Mental health services in Birmingham should review how they share information about service users with the police, an independent report into the fatal stabbing of a police officer has recommended.
Glaister Earle Butler was convicted of manslaughter on the grounds of diminished responsibility and was given a sentence of indeterminate length in a secure medical unit for the killing in May 2004.
An independent inquiry into the treatment given to Mr Butler has detailed a series of errors. Outreach workers failed to realise the extent of Mr Butler’s illness and understand the grave risk he posed to the community, according to the 282-page report commissioned by West Midlands strategic health authority.
The inquiry found the team responsible for monitoring Mr Butler engaged in only “brief interaction and superficial contact” with him, often speaking to him on his doorstep and visiting him just once every two weeks.
Police had asked mental health services for information about Mr Butler but were given only “the briefest of details”, the inquiry panel said.
The report recommended that mental health services in Birmingham should review with West Midlands Police the advice, support and training available to the police for dealing with mentally ill patients. It said the trust and the strategic health authority “should review with the police procedures and resources whereby advice could be made available to the police in relation to incidents involving known mental health service users”.
Birmingham and Solihull Mental Health NHS Trust chief executive Sue Turner said: “Mr Butler’s situation and condition could and should have been more assertively treated and managed.”
She added that the team was responsible for “a pretty devastating set of shortcomings”, promising that vast improvements have been made over the last five years.
In a statement, NHS West Midlands said: “Birmingham and Solihull Mental Health NHS Foundation Trust has agreed a joint action plan with NHS Birmingham East and North and Heart of Birmingham teaching PCT. This will be followed up and overseen by the PCTs and Monitor.”