When 18-year-old Daniel Joseph finally went berserk it was hardly a surprise. As long ago as last summer he had been diagnosed as psychotic. And the warning bells rang ever louder, up until the time he killed Carla Thompson: Nick Davies on another tragic failure for Community Care.
At about ten to eight on January 22 this year, an 18-year-old Londoner named Daniel Joseph kicked in the door of a council-flat in Brixton, south London, strode into the bedroom, twisted his fists into the hair of the woman who was sleeping there and dragged her onto the floor. He then unleashed a hurricane of unmitigated violence.
Daniel, who was muscular and fit and six foot seven inches tall, set about his victim with his fists and his feet. Within minutes she was unconscious, and he started hauling her around the flat by her hair, smashing up tables and chairs, pausing every so often to beat her or kick her or to batter her head against a radiator until the wall was sprayed with red. At one point, he lit a piece of paper and tried to set fire to her hair. When that failed, he fetched a tow-rope and announced that he was going to hang her.
As he towed his victim’s naked body outside to the car park, the first emergency calls reached the police. By the time they arrived, Daniel had broken down the door of a second flat, battered a second woman senseless, carried her out into the road, roped her by the neck to his first victim, stamped on them, kicked them and started smashing up cars. It took the police some 20 minutes to arrest him as he ripped their riot shields from them, bombarded them with broken furniture and swung at them with a length of drainpipe. While they waited for reinforcements, he jumped up and down on a car roof, beating his chest and grunting loudly. Finally, using CS spray, the police wrestled him into a van and deposited him in Brixton police station. It was only then that the truth about Daniel Joseph began to emerge.
A year earlier, when he was only 17, doctors had diagnosed Daniel as psychotic. After eight months in a mental hospital, they had followed the philosophy of Community Care and released him, in August last year, with instructions to take medication and to attend further appointments. He had done so for three months. And then he had stopped and fallen into the gap between four different agencies which were supposed to be responsible for him. For two months, as his behaviour became increasingly bizarre and aggressive, his mother had appealed for someone to help. A community psychiatric nurse had warned that he needed ‘urgent intervention. A specialist registrar had examined him and concluded he was ‘psychotic and gradually relapsing’. Yet he had been left in the community, with each agency looking to another to take care of him, until finally he killed.
Carla Thompson, the 57-year-old woman who was at the eye of his storm of violence, died from her 50 different injuries 21 hours after the attack. Agnes Erume, aged 53, who was pulled into the chaos suffered a heart attack on the ground where she lay, spent a week in intensive care and survived with two broken bones in her face and a constant fear. After his arrest, Daniel remained at such a peak of aggression that, three weeks later, for the first time in its history, Broadmoor Hospital was forced to hold a magistrate’s hearing within its walls: their patient was simply too violent to risk a trip outside.
Yesterday, at the Old Bailey, Daniel, now 19, was sent to Broadmoor Hospital without limit of time. Lambeth, Southwark and Lewisham Health Authority announced an independent inquiry to be chaired by a QC, and a spokesman for the health secretary, Frank Dobson, repeated his view that the policy of Community Care had failed too many patients who had been given too little support. The department says it will publish new proposals later this year.
Daniel Joseph ’s descent into violence is a familiar story. The best available figures suggest Community Care patients now kill 50 people a year – about one a week – and that they are driven to suicide at the alarming rate of 1,000 a year. The mental health charity, Sane, says almost all of these deaths are preventable. Critics say Community Care has been suffocated by lack of funding and by administrative confusion and that, apart from the high-profile cases of homicide, there are countless mundane incidents of mentally ill people living in a state of miserable neglect with neighbours who feel threatened and disrupted by their behaviour.
Daniel’s is a tale of failure, not so much of the doctors and nurses who were dealing with him, but of the system which expected them to help him even though he was frequently beyond their reach, often beyond their control. It is a revealing irony that his victim had become close to him after opening her home as a refuge for the wasted and wandering casualties of Community Care, trying to give them the support the system denied them.
Indeed, Carla Thompson was herself, to a lesser extent, one of these casualties. She had worked as a copywriter until the mid-1980s, when she suffered a nervous breakdown and emerged from mental hospital with a profound but eccentric faith in God. Left to fend for herself, she turned her council flat into an improvised church where she drank heavily, smoked dope, read the scriptures, played the guitar and gathered a flock of stray dogs and stray people. She offered kindness and shelter and her own particular mix of marijuana and miracles. She used the bathroom to baptise several of them. Agnes Erume, who lived upstairs, sometimes joined the prayer meetings.
