Mental Health Care Failings In Killings

A man who killed a 21-year-old man had told mental health services of his fantasies to murder – but was not given adequate help, a report has found.

A review by Healthcare Inspectorate Wales into the case said there were failures in diagnosing and treating Mr Royston’s “personality disorder”.

Similar shortcomings were also uncovered in the treatment of Deborah Hancock, who killed a woman in Cardiff.

The report from Healthcare Inspectorate Wales (HIW), which was commissioned by the Welsh Assembly Government, concluded that there was not enough understanding of Mr Royston’s “complex” and “confusing” personality traits.

He was referred to the Bryn Golau Community Mental Health Team (CMHT) as an urgent case by his GP in October 2003 after admitting having homicidal thoughts.

It was concluded he posed a “significant level of risk” and that he was at risk of future violence, including acting out scenarios which he had fantasised about.

Over the years, Mr Royston, from Bargoed, who was married with a young daughter, said he fantasised about killing people he saw on the street and even his own brother.

He was later referred to the medium secure psychiatric Caswell Clinic in Bridgend – but his diagnosis here differed from his diagnosis at CMHT.

The report said that it was this confusion in diagnosing his exact problems that meant it was never clear which service should take overall responsibility for Mr Royston’s care.

The review also highlighted the poor communication between the mental health services and other agencies, including social services, with referrals not acted upon and recommendations not passed on.

At one meeting Mr Royston “claimed that he was not being given appropriate care and advice and said that if he committed a crime it would be the CMHT’s fault”, the report said.

He went on to kill a stranger – Mr Shorney, who had learning difficulties – stabbing him 38 times in a “frenzied attack” in a park in April 2006.

He was ordered to serve 20 years in jail for the murder by a judge at Cardiff Crown Court in November 2006.

Random attack

The HIW report recommended better training programmes for mental health staff to diagnose and deal with personality disorders, while improving communication.

In a statement, Caerphilly Teaching Local Health Board, Gwent Healthcare NHS Trust and Caerphilly County Borough Council said many processes had been improved and updated over the past two years.

“Improved joint working between key agencies will help enhance our services,” it added.

A separate HIW report highlighted the mental health problems behind another south Wales killing.

Deborah Hancock, of Butetown, Cardiff, killed retired hairdresser Valerie Thomas, 75, in a random attack at a Poundstretcher store in the city centre in October 2005.

The 45-year-old, who had been diagnosed with schizophrenia in 1992, took an 8in carving knife from the shelf of the Church Street store and plunged it into Mrs Thomas’s back.

She admitted manslaughter on the grounds of diminished responsibility and was sentenced at Cardiff Crown Court to an indefinite term in a psychiatric unit.

The report said the death “could not have been predicted and that there were no indications, which suggested that the homicide could have been prevented”.

However, it said Ms Hancock, who was later diagnosed with a borderline personality disorder, had difficulty in keeping her appointments with mental health teams.

The report said there were also no dedicated services in Cardiff for those suffering from personality disorders – something it has now recommended be implemented.

It also said a more proactive approach should be made to ensure people who may be unwilling or unable to get help, are seen by mental health services.

In a statement, Cardiff Local Health Board, Cardiff County Council and Cardiff and Vale NHS Trust said: “We are working together to ensure improvements are made for the future.”

Dr Peter Higson, chief executive of HIW, said: “There are important lessons to be learned from both of these tragic cases to ensure that mental health services are better able to minimise the risk of similar incidents in the future.”

Ann Lloyd, chief executive of NHS Wales and head of the assembly government’s health and social services department said: “We believe that much of what has been recommended is already being addressed in a range of work that is in development.”