Mary and Bryan Andrews: Medication could have prevented Sheffield man killing his parents in psychotic episode

Mary and Bryan Andrews, aged 76 and 79, were found fatally injured with stab wounds at their home in Terrey Road, Totley, on November 27, 2022.

Their son, James Andrews, known as Duncan, was indefinitely detained at Rampton Hospital in July 2023 after he pleaded guilty to manslaughter by diminished responsibility.

Senior coroner Ms Tanyka Rawden resumed the inquest at Sheffield’s Medico-Legal Centre today (October 1) into the deaths of Mary and Bryan. A focus was placed on their son’s mental health care in the lead up to the deaths.

Members of the family, represented by Ruth Costello, were in attendance in the court, as well as Duncan via an online video link.

Giving evidence, Dr Jonathan Mitchell, consultant psychiatrist at Sheffield Health and Social Care NHS Foundation Trust, revealed Duncan had records with the Trust spanning more than a decade.

His “severe and persistent” epilepsy had an impact on his mental health, causing longstanding depression, suicidal thoughts, and periods of paranoia, the inquest heard.

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In November 2020, Duncan self-referred to what is now known as Sheffield Talking Therapies, for his paranoid thoughts and low mood. He was placed on an 18-month wait list for neurology psychotherapy services, and prescribed antidepressants.

A year later, he suffered the first of his two “brief psychotic episodes” in the months leading up to his parents’ deaths.

The out-of-hours crisis team spoke to Duncan’s parents who reported he was showing signs of psychosis, and believed the radio was speaking about him.

Duncan denied plans for suicide, and was given an urgent assessment during a home visit two days later.

He was observed as paranoid, and having experienced a recent deterioration in his mood, with psychotic symptoms.

In the following weeks, Duncan began reporting an improvement in his symptoms. He decided to come off antidepressants and was given information on alternative support. He was later discharged from the crisis team, and given a diagnosis of anxiety and adjustment disorder.

Dr Mitchell said: “Overall, most things were done in line with expectations.”

But Dr Mitchell told the court of one missed opportunity following a second psychotic episode in April 2022.

On April 29, Andrews called Single Point of Access and said: “I think I’m going to kill someone.”

He was urged to go to A&E where he was given an urgent assessment. He said he was hearing voices, and felt like he wasn’t in reality, and that his symptoms had been worsening over the last few weeks.

He also told of some distressing thoughts about harming a relative. This was reported as a safeguarding concern, and an appropriate family member was informed.

‘The decision by the team to reject the referral was not correct’

Two days later, Duncan was seen by a nurse who instructed a medication review for the following day, as he was not taking any. He was also referred to the early intervention service, for people who are experiencing symptoms of first episode psychosis.

However, it was decided he did not meet the requirements of the service, and that his thoughts relating to his relative were “intrusive thoughts”, rather than psychosis symptoms.

Dr Mitchells said: “The decision by the team to reject the referral was not correct. It was clear from the assessment that he was suffering from psychotic symptoms and should have been assessed by early intervention service.

“Had he had that assessment from that service, and it had become apparent that he had developed a more persistent psychotic episode, he would’ve gotten a broad package of care offered to him.

“He would have been offered a trial with antipsychotics. If he had taken it, it probably would have improved his outcome.”

The early intervention service now has a different way of considering referrals, which Dr Mitchell described as “more robust”.

If he had received a referral today, Dr Mitchell said: “It’s not clear it would’ve led to a different outcome. But I think it is certainly possible it would’ve.”

The inquest continues.