a particularly brutal and vicious attack on a well-loved member of the community.
“We’re now satisfied a very violent individual has been taken off the streets for a substantial period of time. Hopefully Colin’s family and fiancee can now begin rebuilding their lives.”
A statement released by Mr Johnson’s family said: “Colin will always be remembered as a man who never upset anyone.
“He had a family and a fiancee who adored him and the whole community has been left shocked by his killing.
“If he was killed through jealousy, Taylor must have been jealous of the fact Colin had a family and fiancee who adored him. Taylor knew he would never have that.”
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REPORT TO THE NORTH EAST STRATEGIC HEALTH AUTHORITY OF THE INDEPENDENT INQUIRY INTO THE HEALTH CARE AND TREATMENT OF GARRY TAYLOR
(Page 7) On 17 January 2004 Garry Taylor went to Colin Johnson’s home in Sunderland and attacked him with an axe. Colin Johnson died as a result of the attack. Colin Johnson was a 40 year old local man who had lived in the Sunderland area for his entire life; he was well known and liked in the area. He left two daughters and a fiancée with whom he had had a long-term relationship. Garry Taylor had known Colin Johnson since school days. There is no evidence to suggest that there had been any violence or untoward incidents between the two prior to the attack that killed Colin Johnson. After his death some evidence emerged that Colin Johnson had become a little tired of Garry Taylor visiting him at his home. There was no obvious motive for the attack but, in the light of what was to emerge, it seems highly likely that Garry Taylor had become suspicious that his girlfriend was having an affair with Colin Johnson. Such a suspicion was wholly unfounded; there is no suggestion that there was any such relationship between the deceased and Garry Taylor’s girlfriend.
(Page 11) EARLY HISTORY
Garry Taylor was born on 12 July 1965 and was therefore 38 years of age at the time of the killing of Colin Johnson, on 17 January 2004. Prior to 1993 he had no involvement with any psychiatric services and, so far as can be judged from the material before the inquiry panel, there was nothing that had occurred in his life that is of particular significance in relation to later events. Garry Taylor was the youngest of four children and seems to have had a relatively trouble free childhood. The family lived in the Millfield area of Sunderland and Garry attended a local school, leaving after achieving five “O” levels. He gained employment on leaving school and, as his last employment, worked for a computer firm until 1989.
(Page 12) EARLY PSYCHIATRIC CONTACT
In January 1993 Garry Taylor was referred, at the behest of his mother, to the Community Addiction Team. The outcome of this is unclear, but by 4 June 1993 he was noted in his general practitioner (GP) records to be possibly depressed and paranoid, aggressive, moody, suicidal and possibly schizophrenic. He was prescribed chlorpromazine, an anti-psychotic drug. By 14 June 1993 he had assaulted both of his parents, fracturing his mother’s arm and knocking his father unconscious. As a result, he was the subject of an emergency outpatient referral by his GP (GP1) to Cherry Knowle Hospital. He was admitted on 23 June when his history was said to be of his life falling apart over the last few months, losing his job, his girlfriend leaving him and his house being re-possessed. He had been abusing drugs (ecstasy, amphetamine and cannabis). Garry Taylor himself was of the view that his problems related to depression and a bad temper.
His brother (Brother 1) was of the opinion that the problems were extreme rage and paranoia. Garry Taylor said that he wanted to kill his brother-in-law for breaking up the relationship with his girlfriend and he believed that people were talking about him in sign language. He was discharged from Cherry Knowle on 29 June, on chlorpromazine. In a letter of 27 July to GP1 he was described as having had an 18 month history of alteration of mood, which had become much worse in the last three months. The diagnosis was of a paranoid psychotic illness, which was possibly secondary to abuse of ecstasy and amphetamine. It was also possibly secondary to a depressive illness with features of morbid jealousy. He was reported to have settled well on the ward and he was encouraged to continue on the medication, to avoid illicit drugs, to be reviewed in a couple of weeks and, if improving, for the medication to be reduced.
(Page 57) DRUG TREATMENT
The mainstay of Garry Taylor’s drug treatment from October 2002 onwards was the oral atypical anti-psychotic, olanzapine. For a brief period of time this was unsuccessfully changed to an alternative anti-psychotic quetiapine and on two separate occasions he received periods of treatment with the anti-depressant, venlafaxine. There was no attempt to conduct routine monitoring of side effects, weight, blood pressure or blood tests in relation to the use of these drugs. Little consideration was given as to whether physical symptoms (headaches and chest pain) were possible side effects from the medication. When it was known that the patient had problems with compliance venlafaxine should not have been used as a first line anti-depressant, given its propensity to cause a withdrawal syndrome…
From March 2003 onwards anti-psychotic medication was covertly administered to Garry Taylor by his mother. Whilst on a few occasions the care team may have advised against this practice, the underlying pattern was one of collusion by Consultant 4 and the AOT with Mrs Taylor in this covert administration. The panel were concerned on a number of points in relation to this practice; technically it may have amounted to an assault on Garry Taylor and should have led to the MAPPVA policy being invoked (the covert use of medication is given as a specific example in the Sunderland MAPPVA policy). He was denied the safeguards usually afforded by the MHA, it was dangerous given there was little or no control over the dose and it gave him a false impression of his ability to manage without medication.
