To view original article click here
SSRI Stories Summary: DF is given psychoactive drugs at the age of 15, and ever since experiences episodes of low mood. For many years, he takes lithium and amitriptyline. When in 1985 his GP adds mianserin, a tetracyclic antidepressant “known on occasion to aggravate psychotic symptoms, such as feelings of persecution”, “Mr Foskett reported feeling worse, reckless and agitated”. Less than a week later, he calls his GP urgently requesting a home visit. The GP complies but DF batters both her, and his beloved wife, to death with a hammer. He remembers nothing about these killings. He is diagnosed with psychotic depression.
Obviously, there was a connection between the introduction of mianserin, the akathisia it immediately produced (about which DF complained to his GP), and the killings. However the independent review, which purported to consider the role of medication, dismissed this important issue, noting: “the level of any contribution, if any, of mianserin is impossible to determine”. They quote Dr David Healy in support of their contention that there is no established connection between violence and antidepressants: “the more severe the mood disorder, the greater the likelihood that the disorder rather than its treatment led to the violence”. They did not mention that Dr Healy has often also noted that the risk of adverse medication reactions increases following medication introduction or dosage increase.
In 1995 Mr Foskett is absolutely discharged. He remarries. In 2003, a couple of weeks after his amitriptyline dosage is increased, he reports insomnia and increased anxiety. Within another week, he murders his 2nd wife. The review dismisses the role of medication in this instance, also, noting that: “Mr Foskett had been treated with amitryptiline [and lithium] for many years without any recorded problems. This allows for a fairly conclusive opinion that it is highly unlikely that medication contributed to Mr Foskett’s actions in July 2003.”
Bucks Free Press
4:02pm Wednesday 26th May 2004
By Times Group
A New Barnet man stabbed his soulmate’ to death after he was released from hospital for killing his wife and doctor, the Old Bailey heard on Monday.
He then took an overdose of pills before dialling 999 to tell police and paramedics: “Oh, it’s terrible here. I just can’t believe it.”
Foskett, of Spar House, Lytton Road, was found with Miss Cole’s body in her one-bedroom flat in Manor Park, east London.
A psychiatrist told the court that Foskett suffers from a depressive psychosis with an underlying personality disorder.
Miss Cole met Foskett when she was being treated for depression at the Goodmayes Hospital in Essex. Foskett had been detained there for killing his wife of 20 years, Margaret Foskett, and Dr Eva Glickman with a hammer at his home on May 17, 1985.
He had admitted two counts of manslaughter on the grounds of diminished responsibility but was released from the facility in 1993.
It was then he developed a relationship with Miss Cole.
Foskett denied murdering Miss Cole, but admitted manslaughter on the grounds of diminished responsibility.
The Common Serjeant of London, Judge Peter Beaumont, told Foskett he would be detained in a mental hospital indefinitely under the Mental Health Act.
To view complete original report click here
REPORT OF THE INDEPENDENT INQUIRY INTO THE CARE AND TREATMENT OF DENNIS FOSKETT
Issues and relevant services
- Sometime during 27 July 2003 Dennis Foskett, aged sixty, killed PC his longterm partner, whom he had met at Goodmayes Hospital, Goodmayes, Essex, in about November 1987. Mr Foskett called the emergency services at 1.02 a.m. on 28 July saying that he had killed his ‘wife’ and taken an overdose. The police found PC with multiple lacerations to her head and neck; she had bled to death and had been dead for some time. Mr Foskett remains amnesic of the details of this event which is the trigger for this Inquiry. He was suffering from severe depression.
- At the time that Mr Foskett and PC met, he was an inpatient at Goodmayes hospital under sections 37 and 41 of the Mental Health Act 1983 (‘MHA’), having killed his wife Margaret and their general practitioner, Dr Eva Glickman, on 17 May 1985. He was then aged forty two. He was diagnosed as suffering from severe depression at the time. Chapter Two summarises Mr Foskett’s early history and the events leading to these killings of which he is similarly amnesic. PC also suffered severe mental health problems and was an inpatient at Goodmayes Hospital when they met. These details are relevant to Mr Foskett’s care and are set out in Chapter Five.
- Following the double homicide in 1985 and having spent a period on remand at HMP Brixton, he pleaded guilty to two counts of manslaughter on the grounds of diminished responsibility at the Central Criminal Court, London. On the advice of two consultant psychiatrists he was made the subject of a MHA disposal. In a controversial decision, the judge accepted the evidence of the two psychiatrists that Mr Foskett was no danger to the public unless the depression recurred and directed that he be treated at a local hospital rather than under conditions of high security. The depression had receded and was well controlled by medication with which Mr Foskett was completely compliant. Mr Foskett’s early history and offences in 1985 are set out in more detail in Chapter Three.
- On 11 April 1995 Mr Foskett was absolutely discharged by a Mental Health Review Tribunal…Mr Foskett gained his own independent accommodation in October 1996, from which time he and PC were effectively co-habiting, dividing their time between their two homes. This period and the events leading to PC’s death are described in Chapter Nine.
- Dennis Foskett… has a long history of mental illness and first developed problems during his adolescence, aged about fifteen. This was his first diagnosis of depression following a bout of ‘flu. Thereafter he developed a significant illness which manifested itself on at least another three occasions prior to 1985. In March 1970 he was admitted to hospital for ten days following another round of bad ‘flu about two months previously. It is noted that Mr Foskett thought that he was going to die and became very depressed with suicidal thoughts. As a result, he lost his job. He had been married for six years by this time. It was recorded that during the course of his depression he had often felt ‘extremely aggressive towards other people, but realises that this feeling is irrational’. He was treated with amitryptiline. This appears to have been his second episode of depression.
