To view complete original report click here
SSRI Stories Summary – Deborah Hancock is a long-time “client” of NHS mental health services in Wales. In the past she was diagnosed with schizophrenia but more recently this was changed to personality disorder. There seems to have been a belief by the mental health services team that there is less that can be done to help people with personality disorders. When, on Oct 5, 2005, she stabs and kills a pensioner, an Inquiry is ordered. The resulting report is unusual in that it lists all the medications Deborah had been prescribed, but the narrative omits information about dosage, timing and start and stop dates. Thus it is impossible to figure out the potential role of these medications (Diazepam, Prozac, Clopixol Depot, Depixol Depot, Lofepramine, Prothiaden, Sertraline, Temazepam, and Trifluoperazine (Stelazine) in the tragedy. With this list, it would appear that the first place the review team might have looked for the problem was in medication management, but this was never addressed. A review of the glossary reveals a potential explanation, in that the review team appears unaware that most of the drugs that Ms Hancock was taking can induce psychosis. As usual, the press does not even mention medication, as if inherent mental illness is an equally plausible explanation.
9 May 2008
Deborah Hancock had been re-diagnosed as having a personality disorder before she attacked and killed pensioner Valerie Thomas. The 47-year-old had been treated in Cardiff in the 1990s for schizophrenia with anti-psychotic drugs and regular contact with health services.
It was during this time that she was diagnosed with a borderline personality disorder and it was decided that there was no mental health intervention which could be offered.
Despite repeated contact with health and social services in the period leading up to Mrs Thomas’ killing, few risk assessments on Hancock were carried out.
Instead, the main focus was on her housing problems.
Hancock stabbed Mrs Thomas, 75, on October 19, 2005, in the Cardiff city centre Poundstretcher store.
A shop video of events showed Hancock enter the store, remove a knife from a shelf and open the plastic covering with a lighter.
Hancock is then seen approaching a woman, apparently with the intention of stabbing her.
She disappears from shot but when she returns another woman – Mrs Thomas – is seen with a knife handle sticking out of her back.
A joint statement from Cardiff Council, Cardiff Local Health Board and Cardiff and Vale NHS Trust said: “Although the report makes it clear that the homicide could not have been predicted, we acknowledge that Deborah Hancock received services that were less than optimal.
“We are working together to ensure improvements are made .
“Since this incident, specific changes in assessments, care planning and communication have been made.”
To view complete original report click here
Report of a review in respect of Ms A and the Provision of Mental Health Services, following a Homicide committed in October 2005
Summary of the index offence
1.1. On 19 October 2005 at 12.20pm, in a shop in the City centre of Cardiff, a woman was stabbed and later died.
1.2. A shop video of events, supported by eyewitness accounts, shows Ms A going into the shop, getting a knife from a shelf display and removing it from its wrapping (using a cigarette lighter to burn away the plastic covering). The video gives the impression of Ms A going up to a woman intending to stab her, which she did not do. Ms A then goes out of camera shot, she comes back into shot, as does a third woman. The third woman is seen with a knife handle sticking out of her back. That woman had been stabbed and subsequently died.
1.3. Following these events, witnesses gave evidence to the effect that Ms A had acknowledged her responsibility for the homicide. Ms A was heard to have said, “I’ve just stabbed someone, call an ambulance”, “Call the police, they need to arrest me”, and later, addressing the arresting police officers, “I f*****g stabbed her, take me away”, “I did it. It was premeditated.” “I didn’t know her. I picked her out. She was the second one. I bottled it on the first one.
1.4. Later in the police station Ms A said in interview, “I completely deny stabbing her”. At Cardiff Crown Court on 27 October 2006 Ms A was found guilty of the offence of manslaughter on the grounds of diminished responsibility and was made subject to an order under the terms of sections 37 and 41 of the Mental Health Act 1983. She is currently receiving treatment at a Medium Secure Unit.