On 28 November that arranged outpatient appointment took place with Garry Taylor, Mrs Taylor, Brother 1, AOT1 and AOT2 in attendance. Garry Taylor was not happy at being there and left after only five minutes. Mrs Taylor was upset, tearful and worried about his well-being. She reported to Consultant 4 that “she got olanzapine into him usually”. AOT1 reported that she was seeing him monthly but that he was not happy about it. Brother 1 reported that he was “doing OK”. At the end of the appointment Consultant 4 prescribed venlafaxine 75mg daily and Mrs Taylor was asked to monitor his sleep. A further outpatient appointment was arranged for 23 December.
On 16 December AOT1 rang Garry Taylor who refused to see her and informed her that he would not see Consultant 4 either. A message to this effect was left by AOT1 for Consultant 4. On 23 December Garry Taylor duly failed to keep the outpatient appointment.
AOT2 noted that Consultant 4 had explained that he had spoken to Mrs Taylor the previous day who stated that Garry Taylor was better on venlafaxine and olanzapine but that he did not get his medication each day. He was refusing to see the members of the AOT, a fact of which Consultant 4 was aware.
On 24 December Mrs Taylor rang AOT1 saying that Garry Taylor needed medication over the Christmas period and asking that someone contact her. There was an exchange of telephone calls but the medication was not picked up and was left with the CRT for over the Christmas period.
On 30 December AOT1 noted that there had been no contact with the CRT over the Christmas period and left a message for Mrs Taylor to contact her.
On 31 December, after a series of telephone calls, AOT1 met Mrs Taylor at the Sunderland Royal Hospital and gave her Garry Taylor’s medication.
Mrs Taylor was upset and “weepy” and said that he was “OK”, “but she was worried that it was the quiet before the storm.”
On 13 January 2004 Mrs Taylor attempted to contact AOT1, eventually leaving a message for her on 14 January that she would like Garry Taylor’s medication in syrup form as he was getting suspicious.
On 17 January Garry Taylor killed Colin Johnson.
(Page 54) THE ADMISSION SEPTEMBER – OCTOBER 2002
On admission Garry Taylor was noted to have stopped his oral anti-psychotic medication four months earlier. The patient and his family described delusions of reference including systematised paranoid delusions and abnormal mood. The patient denied regular use of illicit drugs. SHO1 came to a differential diagnosis of drug induced psychosis or bipolar disorder. During the early part of this admission Garry Taylor was treated with oral anti-psychotic drugs and was identified as potentially dangerous. In a little under two weeks, on two different wards, despite anxieties from Mrs Taylor and CPN1, a decision had been made to begin a programme of leave leading towards discharge.
The whole admission lasted approximately three weeks. It is of note that during this brief admission all three significant professionals involved in his care (consultant psychiatrist, CPN and social worker) were changed. The diagnosis at the time of his discharge was one of ‘paranoid psychosis ? drug induced or delusional disorder’.
There was partial documentation of his history of violence and psychotic symptoms when unwell and a minimalist risk assessment contained in the discharge summary sent to the GP. The three main components of his treatment plan were; outpatient appointments with SHO1, monthly AOT appointments and oral anti-psychotic drugs.
The risk assessment of violence was ‘low on treatment significant if stops Rx’. A difficult case of this nature and a case where the family had recently requested a change of consultant should not have been allocated to outpatient follow up with an inexperienced SHO following the discharge from hospital in October 2002. The admission in September/October of 2002 should have been seen as an opportunity to re-instate treatment with depot anti-psychotic medication and no consideration appears to have been given to the use of a new atypical depot injection that became available at around that time. At the very least consideration should have been given to a longer period of detention with periods of extended leave. In short, the discharge from inpatient status was again premature
OCTOBER 2002 – MARCH 2003
By January 2003 there was evidence that all three components of the treatment plan had failed, in addition he was drinking heavily and had had a violent outburst. Despite this there was no re-evaluation of the care plan or updated risk assessment.
(Page 55) MARCH 2003 – FEBRUARY 2004
When interviewed by doctors during this period, Garry Taylor would say very little or respond with the phrase ‘no comment’ and he usually terminated interviews after only a few minutes. The consultants and forensic medical examiners who saw him seemed to place an over-reliance on the absence of florid psychotic symptoms at interview.
The presentation at interview seems to have been equated with there being no signs or symptoms of mental illness. An alternative hypothesis that this was abnormal behaviour and part of a paranoid illness does not seem to have been given due consideration. Independent accounts from the family or AOT members were seldom sought and even when such independent accounts were available, little attention appears to have been paid to them.