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Clues to homicide by the mentally ill
Cholera in Russian Federation
Clues to homicide by the mentally ill
preliminary results of a confidential A cholera outbreak in Dagestan, a repubinquiry’ into homicides committed by lic within the Russian Federation, has triggered emergency measures throughout people who had received specialist psychi-
The
has added fuel to the debate in the UK over how to encourage people with serious psychiatric illnesses to maintain contact with and accept treatment from the mental health services. : This audit was set up in 1991 because . of concern over the treatment of the mentally ill and their potential for violence. The remit of this independent which is funded by the Department of Health, is to investigate the circumstances of patients who had been in touch with the psychiatric services within the 12 months before the homicide or suicide, identify aspects of the patients’ management that might be related to the deaths, and recommend ways of reducing the number of these incidents. : The preliminary report is based on the limited data that have been gathered on homicides (a term covering murder, manslaughter, and infanticide) committed between July, 1992, and the end of December, 1993. Out of the 100 cases identified during this time, the inquiry found 34 where there had been contact with the psychiatric services during the 12 months before the homicide. : The inquiry found it "surprisingly difficult to follow up these 34 cases", and in 3 instances the consultant psychiatrist who had been looking after the patient before the homicide could not be identified; a further 9 cases could not be followed up for legal or practical reasons, thus only 22 cases could be examined in depth. The majority were being treated as outpatients or living at home and attending day hospitals. In only 2 cases was the person who died not acquainted with the aggressor. Women were likely to have killed one of their own children. : All but 3 patients were being treated as outpatients at the time of the homicide. The inquiry found that the professionals who had been looking after the patient felt that each homicide had been unexpected and unpredictable. The replies to the confidential questionnaire sent out by the inquiry team also indicated that supervision of the patient had been appropriate and that staffing levels had been adequate. However, for 13 of these patients, responders indicated that the homicide followed a period of non-compliance with recommended treatment. : A "much more comprehensive report on homicide will be produced at a later
atric
care
inquiry,
1
Ramsay
Confidential inquiry into homicides and suicides by mentally ill people. A preliminary report on homicide. From: PO Box 1515, London SW1X 8PL, UK.
Vera Rich
able. 1 of these had never received rabies vaccine. He had trapped for about 47 Alaska years and his fox harvest was estimated to be about 3000. His serum neutralising Alaskan natives have for generations lived antibody concentration was 2-30 IU/mL. by trapping, hunting, and skinning aniFollman and colleagues say that this mals. During skinning it is common pracis the first of probable exposure to tice to place a bare hand in the animal’s report wild rabies leading to a rabies neutralising mouth or to grasp the carcass or hide with concentration considered proone’s mouth. Could such exposure induce antibody tective by WHO. immunity, which might account for the rarity of rabies in the Arctic? Follmann Vivien Choo and colleagues’ think it is possible. In: their survey of 26 trappers, 3 had neutrali1 Follman EH, Ritter DG, Beller M. Survey ing antibody concentrations of more than of fox trappers in northern Alaska for rabies 0-05 IU/mL, the level considered by the antibody. Epidemiol Infect 1994; 113: 137-41. World Health Organization to be accept-
Immunity to rabies
in
News in brief Alternative council After the unexpected resignation of Joseph Jacobs, director of the US Office of Alternative Medicine, Department of Health and Human Services Donna Shalala, secretary, announced this week the appointment of a new advisory council to the OAM. The council will be chaired by Dr James Gordon, currently director of the Center for Mind-Body Medicine, Washington, DC. His 17-member team will not only advise the troubled OAM, which was established at the National Institutes of Health in 1992, but also will act as a watchdog over its activities. Terror in Burundi Physicians for Human has urged international leaders and the UN Secretary General to turn their attention to the impending crisis in Burundi and to put pressure on the county’s political parties to agree on the appointment of a president; to deploy at
: Rights (PHR)
stage". Sarah
the southern part of the Commonwealth of Independent States, and as far afield as Poland. In Dagestan itself, where the outbreak started in July, 208 cases (10 deaths) and 130 carriers have been recorded in 3 towns and over 25 villages. Despite strict quarantine measures there, travel restrictions, chlorination of water, and a ban on hawker food, by early August 5 cholera patients and 3 carriers had been registered in Azerbaijan, where border controls were tightened and bathing in the Caspian forbidden. The Russian State Committee for Public Health set up special checkpoints to screen arrivals from Dagestan and also those from the Middle East, India, and Rwanda. Other CIS republics did likewise. Kyrgyastan and Kazakhstan have each identified 2 cases arriving from Pak-
istan. In Kazakhstan, the vibrio was discovered in the Alma-Atinka river. When the organism was found in the Izov sea, off the coast of Ukraine, sea-bathing was banned there. At least 14 cases of cholera have been diagnosed in Moscow among visitors and new arrivals, and doctors there have appealed to Muscovites to avoid hawker food, in particular melons brought in by traders from the fruit-producing south. Some Dagestanis go further, ostensibly as tourists to central Europe, but laden with fruit and other food products. Poland has now imposed special checks on Dagestani arrivals, turning back suspected cholera contacts without cholera vaccination certificates. Reports received by WHO have been of El Tor serotype Ogawa. The latest reports of cases have come from Moldova (6 cases), which has asked for epidemiological and bacteriological assistance. The other states have not take up WHO’s offer of help.
least 500 human rights monitors and advisors there; and to ensure cessation of the hateful and inflammatory radio and other messages. A PHR team has found violent incidents and killings in several areas. The Rwandan war has led to a return of Burundian refugees, to an influx of Rwandan Hutu refugees, and to the emigration of many educated Rwandan Tutsis who have been living in exile in Burundi. This brain-drain is disrupting the health and education sectors. Criminal DNA database planned Michael Howard, Home Secretary for England and Wales, indicated his continued commitment last week to the setting up of a national DNA database. At present, a small DNA database of those convicted of very serious crimes (murder, rape) is kept. Under new legislation, information on the DNA of those suspected of minor crimes may be recorded. Civil rights activists have voiced their concerns over the abuse to which such an expanded database would be open.
607
Clues to homicide by the mentally ill
preliminary results of a confidential A cholera outbreak in Dagestan, a repubinquiry’ into homicides committed by lic within the Russian Federation, has triggered emergency measures throughout people who had received specialist psychi-
The
has added fuel to the debate in the UK over how to encourage people with serious psychiatric illnesses to maintain contact with and accept treatment from the mental health services. : This audit was set up in 1991 because . of concern over the treatment of the mentally ill and their potential for violence. The remit of this independent which is funded by the Department of Health, is to investigate the circumstances of patients who had been in touch with the psychiatric services within the 12 months before the homicide or suicide, identify aspects of the patients’ management that might be related to the deaths, and recommend ways of reducing the number of these incidents. : The preliminary report is based on the limited data that have been gathered on homicides (a term covering murder, manslaughter, and infanticide) committed between July, 1992, and the end of December, 1993. Out of the 100 cases identified during this time, the inquiry found 34 where there had been contact with the psychiatric services during the 12 months before the homicide. : The inquiry found it "surprisingly difficult to follow up these 34 cases", and in 3 instances the consultant psychiatrist who had been looking after the patient before the homicide could not be identified; a further 9 cases could not be followed up for legal or practical reasons, thus only 22 cases could be examined in depth. The majority were being treated as outpatients or living at home and attending day hospitals. In only 2 cases was the person who died not acquainted with the aggressor. Women were likely to have killed one of their own children. : All but 3 patients were being treated as outpatients at the time of the homicide. The inquiry found that the professionals who had been looking after the patient felt that each homicide had been unexpected and unpredictable. The replies to the confidential questionnaire sent out by the inquiry team also indicated that supervision of the patient had been appropriate and that staffing levels had been adequate. However, for 13 of these patients, responders indicated that the homicide followed a period of non-compliance with recommended treatment. : A "much more comprehensive report on homicide will be produced at a later
atric
care
inquiry,
1
Ramsay
Confidential inquiry into homicides and suicides by mentally ill people. A preliminary report on homicide. From: PO Box 1515, London SW1X 8PL, UK.
Vera Rich
able. 1 of these had never received rabies vaccine. He had trapped for about 47 Alaska years and his fox harvest was estimated to be about 3000. His serum neutralising Alaskan natives have for generations lived antibody concentration was 2-30 IU/mL. by trapping, hunting, and skinning aniFollman and colleagues say that this mals. During skinning it is common pracis the first of probable exposure to tice to place a bare hand in the animal’s report wild rabies leading to a rabies neutralising mouth or to grasp the carcass or hide with concentration considered proone’s mouth. Could such exposure induce antibody tective by WHO. immunity, which might account for the rarity of rabies in the Arctic? Follmann Vivien Choo and colleagues’ think it is possible. In: their survey of 26 trappers, 3 had neutrali1 Follman EH, Ritter DG, Beller M. Survey ing antibody concentrations of more than of fox trappers in northern Alaska for rabies 0-05 IU/mL, the level considered by the antibody. Epidemiol Infect 1994; 113: 137-41. World Health Organization to be accept-
Immunity to rabies
in
News in brief Alternative council After the unexpected resignation of Joseph Jacobs, director of the US Office of Alternative Medicine, Department of Health and Human Services Donna Shalala, secretary, announced this week the appointment of a new advisory council to the OAM. The council will be chaired by Dr James Gordon, currently director of the Center for Mind-Body Medicine, Washington, DC. His 17-member team will not only advise the troubled OAM, which was established at the National Institutes of Health in 1992, but also will act as a watchdog over its activities. Terror in Burundi Physicians for Human has urged international leaders and the UN Secretary General to turn their attention to the impending crisis in Burundi and to put pressure on the county’s political parties to agree on the appointment of a president; to deploy at
: Rights (PHR)
stage". Sarah
the southern part of the Commonwealth of Independent States, and as far afield as Poland. In Dagestan itself, where the outbreak started in July, 208 cases (10 deaths) and 130 carriers have been recorded in 3 towns and over 25 villages. Despite strict quarantine measures there, travel restrictions, chlorination of water, and a ban on hawker food, by early August 5 cholera patients and 3 carriers had been registered in Azerbaijan, where border controls were tightened and bathing in the Caspian forbidden. The Russian State Committee for Public Health set up special checkpoints to screen arrivals from Dagestan and also those from the Middle East, India, and Rwanda. Other CIS republics did likewise. Kyrgyastan and Kazakhstan have each identified 2 cases arriving from Pak-
istan. In Kazakhstan, the vibrio was discovered in the Alma-Atinka river. When the organism was found in the Izov sea, off the coast of Ukraine, sea-bathing was banned there. At least 14 cases of cholera have been diagnosed in Moscow among visitors and new arrivals, and doctors there have appealed to Muscovites to avoid hawker food, in particular melons brought in by traders from the fruit-producing south. Some Dagestanis go further, ostensibly as tourists to central Europe, but laden with fruit and other food products. Poland has now imposed special checks on Dagestani arrivals, turning back suspected cholera contacts without cholera vaccination certificates. Reports received by WHO have been of El Tor serotype Ogawa. The latest reports of cases have come from Moldova (6 cases), which has asked for epidemiological and bacteriological assistance. The other states have not take up WHO’s offer of help.
least 500 human rights monitors and advisors there; and to ensure cessation of the hateful and inflammatory radio and other messages. A PHR team has found violent incidents and killings in several areas. The Rwandan war has led to a return of Burundian refugees, to an influx of Rwandan Hutu refugees, and to the emigration of many educated Rwandan Tutsis who have been living in exile in Burundi. This brain-drain is disrupting the health and education sectors. Criminal DNA database planned Michael Howard, Home Secretary for England and Wales, indicated his continued commitment last week to the setting up of a national DNA database. At present, a small DNA database of those convicted of very serious crimes (murder, rape) is kept. Under new legislation, information on the DNA of those suspected of minor crimes may be recorded. Civil rights activists have voiced their concerns over the abuse to which such an expanded database would be open.
607