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Monday, April 19, 1999 Published at 12:53 GMT 13:53 UK


Mentally ill 'need more support'

Magdi Elgizouli stabbed PC Nina Mackay to death in 1997

Mentally ill people should have be given greater support so they can keep taking their medication, an inquiry into a community care murder has recommended.

Failure to take medication has been a major factor in many recent killings by community care patients.

The inquiry into the killing of WPC Nina Mackay by paranoid schizophrenic Magdi Elgizouli says guidance on helping people take their medication needs to be improved.

The controversial issue of community care patients and medication is at the centre of the government's plans to review mental health legislation.

A draft report by the committee appointed to review existing legislation is recommending the issuing of compulsory treatment orders.

Community care patients issued with the orders would be forced to take their medication or risk being committed to hospital.

Mental health charities are divided over compulsion and many believe it should be used very much as a last resort.

Therapeutic relationship

The inquiry into Mr Elgizouli, commissioned by Kensington & Chelsea and Westminster Health Authority, East London and The City Health Authority and Westminster and Newham councils, stops short of any recommendations on compulsion.

It recommends that doctors develop a "therapeutic relationship" with mentally ill patients.

This would involve not just the prescription of drugs but care for the wellbeing of the patient.

Mr Elgizouli was at one point sent his medication through the post by his GP.

The inquiry also recommends that greater support is given to people taking their medication in tablet form.

Newer drugs for the mentally ill are taken daily by mouth. Older drugs, which have more side effects, can be injected and one dose can last for up to a month.

Another way of ensuring medication is taken would be to give patients packs of daily pills with the days of the week on them, says the inquiry.

It also calls for other people working with the mentally ill patient and their carers to be involved in encouraging them to take their medication.

It says national guidelines are needed to promote good practice for treating people in the community.

And it calls for tighter checks over medication when the mentally ill are taken into custody.

Mr Elgizouli's family had on several occasions expressed concerns that he was not taking his medication.

[ image: Judi Clements: more money may be needed to ensure patients take their drugs]
Judi Clements: more money may be needed to ensure patients take their drugs
He was remanded in prison in 1997. It was known that he was not taking his drugs, but he received no treatment for his mental illness and no health care professionals took responsibility for ensuring he took the drugs he needed.

Dr Sally Hargreaves, director of public health at Kensington & Chelsea, said: "Too often mentally ill people fail to take their medication. We recognise that very many people can be safely maintained in their own homes with supervision by their GP and community care staff, but we accept the report's recommendation that supervision of patients must be improved."

Judi Clements, chief executive of mental health charity Mind, said extra resources might be necessary to increase supervision.

She believed that information failures between the agencies involved in caring for Mr Elgizouli were "much more relevant" than his problems over taking medication.

Mind is concerned about calls to increase compulsion in the treatment of community care patients.

It says the number of homicides by mentally ill people has decreased in recent years, despite media concentration on community care "failures".

Mind is also calling for national standards over information-sharing between social care agencies.

Marjorie Wallace, chief executive of SANE, said "a massive cultural change" was needed to encourage better information-sharing.

She added that care workers who failed in their duties should be brought to account instead of just being allowed to blame the system for what she described as "avoidable deaths".

Transfer of care

The inquiry recommended that procedures should be tightened up for the transfer of care of a patient when they move to another area.

It recommends that one document should contain all pertinent information, including a risk assessment.

It also calls for closer working between agencies involved in social care, housing, health and the police.

It says this might have shown that forcing entry into the flat of Mr Elgizouli, when he suffered from delusions that he was being persecuted by the police, might not have been the best way to get him into custody.

Other recommendations include issues concerning the housing of mentally ill people.

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