Independent investigation: Janet Keegan, Enfield & Harringay (1997)

The Trust should ensure that consultant psychiatrists review their junior doctors' lists regularly and note the review in each patient's notes.

The Trust and the Social Services Department should make clear precisely whose responsibility it is to obtain a second medical recommendation for the purposes of converting Section 4 of the Mental Health Act to Section 2.

The Trust should ensure that the use of the Act is stringently monitored and the Code of Practice is followed.

Staff involved in the Act should receive regular refresher training.

The Trust should have a policy dealing with detained patients who are absent without leave which complies with the Act Code of Practice.

The Trust should rewrite the CPA policy and guidelines.

The Trust should ensure that all staff involved in CPA receive regular refresher training.

The Social Services Department should clarify its eligibility criteria for long term mental health cases. If the term ·severe and enduring' mental health problems, or a similar term, is used, its definition must be clearly understood. In particular, whether individuals with anti-social personality disorder are eligible needs to be clarified.

Social Services should consider allocating resources to offer counselling and support in cases of serious domestic violence.

The Trust should revise the current system within the psychology department of offering patients assessment appointments only when treatment places are available.

The Trust should ensure that GPs and consultants communicate in writing confirming who is prescribing what medication to a patient.

The Housing Department should draw up guidelines dealing with the communication of information to other agencies.

The Social Services Department should require all agencies referring to Alexandra Road to include a risk assessment form completed by a suitably qualified and experienced professional who is familiar with the patient.

The Social Services Department should ensure that all Alexandra Road staff who will be assessing referrals have comprehensive risk assessment training.

The risk assessment form for Alexandra Road should not limit information to the last two years.

All Alexandra Road staff should receive regular training in risk management.

A risk management policy or guidelines should be implemented for Alexandra Road detailing the steps to be taken in a crisis.

Untoward incidents at Alexandra Road should be recorded in a separate log and an untoward incident policy should be introduced.

The Trust and Haringey Council should implement a joint confidentiality policy as a matter of priority.

The Trust should revise its untoward incident policy, setting out in unambiguous terms the procedure to be followed.