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SSRI Stories Summary: Sean Skelhorn is a long-time user of illegal drugs, and the NHS. He has a “chaotic lifestyle”, and is keen to get the psychiatric drugs which he has been taking for years – quetiapine and citalopram (and at one time, mirtazapine). However, because of his own irregular living patterns and lack of responsibility he is unable to assure himself a steady supply of these meds. He thus goes on and off them. He often casually mentions violent thoughts, and claims to NHS staff to have acted violently. The claims of violent acts (e.g. strangling his sister) tend to be exaggerations or fabrications. Possibly for this reason, NHS mental health staff do not assess him as high risk to himself or others, despite his continuing reports of violent ideation. However, in April, 2011, following a year in which he goes on and off his meds twice, and having been off them for just under one month, he stabs and kills a man. News reports describe him as a killer and do not mention medications. He is sentenced to life in prison.
06:00, 17 Oct 2011 Updated 05:56, 8 May 2013
By Liverpool Echo
THE killer of a Tommy Thompson in a Liverpool hotel room went to hospital just a month before the murder saying he was having violent thoughts, the ECHO can reveal.
Shaun Skelhorn was jailed for life on Friday, alongside his girlfriend Leanne Wilkinson, for the murder of 29-year-old Thomas Thompson, in the Manor Hotel, on Edge Lane.
And today the ECHO can reveal the 30-year-old has suffered for many years from a personality disorder that leaves him having angry thoughts and hearing voices.
Despite them killing Mr Thompson, from Old Swan, in a brutal “one-way traffic attack,” the victim’s mum says she has “no feelings, hatred or otherwise” towards Skelhorn and Wilkinson.
In the last seven years, Skelhorn, of no fixed address, has admitted himself to hospital numerous times asking for treatment because he was afraid of what he might do.
Aged 23, he admitted himself to hospital and was given medication. Similar incidents followed in both 2006 and 2008.
In 2010, he went and asked the hospital to treat him for his “violent thoughts” but when he went back, in January this year, having heard voices, he was turned away because of a lack of beds.
Eventually in March, just a month before Mr Thompson’s murder, he was admitted for two weeks and given more medication to curb his inner anger.
H is barrister, Simon Driver, told the court Skelhorn would spend his prison sentence in “substantial fear of reprisals”.
He told the court the killer’s brother – as reported in the ECHO at the time – had been dragged off the street into a van within days of Mr Thompson’s murder.
Stephen Skelhorn, 26, had both his legs broken and most of one ear sliced off before being dumped on waste ground.
Then at the end of September, just before the trial started, the home of one of Skelhorn’s relatives had a hand grenade thrown through the front window.
Skelhorn admitted murdering Mr Thompson in the Manor Hotel on April 17 and was jailed for life and ordered to serve a minimum of 13 years and nine months.
His partner, and mother of his child, Wilkinson, 26, of Langbar, Whiston, was convicted by a jury and sentenced to a minimum of 15 years.
In a victim impact statement read to the court before the killers were sentenced, Mr Thompson’s mum, Vivian, said: “I cannot explain what it is like living without Thomas.
“I miss him so much.
“The impact on all of the family is immeasurable.”
I have no feelings at all – hatred or otherwise – to the people that have killed my son. They have already destroyed our lives.”
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An independent investigation into the care and treatment of a mental health service user (Patient R) in Liverpool and surrounding area
- EXECUTIVE SUMMARY
1.1 Niche Patient Safety was commissioned by NHS England in April 2014 to carry out an independent investigation into the care and treatment of patient R who pleaded guilty to the murder of T on 17 April 2011. T was robbed and murdered by R and one other in a Liverpool hotel.
1.2 R had a seven year history of contact with mental health and substance misuse services. He had inpatient admissions and community team follow up from two trusts: 5 Boroughs Partnership NHS Foundation Trust – referred to as Trust 1 in this report and Mersey Care NHS Trust – referred to as Trust 2 in this report.
1.3 He had also spent time in prison for a variety of offences. His last period in prison before the homicide was between September and November 2010 and his last admission to an acute inpatient unit was from 6 March to 15 March 2011.
1.7 Through this process we have considered whether there were any identifiable factors which could have caused or contributed to this tragic incident. We found no specific causal factors. However the following contributory factors have been identified:
- A lack, at that time, of robust risk assessment and risk management processes for patients with personality disorder and/or drug dependence;
- No developed care pathway encompassing inpatient admission and community team intervention and follow up for such patients;
- R’s diagnosis of personality disorder and his drug misuse;
- R’s non-registration with a GP or registration with a GP in a different locality and
- R’s lack of continuing engagement with the mental health service in Trust 1.
(Page 15) 6.A Mental health assessment
6.A.1 It is clear that R was someone who had a very chaotic lifestyle, and that this was partially recognised by mental health services. He had a seven year history of involvement with mental health services and latterly had repeated emergency admissions to inpatient or crisis team care when he was asking for help to manage his violent and disturbing feelings. Throughout his contact with mental health services he had great difficulty in continuing any engagement with services or was unwilling to engage.
