Tom is a disturbed and potentially violent 18-year-old man living in a York care home. He is alleged to have attempted to rape one woman and sexually assault another. These are impulses he cannot control. More alarmingly, the State is unable or unwilling to control Tom.

This young man is being looked after by Rose Cusick, the care home owner. She has taken responsibility for him because no one else will.

Rampton maximum security hospital could not take Tom. A Northumberland hospital's provisional offer of a place cannot be taken up until March at the earliest, because a special unit would need to be set up to cope with his violent behaviour.

If Tom had not been fortunate enough to come under the care of the remarkable Mrs Cusick he could be walking the streets of York today. The risk to local people of that eventuality is obvious.

But the only way he will be placed in a secure unit is if he were locked up for attacking someone.

This alarming realisation has highlighted once again what Ryedale MP John Greenway calls the "black hole" in the system. The authorities know of other people like Tom, who pose a real danger to the public. Indeed, York psychiatrist Dr Bob Johnson describes his case as "the tip of an extremely noxious iceberg".

And this is not the first time that Mrs Cusick has highlighted the gaps in Britain's mental health provision. She acted as an advocate for Christopher Moody, a disturbed man with a history of violence who mounted a legal challenge to health experts who initially ruled he was not a risk to the public before he was eventually sent to a secure hospital by magistrates.

It is scandalous that we have to wait for an innocent member of the public to be assaulted, raped or killed before such people can be taken out of harm's way.

Today a report condemned the regime at Ashworth Hospital's personality disorder unit in Merseyside. Government ministers should respond by undertaking a wholesale reform of the mental health sector. Until they take responsibility for people like Tom and Mr Moody, the public remains at risk.

see NEWS 'Risk patient in care row'

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