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SSRI Stories Summary: In 1999, Stephen Jacobs’ GP prescribes him citalopram for Irritable Bowel Syndrome and complaints of back pain. SJ has left his job to become full time carer for wife who has various diagnoses and is on psych meds. He takes the citalopram erraticly and over time becomes mentally ill and suicidal. Feb 18, 2011, the couple have numerous problems and SJ is feeling suicidal. GP renews the citalopram prescription. Two days later, SJ drowns his wife and takes an overdose of her Stelazine (a neuropleptic). SJ is found guilty of manslaughter, not murder, by reason of diminished responsibility. The mental illness, not the citalopram, is blamed. The medication is not mentioned in news articles. The independent review notes the prescriptions but does not consider their possible role in events.
17:48 23 May 2012
A MENTALLY ill man who pushed his wife to her death into a lake at a Suffolk beauty spot told police he did it because she was “following him round like a sheep” a court has heard.
The body of 60-year-old Ruth Jacobs, who could not swim, was found floating facedown in shallow water at Needham Lake by anglers at around 8am on February 20 last year, Ipswich Crown Court heard.
Her husband Stephen Jacobs, 60, of Spinner Close, Ipswich had denied murder but admitted manslaughter by reason of diminished responsibility.
Judge John Devaux made Jacobs the subject of a hospital order under the Mental Health Act after hearing he had been suffering from a serious depressive illness at the time of the killing.
Judge Devaux said although a witness claimed weeks before Mrs Jacobs’ death she had heard Jacobs say that if he was going to kill his wife he would drown her, he did not consider the comment was evidence of pre-planning or premeditation. He added that if it was made it was made light-heartedly.
Michael Crimp, prosecuting told the court Jacobs and his wife had lived together in Ipswich for 24 years and had been married for 16 years.
The couple had no children together but Mrs Jacobs had two grown up children from a previous marriage.
Mr Crimp said friends descrbied them as “a happy couple who loved each other”.
Mrs Jacobs suffered from arthritis which affected her mobility and she was unable to work. Her husband was her full time carer and had given up his employment to look after her, said Mr Crimp.
In the weeks leading up to Mrs Jacobs’ death friends noticed Jacobs had lost weight and that he appeared depressed.
A post mortem examination on Mrs Jacobs found she had drowned but there were no marks on her body to suggest someone had attempted to get her in the water by force.
Jacobs was arrested at Wissett Lake near Halesworth at 3.45pm the same day as Mrs Jacob’s body was found after the police were called by a member of the public who was worried he was going to throw himself into the lake.
He told police: “We drove to Needham Market to the lake and she kept following me. She always followed me like a sheep so I pushed her in.”
John Black QC for Jacobs said his client had been diagnosed as suffering from a serious depressive illness at the time of the killing and had been receiving treatment since his arrest.
He said Jacobs was now recovering from his mental illness and did not represent a risk to members of the public.
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An independent investigation into the death of B, a mental ill-health related homicide
Carried out on behalf of NHS England by ANNE RICHARDSON CONSULTING LTD EXPERIENCE, KNOWLEDGE AND EXPERTISE IN MANAGING RISK
NHS Midlands and East
9 September 2014
2.6. BACKGROUND TO THE CASE A (aged 59 at the time of the incident) had only been known to mental health services at the Trust for three weeks before the tragic incident which resulted in the death of B at his hand on 20 February 2011.
On that day, A appears to have pushed his wife, and she drowned in Needham Lake in Suffolk. The verdict of the Court was that A was guilty of manslaughter with diminished responsibility (by virtue of mental illness, severe psychotic depression)…
Whilst the early days of their relationship appear to have been described in positive terms (and A’s family confirms that they were very attached to each other) it seems that there were a number of difficulties later on. Immediately prior to the incident, in the early part of January, members of the family received a number of telephone calls from A which led them to think he was worried and unhappy and they had a sense that his health and wellbeing were deteriorating.
