Care in the community

He went berserk and stabbed his mother 43 times with a 12-inch Bowie knife. When his 11-year-old brother tried to intervene, he stabbed him 25 times before clubbing them both with an iron bar. Later, he said: `It was inevitable'

GLENDA COOPER

Failings in the Government's Care in the Community policy were highlighted yet again yesterday by a judge who described as a "nightmare" the case of a paranoid schizophrenic who discharged himself from hospital and a month later stabbed to death his mother and young brother.

The case is the latest in a series of tragic killings involving mentally ill people under NHS supervision. Last month Stephen Dorrell, the Secretary of State for Health, announced new measures in response to widespread public alarm, but they have already been criticised as inadequate.

Mr Dorrell allocated pounds 95m for new long-stay homes providing 24-hour care, but it is estimated it would cost up to pounds 400m to build and pounds 250m to run all the units required for the 5,000 people needing accommodation. At present there are about 40 health service inquiries into deaths involving Care in the Community cases. In the latest, Anthony Smith, 24, pleaded guilty yesterday at Nottingham Crown Court to manslaughter with diminished responsibility and was ordered to be detained in Rampton secure hospital indefinitely.

The judge, Mr Justice Latham, ordered an inquiry saying that the case presented "the nightmare that those who care for people with schizophrenia must fear". Smith was diagnosed as a paranoid schizophrenic in July 1995 and had been a patient at Derby City General Hospital for less than a month before discharging himself and returning home with the approval of his consultant, Dr Sarah Barrett. At home he stopped taking medication.

A month later, after an argument with his mother, Gwendoline, he said he had "just gone berserk" and stabbed her 43 times with a 12in serrated Bowie knife. When his 11-year-old half-brother David tried to intervene he stabbed him 25 times, before clubbing them with an iron bar.

Smith cleaned the knife, showered and changed his clothes. He then left a note on his brother's body, saying: "I am sorry David, I love you," before locking up the house and handing himself in at his local medical centre. He told staff there: "It was inevitable."

Ordering Smith to be detained indefinitely, the judge said: "This is a case where the circumstances of this young man's release into the community, and perhaps more importantly, the circumstances of the care that he was given in the community, will have to be looked at with great care."

His adoptive father, Peter Smith, said yesterday: "I knew something was going to happen from what I was learning about the illness. There was nobody else to help, it was down to me. I had nowhere else to turn. I don't want this to happen to somebody else, to some other family.

"I have nothing to say to [Anthony] any more. I have said what I wanted to say and that is it. As far as I am concerned . . . I have lost both my sons."

Southern Derbyshire Health Trust said an inquiry would be held into the case but that an internal review had found "no major breakdowns" in the care given. Dr Barrett, who is now on maternity leave, will not face disciplinary action.

"[Anthony] Smith was keen to return home and the consultant felt that he was ready to return to an environment where he had lived safely for 23 years, providing he took medication regularly and agreed to out- patient follow-up," said a spokesman. "The acts committed were totally unexpected."

Smith's case is just the latest to provoke bitter criticism of Care in the Community: Christopher Clunis stabbed to death Jonathan Zito at Finsbury Park Tube station, north London, in 1993; Wayne Hutchinson, a paranoid schizophrenic who was released by mistake, killed two and injured three in Brixton, south London; Gilbert Steckel was allowed to discharge himself from psychiatric ward in Croydon. He returned home, killed his mother and committed suicide; Paul Medley, a paranoid schizophrenic, battered a pensioner to death within days of pleading with a hospital to admit him; Stephen Mitchell murdered his father and two pensioners seven months after being freed from hospital by psychiatrists.

Mr Dorrell's announcement of long-stay homes for the mentally ill was widely interpreted as an acknowledgement that Care in the Community had failed. The health department admitted last month that one in three health authorities would not have comprehensive mental health services in place in 13 months even if all authorities' development plans were fully implemented. Of 101 English authorities surveyed last autumn, 68 were officially expected to be providing acceptable services by the end of March: some 33 were not, including Manchester, Liverpool, Sheffield, Avon, Hertfordshire, Cornwall and West Sussex.

Jayne Zito, of the Zito Trust, said the Smith left the Government with "blood on its hands".