Care of psychiatric patients who are a danger to others — (Leigh Day & Co)

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SSRI Stories summary:  Man, angry at neighbours and reporting violent thoughts, comes to NHS mental health services when he attacks the neighbours’ property with a machete.  He is put in hospital in January, 2003.  There he is calm and cooperative, and he claims not to be depressed.  Nevertheless, the only treatment he receives is escitalopram.  He complains of feeling “light-headed, ‘like I’ve had a few drinks’ “, but this is dismissed as not a potential side-effect of the meds.  In March, 2003, he simply leaves the hospital.  He is still taking the escitalopram;  continuing it was part of his discharge plan.   There is no follow-up, and probably there was no repeat prescription.  If this were true, he would not have taken the meds past his initial prescription, the length of which is not disclosed in the Inquiry report.  The report describes his behaviour in early 2004 as follows: “He had become increasingly irritated and disturbed by building works SB was carrying out”.  He then planned to kill his neighbour Simon Breed, and did so, lying in wait and stabbing him when he returned home from work.   It is possible that this severe irritability and potential psychosis was a withdrawal effect, but there is not enough information available to know.

Leigh Day & Co

9 August 2005

The Government is considering a draft mental health bill which, among many other elements, will give psychiatric services the right to treat some patients with mental health problems compulsorily.

The Government is considering a draft mental health bill which, among many other elements, will give psychiatric services the right to treat some patients with mental health problems compulsorily. The existing mental health laws are over 20 years old and were drawn up when most patients received their treatment as in-patients in hospital, rather than in the community, as they do now.

The bill will allow compulsory treatment of patients in the community and will focus on those patients who yo-yo between relapse and readmission because they fail to take their medication. These extended powers will be limited so that only patients assessed in hospital can be forcibly treated in the community.

The bill means that patients with dangerous and severe personality disorders will also be able to be treated and patients who are at risk of harming themselves or others will be able to be treated compulsorily.

Patients will also be better protected by a new independent mental health tribunal and by being able to choose their own representative or advocate.

The draft bill has proved incredibly controversial and has united organisations dealing with mental health who were hoping for increased rights for patients rather than more compulsion. They also fear that the legislation will increase the public’s fear of those with mental health problems.

Michael Howlett, Director of The Zito Trust commented: ‘’The Government has made it clear that mental health legislation has nothing to do with the provision of services.  The purpose of legislation is to describe and define when and how people may be given treatment against their will, and then to build in safeguards such as the new tribunal system and statutory advocacy.

“For years people with severe and enduring personality disorders have been denied treatment from the NHS and this Bill will radically alter their experience.  Much of the criticism of the Bill has been based on a misunderstanding of what the legislation is for.  We expect a new Mental Health Act to respond to the complex demands of a completely different approach to the treatment of mentally illness and disorder in a range of settings, principally the community.”

Marjorie Wallace, Chief Executive of the mental health charity SANE said:  “SANE believes that many of the 40 homicides a year committed by people in contact with mental health services, if not predictable, could have been prevented had the patients been properly treated and cared for and not allowed to discharge themselves, abscond or simply leave psychiatric wards, with little effort being made to follow them up or give adequate information to families, police or those entrusted with their care.

“There seems to be a worrying increase in the numbers of patients who are allowed to disappear in the community while they are extremely disturbed, who then commit suicide and occasionally attack others. These cases further shatter the public’s confidence in the care in the community policy and increase the stigma for the majority of people with mental illness who are never violent.”

Leigh Day has been involved with a number of cases where psychiatric patients have received inadequate treatment and have then harmed or killed someone else and/or themselves:

Theophillous (Phillip) Theophilou

On the 15th April 2004, Phillip Theophilou, a dangerous psychiatric patient who was under the care of Barnet, Enfield and Haringey Mental Health NHS Trust,  stabbed his next door neighbour, Simon Breed, to death on his doorstep.

Mrs Breed helped her husband after the attack and was with him when he was rushed to hospital. Simon Breed later died of his stab wounds.

Philip Theophilou pleaded guilty to manslaughter on the grounds of diminished responsibility and is awaiting sentencing in Broadmoor.

The year before, Philip had smashed the windows of the Breed’s family car and van, and all of their downstairs windows, with a meat cleaver. Mr Theophilou was arrested and then put in the care of the local mental health services. During his initial medical assessment he told an independent psychiatrist that he wanted to kill children in the street and that he would have killed the neighbours if they had been around. He was held in a secure unit.

Over time he was thought to be less of a threat and when he finally escaped from the unit, he was discharged without any formal review of his mental state or a proper plan for his follow up in the community.