| Excerpts from APPENDIX B – Chronology of care and treatment – Page 38 | |
| KEY DATE | EVENT |
| Aug 11 2010 – Aug 17 2010 | Extremely chaotic period with a number of missed appointments, drug taking and requests for prescribed medication. |
| Sept 9, 2010 | R attended A&E stating that he had taken an overdose of 16 citalopram, 6 seroquel and a number of mirtazapine. (Blood results were reported as normal.) He also said he felt very depressed and was hearing voices telling him to hurt people and self-harm. Assessed by mental health practitioner. He told her that he had assaulted three strangers in the street over the past week and was scared that he may kill someone. Further assessment the following morning. Assessed as not psychotic or depressed and not admitted, but to be followed up by community team. |
| Sept 10, 2010 | R went into prison for burglary. |
| Nov 9, 2010 | Released from prison |
| Nov 10, 2010 | Attended drug service. Told drug worker that he now lived in the Bootle area and will sign on with a new GP. Transferred to Sefton DRR (Dug Rehabilitation Requirements40) team. Referral faxed to the CRI team and letter sent to GP |
| Nov 16, 2010 | Final appointment with Liverpool DRR team. Said that he had been using heroin as ‘had lost script last week’. Advised to ensure attendance at Sefton DRR team the next day. Case closed at Liverpool DRR team. |
| Jan 1, 2011 | R presented at Whiston Hospital A&E saying that he had violent thoughts that he would hurt someone, and that his heart was pounding. It was known that he had previous admissions and diagnosis of anxiety and personality disorder. Assessed by St Helens CRHT staff member and SHO. Said that his brother had been shot and his mother’s house petrol bombed in the past. Citalopram may be started straight away, but quetiapine would need to be titrated and he would need to be registered with a GP… |
| Jan 30, 2011 | Member of CRHT explained the prescribing situation to him on home visit, but he became very angry, said that the citalopram did not work, and that he would not engage with team and asked them to leave. |
| Feb 2, 2011 | Medication collected from the pharmacy and two members of CRHT visited his home three times to deliver it with no success. In the evening the television and lights were on, but no answer at the door. |
| Feb 3, 2011 | Home visit by two members of CHRT team. R opened the door and let them in. Initially very angry but later calmed down. He told them the citalopram did not work and they said they would find out why he had not been prescribed quetiapine. |
| Feb 14, 2011 | Note on file to say that R had not responded to letter sent and had not engaged with the service. Therefore he was to be discharged back to his GP. |
| March 3, 2011 | 11.40 hrs Seen by SHO and CPN Said that mental health had deteriorated over past few weeks. Said that he is ‘like an animal and would attack anyone on minor things.’ Again reported that he had strangled his sister. Denied any hallucinations. Diagnosis was ‘worsening of psychosis, non-compliance with medication. High risk of harm to self or others’.
Accepted little responsibility for not having his medication. Said he could ‘snap and kill anyone by battering them with a hammer’. .. Put on level 2 observations and started on quetiapine and citalopram. Said that he had not been taking his medication since released from prison in Nov 10, as he had no GP. Denied recent alcohol or illicit substance use, but said that he had taken cocaine, cannabis and ecstasy in the past. |
| March 3, 2011 | He reported his mood as low, but objectively appeared euthymic. On level 2, 15 minute observations. HoNOS partially completed. Risk assessment and summary completed. Assessed as LOW for risk of violence and aggression |
| March 5, 2011 | 20.20 hrs Presented at Whiston Hospital A&E. Seen by Specialist Registrar complaining of PTSD and split personality. Said he had felt unwell for four months. Last contact with mental health services three weeks ago. Intrusive thoughts about harming others. Said he strangled his sister until she passed out yesterday. He had had no medication since leaving prison in November 2010. Said he was tee-total and no current drug use. Doctor’s impression was ‘acute on chronic mental health problem’ – risk to others. |
| March 5, 2011 | 11 pm Approached staff to ask if he would be starting his medication tonight, and said that as long as he received it that night he would be OK. |
| March 6, 2011
06.00 hrs
|
Admitted to Bridge ward (a ward in Halton for men), from Whiston A&E (where he had self-referred). Diagnosis on admission particulars: anxiety and depression personality disorder
Put on level 2 observations and started on quetiapine and citalopram. |
| March 7, 2011 | am 72 hr post-admission review. Appeared calmer and no obvious sign of agitation. No evidence of psychosis, depression or anxiety. Said he needs medication to calm him down, and said that if he did not get it he would ‘kick off’. Drug screen was positive for cocaine. Keen to have psychological assessment. Possible diagnosis of personality disorder, antisocial type. Plan to consider referral to personality disorder hub, and to transfer to a local hospital. |
| March 10, 2011 | Multi-disciplinary review. Said that he had taken cocaine and methadone recently. Also said he would return to his mother’s house. Told CPN that his brain was too active and he had sick thoughts of wanting to hurt others. Noted in the review record that he had appeared relaxed since admission, and that there were no thoughts of self harm or harm to others. Plan: Continue medication |
| March 15, 2011 | Discharged himself against medical advice. No medication provided. |
| March 17, 2011 | Home visit by members of CRHT team. He appeared slightly suspicious but pleasant. Said he had no medication. Team said they would check for any medication on Coniston and asked him to register with a GP.
Agreed that his case would be closed to both the CRHT and to Montgomery Road CMHT. |
| April 11, 2011 | Letter sent to R with an appointment for 19/4/11 to see the dual diagnosis practitioner/CPN. |
| April 13, 2011 | Letter sent to Abercromby Health Centre about the A&E assessment on 30/1/11. Returned to the trust with a note to say R was not their patient. |
| April 18, 2011 | Letter from the CMHT manager saying that he had not attended the appointment and he could ask his GP to refer him again if he wished. |
| April 17, 2011 | Homicide in very early hours of the morning |
| April 20, 2011 | Assessed in custody by Trust 2 Criminal Justice Liaison team. Did not require diversion. No further contact until the involvement of the Criminal Justice Liaison team on 27/4/11 following the homicide. |