The Falling Shadow page 148 para 6" ... Clearly the staff at Moorhaven did not realise how ill he was, but as soon as he was released and came home, at the beginning of October 1986, it was immediately apparent, not only to us but to all our neighbours and those who visited the house that he was very ill indeed.He demanded to be sent abroad to escape 'the Nazi dictatorship in this country' and he seemed to be in a constant state of fear, locking and bolting doors and making sure the curtains were tightly drawn, and he complained of being radiated by nuclear rays which he said were being directed at him from Devonport dockyard via the television or radio. If we switched on either he became very disturbed.
The Chernobyl disaster triggered this off.
He kept telephoning people all over the country, including the Prime Minister at 10 Downing Street, and when I put a lock on the instrument he broke it
Sometimes he would pace up and down in a very agitated state, and at other times he would wander outside without any shoes and stand motionless in the rain for long periods of time, and once he sat slumped on the bathroom floor for several hours in a catatonic state.He would cry out in terror because he thought flames were coming through the floorboards or he was being shot at through the window.
Afterwards he seemed to have no
recollection of these events.That is ... In a different place, to an examining doctor he did not, and could not, relate these events at a later time.
When he did attend the doctor the family could not recount their observations because the doctor was building trust, and the patient was against the parents being seen
.So how did the mental health service expect to know how serious the illness was; the patient could not recall or recount the behaviour of his illness; the parents and their community were never approached for their observations
The professional team did not know how ill he was and did not take the steps to remedy that - that is by speaking with the carers. It seems that professional assessment is lacking, and often they do not believe this, so that they are misguided in their judgement, unless they have the observation of behaviour that has been going on apart and in between their face to face interviews.
The professional assessment was based on what was shown to them. He could not describe the degree of his illness to them because what, in the brain, is needed to describe the nature of it is denied expression by the fault line in the illness itself.
Because the professional input refused for itself the benefit of of receiving observations from others, particularly family, the patient was denied the benefit of an adequate intervention from them, and was failed.
Now there are two limitations.
1.The patient cannot recall his illness.
2. Those who observed its florid state are shut out from reporting it.
.....
These will be compelling themes in subsequent Inquiries and surface again in discussion about a new Mental Health Act . How to assess the capacity in a patient where there are the limitations of their own ability to relate and recall their behaviour in-between point examinations, especially if the patient debars the family from filling in the gaps.
....
It encouraged the application of more supervision - to be felt by all working staff at all levels. This would encourage reflection and continuous review on current practice. But the Report is unclear as to how to bring this about; especially for those at the top of the tree, or those becoming maybe over-assured in their own long experience - experience which then becomes out-dated in any new working practice. The Chair meets this difficulty again ( Blom-Cooper;Mitchell ) without giving any answer.
It examined how it was that psychiatrists had come to be hesitant in using admitting MHA detaining sections because signs of a recurring illness were still insufficient for them to decide that the situation was serious enough to apply these Orders.
The Report concluded - the most immediate consequence for future practice - that an illness which had previously been shown to reappear floridly when medication was withheld , could be held to warrant early Detaining Order intervention, if medication stopped --because there was a definite prospect of the illness proceeding to a serious breakdown of judgement control , and to the previous consequences of that , happening again .
This became the main argument , referred to again in the preamble - at what point in mental illness does individual freedom have to give way to other authority .