Friday, November 13, 1998 Published at 18:35 GMT
Scissors death report criticises health workers
Folkes was sentenced to be detained indefinitely at Broadmoor
An independent inquiry into a mental health patient who stabbed his girlfriend to death with scissors has criticised a London health authority for not doing more to prevent the tragedy.
The inquiry team also makes wider recommendations about mental health provision, calling on health authorities and trusts to ensure mental health doctors' caseload is not too heavy and recommending the provision of out of hours crisis teams.
Michael Folkes was suffering from paranoid schizophrenia and had been released into the community when he stabbed Susan Milner 70 times at his London flat in April 1994.
Folkes, 32, was an outpatient under the care of the Bethlem and Maudsley NHS trust, having been released from hospital against Home Office and expert advice by a Mental Health Review Tribunal.
His release was on the condition that he continued to take his medicine.
However, he later refused to take injected anti-psychotic drugs and asked to be allowed to administer his own orally taken medicine.
His aftercare team and the Home Office were not told of the decision, despite him having become violent on numerous previous occasions when he stopped taking injected medication.
Tests after the attack on Ms Milner demonstrated no traces of medication in his body, showing he had stopped taking his medicine.
He was put on an emergency list for a community nurse to visit him.
Mr Folkes, who reverted to his original name in 1994 and was described by one psychiatrist as "an extremely dangerous man", had been in and out of mental institutions since 1983.
He had taken the name of Luke Warm Luke from a character in the BBC1 comedy series Porridge in 1992.
He was convicted of manslaughter in 1995 and was sentenced to be detained indefinitely at Broadmoor.
Lack of communication
The inquiry team criticised the lack of communication between the community care team dealing with his case.
The three members of the aftercare team did not meet once together in the 25 months leading up to the killing of Susan Milner.
The inquiry also criticised the decision to allow Mr Folkes not to take injected medicine. It said: "It would be difficult to identify a more important decision" since medication had kept him relatively stable.
It said that, had he not been forced to look after himself, the killing would not have happened.
Its wider recommendations on mental health policy include a call for appropriate sheltered housing for mentally disordered people and the provision of community forensic outreach teams of specially trained nurses and psychiatrists.
The government has backed the provision of crisis mental health teams in its review of mental health care, but has not yet stated how much money it will provide for any changes in policy.
An announcement is expected in the next two weeks.
Lambeth, Southwark and Lewisham health authority and the Bethlem and Maudsley NHS Trust welcomed the report and said they recognised that more should have been done to prevent the killing.
But they said they had made many changes since 1994.
They are considering whether disciplinary action is necessary.
The health authority added that it would draw the report, which recommeds changes in mental health legislation, to the attention of the Mental Health Act Commission and the Department of Health.
There have been 22 inquiries into attacks by community care patients in the last year.
Mental health law
Mental health charity Sane, one of the organisations which helped with the report, said 96% were due to lack of communication and in one in three cases the patient had asked for help.
Saying that community care could work and stressing that only a minority of schizophrenics were violent, she called for changes in mental health legislation.
"We need to balance the rights between the patients, and the families and the public, and that's what we hope that this new legislation will do."
The government will be bringing out its own report on reforming mental health care in the UK next spring.
However, mental health charity Mind said the inquiry report showed no need for an extension of existing powers since Mr Folkes was released on condition he take his medication.
"The Home Secretary could have been asked to recall him to hospital at any time if there were concerns that he was relapsing and presented a risk," said Margaret Pedler, head of legal and policy development.