The Inquiry report is content with an overall look at the care without putting a name to what was being treated here. Care and treatment require a diagnosis as part of any plan. The first hospital admission is clear about this. The illness is diagnosed an endogenous depression, and treated with medication specific for that condition with appropriate success. That succesful medication seems never to have been offered subsequently.
Why then was that category of medication never tried in any of the subsequent presentations of morbid mood symptoms?
The success of previous treatments is a very good basis for confidence with subsequent depressive presentation. The recipient knows it has been succesful before. They do not have to wonder, in their depressed condition, about possible new side effects, whilst waiting an early response.
The Report is unhelpful with the absence of any account around the circumstances leading to the event of the tragedy. Although a landlady living in a house with tenants is a relatively closely involved person, there are no references to what sort of relationship there was , or what may have led to the event, or what account RB gave in his final clinical interview of that situation.
His parents were in some difficulty about keeping in contact - because he is an adult, because of his wish to be independent of them and particularly it seems from his father.
The report concentrates on listing the quantity of psychiatric and psychological intervention without reflecting on its relevance or the usefulness of its application.
The Inquiry seems to have stealed itself to keep clear of explanation, in favour of an account of all that was provided from the mental health services, rather than an appraisal of its relevant value to him and the diagnostic imprecision.
Yet that must be part of any Inquiry.
Were - with hindsight - appropriate measures applied? If not, were their things in the systems of care at the time which inhibited what - with hindsight - were available and might have been tried out, but were not because the systems in place discouraged their application.
Hindsight is the point of these Inquiries.Were there "admission beds" readily available to the junior doctor examining RB when he finally presented at casualty - as an alternative to be contemplated for this 'loner'? Was the second opinion of a senior doctor available from the casulaty? Would it have been straightforward for the junior doctor themselves to have asked for and got social work intervention at the time of that interview? Could that junior doctor have called for and got a community team mental health nurse to have been introduced - at the time of that casualty clinical interview, so that the interview could have been conducted with all these options in mind.
Was the Care programme approach in place at the time , and appropriately followed.
E-mail reaction is welcome
mica@didgy.freeserve.co.uk |