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| Killer slipped through safety net | Killer slipped through safety net |
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| A mentally ill man who killed a stranger in a stabbing rampage "slipped through the safety net", a report into his treatment has found. | A mentally ill man who killed a stranger in a stabbing rampage "slipped through the safety net", a report into his treatment has found. |
| The independent review into the care of Ismail Dogan, a paranoid schizophrenic, was commissioned by NHS London. | The independent review into the care of Ismail Dogan, a paranoid schizophrenic, was commissioned by NHS London. |
| Ernie Meads, 58, was killed by Dogan in Edmonton, north London, in December 2004. Five others were badly injured. | Ernie Meads, 58, was killed by Dogan in Edmonton, north London, in December 2004. Five others were badly injured. |
| Dogan, 33, admitted manslaughter due to diminished responsibility and is being held indefinitely in Broadmoor. | Dogan, 33, admitted manslaughter due to diminished responsibility and is being held indefinitely in Broadmoor. |
| The report examined the actions of the Barnet, Enfield and Haringey Mental Health Trust and the Haringey Teaching Primary Care Trust, relating to Dogan's care between 2000-2004. | |
| Yet again, the warnings and pleas of family members went unheeded, with fatal consequences Marjorie Wallace, Sane | Yet again, the warnings and pleas of family members went unheeded, with fatal consequences Marjorie Wallace, Sane |
| Dogan stopped taking his medication in June 2004 and shortly afterwards began talking to himself and behaving oddly. | Dogan stopped taking his medication in June 2004 and shortly afterwards began talking to himself and behaving oddly. |
| The report found that key opportunities to stabilise Dogan's condition were missed by the health system and that the various professionals responsible for his care in the hospital and in the community did not share vital information. | The report found that key opportunities to stabilise Dogan's condition were missed by the health system and that the various professionals responsible for his care in the hospital and in the community did not share vital information. |
| Turkish-born Dogan, who had been released from a psychiatric hospital in 2001, told psychiatrists in Broadmoor that a bird had spoken to him telling him to carry out attacks on English people. | Turkish-born Dogan, who had been released from a psychiatric hospital in 2001, told psychiatrists in Broadmoor that a bird had spoken to him telling him to carry out attacks on English people. |
| 'Parents afraid' | 'Parents afraid' |
| The report also found that Dogan's parents were afraid of him and tried at least five times to get help for their son. | The report also found that Dogan's parents were afraid of him and tried at least five times to get help for their son. |
| There was also evidence that the care co-ordinator responsible for Dogan altered notes after his violent attacks, the report found. | There was also evidence that the care co-ordinator responsible for Dogan altered notes after his violent attacks, the report found. |
| That person has since been suspended. | That person has since been suspended. |
| Marjorie Wallace, of the mental health charity Sane, said the review detailed a catalogue of errors. | Marjorie Wallace, of the mental health charity Sane, said the review detailed a catalogue of errors. |
| "This report highlights a familiar litany of serial blunders, mismanagement and miscommunication. | "This report highlights a familiar litany of serial blunders, mismanagement and miscommunication. |
| "Yet again, the warnings and pleas of family members went unheeded, with fatal consequences." | "Yet again, the warnings and pleas of family members went unheeded, with fatal consequences." |
| Ms Wallace reiterated Sane's call for a "red alert" system to be created that allows authorities and police to respond quickly should a family raise the alarm about loved ones' deteriorating mental health. | Ms Wallace reiterated Sane's call for a "red alert" system to be created that allows authorities and police to respond quickly should a family raise the alarm about loved ones' deteriorating mental health. |