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.
British Journal of Psychiatry(1990),157-671 - 674; C. R. Brewin, J. K. Wing, B. Macarthy and T. S. Brughabr The Assessment of Psychiatric Disability in the Community A Comparison of Clinical, Staff, and Family Interviews
.... "Assessments of some of the symptoms and behaviour problems of long-term psychiatric patients living in the community were obtained independently from clinical interviews with such patients, and from interviews with day staff, residential staff and families caring for them. *** In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. [ that is the core explanation of many failures in care delivery. My sufferer comes across well at interview - hours later at at home he is shouting grimacing and negative to appraoch - visted by a Home Treament call, he holds up well for the brief encounter "
These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff "