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SSRI Stories Summary: Lee Anstice, a man with no history of aggression or violence, is upset by breaking up with his wife, Tracy. He feels suicidal in June, 2011 and so is admitted to Albany Lodge for mental health services. Around this date he is prescribed citalopram (120 mg, a fairly high dose) and zopiclone. He is diagnosed with psychotic depression (although a separate letter notes he is not psychotic) and discharged July 10. By mid-August LA is not doing well, complaining of anxiety, suicidal thoughts, and insomnia. August 24 he sees his GP who calls the Trust to ask why LA has been discharged, perhaps an indication that the GP has concerns about LA’s mental state. Two days later he stabs his estranged wife to death, after approximately two months on citalopram. No mention of the medication is made in the news article, and the independent review does not consider its possible role in the tragedy. It finds that the incident was not preventable.
22 July 2015
Health professionals could not have prevented the murder of a woman by her estranged husband in Bedfordshire, an independent report has said.
Tracy Anstice, 37, was stabbed outside her parents’ home in Flitwick, Bedfordshire, in 2011. Lee Anstice, 50, was jailed for 24 years.
The report said there was no evidence that Anstice would be violent despite having suicidal thoughts.
It concluded the incident was neither predictable nor preventable.
Mrs Anstice died when her husband stabbed her four times on 26 August 2011, with one blow penetrating her heart.
Lee Anstice denied murder, claiming he was hearing disturbing voices
On sentencing at Luton Crown Court in 2012, Judge Richard Foster said Anstice used military training to kill her “with brutal efficiency”.
Anstice had denied murder and claimed he was severely depressed and hearing voices which had disturbed the balance of his mind.
Three years on, the independent report – carried out by Verita for NHS England – was called for because Anstice had been a mental health patient with five different health trusts involved in his care.
It looked to assess whether he had received appropriate care and whether any lessons could be learned.
The document said he turned up at the Luton and Dunstable hospital in June 2011 after telling his wife he intended to commit suicide.
It concluded, however, that there was no evidence to suggest he might become violent imminently. It said he had expressed hatred of his wife once, but had no history of violence or aggression.
The report also stated he was well enough to be treated in the community and could not have been sectioned under the Mental Health Act.
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VERITA Independent investigation into the care and treatment of Mr Z – A report for NHS England, Midlands and East Region
Liz Howes, Tariq Hussain, Dr Peter Jefferys
On 26 August 2011, Mr Z, a 49-year-old man, stabbed and killed his estranged wife, by whom he had a daughter then aged eight. He was found guilty of murder and sentenced to life imprisonment with a recommended 24-year minimum term.
Mr Z had received inpatient and community care and treatment from five trusts:
The initial decision to admit Mr Z on 17 June 2011 was made by the SEPT liaison nurse in A&E who learned that Mr Z’s wife was employed by SEPT. After a clinical decision to arrange admission had been made, Mr Z’s wife requested admission to a non-SEPT bed. Clearance from an on-call SEPT manager was sought and provided. It is clear from the internal reviews undertaken by SEPT and the multi-health agency report that there was a widespread belief within SEPT that such arrangements could be made in these circumstances.
Mr Z clearly needed an urgent admission and it was appropriate for the assessing clinician to take note of the request by Mr Z’s wife for an out-of-area admission, given that she was employed by SEPT. The decision on where the admission should be was made late at night by senior management. It is clear that in 2011 SEPT staff believed that reciprocal arrangements for out-of-area admissions were in place to accommodate circumstances such as these. It would not have been appropriate, given the need to arrange immediate admission, for the manager on call to insist on fresh information from Mr Z or his wife about her employment once an available bed had been identified.
This was Mr Z’s first contact with mental health services since 1994; therefore there were no issues about the need for continuity of mental health at this stage. Mr Z needed a brief assessment admission to reduce immediate suicide risk. The admission to a bed less than 20 miles from his home met with the trust protocol for out-of-area placement and had no adverse consequences at this stage…
Mr Z’s initial management at Albany Lodge was appropriately focused on careful observation and monitoring of his mental state and suicide risk. It was followed by engagement with clinical staff from which two strands of focused work were pursued, both of which were appropriate. One strand was liaison with his wife including arrangements for contact with his daughter, which was appropriate. The second was more intensive psychological work led by a clinical psychologist examining his life situation more widely and adjustment to his changed circumstances. There is useful evidence in his clinical records that he engaged well with both these elements of his care pathway with apparent benefit during the admission. The need for antidepressant medication was carefully considered and Mr Z was appropriately given Citalopram, to continue after discharge.
