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Lythgoe - henceforward -L.- showed normal childhood behaviour and family relationship , with only minor asthma as any trouble, until after educational O-level results which were average but disappointing and less than expected.There was some truancy and contact with street drugs. Although he entered for educational A-levels , he abandoned these studies and failed the examinations. Instead he earned cash. Whilst doing that he may have been forced into a scam type illegality. Aged 19 he left that work and helped his father in a window cleaning business. His father noted a more obvious irritability and sleep/waking problem, but not until after his father fell and suffered a severe head injury, did a definite kind of mental change become clear to his family . He talked wildly and with a content of misbeliefs. After leaving home he must have seen his family doctor , who then referred him to a Local Authority run mental health cantre staffed by Approved social workers in mental health, and attended by student social work staff. It is not made clear in the Report why this was the route into mental health services chosen by the family doctor, nor is it clear what the reply from the centre was made to the fmily doctor. Subsequently in the next months he returned to that Centre. He was never advised from that source that he should be seen by adult NHS mental health services The Inquiry Report comments that the Centre should have a clear methodology to separate mental health problems from, what would be for the Social Service Centre , a more appropriate concern - the social consequences of that. Eventually after a mental health qualified doctor at the family practice saw him and saw signs of mental illness and noted a story of L. taking a knife to his mother, he discussed formal admission with a Social worker. L. is treated with neuroleptic medication suitable for the treatment of schizophrenia and he responds - his mother witnesses he was as well as he had been five years before any illness. The Inquiry Report is puzzled as to how the Consultant Psychiatrist who was the RMO from the local NHS catchment service was not drawn in to any decision about proceeding. In fact the appropriate consultant was on leave and there was no particular cover arrangement. A full admission mental health examination account was made by the ward doctor who also took a telephone history from the family, which included an account of the threat to his mother. The Report summarises ... There was no Care Programme Approach plan on discharge. He was not assigned a community worker despite the history of threatening behaviour." He did not keep his out-patient appointment and it was left to him to find his own accomodation. The Report comments ... "The use of speculative diagnoses in the dischage summary almost certainly affected the future . The approach by staff to patients diagnosed as seriously ill may be very different from those whose troubles seem to have been brought on by themselves" . Subsequently the ward staff and consultant were quite definite in deciding the mental disturbance and symptom progress were all down to drug abuse, and reacted accordingly - that this was a self inflicted matter or irresponsibility. Following the first admission he was sent to a Hostel by the Citizens Advice Bureaux and was accepted by a Housing Association hostel for the homeless. He was in arrears of rent after a fortnight which culminated in his trashing his room . He had no family doctor. Soon he showed signs of mental disturbance - talking to himself reporting a voice from the radio. His room was 'bugged' and there was a concealed camera there. He must speak to the prime minister. A delay of fourteen days ensued whilst the hostel worker and family, to whom he returned one weekend, tried to impress and invoke compulsory admission. The Approved Social worker spoke to four appropriate doctors but could not get anybody to come out , examine, and to consider a Mental Health act Section admission; including the catchment area Consultant to whose ward he would eventually go. That admission eventually came about because a family doctor lost patience " he had a past history of having knives to people's throats " , and decided things were getting so out of hand that a danger was likely, and therefore a one doctor emergency three day Order admission was correct without getting a specialist view. The admitting ward doctor writes a good account and notes 'paranoid psychosis with possible personality disorder'. Interviewed the following day during lunchtime by the Consultant the conclusion is 'vague in ideation, nothing else, wants to go back to the hostel, no grounds for compulsion, revoke the three day detention Order ... ' discharge as it suits him'. The two Approved Social Workers oppose this , one in writing - that he has no hostel place and he has no family doctor to go to. Both parents protested his early discharge. L. leaves the ward two days later , returns home for money, kicks the furniture and boards a train for London. Without money he is sent off the train near London. He hitches and arrives at Buckingham Palace gates where the sentry sends him away. Moved on he feels physically ill and goes to a nearby Hospital wher he is found to be mentally ill , admitted - transferred because no local beds available - to a private hospital - and from there five days after his departure, is retrieved by his local hospital. The next three weeks are a mixture of compliance and refusal with medication and a continuation of 'paranoid ideation'. He tests weakly positive for cannabis. A clinical review is held and he is to be discharged - ' medication to be withheld as he will not take it .. if no accomodation to go to the Salvation Hostel' . There is no discharge summary. L was discharged to his parents address, but goes to friends, finds a flat and a job, and finds a new family doctor, whom he sees many times , and collects some medication of the kind succesfully used in the first admission to hospital. The discharge summary from that admission had arrived but not the later one from his second admission. He hears voices . He is not referred to the aftercare services. Six months later he is on one of many visits home - 'to collect his washing and get a good meal'. He went upstairs talking to himself ,then clubbed his mother unconscious with a hammer, and then attacked his father with that and a kitchen knife. In detention and after at the secure hospital it is plain that his illness is schizophrenia. One specialist in the Secure Hospital records ... 'he is adept at concealing his symptoms' . L. tells the Inquiry Panel when seen in that hospital - better after medication ... 'he did not tell his thoughts as he believed them to be reality and there was no need to do so'.... But not 'offguard' with his family and lay companions. They knew.
E-mail reaction is welcome
M
ental
They knew he was at times taking more street drugs. His home behaviour became insupportable and he was made to leave home during an argument when he destroyed some furniture.
The basis for a Mental Health Act Section admission was not thought to be there.
Very soon after, the family and all agreed he should be reexamined - at the Centre. An Approved Social Worker ( qualified to make an application for a section admission ) and the the Section 12 Approved family doctor (approved for giving a specialist recommendation for a Mental health act Section admission ) who had seen him before, decided he should be admitted directly to the NHS mental health admission services, and with some difficulty that happened.
" After a thirty-five day stay in hopital ... the discharge summary was written by a Senior House Officer ...( junior, training grade, ward doctor ) who does not seem to have had much contact with L.during his admission , and repeated the diagnoses of Drug induced Psychosis and personality disorder, without any evidence for doing so". His father comments to the Inquiry - " ... no contact from the ward - both times -(admissions) .. no doctor had a word with us, no doctor told us what was wrong - L told us himself ' I'm a paranoid schizophrenic'.
I had not a clue what that was " .At official interview - yes.