Schizophrenia and violence: Are new mental health policies needed?

The North East Thames and South East Thames Regional Health Authorities merit congratulations for conducting an inquiry into the treatment and care of a schizophrenic man, Christopher Clunis, who stabbed to death a stranger on a subway platform. Nothing in this report (North East Thames and South East Thames Regional Health Authorities, 1994) suggests that these regions of London are different from other western countries in the management and services provided to patients suffering from schizophrenia. In fact, the familiarity of this case is striking, both with respect to the characteristics and history of the patient and the response to him by the mental health and criminal justice systems. The patient was 29 years old, had been diagnosed schizophrenic and had a history of admissions dating back at least 6 years. His treatment could be characterized as chaotic, in that no mental health professional appears to have had continual or even intermittent contact with him, he was sometimes homeless, no complete record of care appears to exist, and almost every demand for service by either the patient or a mental health professional working on his behalf required a complete reassessment of the patient and his history. The inquiry, in retrospect, was able to document a series of incidents of aggressive behaviour towards others which escalated in severity and which went largely unnoticed and unrecorded by mental health professionals until after the murder. The report documents in great detail the care provided to Mr Clunis, and makes a series of recommendations in an effort to prevent similar tragedies. The recommendations focus on numerous strategies which would ensure consistency in both records and treatment, increased supervision in the community and