Members of his family, and A himself, were able to tell the investigation team about the couple’s 22 years together. In particular, they related a significant level of abusive, controlling and bullying behaviour by B towards A. Not only was her health poor (with asthma, diabetes, arthritis, migraines, panic attacks and fainting fits) she seemed highly anxious. For example, she was not content for A to leave her alone, even in a different aisle in the local supermarket. On these occasions, she occasionally had what were described as “temper tantrums” and `fits.’ Once or twice she removed her clothes in public and/or threatened suicide. A described how he would occasionally have to remove a knife from her hand as she stood shaking in the kitchen. Occasionally, the police and/or ambulances were called.
In summary, it appeared that B was psychologically dependent on her husband and they were rarely apart. This is an impression that is reinforced in primary care notes as well as notes made by social care staff and staff of the Trust over approximately the same period (1992-2005). The information provided by members of A’s family, coupled with accounts in the care records, and
information from A’s GP also suggest that he had been depressed for some time before the tragic incident which occurred on 20 February 2011. The GP had, for example, prescribed an antidepressant although the notes apparently suggest that he only took this intermittently…
The investigation team has checked and verified this information, and it has been used to supplement the more detailed chronology of events which appears in Section 2.6 below.
2.7 Incident Chronology
|1999||A is diagnosed with Irritable Bowel Syndrome and complains of back pain. Notes record frequent visits to his GP. He was prescribed Citalopram 20mg (an anti-depressant) but notes suggest that he took it only erratically.|
|16/02/2011||A telephoned the crisis team to say he had felt low, but now was feeling better. Staff nurse X suggested he contact his GP which he agreed to do.
|See comment 2.8.3:
…there was no substantial evidence to suggest that staff in the crisis team responded inappropriately when A telephoned them on the 16 February just over two weeks after his S136 assessment. Although, it is likely (with the benefit of hindsight) that A’s telephone call on this day, just a short time before the tragic incident which resulted in the death of B, was, in fact, a signal that all was not well, it would have been routine practice to refer back to the GP without sound evidence of the need to respond any other way.
|18/02/2011||Worried for his safety and disturbed by his frail appearance, members of A’s family took him (after calling the crisis team and following their advice) to see his GP. A told the GP (in his daughter-in-law’s presence) that he wanted to kill himself. The GP made an urgent referral to the crisis team describing how A’s symptoms had deteriorated in the past 2-3 weeks, including anxiety about his bowels, and thoughts of suicide. He prescribed Citalopram. The family went home again. Members of A’s family then left the couple alone for an hour, but continuing to feel concern for A’s welfare, they returned to find B hitting him following an altercation…||See comments 2.8.3 (above), 2.8.4 and 2.8.5 (below)
2.8.4: The crisis team made a judgement on 16 Feb 2011 when A called; that referral back to the GP was the most appropriate course of action.
2.8.5: As it seems that there was insufficient evidence available at the time to warrant use of the Mental Health Act there was no alternative but to let him go home.
See comments 2.8.6 and 2.8..7
|20/02/2011||…When two representatives from the crisis team visited as agreed, A wasn’t there. His son telephoned the team again to check whether, despite this, they would still provide support, which they reassured him that they would. However, when a representative from the crisis team went back for a second time, the police were already there, the house was cordoned off, and it was clear that there had been an incident. It appeared that A and B had gone for a very early drive to the lakes (it was still dark), something they periodically did, and A had allegedly pushed B into the water. He had then taken an overdose of her Stelazine. By 21:30 that evening, A was picked up by the police and taken to Ipswich Hospital. At interview he was still hazy about the events of that day although he was aware that he had had thoughts of suicide.||This was thorough and effective practice|
|21/02/2011||Having been contacted by the police, the consultant psychiatrist located A on the short stay acute admissions ward where he was receiving treatment for the effects of his overdose. The consultant and the `modern matron’ completed a clinical assessment, judging A to be suffering from a profound level of depression with psychotic symptoms. He was subsequently detained under Section 2 of the Mental Health Act.||This was thorough and effective practice|
|28/02/2011||A’s symptoms worsened initially, but by May of 2011 he was improving. His plea of manslaughter on the grounds of diminished responsibility (severe psychotic depression) was accepted.|