By Chris Summers
A paranoid schizophrenic has been convicted of killing a stranger and stabbing five others during 90 minutes of violence in north London.
Two leading charities say the case highlights arguments that the care in the community system remains "fundamentally flawed".
Ismail Dogan heard voices in his head
In June 2004 Ismail Dogan stopped taking medication to control his paranoid schizophrenia.
Six months later he ran amok in north London, killing one man and seriously injuring five other people after hearing the "voice of God" in his head telling him to stab people.
Turkish-born Dogan, who had been released from a psychiatric hospital in 2001, later told psychiatrists in Broadmoor that a bird had spoken to him telling him to carry out the attacks on English people.
Laurence Chesterman, a consultant forensic psychiatrist, told the Old Bailey: "He felt he was under the influence of the voices and could not stop himself.
"He was told (by the voices) he would become like the son of Allah and would become a prophet."
Dr Chesterman told the court it was inevitable that Dogan would suffer a relapse of his schizophrenia once he stopped taking olanzapine, a powerful anti-psychotic medicine.
Jonathan Laidlaw, prosecuting, told the court that Dogan's mother, Hanim, sought help for her son as his mental health deteriorated.
On one occasion he put his hands around her neck and started strangling her, telling her: "I'm going to kill you". He also slashed himself with a razor blade.
Haringey social services referred her to the family GP, who suggested that Dogan should come to his practice rather than him visit the family home.
In a statement read to the court Mrs Dogan said: "I'm really sure that, when I cried for help, if the social services and my GP had helped me at the time we wouldn't be in this situation."
She added: "I always feared that Ismail would hurt himself or me, but never thought he would hurt someone else."
The stabbings occurred during rush hour.
One of Dogan's victims, Ernie Meads, died from his injuries. His widow, Christine, told police: "Ernie's death ruined all our plans, not just for Christmas but for our entire lives."
Vicki Cann, who survived being stabbed, said she felt no ill-will towards Dogan and she added: "I hope that there will now be a full, independent inquiry into what happened as it is important to learn any lessons from this case, both in Haringey and perhaps more widely too.
"I hope that this will lead to an eventual outcome where people with mental health problems and their families always receive the full and appropriate care and treatment which they need."
Sentencing Dogan, the judge, the Common Serjeant of London Brian Barker, said: "I am not in a position to apportion blame, but it is the greatest sadness you stopped taking your medication and the warnings were not quickly heeded."
Two leading mental health charities say the Dogan case highlights flaws in the care in the community system.
The Zito Trust says the government needs to push through its draft Mental Health Bill as quickly as possible.
The bill was in the Queen's Speech but a Department of Health spokesman said this week: "We are planning to introduce it when parliamentary time allows."
But, with several controversial pieces of legislation ahead of it in the queue - including ones concerning education, terrorism and ID cards - many political experts believe the bill will fall by the wayside.
Zito Trust director Michael Howlett said: "If we do not get a new Mental Health Bill to reflect the fact that people are living in the community now we are going to have these problems for years to come."
He said the new legislation would introduce compulsory treatment orders which would compel people to take their medication or face being sectioned.
'Lessons not learnt'
Marjorie Wallace, chief executive of the charity Sane, said the Mental Health Bill would not have helped in the Dogan case.
But she added: "The case of Ismail Dogan shows yet again the failure of the community care policy, which for years we have been highlighting as a fundamentally flawed system because it does not provide the fail-safe mechanisms to prevent those who are seriously disturbed from being a risk to themselves, their families and, very occasionally, others.
"We have had 14 years of inquiries into the approximately 40 homicides a year committed by people in contact with mental health services. The lessons of these have still not been learned."
The Mental Health Alliance, a coalition of 75 organisations, said that homicides by people with severe mental health problems were still "extremely rare events".
"For the vast majority of people with severe mental health problems community care works, " said the alliance's Andy Bell.
"It is not the case that the Mental Health Act needs hardening. That would simply drive people from services and damage the civil liberties of people who have never committed an offence," he added.
Haringey Teaching Primary Care Trust said it had begun an internal investigation into the Dogan case which had been suspended pending the criminal proceedings.
A Trust spokesman said the inquiry would be concluded and a full report submitted to the North Central London Strategic Health Authority for independent scrutiny.
Dogan drove from one attack to the other
The Conservatives' mental health spokesman, Tim Loughton MP, said he was concerned by cases such as that of Dogan.
But he told the BBC News Website he did not believe the government's Mental Health Bill was the way forward.
"We are opposed to it because we feel that, if they are going to be sectioned and coerced, people with mental health problems are not going to come forward and present. They will instead fester."
Mr Loughton said one of the main problems was that the mental health system was the "Cinderella service" of the NHS and was the first to bear the brunt of any funding cuts.
He said: "Mental health needs to have a larger slice of the NHS funding cake and there also needs to be a serious recruitment exercise. There is also a need to speed up referral times so that people are not deteriorating while waiting to see specialists."
Local MP Lynne Featherstone said she was on record as having called for a review of the care in the community system.
Miss Featherstone, a Liberal Democrat, said: "It's not just cases like this, which are hideous and tragic events, but at a lower level there are a host of assaults and other incidents involving people who have mental health issues. The support is just not there for them."
Dogan will be detained indefinitely under the Mental Health Act.