Claire Wilson murder special report: Killer's actions may never be understood
An independent report into the care Alan McMullan received before he murdered Grimsby mum-to-be Claire Wilson has been welcomed by local health chiefs. News editor Lucy Wood examines it in detail and hears responses from Kevin Bond, chief executive of the mental health service in this area.
"EVERYONE wanted to know why he did this. People have speculated and no one will be sure – but he wilfully committed murder, and sometimes, actions like his are beyond reasonable explanation."
The question of "why" may never be answered. But yesterday, an independent report into the care Alan McMullan received from the area's mental health service before he killed Claire Wilson has made it clear there was no causal link between the care he received and his actions in 2009, when he attacked the 21-year-old in Grimsby town centre, as she walked to work, as reported in a breaking news edition of the Grimsby Telegraph.
Although it has made criticisms and, as a result, recommendations, the report is further evidence that the jurors in McMullan's murder trial made the right decision – when they dismissed his not guilty plea on the grounds of diminished responsibility and jailed him for life.
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Kevin Bond is chief executive of Navigo, which now manages – and has massively improved – mental health services in North East Lincolnshire.
At the time of the murder, the Care Trust Plus was in charge of services. Changes were made then, and Navigo has continued to do so, too.
Mr Bond said: "We were shell-shocked when Miss Wilson died. Our service users and staff are part of the community, so anything which happens within it profoundly matters.
"We can only imagine the hurt her family, and her friends, have endured.
"I wish we could answer the key question – why did this man do such a terrible thing?
"Sadly we cannot. What we can say is that Mr McMullan was in control of his own actions and chose to act as he did, as evidenced by detailed discussion including expert witnesses in the court and the court's refusal to accept his plea of diminished responsibility.
"They found him guilty of the willful act of murder.
"Why a man would behave in such a vulgar and unpredictable way is upsetting to us all. But that behaviour does not mean he had mental health problems.
"The man had capacity and we agreed with the court case's outcome.
"We welcome the publication of this report and share the opinion that there was no causal link between the care Mr McMullan received and this extremely tragic event, but recognise services at the time could have been improved."
As reported, McMullan spent a total of 35 days in hospital for psychiatric treatment, after attending Grimsby Police Station with a knife three times, claiming he heard voices in his head telling him to kill – medically known as hallucinations.
But doctors found he had no psychotic symptoms.
Mr Bond said: "This was a very unusual and rare case. Mr McMullan had contact with the service for a short period almost a year before the tragic event, during which time we made a comprehensive assessment of his mental health.
"He had no previous history of psychological problems or violence.
"When he stayed in the unit, Mr McMullan was quiet and compliant. He was a solitary man, did not have many friends and had no hobbies.
"He blended in and took part in the activities – and showed no signs of hearing voices.
"When you hear voices, you hear them outside of your head and as a separate entity, not inside. Mr McMullan said he heard them inside his head.
"If you were experiencing voices, you would be distracted, and no one ever observed that in Mr McMullan when he was an inpatient.
"He did not stop drinking during his time with us. We gave him some medication to ease the distress he said he was in; not to treat anything especially.
"In the assessments requested of mental health service locally, the last of which was ten-and-a-half months before the dreadful murder, there was nothing to suggest he was lacking capacity and he was judged to be in control of his own actions.
"Indeed, the service worked closely with the local police to warn him regarding the criminal behaviour of carrying a knife.
"Mr McMullan was a heavy user of alcohol and had received treatment for this in the past.
"He continued to drink despite being advised not to. It is important to recognise that prolonged, excessive use of alcohol can have many detrimental effects."
The purpose of the independent report released yesterday was to investigate the care and treatment of McMullan following his conviction for murder.
It stated: "Mr McMullan presented a complicated picture of self-reported hallucinations, heavy use of alcohol and possible brain damage."
The court, however, had discounted the possible brain damage as not significant in affecting his behaviour after hearing from expert witnesses.
"The multidisciplinary team (MDT) requested appropriate investigations but missed some opportunities for clarification and consultation during Mr McMullan's admissions," the document continued.
"The various elements of his assessment and treatment did not appear to have been considered as a whole.
"The service lost touch with Mr McMullan when he was discharged from hospital, although attempts were made to contact him for outpatient appointments.
"He was consistently calm and pleasant when he was in hospital, with no history of violence, but there were factors suggesting a higher level of risk than the MDT perceived.
"It was reasonable to discharge Mr McMullan from hospital, but he should have been monitored in the community with a better understanding of the risk he might pose to the public."
The report continued: "The standard of Mr McMullan's paper records was generally good but with some significant gaps.
"For example, records showed no discussion with the MDT of the uncertainty about Mr McMullan's case. Nursing and medical records were on the same pages in the case file, but multiple other records systems in use at the time prevented a clear overview of Mr McMullan's care and treatment.
"The MDT was diligent in requesting tests and opinions but did not use the outcomes well.
"Referrals and requests for an opinion on Mr McMullan were considered or made to eight complementary services.
"Test results were not fully taken into account and there were no reliable records of some of the requests for specialist opinions or of some of the responses.
"There was no evidence in Mr McMullan's case notes of direct consultation with colleagues in related specialities about the uncertainties of this case."
The report was critical of the process used to access the psychology service for McMullan, labelling it as "not fit for purpose".
