Community Care Questions Remain; Cousin's Moving Tribute to Mental Health the Inquest into Ashleigh Ewing's Death Posed Fresh Questions on How Mental Health Patients Are Cared for in the Community and Raised Issues of How Patients Are Assessed and Managed in Terms of Risk. ANDREW GLOVER Reports

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Byline: ANDREW GLOVER

KILLER Ronald Dixon was a ticking timebomb waiting to explode.

He'd subjected his parents to a brutal hammer attack, 12 years before he stabbed 22-year old care worker Ashleigh Ewing to death.

And four months before killing Ashleigh, Dixon had travelled to London intending to break into Buckingham Palace, believing he was a member of the Royal family.

He was detained by the Metropolitan Police and spent a short time in a Newcastle clinic before moving back to his Heaton flat.

The paranoid schizophrenic launched his gruesome attack after Ashleigh called to deliver post at accommodation provided to him by a mental health charity.

Staff from Mental Health Matters were supporting Dixon back into the community after he'd undergone psychiatric treatment at a Sunderland hospital.

At the inquest into Ashleigh's death this week, coroner David Mitford ruled there had been "major failings" within the management of Mental Health Matters, who admitted that Dixon's risk assessment wasn't up to date.

The charity is one of five private providers of community mental health care contracted by Newcastle Council through its Supporting People programme.

Around 200 adults with mental health problems are currently receiving care in the community in the city, 19 of them under the supervision of Mental Health Matters, which says it has "completely reviewed and revised" its practices and controls since Ashleigh's death.

Supporting People is managed by a partnership between the council, the Probation Service for Northumbria and Newcastle Primary Care Trust.

The programme commissions and monitors housing services for people with different needs, including mental health care. Provision of mental health care has changed dramatically over the last two decades, with a shift towards caring for patients in their own homes or supported accommodation.

Tony Machin, principal lecturer in mental health issues at Northumbria University, said tragic cases like Ashleigh's served as a "learning episode" for all providers of care in the community. He said: "The key issue about this particular tragic case is the assessment and management of risk.

"Historically, the creation of large institutions was society's way of risk management.

"The introduction of care in the community saw a reduction of the stigma attached to mental health and learning disabilities, but that's not to compromise the assessment and management of risk which is much more complex in the community. …