Killings in Swindon by mental health patients 'avoidable'
The deaths of three people who were killed by mental health patients in Wiltshire could have been avoided, two independent reports have found.
Timothy Crook battered his elderly parents Bob and Elsie Crook to death in Swindon in 2007.
Carl James, 21, was killed by his schizophrenic friend Michael Harris in Swindon in March 2007.
Avon and Wiltshire Mental Health Partnership NHS Trust accepted the reports' findings and apologised.
The reports were commissioned by the South West Strategic Health Authority and the East Midlands Strategic Health Authority, and were received by the NHS South of England on Tuesday.
Crook killed his parents while he was under the care of specialist mental health services in Wiltshire and Lincoln.
The 330-page report states the trusts knew Crook presented a "significant risk to the safety of other people" but "failed to deliver the required standard of care and treatment" and "systematically ignored policy and procedure".
"The assertive clinical management of Mr Crook would have prevented the steady deterioration of his mental illness and the subsequent deaths of his parents," it says.
Harris pleaded guilty to manslaughter on the grounds of diminished responsibility and was detained indefinitely under the Mental Health Act in 2007.
The second report says he was let down by Avon and Wiltshire Mental Health Partnership NHS Trust and the poor treatment he received, and in particular the lack of management direction, were contributory factors to Mr James's death.
The report authors said they were "pleased to learn" that action had been taken regarding all 71 recommendations to the trust.
Crook's sister Janice Lawrence, who repeatedly asked for help, said the report on her brother's case did not go far enough and contained omissions and discrepancies.
Mrs Lawrence tried to get her brother sectioned, but nothing was done.
She said she wanted to see more independent reviews of what happened in the run-up to her parents' death.
Mrs Lawrence said: "They [her parents] brought him home, nobody cared about their safety or the family's safety and we struggled with him, they knew he was in the community and they knew how dangerous he was."
Avon and Wiltshire Mental Health Partnership NHS Trust and Lincolnshire Partnership NHS Foundation Trust have apologised, accepted the report's findings and said they were working through its 23 recommendations.
Hazel Watson, from the Avon and Wiltshire Mental Health Partnership, admitted Crook's family could not have done more to warn the authorities about his condition.
"They spoke to us, they spoke to the police, they spoke to social services, they spoke to almost every organisation in Swindon," she said.
"We absolutely accept the findings of the report, that we failed to hear what they were saying and we failed to act appropriately on it."
Seamus Edney, a solicitor specialising in clinical negligence, said: "I've already advised the family that there may well be a claim for compensation, although their priority at the moment is the report and the recommendations, and seeing those recommendations implemented, to ensure this tragedy doesn't happen again in the future, this is one [of] the worst I've heard of."
Timothy Crook went to live with his parents at their home in Thames Avenue, Swindon, in 2003.
He had been treated for mental health problems at his previous home in Lincoln and had been diagnosed with a delusional disorder, but his family were not told.
After 18 months living with his parents, he came off his medication and his behaviour became increasingly aggressive.
Despite a prior attack on his parents in 1999, and calls for help made by his sister to the authorities, nothing was done.
Four days before they were killed, it has been claimed the health trust failed to section him.
Bristol Crown Court heard in 2008 that Crook had repeatedly hit his parents with a hammer and strangled them before putting them into a car, taking them to his house in Lincoln and leaving their bodies in the garden.
Crook was deemed to be too mentally ill to plead but jurors at his trial decided he did kill Mr Crook, 83, and his 76-year-old wife.
He was sentenced to an indefinite period in a secure hospital.
The investigations were carried out by the Health and Social Care Advisory Service and Rae Wallin Ltd.