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SSRIStories Summary: A former soldier with a history of reacting badly to antidepressants, especially in withdrawal, is given a number of medications including unspecified antidepressants. He becomes paranoid, increasingly aggressive, anxious, and suicidal. In mid Feb, 2011 he gets another (additional?) antidepressant prescription. After this he experiences hallucinations and serious thought distortion. A week later he is psychotic and a GP “adjusts his medication”. He threatens to harm his wife and children. Eight days later he stabs his wife to death in front of the kids. Medication is not mentioned in the media coverage.
BBC News
19 September 2013
Mrs Walker’s family said they planned to take legal action
A mental health trust missed the opportunity to assess the risk posed by a man who stabbed his estranged wife to death, an investigation has concluded.
Former soldier Gary Walker attacked Natalie Walker, 34, at their former home in Broadstairs, Kent, in 2011.
She died of her injuries in hospital. Walker was later jailed for manslaughter.
James Thallon, medical director of NHS Kent and Medway, said he thought the killing could have been prevented.
“But I think the NHS is doing its job properly now in taking what steps it can to put its own house in order,” he said.
Walker stabbed his wife to death in front of their three-year-old daughter.
‘No mum’
He admitted manslaughter on grounds of diminished responsibility and was jailed indefinitely at Canterbury Crown Court.
He was told he would have to serve five years before being considered for parole.
The judge criticised Kent and Medway NHS and Social Care Partnership Trust for not admitting Walker, then aged 42.
She ordered an independent review, which has now been published.
Jackie Gardner, Mrs Walker’s mother, said: “My daughter’s missing. She’s never going to be in any of our holidays or photos.
“My grandson said to me the other day ‘it’s all right for you, Nan, you had your mum all your life. I had mine for a short time’.
“Those children have been let down. They’ve got no mum.”
‘Missed opportunity’
In February 2011, Walker went to A&E at the Queen Elizabeth The Queen Mother Hospital in Margate after cutting his wrists. He had sought help for psychotic symptoms in the past, believing he was being harassed by the Taliban.
A psychiatric nurse employed by the Kent and Medway NHS and Social Care Partnership Trust failed to carry out a full assessment, concluding that he was not a risk and telling him to go home and seek further help from the community mental health team.
The report concluded that the nurse’s actions constituted gross misconduct and they would have been dismissed if they had not subsequently left the trust.
Image caption The trust has apologised to Mrs Walker’s familyIt said a full psychiatric assessment should have taken place.
“This was a missed opportunity to fully assess the risk that he posed,” it said.
The report added that the violence could reasonably have been predicted, even if how far it would escalate could not.
Mrs Walker’s family has also been told that more could have been done when Walker sought help months before the killing.
Karen White, medical director of Kent and Medway NHS and Social Care Partnership Trust, said: “I have apologised for the two key missed opportunities to prevent this tragedy.
“And I have explained to them [the family] the actions that we’ve taken to strengthen the skills of our staff in risk assessment, to ensure that all our staff get clinical supervision on a regular basis to review their work.”
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An independent investigation into the care and treatment of Mr G, A report for NHS South of England — (Veritas)
May 2013
1. Introduction
1.1 Mr G (Gary Walker) stabbed his wife, Mrs P (Natalie Walker), in the family home on 5 March 2011. Their three children were at the address at the time. She died of her injuries in hospital a short while after the attack. She was 34 years old.
1.2 Mr G had been assessed by staff from Kent and Medway NHS and Social Care Partnership Trust (the trust) in the months before the incident. He had also consulted his GP.
1.3 On 21 November 2011 Mr G was found guilty of manslaughter. Mr G is in HMP Swaleside in Kent.
1.4 In her closing statement the judge criticised the trust‟s decision not to admit Mr G to hospital on 24 February 2011. The judge recommended that an inquiry be carried out to establish why Mr G had not been admitted.
1.5 The trust commissioned an internal investigation into Mr G‟s care and treatment in March 2011 that was completed in April 2011. Kent Police also carried out an individual management review in April 2011. In 2012 agencies in Kent decided not to conduct a domestic homicide review into Mrs P‟s death. Mrs P‟s family were told about this decision.
5.23 Mr G saw GP 1 in August 2006 about his anger. This coincided with an incident of domestic violence at home, when Mr G had thrown a plastic tub at Mrs P injuring her. GP 1 prescribed Mr G antidepressants and referred him to the CMHT for anger management. GP 1 referred him for anger management again in October 2006. Both of these referrals were rejected.
5.26 Mr G and Mrs P married in June 2007. Mr G and Mrs P had three children, all of whom were born before the marriage.
5.27 GP 1 referred Mr G again for counselling in September 2007. Mr G phoned the surgery in early November to decline any counselling. It was recorded in the surgery notes that this was “a pity as there are many underlying issues that need to be dealt with to help his anger”. When commenting on ourdraft report Mr G told us that he had been informed that if he wished to attend counselling he would need to stop drinking. He did not want to do this therefore cancelled the appointment.
5.28 Mr G was arrested for ABH following an unprovoked assault on a man on 12 November 2007. Mr G attended a counselling session at his GP surgery two days after this assault. He subsequently failed to attend another counselling session in February 2008.
