This laisser faire attitude towards schizophrenia is what we should be campaigning against.
A refusal and a reluctance to recognise that capacity in schizophrenia may be accepted but as to be unreliable,
fluctuating as it does over time and in situation,
and limited often to particular routine functions.
They are far from being depended upon for capacity to call up help, or describe their recent behaviour,
so can often be left isolated, without what other people's observation of behavior shows about the continuing nature of the illness,' Not ill enough as we saw them ... it was their choice ...'
There must be a source of continuing ordinary observation, and a reliable contact with the local profesional service, for intervention.
a failure - not to have consulted family and community observers about recent behaviour.ab
E-mail re action is welcome .. davidwatch@btinternet.com
Community Care
This is Local London, 18th September 2009
South west London's mental health trust under fire for its 'human rights' policy,Could anything else have been done ?
The brother of a man with schizophrenia who died in a squalid Clapham flat criticised the care workers who feared moving him would violate his human rights.
Mayan Coomeraswamy was found dead on January 9 this year in a filthy, unheated flat deemed barely fit for human habitation, an inquest heard yesterday. His brother, Anthony Coombe, accused the authorities of failing in their duty of care after a post mortem examination showed signs of hypothermia.
The case has triggered a review into how local mental health services handle vulnerable patients choosing to live in such conditions.
Mr Coombe said: "My brother has been a mentally ill person for 37 years.
For the last four years we know the state of his residence where he was living was squalor.
I think even an animal couldn't have lived in that." He added: "If my brother died for one [reason], I hope we can learn by this."Mr Coomeraswamy lived in Thurleigh Court, Nightingale Lane, under the supervision of South West London and St George's Mental Health Trust.
For years the landlord, Gary Burns, wanted to clean the flat up - but the trust refused to forcibly move the patient to allow work to take place.
The boiler was broken, the bathroom ceiling had collapsed, the walls were damp and a thick coat of dirt covered every surface.Showing photographs of the scene to the court, Dr Paul Knapman, the coroner, said:
"This is barely fit for human habitation.
He added: "Photograph five shows an absolutely filthy kitchen with stuff all over the place.
One thing it doesn't show is rodents or insects, if there were any. I can't believe there wouldn't be."The patient, who was visited regularly by a psychiatric nurse,
was found dead, partially clothed, in his bedroom
after police were told he would not answer the door.
A post mortem examination found ulcerations in his stomach,
often found in those suffering from hypothermia.Speaking in court, Dr RA, director of social work at Tooting's Springfield Hospital, said human rights had to be considered before removing patients from their homes.
She said people were only sectioned when they refused to comply with treatment, but this was never the case with Mr Coomeraswamy.
She added: " She highlighted that workers were always aware of the patient's right to choose their living circumstances, citing the Mental Capacity Act and the Human Rights Act.But Dr Knapman called for a review into the trust's interpretation of these laws.
He said: "You will know that month after month in this court we hear about elderly people
often dead for weeks and weeks -sometimes months - living in absolutely appalling circumstances. He added:
"The pendulum may have swung too far."
The results of the review could affect adult care policy nationally, with knock-on effects for Alzheimer's patients
and others living supervised in the community.Mr Coomeraswamy came to England from Sri Lanka in 1970 to study chemical engineering,
but during his last year of work experience he developed chronic schizophrenia
and never worked again.The inquest, at Westminster Coroner's Court, was adjourned to 11am on Wednesday, December 9, pending the trust's review.
Guidance as to the Coroner rules on release of documents
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from the National Framework for Continuing Health Care: July 2009
12.
... if an appropriate clinician (see paragraphs 85-86) considers a person to have a primary health need arising
from a rapidly deteriorating condition that is entering a terminal phase and completes a Fast Track Pathway Tool,
the PCT will be required, on receipt of the completed pathway, to determine that a person is eligible for NHS continuing healthcare,
until such time as a full assessment is completed for NHS continuing healthcare, using the Decision Support Tool.