(Page 31) Engagement
2.20. Planned intervention with those suffering from mental health problems should be based upon a number of factors. The assessment of the risk they might pose to themselves or others is one of those factors. In the case Ms A the level of risk posed by her behaviours was assessed from time to time throughout the period of her contact with services and was taken into account in making decisions about the extent to which services might pursue engagement with her. However risk is not the only criterion upon which such decisions should be made. Among others might be the level of distress experienced by the patient/client, their family or others, the extent to which their standard of life might be improved through interventions, the alternative costs of attempting engagement and not pursuing it.
2.21. The review team accepts that a patient’s willingness to engage with services is important and that, short of a situation in which the law permits treatment without the consent of the patient, services cannot be imposed upon patients. Ms A led what has been described as a chaotic lifestyle, certainly her willingness or ability to maintain orderly, formal contact with services of any sort was variable.
2.22. However, the review team takes the view that people who are suffering from a mental health or social problem are often unable to engage with services in a formal, organised way as a result of their problems. That being so there is an obligation upon services to take responsibility for engagement with such people. We note that in the first period of Ms A’s contact in Cardiff both health and social services staff did just that, with more extensive home visiting and use of informal settings, such as a women’s group and the family centre. There was no planned outreach to Ms A in her second period in Cardiff.
2.23. While there is an eligibility dependant outreach service working out of the social care day service in Cardiff, there continues to be no outreach team either jointly or within the separate management lines of health and social care services in Cardiff for the homeless suffering from mental health problems. Had there been such, or an alternative way of trying to engage with the homeless and other groups who find it difficult to respond to more formal arrangement for provision of services. It might have offered additional opportunities to engage with Ms A on terms to which she may have been able to respond. However, aside from the question of whether or not an outreach team would provide one way to meet the needs of people such as Ms A the issue of engagement with such people is an issue the review team believes should be addressed as a matter of priority.
(Page 59) List of Drugs Prescribed for Ms A and their Use:
- Diazepam Anxiolytic (reducing anxiety)
- Prozac Anti-depressive
- Clopixol Depot Anti psychotic
- Depixol Depot Anti psychotic
- Lofepramine Anti depressive
- Prothiaden Anti depressive
- Sertraline Anti depressive
- Temazepam Hypnotic (‘sleeping tablet’)
- Trifluoperazine (Stelazine) Oral Anti psychotic
Page 60) Annex H – Glossary
Accident and Emergency (A&E) – A hospital department which provides emergency treatment and initial treatment for both injuries and illnesses.
Anti-psychotics – They are drugs which act on the brain used to treat psychotic symptoms. They are sometimes known as major tranquillisers as they may also sedate and calm the user. Sometimes called ‘neuroleptic’ drugs.
Depressive Illness – A generic term denoting a number of more specific illnesses characterised by exceptional sadness over a prolonged period, the length and depth of which are well beyond the limits of normality. This mood change is accompanied by other features such as loss of interest and pleasure, loss of energy, difficulty concentrating, worthlessness and guilt, weight loss and disruptive sleep patterns.
Drug Induced Psychosis – A psychosis developed as a result of injection of specific substances. These may be illegal drugs (e.g. heroin, cocaine, cannabis, LSD) or prescribed medications (e.g. steroids, anticonvulsants) or toxic substances (e.g. insecticides, fuel, paint). [Note that drug induced psychosis is also a not-uncommon side effect of neuroleptics (so-called anti-psychotics which do not, as claimed in the definition above, “treat psychotic symptoms”. They just suppress brain function. Drug induced psychosis can also be caused by antidepressants – Ed]
Psychosis (psychotic illness) – Severe mental derangement involving the whole personality. These are severe mental disorders characterised by psychotic symptoms e.g. delusions, hallucinations and disorganised thinking, [sentence truncated here – possibly a sign of disordered thinking?? SSRI Stories Ed]
(Page 63) These disorders, historically and in common parlance, have been referred to as ‘madness’. They are often divided into Functional Psychoses (mainly schizophrenia and manic depressive psychosis (or Bipolar affective disorder)) and Organic Psychoses (confusional states or delirium, dementias, drug induced psychosis).
Reactive Psychosis – A psychosis occurring as a result of an external stimulus arising in the patient’s environment. [This definition implies that there is some other kind of psychosis, probably inherent? – Ed]