THE outcome of an investigation into how a mentally ill patient killed a North-East care worker has found a number of failings in the way he was dealt with.

On May 19 2006, Ronald Dixon killed Ashleigh Ewing when she attended his home in Heaton, Newcastle for a support visit, in the course of her work for the charity Mental Health Matters.

A year later Dixon pleaded guilty to manslaughter on the grounds of diminished responsibility and Newcastle Crown Court and was ordered to be detained indefinitely in a secure psychiatric unit. At the time of the offence, Ronald Dixon was receiving care from Northumberland, Tyne and Wear NHS Foundation Trust, provider of mental health services. Following completion of legal proceedings, North East Strategic Health Authority commissioned an independent investigation to look at the healthcare and treatment provided to Dixon, to see if there were lessons to be learned by local mental health services.

While the panel found that that "...it is impossible to conclude with absolute certainty that the vicious attack could have been predicted or avoided" they also stated that a more robust approach to the care and treatment of Ronald Dixon, particularly in the five weeks leading up to Ashleigh Ewing's murder, would have resulted in some elements of care being provided differently.

The panel's main findings were: That a reassessment of risk [in the weeks and months leading up to Ashleigh's murder] would have concluded that Ronald Dixon had relapsed.

Given Ronald Dixon's deterioration in presentation and his relapse, he probably could and should have been detained under the Mental Health Act.

If Ronald Dixon was not detained under the Mental Health Act in the weeks and days leading up to 19 May 2006, a more robust care plan based on the reassessment of his risk should and would have been in place, and visits to Ronald Dixon by lone workers would likely have ceased. Whether this would have prevented the attack on Ashleigh Ewing is a matter of speculation.

Since the attack by Ronald Dixon on his parents on 11 November 1994, there had been no clear risk formulation, particularly taking into consideration the cumulative effect of previous significant events, behaviour and influences.

Between 1994 and 2006, no analysis was undertaken by any clinician as to whether Ronald Dixon was capable of successfully hiding symptoms.

From January 2006 onwards, there was an over-reliance by mental health trust staff on Mental Health Matters reporting and interpretation of Ronald Dixon's behaviour.