Daniel was only a baby when he was singled out by bad luck: an ear infection became so bad that he completely lost his hearing. While his nine brothers and sisters studied and prospered, Daniel drifted off course, unable to speak, unable to learn. He learned sign language, but never managed to read or write properly. He wanted to play football, but other players could not cope with his deafness. By the time he was 14, teachers were complaining that he was disruptive, doctors were saying he was hyperactive, and his mother was worried that he was simply bursting with frustration. Then he found a private world and began to slide downhill.
He became captivated by American wrestling, which he watched endlessly on television. By the time he was 15, he was devoting most of his time to Sid Sycho and Randy Savager and he was convinced that if he could get in touch with his favourite fighter, Shawn Michaels, he could join his team and enter a world where strength alone was enough to succeed. It was this adoration which caused his first crisis.
When Daniel was 17, in December 1996, he heard that his hero was coming to the London Arena for a bout. He packed his suitcase and his out-of-date passport and set off, but he could not make contact with Michaels and was eventually found wandering outside the arena by a security man, who sent him home in a taxi. That night he was bitterly angry. He started to blame his mother: she must have told Michaels to stay away from him. He became agitated, pushing one of his brothers, threatening his mother. She became so alarmed that she called the police who, in turn, called a doctor, who saw his seething anger and advised he enter hospital. Daniel spent the next eight months at a specialist unit for the deaf and mentally ill in Tooting, south London, run by the Pathfinder National Deaf Service.
By the time he was released in August 1997, he had been diagnosed as psychotic. The Pathfinder doctors said he was ‘thought-disordered and expressing paranoid delusions’. They prescribed Risperidone, recommended for ‘acute and chronic psychosis’ and provided him with the best of Community Care: a place in the Ian Collie hostel for the deaf in Wandsworth; follow-up appointments in Tooting and in Devon; a community psychiatric nurse and a social worker to keep an eye on him. However, there were two fundamental problems, both familiar to critics of Community Care.
The first was that the mental illness which required all this care also encouraged him to reject it. After less than a month, he walked out of the hostel to live with his mother and started to miss appointments. The second problem was that nobody could agree who was responsible for him. Pathfinder said he belonged to Lambeth Healthcare, in whose patch he had been living with his mother. Lambeth Healthcare said he belonged to Pathfinder, because he was deaf and because the Ian Collie hostel was in their area. In the background, Lambeth Social Services were also responsible for him, but believed the primary responsibility lay with Pathfinder or Lambeth Healthcare.
Daniel added more confusion in November by leaving his mother’s home to live with Carla Thompson. This meant he was now on the patch of a fourth authority, Bethlem and Maudsley. He was also exposed to a particularly cruel irony. Carla was convinced that God could solve all problems. If they ran out of food in the flat, God would provide. When one of her dogs was dying, she hid him in a cupboard to stop the RSPCA finding him, because it was for God to decide when the animal should die. Now she told Daniel that it was not for the doctors to cure him, it was no good relying on tablets for help. And so sometime in November, he turned to the Lord and stopped taking his Risperidone. Disaster was only two months away.
The pharmaceutical plug which had held back his illness started to dissolve, and the psychosis leaked back into his system. Soon, he was becoming violent, looking thin and unkempt. When his stepfather refused to drive him to American football practice, Daniel stole his car and smashed it into a tree. He had started a relationship with a girl called Kirsty, who lived with Carla, and when he saw another young man talking to her, he picked him up and hurled him across the room. He lost his temper with his stepfather, locked his arm around his neck (just like Shawn Michaels) and started punching him. Carla burst out praying, and Daniel fell to his knees.
Daniel realised his mother was trying to get him sent back to hospital and – with Carla’s help – he and Kirsty fled to a flat in Streatham. There he started raving about attackers. He assembled a pile of weapons, including a hammer and a knife, and leaped around the room aiming kung-fu kicks at the walls. Kirsty fled back to Carla’s. Daniel followed her there the next day, with a hammer in his hand, to retrieve his TV set. Carla handed him a piece of paper, which Daniel read and threw away. ‘Kirsty is going to have your baby’, it said. He strode away alone.
