The full Report released on Sept 10th 2009 is downloadable now from the Strategic Health Authority is available HERE
Sue Turner, chief executive of Birmingham and Solihull Mental Health NHS Trust, apologised to the family, friends and colleagues of Det Con Michael Swindells and also to Butler for the shortcomings in his care and treatment.
She said the team was responsible for a "pretty devastating set of shortcomings" and promised that vast improvements had been made since.
More from the Report below :
13.4 Unhappily we suspect that many of the problems we have identified in this Inquiry are not confined to one Assertive Outreach Team in Birmingham and that there may be a case for a review of practice elsewhere. Unless the report is published in full this benefit may be prejudiced.
25.4 The result was a focus on a medical model of care rather than a social one and a failure to devise exit strategies and targets for each service user. They did not seek out new ways of tackling difficult cases such as Mr. Butler‟s.