5.30 On 24 October 2008, Mr G (Gary) seriously assaulted Mrs P (Natalie) at home.
5.32 At the time of the assault on 24 October 2008 Mr G was subject to a suspended sentence for the supermarket assault in November 2007. As a result he went straight from police custody to prison. Mr G was subsequently imprisoned for 84 weeks for assaulting Mrs P.
5.34 Mr G was released in August 2009…
5.35 By Christmas 2009 Mr G and Mrs P were living as a couple again.
5.37 Mr G went to Margate police station on 25 October 2010 complaining that someone had hacked into his Facebook account, tapped his mobile phone, and that he was receiving messages from the Taliban.
5.38 By Christmas 2010, Mr G‟s mental health had started to deteriorate. Mrs P told her mother that Mr G had started to act in a paranoid manner and he thought people in cars were watching him. Mr G‟s family and friends were concerned about him and had noticed a change in his mental state.
5.39 Mr G was seen by GP 2, another GP, on 30 December 2010. Mrs P attended this appointment. Mrs P and Mr G gave a history consistent with the complaints Mr G had made to the police in October. From this, GP 2 noted that Mr G had symptoms of “depression, anxiousness and a lot of paranoia”. Mr G was also experiencing auditory and visual hallucinations, depression and sleep deprivation. He admitted to taking amphetamines.
5.40 GP 2 recorded that Mr G had a history of taking cocaine and amphetamines, drank alcohol to excess and had previously used cannabis. Mr G had abused drugs over the Christmas period.
5.41 Mr G told GP 2 that he had thought about cutting himself over the Christmas period… GP 2 put Mr G on a short course of diazepam, an anxiolytic (antianxiety medication).
5.42 Mr G and Mrs P returned to the GP surgery the next day, 31 December 2010. He was seen again by GP 2 who prescribed an additional antidepressant.
5.43 GP 2 referred Mr G to the CMHT Access Team (formerly the Intake Team) for an urgent assessment within 24 hours. He described Mr G as experiencing various symptoms of depression, anxiety and suicidal thoughts. GP 2 wrote that Mr G had a history of psychosis five years ago after discontinuing illicit drugs. A member of the team telephoned Mr G the same day and arranged an appointment.
5.45 Mr G and Mrs P saw GP 2 again on 4 January 2011. Mr G reported that he was feeling better with the antidepressant medication…
5.46 Mr G and Mrs P attended the assessment with the CMHT Access Team on 10 January 2011.
5.48 Mrs P‟s presence and her confirmation that Mr G was not using drugs or alcohol [note: in the wierd world of the NHS, antidepressants are not “drugs” – Ed] reassured the workers that the crisis had passed…
5.52 Mr G went to his GP surgery on 16 February 2011. He attended the surgery with Mrs P and their children. He was seen by GP 2 who noted that Mr G was… experiencing paranoia and was anxious. GP 2 prescribed Mr G antidepressants…
5.53 Mrs P and her children left the family home to stay with her mother on 23 February. Mr G destroyed electrical equipment and the telephone within the family home.
5.54 In the early hours of 24 February Mr G rang the telephone in Mrs R‟s home and accused Mrs P of not being at her mother‟s house, though he was actually speaking to her on her mother‟s landline. He threatened to kill himself and his brother-in-law. Mrs R reported that Mrs P rang the police at 3.30am but they said that Mr G had not done anything that warranted their attendance. They gave Mrs P the number for the mental health services. Neighbours of Mr G also contacted the police to complain about the loud music he was playing.
5.55 Mr G visited his GP surgery on 24 February 2011. The practice administrator recorded that Mr G “politely requested to see a GP urgently as he was feeling extremely agitated and anxious”. He was carrying a large army holdall of clothes. No GPs were immediately available so Mr G rang the CMHT from the surgery. After a short conversation Mr G told the member of staff at the CMHT that they could not help him. There is no record of this call in the CMHT duty log.
5.56 GP 2 saw Mr G as an emergency appointment [Feb 24]. It was GP 2’s view that Mr G was suffering from depression, anxiety and psychosis and he requested a response from the access team within four hours. He altered Mr G’s medication. Mr G told GP 2 that his wife and children had left him, and that he had destroyed the family home as a result.
5.60 [The next day] Mr G was seen by junior doctor 1 at 4.54pm who conducted an assessment. Junior doctor 1 worked for East Kent Hospitals University NHS Foundation Trust and was not part of the mental health service. Junior doctor 1 recorded in the notes that Mr G was experiencing auditory and visual hallucinations, paranoia and that he had threatened to hurt his wife and children. When commenting on our draft report Mr G stated that he did not threaten to harm his children. It was also recorded that Mr G had abused drugs and alcohol the night before and felt suicidal.
5.68 …After the hospital discharged him, [Mr G] went home, collected his wedding suit and slept in the woods near his house until Sunday 27 February. Relatives tried to get hold of him at this time however he had broken his phone and could not be contacted.
5.73 Mr G returned home from the woods on 27 February. He did not have his keys so kicked the front door in. Mr G contacted Mrs P and she went to the family home to get the children‟s school uniforms. Mrs P returned to her mother’s house and told her that Mr G seemed fine.
5.77 On 5 March Mr G attacked his wife with a knife. The youngest child was in the house at the time. Their two other children, aged seven and 12 were in the garden. They ran to their mother when she fled the family home. Mr G contacted the emergency services to inform them that he had killed his wife. He requested the police and an ambulance. Mrs P died later the same day as a result of her injuries.