Comment on Scott-Moncrieff; Gonzales.

....go to the full Report ... Inquiry Scott-Moncrieff; Gonzales ...... ** This is very humane analysis of the care and treatment given before a horrific tragedy. A young man kills strangers, and later, in security, better from maintained medication and that shelter, in some way facing the terms of what he had done, kills himself. Care has gone horribly wrong, despite reasonably good contact with secondary mental health service. The principal failure is an insufficent conviction that his illness, which he himself accepted was schizophrenia, required continual acceptance and engagement. A diagnosis of schizophrenia , verified in hospital as responding to medication, AND as relapsing whilst tried in hospital without it, is never fully accepted subsequently. The illness is not florid nor observed in subsequent professional inerviews as substantial. The care and treatment consequently is inadequate, as the illness is insufficiently engaged. Because the illness is not expressed flagrantly, and there is no story of violence or resentment, it is not thought to be capable of becoming at risk. Medication is not given the attention it warrants for this condition, because the lack of conviction about the diagnosis,as together with the lack of illness behaviour at contact, reduced the seriousness with which he was addressed.   Schizophrenia is sufficiently a risk illness, what is going on being often kept within the mind of the patient, who dos not reveal the inner world, or cannot do so, that thorough consideration to discovering and prescribing medication that is acceptable to the long run, must always be sought, The other necessity requiring serious attention, for without it medication is not taken seriously enough by the patient [ what's the point ] , is the delivery of an aftercare programme which provides hope and some level of success in allowing the sufferer, an occupational outlet of meaning for his future living. There is a long and worthwhile list of comments on a 'Recovery' programme from Para 11.00 [ engagement ] to para 11.22 onwards 'the recovery model' go to full Report Inquiry Scott-Moncrieff; Gonzales "The failure to engage with Mr Gonzales, exemplified by individual and system failures, was influenced by the negative attitude about his care and treatment which existed throughout his contact with the service after he left the Oaktree clinic. To succeed, the approach must be one of determined therapeutic optimism. Goals need to be achievable rather than unattainable dreams, and failures need to be treated as correctable mistakes. Service-providers should not punish themselves for making mistakes, but see them as an opportunity to find out why the plan did not work and to make a better one. If the next attempt fails, it again needs to be rectified by analysing the failure and trying something else. And so on until, if necessary, all the creative and professional resources of the trust have been brought to bear. Front line staff should be given the resources to work in this way. " That is the most telling comment. It is time the service to this illness, schizophrenia, was given it's own specific examination. Are there somewhere , Mental Health Trusts who can be exemplars of and comparators for a definition of, a funding assessmet of, a good continuing aftercare service for this condition - success with this illness in a whole catchment area - not a selected few patients - that can be the guide? Does anybody know of any ? The final tragedy is preceded by G. running out of the house, naked through the streets, reported to the police by the man living in the house, but through misunderstanding, a failure to connect up following that, to an appropriate service, that would, or could, respond appropriately. There seems not to have been a fail-safe, fall-back preparation for a procedure that earlier, could and would have taken G back into specialist mental health service care. *[ Scott-Moncrieff was the lawyer in "C" the patient with schizophrenia who refused consent to have his gangrenous amputated, advice given on the grounds that a surgeon said this was necessary. The consultant who received this advice got to Court to claim "C" had not the capacity to decide. "C" had said he was a medical doctor [he was not ] and knew better. By the time the case came to Court "C" had ben given antibiotics and the gangrene had receded as a danger. The Court found "C" had capacity. The case became the basic decsion for capacity in people with mental illness. They could have capacity even when very ill "C" subsequently stayed in touch with Scott- Moncrieff and she was part in drawing up his will. What was his declared intent in that will, persuaded her that "C", at the time his capacity was challenged, had indeed been incapacitous for the decision [ All this now replaced by the the 'Bournewood' matter, and the subsequent Mental Capacity Act 'capacity' in the ( specialist ) secondary mental health services go back to Inquiry List go back to Index page.

	M ental I llness C oncerns A ll . back to Home Page " Fellow citizens, we cannot escape history ".... Lincoln.