Tuesday, May 5, 2009

Humber Mental Health Teaching NHS Trust: Learning From The Past.

The Telegraph reported on another random killing by a psychiatric patient, Benjamin Holiday:

NHS trust admits errors let schizophrenic kill pregnant woman.
May 5, 2009.

“After four years of denying any mistakes were made, the Humber Mental Health Teaching NHS Trust apologised yesterday after a report detailed 11 damning failings in the killer’s treatment.”

"Holiday handed himself in to the care of a secure unit, but the following month a social worker let him back out into the community. This was a 'missed opportunity' to have him sectioned, according to the report, which was written by the region’s strategic health authority, NHS Yorkshire and the Humber. Holiday missed his fortnightly dose of anti-psychotic drugs the day before the killing because he had not been home when a nurse called."

If psychiatrists can no longer deal with the most basic of psychiatric conditions: psychosis, then we have to look closely at how we might want the psychiatric services run. It did appear that a social worker in this case has already taken on the role of discharging a dangerous poorly treated psychotic. Should we not look at why France still kept more traditional mental hospitals? Or are we going to continue to accept such random killings as it was only around one a week?
Or should we bring back the mental hospitals and keep psychotic patients in for a much longer spell without any need for them to have killed someone first?

Perhaps we need to look back and see if we can learn from the past.

Leading Article: Empty gestures fail the mentally ill
“THE National Health Service and Britain's welfare agencies work well for people who fit in with their bureaucratic ways. But for someone who is mentally ill, perhaps homeless and certainly in need of long-term support, they are fragmented and ineffective. These institutions may feel they do their bit but collectively they often fail to take responsibility for the individual's continuous care.”

That was in The Independent, Feb 25 1994.

On the afternoon of 17 December 1992, Christopher Clunis killed Jonathan Zito.
Has anything really changed? The same article could be recycled today and most of what it said would unfortunately still hold true.

“It is perfectly possible to make these services work. If mentally ill people carried a dangerous and highly infectious disease, the Government would be quick to devise, enforce and pay for a way of keeping track of them. It would not take 30 years to set up a national register of people at risk of serious relapse. Sufferers would not be passed between institutions that remained ignorant of their medical histories.

“Yet because psychiatric illness imposes its burden principally on sufferers and their families, politicians - and many providers of services - have all too often contented themselves with empty gestures about offering better care. The killing of Jonathan Zito finally made such complacency untenable.

“Yesterday Virginia Bottomley recited a litany of what has been done to improve mental health care. This is not enough. She should impose minimum standards for staffing and facilities in the NHS and replace her voluminous but much-ignored 'guidance' with binding directives. It is a step her predecessors have avoided because they would not pay for proper services. Jonathan Zito's death demands nothing less.”

The report by Jean Richie is first class. Yet how many trainee psychiatrists have studied it and are we going to continue to have QCs of this quality in the future.

Here is my own summary of
Jean Ritchie’s report:

“The enquiry concluded that Jonathan Zito died because the care and treatment Christopher Clunis received was a ‘catalogue of failure and missed opportunity’.

“Disciplinary proceedings, increasingly the price of failure in the health service, cannot occur when there are simply too many healthcare professionals involved and where the buck never stopped.”

“But the new guidelines will ensure that the buck stops in the future.”

Typical of the whole psychiatric service in the U.K.:

“Were the services, agencies, and professionals who failed Christopher Clunis inherently worse or substantially different from the rest? The possibility must be faced that the services found deficient by the enquiry are merely typical of psychiatric care throughout much of London and in many other parts of the country. The main importance of the Christopher Clunis enquiry is that it now poses very unpleasant questions about the ideology of healthcare delivery and the routine clinical management of severely mentally ill persons in the UK.”

Unrealistic expectations:

“It reveals a system in which many professionals are undertrained for the CPA, under-resourced for its successful introduction, and where new guidelines on standards of care are being imposed without the means to achieve them. It inevitably questions whether unrealistic expectations of psychiatry have been fuelled by a small number of widely publicised, relatively well-resourced, model community services, but where the results of these experiments have so far failed to successfully translate into mainstream psychiatry.”

Assumptions of community psychiatry:

“Christopher Clunis challenges some of the assumptions on which community psychiatry is currently based. His downward progress challenges not only the effectiveness but the relevance of community outreach services for a subgroup of severely mentally ill persons (Cold, 1991). His short stay in one in-patient service was also criticized severely in the report. Yet this was well in excess of the mean length of stay considered a hallmark of success in some experimental community based services. It cannot be routinely assumed in the future that dangerousness has been adequately assessed in less than two weeks, or that schizophrenia has been adequately treated, without placing clinicians at some risk of litigation and disciplinary proceedings.”


“Jonathan Zito died because the ideology and organisation of mental health care services, the training of healthcare professionals, and the facilities available are simply inadequate for patients whose conditions remain intractable and render them uncooperative with care in the community. The legislation which might have ensured some chance of his receiving treatment outside of hospital does not exist.”

Her final words:

“Furthermore, the type of in-patient facility that he truly needed has been closed in much of the UK. If ever a patient required prolonged institutional care it was Clunis. Sadly, it was only after he killed an innocent member of the public that he could receive it.

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Spirit of 1976 said...

I've never heard of a social worker discharging people from hospital or making decisions about leave. I wonder if that's a reporting error by the Telegraph?

Cockroach Catcher said...

Once I can get my hands on a full copy of the report, I will check it out. Unfortunately, I have spent too long in the NHS to believe the unbelievable.

If you have a link, please send it as I have a good universty subscription.