A report by an independent doctor raised significant concerns about the clinical and administrative management of Theophilou’s care. Despite being a high risk patient and stating his intention to kill others including specifically his neighbours, he was discharged before any effective community follow up could be devised. No contact was made with the police or his neighbours, the Breed family, despite his homicidal ideas towards them. Community follow-up in the period before the killing could probably have identified that Phillip’s condition was deteriorating and could have prevented the death of Simon Breed.

The Legal Case

We are advising Mrs Breed generally in respect of the various enquiries being conducted and concerning a compensation claim for the death of her husband and for the psychological injury she suffered as a result of witnessing the immediate aftermath of her husband’s murder. She has not yet returned to work as a teacher.

The claim will be against Barnet, Enfield and Haringey Mental Health NHS Trust.

The law

Previous legal cases have shown that a ‘duty of care’ exists between a medical practitioner and a third party to any treatment if a close relationship, legally speaking, exists between them and that it is ‘reasonably foreseeable’ that the third party could be harmed as a result of the medical practitioner’s negligence.

Phillip Theophilou was Simon Breed’s next-door neighbour. Philip had already attacked their property, and had said that he would have killed them too if they had been there.

Mrs Breed and her children are being represented by Sally Moore, head of the Personal Injury Department at Leigh Day.

For more information about these cases or if you have been affected by a similar case and need legal advice please call 020 7650 1200 or email us at


To view complete original report click here

An independent  investigation into the  care and treatment of PT

A report for  NHS London January 2010

  1. Introduction

1.1 On 15 April 2004 PT killed SB.  He had become increasingly irritated and disturbed by building works SB was carrying out.  (SB’s family and PT’s family were next door neighbours.)  Having planned to kill him for several weeks, he took a kitchen knife and waited for SB to return from a regular evening engagement.  On hearing SB’s van returning, PT immediately approached him and without warning stabbed him several times in the chest.  SB managed to stagger to his front door and alert his wife to what had happened, but despite being immediately taken to hospital by ambulance, he died of his injuries soon afterwards.

1.2  PT had received psychiatric care and treatment from Barnet Enfield and Haringey Mental Health NHS Trust (the trust) in 2003. Guidelines issued by the Department of Health in circular HSG (94)27, The Discharge  of Mentally Disordered People and their Continuing Care in the Community and the updated paragraphs 33-36 issued in June 2005, require an independent inquiry (now referred to as an investigation) to be undertaken when a person in contact with mental health services commits a homicide.

(Page 6) Key events

1.11 SB was born on 23 August 1952. He lived with his wife DB and his two sons SS1 and SS2. PT lived next door to SB’s family. His mother and father spent some months every year in Crete where they had a house. The family is Greek Cypriot. PT has two brothers.

1.12 On 14 January 2003 PT was arrested for damaging some of SB’s property: using a meat cleaver he broke downstairs windows in the house and some car windows.  He was bailed to return to the Hornsey police station on 16 January 2003. He did not answer his bail and was arrested at his home that day. He was taken to the police station and charged. Before being charged he was assessed under the MHA and arrangements were made to transfer him to St Ann’s Hospital.

1.13 PT received inpatient psychiatric treatment in Haringey Ward at St Ann’s Hospital. Haringey ward is a Psychiatric Intensive Care Unit (PICU). He was admitted to the ward on 17 January 2003. He absconded on 14 March 2003 and returned to his parents’ home. The last time he was seen by any mental health professional was on 24 March 2003 when he attended a meeting on Haringey ward.

(Page 29)  4.30 PT was seen and described as calm and co-operative. He said he was not depressed since being in hospital but could not see an alternative to being locked up forever ‘which he knows is unrealistic’. He did not think he would be good at psychotherapy as he was poor at expressing himself.  He was accepting medication but complained of a decreased appetite.

4.31 The only plan recorded was to continue the ‘citalopram’ (really escitalopram) 10mg per day.

(Page 80) 7.35 He complained of occasionally feeling light-headed, ‘like I’ve had a few drinks’, but this was not thought to be a side effect of his medication which was escitalopram 10mg per day.

7.42 The ‘out of hours response’ was: ‘Emergency Reception Centre St Ann’s Hospital’.   The risk assessment form completed by DR2 on 17 January 2003 was added to by PSY1 on 24 March 2003 as follows:

  1. PT was diagnosed as suffering from ‘depression with psychotic features’.
  2. Factors decreasing risk were said to be ‘taking medication’ and ‘regular OPA’ (outpatient appointments).