Following successful periods of day leave and some overnight leave, which was managed appropriately, Mr Z’s discharge was delayed. This was primarily because of difficulty re-engaging SEPT who needed to allocate a care coordinator. It was complicated by Mr Z’s decision to live temporarily with his parents in Oxford on discharge. Determined efforts were made by the ward clinical team to keep SEPT informed and avoid an ill-prepared discharge. There is no evidence that the delay in discharge from the ward, had a significant adverse impact on Mr Z’s mental state or prognosis. A SEPT CMHT care coordinator was eventually allocated, who had never met Mr Z, and was given the lead in arranging initial follow-up on discharge with the Oxford CRHT team.
A discharge letter, despatched on the day Mr Z left hospital was sent to Mr Z’s former GP, registration with a new GP in Oxford was planned, and to the designated SEPT care coordinator. The letter lists discharge medication and includes a diagnosis of severe depressive episode without psychotic symptoms. There is no reference to Mr Z’s recent life events or of any risk to himself or others. The care plan and follow up arrangements simply refer to initial follow up by the Oxford CRHT whilst staying with his parents in Oxford and states that his named care coordinator would arrange further follow up as required. This represents the only formal written communication from HPFT relating to Mr Z’s hospital admission made available to the professionals who were to take responsibility for his subsequent community care.
We have relied on the information provided in the multi-health agency investigation in relation to Mr Z’s referral to the Oxford CRHT team. We concour with the investigation conclusions about the serious operational gaps and flaws relating to discharge and follow-up arrangements.
There was a period of six days between Mr Z’s discharge from Albany Lodge and his visit to his GP on 24 August. Neither SEPT nor OHFT undertook a detailed assessment between his discharge from Albany Lodge and 26 August, the date of the incident.
The South Bedfordshire CMHT care coordinator contacted Mr Z to see if he had settled in Oxfordshire. Mr Z told the care coordinator that he had been discharged by the OHFT CRHT team on 10 July, the day he was discharged from Albany Lodge. The care coordinator made an appointment to meet Mr Z on 26 August at 3.00 pm. Mr Z had said that he was coming to Dunstable that day and could see the care coordinator as well.
On 24 August Mr Z went to see his temporary GP in Oxford. As a result of this consultation the GP contacted the OHFT CRHT team by phone on the same day. He wanted to know why Mr Z had been discharged. The person he spoke to was unable to give him any further information because Mr Z had never been formally referred and accepted onto the caseload, and advised him to contact the CMHT, because during working hours urgent assessments go through the team’s duty worker.
The GP contacted the CMHT as directed and left a message on the answer phone requesting a call back by the end of the day.
The GP received no response, so on 25 August, after 5.00 pm, he faxed a referral to the City Central CMHT in Oxford. The referral requested an urgent assessment as Mr Z was having thoughts of self-harm, although he did not have a suicide plan. He had complained to the GP about poor sleep and anxiety. The GP wrote the following in his referral:
- “Mr Z had insight and was not suicidal;
- his mother was dispensing medication, which was citalopram 120mg once a day and zopiclone 3.75mg once or twice a night, and he had a prescription until the 24 August; and
- Mr Z has an appointment with his care coordinator Friday 26 August”.
The referral was read by the duty worker on 26 August. He made three attempts to call Mr Z and left a message on his answer phone for him to call back.
On the same day, Mr Z failed to keep his appointment with his care coordinator in Dunstable.
When we met with Mr Z he told us that he received the message on his phone but by this time he had decided to kill himself so did not ring back.
Also on 26 August [the day of the murder], the psychiatrist from the OHFT CMHT called the GP to discuss the case in greater detail. The GP provided further information about Mr Z’s circumstances, including that he had taken an overdose due to the breakdown of his marriage and he had no previous psychiatric history before the marital problems. The GP said that in his clinical judgement Mr Z was a low risk to himself. The GP also reported that Mr Z had told him he had an appointment with his care coordinator in Dunstable for “today” (Friday 26 August) but the GP did not know the name of the coordinator or which CMHT.
We find that the incident was not preventable.