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Catalogue of errors allowed cannibal killer to claim two more lives
Sophie Goodchild, Health and Social Affairs Correspondent3 Sep 2009
A convicted killer was set free to claim two more victims after an "inexperienced" social worker convinced the Home Office he was not a danger.
An inquiry published today blames a "systemic failure" for allowing schizophrenic Peter Bryan to walk free from a London psychiatric unit.
Three hours after his discharge from medium secure unit Riverside House, he killed friend Brian Cherry, cut up his body and cooked part of his brain.
NHS managers left Bryan, now 39, in the care of Roland Silcott - who had no mental health training and was out of his depth in dealing with the "manipulative" patient.
Serious "deficiencies in care" at Broadmoor Hospital also led to Bryan strangling fellow patient Richard Loudwell.
The report, running into nearly 2,000 pages, says staff employed by NHS East London failed to listen to "alarm bells" that Bryan was still deeply disturbed after hammering to death a shop assistant.
Months before he killed epileptic Mr Cherry, Bryan persuaded mental health staff to halve his anti-psychotic drugs after lying about previous levels of medication he had received.
Other findings include:
■ Evidence that Bryan was "relapsing" in the months before his third attack but staff failed to act.
■ Bryan's alleged sex assault on a 17-year-old girl two weeks before he killed Mr Cherry.
■ The failure of community mental health teams to act together in supervising Bryan.
■ His release into the community from a mental health unit before he was properly "rehabilitated."
The independent inquiry highlights key events which could have prevented him committing "any further homicide".
These include his release in 2001 from Rampton Hospital after his lawyer persuaded a review panel that his client was fit for transfer in 2001.
Eight years earlier he used a hammer to bludgeon to death South Bank University student Nisha Sheth.
A known drug user, Bryan is described by the investigation panel as able to dupe staff into believing he was responding to treatment.
At Rampton, he was described as "a model patient" and was sent to a lower security unit, the John Howard Centre in Hackney.
He was then sent to Riverside House where he was placed under the supervision of Mr Silcott who wrote to the Home Office saying the patient was "no longer a danger".
NHS London said it accepted there were "shortcomings in the care" of Bryan and Mr Loudwell.
Reader views (25)
My son died in hospital after he suffered an agressive mental breakdown after his fathers death, He didnt kill anyone or eat their brains and this hysterial 'human interest' reporting only serves to call people names that will in time frighten us all. We need to be asking why the managers are allowed to carry on employing untrained people and why the regulators are not seeking evidence of lessons learnt!
The Trust who managed Broadmoor gained an Excellent rating just six months before a full investigation into Patient safety was launched. What had fundamentally changed?
Are we justifying the job or running a public service?
- Dee, Reading, 15/10/2009 18:02
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Bryan took the life of a 20 year old shop assistant. I fail to see how he deserves "care" and if we had a life for a life, two further victims would have been spared. Some people are just pure evil and surely he is one of them.
- Ab, London, 15/10/2009 17:02
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I wonder if those brilliant men and women, taking thousands of pounds of tax payers hard earned money while working for McKinsey ever considered the implications of cutting Mental Healthcare budgets.
They should be made to work in these areas for 6 months.
University Garduates who would not know their arm from their elbow.
- Peterb, chelmsford, England, 15/10/2009 17:02
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"inexperienced" ? or a social worker with a strong social bias? Middle class guilt aided and abetted by the social engineering industry.
- Hatchet, Newcastle, Australia, 15/10/2009 17:02
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I cannot understand why these experts failed to notice the signs, regardless of how much pressure they may be under, surely, their first priority was the patient – if he was not fit to be released into the community; why did they release him early in the first place, knowing that he was potentially dangerous? Then after his release they failed to provide him with adequate care and supervision. Somebody needs to take responsibility for such errors! The man was obviously a risk
and it is not these so-called experts who have to deal with the repercussions of such a mistake, but the public who are the victims of these failures!
- Anon, London, UK, 15/10/2009 17:02
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So, is he going to be released again because of another error? I guess so. I'm not surprised to see cannibals in London. Actually they will complement the rest of the criminals and Psychos well in ruling the streets of London.Good Job, Authorities!! Keep entertaining us with your stupidity.No wonder why I got out that hole called London.
- Zak, London, 15/10/2009 17:02
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Dear Sir/Madam
I have to wonder why we bother with Social Services at all when it seems blatantly obvious when something goes horribly wrong it always comes out that they are overworked or inexperienced. They seem to have difficulty in spotting a potential disaster so why do we fork out all this money - for what....those nutters who are hell bent on hurting children etc., will manage to do it no matter who is "monitoring" them. When it does happen, the blame seems to be laid at the door of some hapless and useless Social worker rather than the depraved perpetrators who seem to get sympathy. This country in enmeshed in a web of social inadequacies - we have created yet another level of society ever more frightening than any horror story we could imagine. All I can say is God help us...
- Pam Sinclair, Exmouth Devon, 15/10/2009 17:02
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He's taken another humans being life, why is he on the streets?
Life for a life.
- Frank, Home Counties, England., 15/10/2009 17:02
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Ab - "Some people are just pure evil and surely he is one of them". So, mental illness equates with "pure evil" in your book, does it?
