Can these tragedies be prevented?

By Jane Dreaper
Health correspondent, BBC News

Bradley may have had post-traumatic stress disorder

A former soldier has admitted the manslaughter of four members of his family, who were found shot dead at the home they shared in Newcastle.

Before the killings David Bradley had complained to doctors of being tense and wound up. He told them he wanted "to kill someone".

The remarks from Bradley's anguished surviving relatives seem horribly familiar: they speak of how the family asked for help from medical services, but no one seemed to have the answers.

In court, there was agreement that Bradley had experienced lifelong behavioural and emotional difficulties.

But there was no consensus about his condition at the time of the killings.

One psychiatrist believed Bradley was suffering from post-traumatic stress disorder, after serving with the Army in Northern Ireland.

This condition can make its sufferers emotionally numb, and drive them to drink or drugs.

The NHS has very stretched resources for treating post-traumatic stress disorder Dr Adrian Lord Consultant psychiatrist

The other expert believed that schizophrenia couldn't be ruled out.

Dr Adrian Lord, a consultant psychiatrist who has treated former soldiers, told the BBC: "The Army have arrangements to treat soldiers, but once they leave the Army, they have to then be treated by the NHS.

"The NHS has very stretched resources for treating post-traumatic stress disorder and allied conditions. The waiting lists can be extremely long.

"The other problem is that post-traumatic stress disorder doesn't necessarily start immediately. It can arise later on - anything up to several years after the trauma."

Deteriorating state

Bradley's reclusiveness and heavy cannabis use were clues of a deteriorating mental state.

But he was in contact with mental health services - and had been assessed and prescribed medication two months before the killings.

He apparently often missed psychiatric appointments, and failed to take his medication.

NHS managers in the North-East of England have announced an independent inquiry into Bradley's treatment.

Doctors say it can be very difficult to spot which patients pose a real danger to society - even if it may have looked obvious with the benefit of hindsight.

It is rare for patients - as Bradley did - to express feelings of violence towards others. More usually they talk about harming themselves.

But even then it requires a thorough examination of the possible motives behind such a statement before any valid conclusions about its real meaning can be drawn.

The government admits that the current system is too bureaucratic, and the NHS needs to be better at detecting the tipping point when someone's illness might drive them to kill.

But the question of depriving someone of their liberty, as a precaution to protect themselves and others, is a highly fraught issue - as the government has found in its three efforts to get fresh mental health legislation through Parliament.

This is not a field, sadly, in which there are easy answers.