Mental health trust criticised over killings

2:46pm Wednesday 2nd July 2008

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Investigators have criticised a mental health trust after two of its patients killed people over the same weekend.

NHS London commissioned two independent reports, one into the case of Sean Perry who killed Matthew Carter, the other into Thomas Wright who killed his wife, both in February 2006.

"These terrible events are always an opportunity to learn about how we improve our services and how we must try to stop these kind of events happening in the future."

Peter Houghton chief executive of the south-west London and St George's Health Trust

Perry, who had been a patient at Tooting's Springfield Hospital, killed Matthew Carter - kicking and stamping him to death as he walked to his Mitcham home.

Perry pleaded guilty to Mr Carter's manslaughter by reason of diminished responsibility and was sent to Broadmoor maximum security hospital indefinitely in 2006.

Wright, 56, from Tooting, stabbed his wife 77 times with a kitchen knife at their home the day before Mr Carter's killing on February 17, 2006.

He appeared at the Old Bailey on 12 February last year. He was unfit to plead and was sectioned the following day.

Wright had been referred to the Tooting and Furzedown community health team by his GP but was not seen - as he refused visits.

Investigators, Verita, looked into the care provided to Perry in the weeks before the killing by South West London and St George's Mental Health Trust's early intervention service (EIS).

They concluded that Perry was known to present a "significant risk" when acutely psychotic and failure to refer him for forensic assessment, because staff felt its value would be limited, was a "lost opportunity".

The report also states health workers had relied too heavily on Perry's mum to monitor his condition.

Neil Hickman, Perry's care coordinator, although praised as a manager, was criticised by the report's authors.

"Neil Hickman was unduly focused on the wishes and desires of Sean Perry and his family rather than on the risks he posed when unwell," the report said.

The report also said it was a "professional misjudgement" not to make sure a face-to-face mental health assessment of Perry had been carried out in February 2006.

The report made 19 recommendations for the trust, the local community council and the EIS.

Investigators also set out a series of recommendations into their report of Wright's care.

But it also praised one team's manager, Jeremy Walker, who the report said had made many improvements.

Dr Simon Tanner, NHS London public health director, said: "We would like to express our deepest sympathies to the families and friends of Mr Carter and Mrs Wright.

"We would also like to thank them for their co-operation in the production of these reports. The strategic health authority, which has an overview of the mental health trust, will be closely monitoring improvements at SW London and St George's."

Welcoming the reports Peter Houghton, chief executive of the south-west London and St George's Health Trust said: "These terrible events are always an opportunity to learn about how we improve our services and how we must try to stop these kind of events happening in the future."

He said that recommendations within the reports would be addressed and added that the trust's EIS had trebled in size and staff had received more training.