Does that make a charity like MIND a pressure group for the forces of "pure evil"?
- Richard, London UK, 15/10/2009 17:02
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How about we actually punish these rabid animals?
- Trunk, US, 15/10/2009 17:02
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Someone must be responsible. There have been too many of these. So a large sum in damages from use the taxpayer over someones incompetance. People should be sacked or gaoled over this. "Lessons will be learned" What again ? How many times will these tired and hackneyed phrase be trotted out.
- Jim, London, 15/10/2009 17:02
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This, just one day after it was revealed that TFL/PCO are allowing a paranoid schizophrenic convicted of murdering his wife to study to become a London Cab driver! Surely this is a reminder of exactly why a murderer should never be considered to drive a Taxi
- Lee, Watford, 15/10/2009 17:02
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Anyone surprised? No? I thought not.
- Philip, London, England, 15/10/2009 17:02
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Nobody will lose their job or pay and more innocent patients will be shoved out into the community. Stigma and innapropriate assessments and care will be offered. In addition if you self medicate your serious mental health issues with alcohol then you will be further stigmatised as mental health services will engage in prejudice and turn you away completely.
- Mary, england, 15/10/2009 17:02
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I have always had a huge problem with the rehabilitation process. If someone is so mentally ill that it leads to murder I don’t think we can ever take a chance on them again. We can never truly be sure that these people are ‘better’. Life if really precious and we only get one chance at it. It seems we often forget how serious it is to take someone’s life. We should all have the right to go about are life’s in safety, no amount of medication or rehabilitation can guarantee these people won’t re-offend. They should be locked up for indefinitely.
- Paul, London, 15/10/2009 17:02
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Seriously does not surprise me!!
- K Alexander, Walthamstow, London, 15/10/2009 17:02
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No-one will lose their job and I expect lessons will be learnt!
- Sue, Orpington, Kent, 15/10/2009 17:02
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'At Newham, Bryan was monitored by social worker Roland Silcott for 18 months'
ie, not by a psychiatrist, who have a hard enough job themselves making assessments of this kind. In my experience, mental health services are heavily staffed by people whose first language is not English: this matters much more here, where nuances of language and expression are a large part of the clinical evidence, than in cases of physical medicine.
- Mdj E10, london uk, 15/10/2009 17:02
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No doubt Mr. Roland Silcott will be congratulated on his "compassionate" but mistaken judgement and promoted. It is only a "shortcoming" nothing serious, and it happens all the time. If I were asked to advise relatives of the victims, then I would say go after his lawyer and Rampton. Got to be a case there - hit them in the pocket, and then the twits begin to think. Fact, who funded the lawyer - us - the tax payes. So, we should take it back from them.
- John Grotrian, London / England, 15/10/2009 17:02
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Over and over and over again this sort of thing happens. We see it in the case of dangerous, mentally ill patients who are released and go on to kill [or kill again] or social workers/police/doctors who miss children at risk, who are then killed.
I don't know why it happens and why it continues but it is high time it was erradicated. If it is lack of resources, they must be provided. If it is lack of training, it must be given. Whatever it takes. If money is tight, then other less pressing projects must be suspended and resources redirected. Even if such redistribution only saves a life or two, it would have been worth it.
- Captain Black Of The Mysterons, London, England, 15/10/2009 17:02
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How nice to know that the authorities and so called experts are protecting the innocent public at large.
- Mark H, London, England, 15/10/2009 17:02
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Unfortunately, the mentally ill people are taken off their medication for social and business reasons. They are treated with sympathy and have more rights than staff. So, if they hit you or kick you - it does not matter. They are talked down before any action being taken! In regards of experienced staff it is more complicated. What University degree and other postgraduals do you need to do such job??! Why does this system employ professionals from other fields, not relevant to mental health at all? When will you get the understanding that you just cannot be more clever/experienced by undertaking a training that takes to read a piece of paper and it is called TRAINING??? These ill people have access to community, they spend our taxpayers money and enjoy things we cannot sometimes afford? They should be locked! When they are ill, they should be treated accordingly. Maybe few percentage will get better but majority will be ill till the end. Do you think that you will talk them out of their illness? Those who have worked in this field know what I am writing about. It does not work like this, you have to be firmer. They are danger but we are becoming more dangerous by giving them rights they should not have. All in all, everything is about business and social life for those who does not behave socially. So, nonsence. However, it is reality! It will not change, just get on with it!!!
- Seheresada, Basingstoke, 15/10/2009 17:02
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If you are going to name one worker why not name all the NHS staff, team including doctors that treated this man??
- Yvonne, London, 15/10/2009 17:02
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Richard - yes this man is pure evil. Think about it... could you kill a 20-year old girl, or cut someone into pieces and fry their brain, imagine the intent and force that has to be used, the horror of the act...... There are degrees of mental illness, but evil people will use the term mental illness as an excuse and a very convenient one to obtain a light sentence and possible early release.
- Ab, london, 15/10/2009 17:02
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Hmm, the conservative's care in the community seems to be bearing fruit, besides from the odd hiccup.
- Daniel, London, 15/10/2009 17:02
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