It said: "The opportunity for a full psychological assessment was missed. We do not know if this would have made any difference in the longer term but it would have increased the understanding of Mr McMullan.
"The separateness of the psychology service, both perceived and actual, put everyone at a disadvantage."
Mr Bond explained: "Not every patient gets a psychological – in other words, behavioural – assessment as part of their care. It is one of many assessments used.
"This was discussed with a psychologist in respect of McMullan and no further assessment was felt necessary."
Significant structural and procedural changes to the psychology service have since been made, the report went on to point out.
Mr Bond said: "We have completely changed our psychology service and have a new leader in charge of it, who has ensured it is fully integrated with other services."
It also highlighted how McMullan, a heavy drinker, "could have been supported" to access the area's alcohol service while he was an inpatient.
"Drinking probably played an important role in his relatively empty days and a big shift in his situation would have been needed to bring about any real change," it said.
Mr Bond said: "It is not possible to make someone give up drinking. This man was a prolonged drinker; all you can do is try to direct them, which is what our staff did. Navigo does not run the alcohol service.
"He misinformed people about how much he drank and he did not want to give up.
"There is no way to compel people to stop drinking; only to support this process when they are ready."
The document classed discharge and follow-up arrangements were "inadequate".
It said: "The mental health service should have seen him again to monitor his treatment, his mental state and his risk profile, and to encourage him to access the alcohol service and reduce his drinking.
"We know little about what happened after his last contact in July 2008.
"He was homeless for a while and he then lived in a Salvation Army hostel.
"His GP thought he was stable in November 2008 and he had moved into his own flat by February 2009. He seemed fine, but quieter than usual when he next saw his family.
"Mr McMullan did not receive letters about three outpatient appointments because he had left his previous address.
"Navigo and the CTP have been diligent in implementing robust new procedures.
"The CTP would have had a much better chance of staying in touch with Mr McMullan until he was ready for full discharge, if these arrangements had been in place earlier."
Mr Bond said: "McMullan told the service he was going to London for work, and failed to leave a forwarding address.
"He was still sent three letters to his Grimsby address in case he hadn't left, and he was also offered day services.
"His GP conducted a mental health review in November 2008, some months before the incident, and concluded that he did not require further contact.
"This would have concluded our dealings with him, even if he had not gone out of contact with services, as we see people in the community at their GP's request."
The report said "there was no effective system" for the police to know he had been discharged, and that no system existed to inform psychiatrists and his GP about the third time he attended the police station with a knife.
Mr Bond explained: "There had been many discussions with the police regarding Mr McMullan's threatening behaviour and he himself had been spoken to about how his actions were criminal and that they were unacceptable.
"Those discussions included the fact McMullan knew right from wrong; that he had capacity and that carrying a weapon was a crime – and nothing to do with his mental state. This all went into his notes."
The report highlighted other points, such as that nothing came of a referral to the Older People's Service, which routinely deals with organic brain problems.
The criminal trial said any suggestion of brain damage in McMullan was insignificant, and Mr Bond said the referral was deemed unnecessary but that this had not been written clearly.
The team was diligent in requesting tests and opinions, said the report, but there were no reliable records of some of those requests.
The document concluded: "There were elements of Mr McMullan's care and treatment which could have been much better but we cannot say that this tragedy could have been prevented."
It said his assessment was incomplete and that he was "given treatment with no evidence it was really needed", but added: "We were not sure Mr McMullan's treatment could have had any positive effect on his mental health."
"The CTP and then Navigo introduced important changes after the internal investigation and their efforts are commendable," it said.
"We have identified further learning but we found no causal link between the learning points and the events of 2009."
A list of 17 recommendations were made, including: Navigo should encourage clinicians to discuss diagnostic uncertainties with peers on an informal basis; a single entry in notes, clarifying the position of the entire team involved in treating a patient, should be made clear; and Navigo should emphasise the potential benefits of contacting close associates of the patient, even if he has no formally identified carer.
The report praised Navigo and its actions since taking over the mental health service in North East Lincolnshire.
"What we really want to do is give an excellent service to vulnerable people," said Mr Bond.
"As the organisation which now runs services, we have already addressed most of the recommendations given in the report.
"There were clearly areas that needed addressing at that time and we have updated our processes as part of the CTP, having conducted our own internal investigation immediately after the incident, making substantial improvements to the service that we offer our local community.
"We have a very dedicated team of mental health staff and as a local not-for-profit organisation with a membership of people who use the services, carers and staff, our top priority is to continue to develop the best possible services for local people.
"We will continue to work hard to provide high quality care and safe local services for the 5,000-plus people we treat every year and will continually strive to develop and improve these services at every opportunity.
"The jury at Mr McMullan's trial in May 2010 found him guilty of murder rather than manslaughter due to diminished responsibility, as he had claimed.
"The experts giving evidence who assessed him for capacity agreed he had full capacity to control his actions and knew right from wrong.
"The vast majority of people we see pose no risk whatsoever to public safety. This was a very rare occurrence.
"I would like to give my deepest condolences to Claire's family and friends once more.
"While the whole community has all found this dreadful incident extremely bewildering and distressing, the family has lost someone close in such an awful way. We can only imagine what this must feel like for close family and friends."