Decisions and rationales that relate to eligibility [ NHS continuing healthcare and NHS-funded nursing care ] should be transparent from the outset: for individuals, carers, family and staff alike.41. If the person lacks the mental capacity either to refuse or to consent, a 'best interests' decision should be taken (and recorded)
as to whether or not to proceed with assessment of eligibility for NHS continuing healthcare.
42. Where a 'best interests' decision needs to be made, the PCT must consult
with any relevant third party who has a genuine interest in the person's welfare.
This will normally include family and friends.
The crucial point here is that St George's Trust NHS hospital secondary specialist Community mental health Team was the lead contact, regularly visiting.
When a top NHS team specialising in serious mental illness, is doing the monitoring of the care and treatment of someone who has been affected by a serious and enduring illness, other people, who would otherwise have an immediate concern, influenced by the care being with people who are better qualified than them to know when to intervene with this illness, they back off - ' they are the specialists - they know what they are doing'.
The GP will not stay in the picture, unless the team keep the GP service regularly updated.Without this team visiting, the GP would be visiting to see the situation for themselves, probably at the behest of the family, noticing that the situation with this serious mental illness , was going wrong.
That the GP is out of the picture will be known to the team - to be taken account of, and if necessary, re-visiting the need to bring the GP into the current picture, if it might be that the GP should be doing something, or would want to be seeing the patient for themselves.
The point person - the visiting psychiatric nurse is from a team - is part of a specialist team, together with a variety of more experienced senior people, some from professions ancillary to psychiatry, to discuss things with, if there seems to be a problem developing.
The team will have a senior clinical lead, usually a psychiatrist, who if not a consultant will be able and should consult with the lead Consultant psychaitrist for the area.
The visiting nurse can turn to their own psychiatric nurse manager if they want backing.
There is a regular weekly meeting of this particular area community mental health Team - held so that matters of concern will have a forum to bring to bear senior experience, one that has the authority within the Mental Health Act [ MHA ] to make decisions.
One hopes a meeting that records who attended, what was brought up - or not, and what decision was arrived at.
In the team will be Social workers with mental health experienceIf a Mental Health Act decision was proposed, an Approved Mental Health Worker, usually one independent from the secondary Specialist hospital Team, would at some stage have to agree that grounds for a MHA section were there, for an admission to go forward. Sometimes preceded by, sometimes accompanied by, two medical recommendations; one by the family doctor with some recent contact, and one by a section 12 MHA approved specialist, usually the consultant psychiatrist in the specialist team.
For urgent necessity , one medical recommendation suffices.In self neglect on this scale, the Local Authority Welfare Social Services people can claim powers to intervene.
Neighbours may have informed them.None of the above decided to intervene on this occasion.
The home conditions were seen on a home visit by the relevant local consultant psychiatrist. It is not clear if this was at the request of the GP who would then have received a Report. More likely as such a report was ot presented to the Inquest, that this was a visit requested by the Team maybe at a request from the brother, who would be there at the visit
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Professional care and treatment does go wrong.*** !!!the List of Inquiries after Homicides
linked to Comments*** !!!What are the lessons - that are not learnt
*** !!!
One piece of information from the Inquiries, where the perpetrator suffered fom schizophrenia, is that very few have been helped into a daily and weekly routine of engagement with a meaningful programme of activity, so that they will want to continue with medication
It's a common finding for most of those suffering from schizophrenia, and it is a failure of NHS provision to deliver a Treatment programme in aftercare.
Only half of the Mental Health Trusts have a Rehabilitation service which includes a consultant psychiatrist [ sometimes called 'Recovery' ] - that is, a team dealing with after-care separate from the community mental health team ( they get the first referrals ), a Home Treatment team ( often the old crisis team ) or the Assertive Outreach Teams.
These have responded and the replies are half and half, yes and no.
the No people here so that you can check the service in your area.
And Complain!!