- There was another hospital referral to Goodmayes Hospital in 1979 and again to the East Ham Memorial Hospital in 1981. The records of these admissions are not now available but they are referred to in a Home Office document of 1990. Subsequent to the 1985 homicides, Dr D.K Hirst, consultant psychiatrist, in his recommendation to the sentencing court commented that he had ‘no doubt from reading case notes of his treatment at Goodmayes Hospital, that he is a man of considerable vulnerability in respect of his personality, prone to anxiety, and responding less robustly to stress than is normal.’ He responded to anti-depressant medication and remained well for the three years leading to 1985.
- Later accounts of this episode of illness indicate that he was experiencing very severe depersonalisation i.e. a change in self awareness such that the person feels unreal, and was having increasing difficulty coping with his job. He had feelings that he was being watched, was frequently crying and stressed by the feeling that he had to cope with his wife Margaret who suffered from epilepsy, see below. There is no evidence whatsoever that he was ever in fact aggressive or violent in any way prior to the offences in 1985.
On 17 May 1985 Dennis Foskett killed his wife Margaret and their general practitioner of many years, Dr Eva Glickman. He was forty two years old and suffering from severe depression at the time. He pleaded guilty to two counts of manslaughter on the grounds of diminished responsibility and on 22 November 1985 was made the subject of a hospital order with restrictions unlimited in time, under sections 37 and 41 of the Mental Health Act 1983. Controversially, the judge directed that Mr Foskett be treated in a local psychiatric hospital, Goodmayes, situated in the London Borough of Redbridge in North East London, rather than a high secure hospital. The serious untoward incident report of 7 October 2003 concluded that Mr Foskett should have been placed in high security. The Inquiry Panel considered the following issues:
- The role of any adverse reaction to medication in the homicides in 1985, and
- the appropriateness of the court disposal to a local hospital.
Depression and homicides
- Mr Foskett’s depression in April/May 1985 was precipitated by a bout of ‘flu a month or so earlier. Mr Foskett says that he and his wife recognised that he was ill. He lost weight and interest in life and developed a belief that he was being watched, including by his work colleagues. He became more anxious and nervous than normal and became concerned about his performance at work. Mr Foskett recalls experiencing auditory hallucinations. He went to see Dr Eva Glickman, his general practitioner, at her surgery. kShe prescribed mianserin (Bolvidon), a tricyclic antidepressant known on occasion to aggravate psychotic symptoms, such as feelings of persecution. Mr Foskett reported feeling worse, reckless and agitated. His feelings of paranoia did not improve. His work colleagues had in fact encouraged him to go to the casualty department of Hackney Hospital, where he worked and he says that he did so.
- Mr Foskett has never been able to provide a coherent account of what happened on 17 May. He was, and remains, almost totally amnesic of the killings. What is known is that Mrs Foskett called Dr Glickman and requested a home visit. This may have been up to a week after Mr Foskett started on mianserin. Dr Glickman left her surgery at around 6.45 p.m. and at 7.10 p.m. Mr Foskett was seen by a neighbour outside his house holding a hammer and shouting for help saying that he had killed his wife. He was very distressed and attempting to swallow a large number of pills. The bodies of the two women were discovered in the house.
- He has since expressed strong feelings of remorse for both killings. He was unable to understand why he had killed two people for whom he had the highest regard and affection.
Adverse reaction to medication
- Professor David Healy of the North Wales Department of Psychological Medicine, is one of the few experts in the UK researching the links between anti-depressant medication and violence. His evidence indicated the inconclusive nature of this research currently. As far as depression and homicide is concerned, his evidence was that while in general there are ‘grounds to believe that antidepressants can precipitate acts of violence up to and including homicide’, there have been only a very few reports making the link in relation to a variety of anti-depressants over the past 40 years. Links between anti-depressant medication and violence are not universally accepted by the medical and scientific communities. Again in general, he said that the more severe the mood disorder, the greater the likelihood that the disorder rather than its treatment led to the violence. It is not doubted that Mr Foskett exhibited a severe degree of disorder at the time of these two homicides and when he killed PC in 2003, but there is no reliable evidence that his illness was caused by improper drug prescription.
- In relation to the killing in 2003, Mr Foskett had been treated with Amitryptiline [and lithium] for many years without any recorded problems. This allows for a fairly conclusive opinion that it is highly unlikely that medication contributed to Mr Foskett’s actions in July 2003. This would be so even if there were some grounds to implicate mianserin in the 1985 killings. These grounds might include the fact that he had started treatment relatively recently and had reported adverse effects to this treatment. However, the level of any contribution, if any, of mianserin is impossible to determine.
Prof Coid’s final meeting with Mr Foskett was on 21 July 2003, about one week before he killed PC. At this interview, Prof Coid recalls that he was looking less well than usual and reported experiencing some anxiety since his benefits problem earlier in the year. He had remained anxious, especially in the previous two weeks. He was experiencing anxiety for periods of three to four hours at a time, but there was no change in the level of anxiety. He specifically denied palpitations, tremors, panics and the like. He was sleeping only four hours a night and waking more anxious. He reported being a little irritable, but not more than usual. He denied any changes in concentration, subjective depression and reported feeling better having increased his amitryptiline medication by 25 mg. Prof Coid expressly noted that he had no suicidal or homicidal ideation.