Community Care This is Local London, 18th September 2009
South west London's mental health trust under fire for its 'human rights' policy, Could anything else have been done ?
The brother of a man with schizophrenia who died in a squalid Clapham flat criticised the care workers who feared moving him would violate his human rights.
Mayan Coomeraswamy was found dead on January 9 this year in a filthy, unheated flat deemed barely fit for human habitation, an inquest heard yesterday.
His brother, Anthony Coombe, accused the authorities of failing in their
duty of care after a post mortem examination showed signs of hypothermia.
The case has triggered a review into how local mental health services handle
vulnerable patients choosing to live in such conditions.
Mr Coombe said: "My brother has been a mentally ill person for 37 years.
For the last four years
we know the state of his residence where he was living was squalor.
I think
even an animal couldn't have lived in that." He added: "If my brother died
for one [reason], I hope we can learn by this."
Mr Coomeraswamy lived in Thurleigh Court, Nightingale Lane, under the supervision of South West London and St George's Mental Health Trust.
For years the landlord, Gary Burns, wanted to clean the flat up - but the trust refused to forcibly move the patient to allow work to take place.
The boiler was broken, the bathroom ceiling had collapsed, the walls were damp and a
thick coat of dirt covered every surface. Showing photographs of the scene
to the court, Dr Paul Knapman, the coroner, said:
"This is barely fit for human habitation.
He added: "Photograph five shows an absolutely filthy kitchen with stuff all over the place.
One thing it doesn't show is rodents or insects, if there were any. I can't believe there wouldn't be."
The patient, who was visited regularly by a psychiatric nurse,
was found dead, partially clothed, in his bedroom
after police were told he would not answer the door.
A post mortem examination found ulcerations in his stomach,
often found in those suffering from hypothermia.
Speaking in court, Dr RA, director of social work at Tooting's Springfield Hospital, said human rights had to be considered before removing patients from their homes.
She said people were only sectioned when they refused to comply with treatment, but this was never the case with Mr Coomeraswamy.
She added: " She highlighted that workers were always aware of the patient's right to choose their living circumstances, citing the Mental Capacity Act and the Human Rights Act.
But Dr Knapman called for a review into the trust's
interpretation of these laws.
He said: "You will know that month after monthin this court we hear about elderly people
often dead for weeks and weeks -sometimes months - living in absolutely appalling circumstances. He added:
"The pendulum may have swung too far."
The results of the review could
affect adult care policy nationally, with knock-on effects for Alzheimer's
patients
and others living supervised in the community.
Mr Coomeraswamy came
to England from Sri Lanka in 1970 to study chemical engineering,
but during
his last year of work experience he developed chronic schizophrenia
and
never worked again. The inquest, at Westminster Coroner's Court, was
adjourned to 11am on Wednesday, December 9, pending the trust's review.
... and these ....... and these ... and these .. System failed 'Satan' crash
pair, BBC News, 13th February 2009
The mental health system let down
a mother and daughter and the mentally ill woman whose car killed them, a judge
has said. Gemma Montanaro, who thought Satan was at the wheel, was cleared of
dangerous driving by reason of insanity.
Jane Malkin, 51, and Nicole Townshend,
24, died instantly on Saffron Lane, Leicester, in January 2007.
Ms Montanaro appeared before
Leicester Crown Court to be sectioned under the Mental Health Act.
At her trial
last year, the court heard Ms Montanaro was in the grip of schizophrenia at the
time of the crash.
The court was told psychiatrist Dr Susan Smith's
recommendation that Ms Montanaro should be admitted to hospital
was overridden
by community health workers the day before the incident. On Friday, the judge
ruled she could be cared for in the community,
but would be returned to a mental
health unit if she became unwell again.
Judge Michael Pert said: "I have
a public duty to have a concern because Ms Montanaro has been let down
and the
families of the deceased have been let down by, effectively, a failure in the
system.
Dr Smith's recommendation was not followed.
Under this system, the
recommendation of the clinicians will be followed.
Dr Smith's care was without
fault.
She made a recommendation at the time, when Gemma Montanaro was
desperately unwell, that was overridden and, as a result, two people died.
I
have seen a document that passes as an NHS report on the circumstances.
It does
not strike me as satisfactory." The trial heard before the collision, Ms
Montanaro had been seen by witnesses driving on the wrong side of the road and
through red lights at speeds of up to 70mph.
Dr Jane Hoskyns, director of
clinical practice for Leicestershire Partnership NHS Trust, said they had
instigated a review of the care given to Montanaro. "We are making sure we
understand and learn all that we can from this profoundly regrettable event,"
she said. "We shall support today's court decision by putting in place thorough
and comprehensive arrangements for the future care of Gemma Montanaro and
monitoring of her health. We also welcome the fact that NHS East Midlands is
undertaking an additional investigation and, when their report becomes
available, we will respond promptly to implement any further actions that might
be required." ... and these ....
Phil Hope MP
Minister of State for Care Services
Department of Health
Richmond House
79 Whitehall
London SW1A 2NS september 22nd 2009
Dear Minister,
I write as a family carer for my son who has been affected by schizophrenia for the last twenty years ,
living at home, to draw your attention to three things to which you should give some serious attention.
The first matter is the facts disclosed in the Annual Confidential Inquiry into suicide and homicide
which discovered that the number of homicides committed by those affected by schizophrenia
rose from 26 a year in 2002 up to 45 in 2005. The increase was from those sufferers not currently in touch with services.
Those in touch continued at the same rate,
but at the time were hardly being delivered care and treatment to the standard required
as shown by the comments and outcome in recommendations when the events were looked into by external Inquiries.
That is the second matter. Someone must draw together the comments from these external Inquiries
as they display the fault lines in the delivery of service.
The third matter arises from the current Inquest into the death by neglect of someone suffering from schizophrenia
despite the fact that they were being visited by a representative from a secondary specialist mental health team.
The Inquest is to be resumed.
The questions raised by the circumstances are such that I believe it imperative
that some one from the Department should attend the resumed inquest.
If the standards of intervention into the care and treatment of people affected by schizophrenia,
as given here in the newspaper report of the early proceedings,
are those practised throughout the mental health services,
the situation of those affected by this very serious illness, is one of continuing jeopardy.
Something must be attempted to give guidance for the long-term monitoring of those
with this illness,
whose insight into their illness is reduced and fluctuating,
and who cannot always reveal what is going on in their minds.
These three matters raised, point the need for a greater degree of supervision and intervention
where this illness, is left outside a service, or when the service is a faltering one.
I append the newspaper Report.
Is it significant the Inquest had hardly any national press publicity?
Yours sincerely
David H Yates FRC Psych
www.schizophreniawatch.co.uk a letter 1. ... from a psychiatrist who hears about the the predicaments at Mental Health Act appeal Tribunal hearings
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