Now the alarm bells were ringing loud, largely because of his mother’s insistence that someone somewhere must take responsibility for him. Finally, a nurse at Lambeth Healthcare agreed that although Daniel was not on her patch, she would visit him at Carla’s. The nurse realised Daniel had stopped taking his medication and that some of those in the flat were boozing and taking drugs. She arranged for a specialist registrar, Simon Edgar, to visit him.
A week later, on December 15, Dr Edgar sat in Carla’s cluttered frontroom and with an audience of six other people and two dogs, tried to assess him. He noted that Daniel still had grandiose ideas, that he was using sign language very fast and concluded that he was ‘psychotic and gradually relapsing’. However, Carla said he was fine and she made no mention of illicit drugs or drink, and Dr Edgar agreed Daniel should be allowed to stay with her. He told Daniel to keep an appointment at a specialist clinic in Devon. Daniel didn’t. He was now only five weeks from disaster.
By January 8, Daniel’s mother, Claudette, had finally persuaded his care workers to hold a case conference, where it was decided he should be taken into the Maudsley Hospital. Ten days later, however, he was still at Carla’s, unassessed and increasingly mad. On January 19 – only three days before the explosion – the nurse from Lambeth Healthcare wrote to the Maudsley warning that his mental state and behaviour were deteriorating and calling for ‘urgent intervention’. It never came.
Two nights later, on Wednesday, January 21, neighbours at the Streatham flat where Daniel was hiding heard him grunting and jumping and slowly smashing up the place. The noise went on into the small hours, when Daniel set out on foot to Carla’s. It was just before 8am when he kicked in her door.
The police who finally overpowered him found him in a seething passion of violence. That Thursday night, he was still leaping around his cell, aiming kicks at the air, grunting and screaming while the care system dithered on the sidelines. A senior registrar from the Maudsley decided he must be admitted, but the Maudsley spent several hours refusing to do so. Finally, on Friday morning, two vans full of police restrained him and moved him to the Maudsley. Over the weekend he remained so violent that 27 police officers in three vans were called to escort him to Broadmoor. He was heavily sedated and strapped to a stretcher. Even so, he managed to bend his handcuffs out of shape.
His case has stirred once more the cauldron of discontent over Community Care. Marjorie Wallace, the chief executive of the mental health charity Sane, said yesterday: ‘This is the most shocking case to date of preventable death. Not only does it show the absurdity of a system that cannot keep track of one patient, but also the huge waste of money and resources with what appears to be a predictable and tragic outcome.’ When Sane studied 23 inquiries into homicides by the mentally ill, it found that 22 of them involved a breakdown of communication between key agencies. In more than half of them, the patient had stopped taking medication. Also in more than half of them, professionals had ignored warnings from families or other carers that the patient was becoming dangerous. Repeatedly, the inquiries found evidence of patients whose records were hopelessly incomplete and whose care plans were sometimes non-existent. A few patients had been recognised as risks and yet no action had been taken most had simply never been assessed to see whether they might pose any kind of risk at all.
The scale of the problem is concealed by statistical confusion – different definitions of mental illness and gaps in available information on homicides and suicides. After a series of high-profile killings in the early 1990s, the government and the Royal College of Psychiatrists set up the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Their final report is due next year, but preliminary results published last year suggested that 12 per cent of homicides and 26 per cent of suicides are committed by people who are mentally ill.
If those figures are correct, the implication is that the mentally ill are being being given care so scant that each year they commit 50 killings and 1,000 suicides. The Zito Trust, which has run a highly effective campaign on the issue, said yesterday it was aware of two more court cases in the next week where killings had allegedly been committed by the mentally ill.
The Department of Health is pulling together the threads of numerous inquiries. Each of the authorities involved in Daniel Joseph ’s case has conducted its own internal review and is now taking part in an independent inquiry to be chaired by a QC. The health minister, Paul Boateng, is completing his own review of policy and is expected to announce two new initiatives – an increase in 24-hour nursing homes for the severely mentally ill and more assertive outreach teams which will follow difficult patients into the community. The question which critics will ask is whether the system can be saved by this kind of amendment, or whether Community Care itself is inherently too weak to protect the welfare of people like Daniel Joseph and Carla Thompson.
