A MENTAL health service has been given recommendations for improvement after a man under its care killed his friend on a Salisbury footpath while having a psychotic breakdown.

James Lee Bible, 20, stabbed Alan Clarke, 59, in the stomach and chest while they walked by the River Avon in the early hours of April 12, 2011.

Bible admitted manslaughter on the grounds of diminished responsibility and was given an indeterminate sentence in a secure mental hospital.

Experts said he was suffering from bipolar affective disorder of a manic type and was experiencing a major psychotic breakdown at the time of the killing.

Bible, 20, had been in contact with Avon and Wiltshire Mental Health Partnership several times in the run-up to the killing but had been discharged after a review appointment just days before he killed Mr Clarke.

An independent report by the strategic health authority has ruled he received “prompt and appropriate care” and there was “no direct causal relationship” between his care and treatment and the killing.

But it also says lessons should be learned from the incident, and recommends improvements including more involvement of a patient’s family and more co-ordination between agencies.

Bible had reported distress due to conflict with family and his family, calling the police for assistance on two occasions, but only one attempt to involve his family in his care was made.

Clinical staff who assessed Bible were under the impression that he had no history of mental health problems, not realising he had been seen by children’s services from when he was as young as six.

The report said the trust’s own investigation findings were “soundly based and appropriate” and that there was a “substantial amount of good practice by those involved”.

The trust’s medical director Arden Tomison said: “This was a tragic incident and on behalf of the trust I would like to offer our condolences to all those who have been affected, in particular the victim’s family.

“I would like to acknowledge and thank our staff for their dedication and commitment in dealing with individuals whose complex needs, behaviour and reluctance to be helped can make delivering support very difficult.”

He said steps have been taken to “radically improve” areas that needed improving over the past five years.

The strategic health authority also published two other reports into homicides by patients under the care of AWP in 2008 and concluded there were also no causal factors in either case.