Almost six years ago, Christina Kopernik-Steckel's family was ripped apart in quite the saddest and most horrifying way imaginable. Her older brother Gilbert, an architect who lived in Berlin, had come home to join the family at their Croydon home for Christmas, and they spent what she remembers as a happy holiday period together. But in the new year, something went seriously wrong for Gilbert, who was 33. He became suddenly, violently unwell, in a shocking descent into mental illness that the family found bewildering and frightening. On January 14 1996, just a few days after the first signs of illness, Gilbert had what was later described as a "psychotic episode". In front of Christina and her elder sister Joanna, he took a knife from the kitchen and stabbed their mother and himself to death.
The bare facts of the incident are shocking enough, but Gilbert's actions are not the only horrifying part of the family's story, because Gilbert had been aware that he needed help, and - in the two days before the incident - had twice checked himself into a secure mental unit at the local hospital, even asking the police at one point to lock him up. A consultant psychiatrist who witnessed his erratic behaviour concluded that Gilbert posed an urgent danger to himself and his mother, and later described Suzanne Kopernik-Steckel as a "sitting duck". But through a series of omissions, mistakes, failures and oversights, Gilbert was not kept in hospital on the day of his death and was able to make his way home, where his family were sitting anxiously awaiting his return.
Last week Christina was awarded more than £500,000 by South London and Maudsley NHS Trust in an extraordinary settlement that amounted to an admission of calamitous failure by the trust. Now 27, she has suffered from post-traumatic stress disorder since witnessing the attack, and does not do paid work, despite having a good degree from Oxford University and what are acknowledged as starry prospects at the time of the attack. The settlement is believed to be the largest ever awarded for psychological injury, and the first time that a third party has won compensation from a hospital for the actions of another person. But as far as she is concerned, the case was mostly about forcing the hospital - and the health service at large - to take responsibility for failing mental health services.
"I felt a big responsibility, and I knew that I wouldn't be able to live with myself if I didn't go forward with [the case]," she says. "It was very clear how weak the mechanisms of accountability were for problems to be recognised, so I had to use whatever mechanisms I could to make that process change, because nobody else was willing or able to do it. And of course I felt it was an act of respect for my family, to make it very clear that this was wrong, and that they hadn't just disappeared off the face of the planet and that was that. Something else had to happen."
Quite what went wrong in Gilbert's head during his psychological collapse may never be properly understood; following an independent inquiry into the incident in 1997, however, the failures in his care are much clearer. The first sign that something was wrong came in the week before Gilbert died, when he started talking strangely to friends and reacting out of character to simple everyday events. An old girlfriend had called to tell him she had throat cancer, and this may be what triggered his disturbance, although Christina says she feels no compulsion to know. The family was not aware that he had struggled with mental illness previously, she says, although the inquiry found that in 1980 a psychiatrist had felt that Gilbert had a severe personality disorder and "was set for a very difficult early adult life".
The simmering crisis reached boiling point on Friday January 12. Gilbert had broken the kitchen window and wrenched the door from its hinges; neighbours called the police, who agreed not to arrest him only on condition that his mother called the GP. Later that afternoon Gilbert was seen by his doctor and a consultant psychiatrist, who recognised immediately that he was very disturbed. The consultant admitted later that he had felt Gilbert was a danger to his mother. But the two doctors did not inform social services (who would need to be involved if Gilbert were to be "sectioned" - compulsorily admitted to hospital) that they were visiting the family, and while the consultant filled out papers to allow this process to go ahead, he did not pass them on to a social worker.
From that point, if anything, the catalogue of failings becomes even more depressing. Later that day Gilbert was persuaded by a friend to voluntarily admit himself to the local mental health ward, which Christina euphemistically describes as "not a good, caring environment". A television was blaring loudly in the corner, and Gilbert started having delusions that the programmes were about him. He was persuaded to stay until the next morning, when he suddenly announced that he wanted to go home and apologise to his mother. He should have been restrained, but Gilbert's medical notes were kept some distance from his nursing notes, and the charge nurse hadn't read them when he tried to leave, so nobody thought to stop him.
"We thought the fact that he had left the hospital meant that he was OK," says Christina, "so we were completely in the dark. We had no idea that the consultant psychiatrist had concluded he was a risk. We felt, well, they must have checked him out and he's fine." But Gilbert was far from fine. He felt that a bunch of flowers that Christina had bought him were very sinister, and put them outside along with a tape that she had been playing in her room. She and her sister Joanna, two years older than Gilbert, sat with him until the early hours.
The following day things got even worse. Gilbert tried to burn the flowers and the tape, then ran out of the house, with Christina following. They went to the police, who took Gilbert back to the hospital, where he was persuaded to remain for much of the day. But again the procedures that should have cared for him went badly awry. It is a terrible irony that it was while two doctors were discussing the best way to section Gilbert that he ran from the hospital and leapt on a bus, and even more ghastly that the police, who this time were alerted by the hospital that he had absconded, arrived at the family home only seconds after he had stabbed his mother and slit his own throat.
Christina and her father, who was absent at the time of the attack, no longer live in the UK. But her compulsion to see services in this country improve is undiminished. South London and Maudsley NHS Trust says it has made "fundamental changes" to its care of the mentally ill since Suzanne and Gilbert died, although the 1997 inquiry, which found that there had been "an overwhelming failure in communications" between carers, concluded: "Our major concern is that, if history were to repeat itself, the outcome today would be no different."
The government has stated that mental health is one of its three priorities for the NHS, along with cancer and heart care. But the Zito Trust, a mental health charity, says there is still a serious shortage of beds and trained staff, and little or no help for patients living in the community. A long-expected new mental health bill was not included in the most recent Queen's Speech, meaning that a new act is not now expected until 2004. "At the moment we still have underresourced and demoralised services, unable to look after the patients most at risk," says the Zito Trust's director, Michael Howlett. The picture painted remains one of crumbling infrastructure, demoralised staff, poor communications and failing systems.
Six years after the incident, Christina admits that the process of bringing the case against the hospital trust has itself been another traumatic ordeal. She is aware of the fact that, as an Oxford graduate, she was deemed worthy of record damages, when another person might not have been; she was also able to bring the case as she was eligible for legal aid, while her sister, for example, would not have been. Part of the settlement will be used to pay for intensive trauma therapy in Holland, where she lives. "Unfortunately, one of the reasons why compensation is needed is that I wouldn't be able to rely on the NHS for support."
Ironically, she says she must now live with the label of being "mentally ill". "It's very easy to pinpoint the people with mental health problems and say that they are the problem. To some extent I feel that happened with me. But it is not their fault; they are being failed by the system.
"My whole family was very public-spirited. My parents worked for the public sector, so that was very much the character of the family. My father, for example, used to have health insurance with his job and he dropped it because he felt that he didn't want to use private medical care. It's very ironic that a very public-spirited family that put so much of its energies into the public services should be so badly failed by them."
