Since Sectioned on S2 on 5 June this is what Elizabeth has experienced under “care” of BEHMHTNHS.

Failed attempt at placing her on mixed ward at Chase Farm Hospital led to several days of seclusion without phone and family contact.

Then onto St Pancreas Hospital Ruby Ward where, guided by Chase Farm RC, forcibly injected with Paliperidone (Risperidone depot).

After several weeks, transferred back to Suffolk Ward traumatised and placed in seclusion c4 days, injected, then sent onto Cygnet Godden Green, Sevenoaks, where forcibly injected with Paliperidone. Elizabeth, who is terrified of needles, advised that she was so ill she lay in bed not able to move and felt very ill afterwards.

Family visit arranged but suddenly cancelled by Cygnet then allowed week after.

Visited ward, took phone as phone not charging to be repaired

Following 5 weeks at Cygnet Sevenoaks, Elizabeth back on Suffolk Ward. Nothing in place in the community and left on the acute ward Elizabeth reacted to situations resulting in further seclusion of several days and deprival of contact with family as punishment.

Visited ward to take her out for a few hours fresh air as 3 hrs leave allocated- did not know she was back in seclusion. All over weekend beautiful weather but kept in a seclusion room as punishment because of no decent facilities such as a sensory room. No staff would give any information and some refused to give their names.

Suggested taking her tol an outdoor adventure style holiday for a few days – no answer from RC no risk whatsoever as Elizabeth could barely walk day before and could not keep food down and kept crying so a little break in the fresh air might have been good for her. However never got any agreement from the RC and next thing, having turned up at the ward yesterday with some things for Elizabeth, was told she had been sent away again – this time to yet another PICU ward at Elysium, Thatcham, Reading.

This shows that care on offer for mental health patients and autism/LD who are all held together on same ward is totally inadequate and untherapeutic when it comes to dealing with someone so very traumatised.

Another former patient suggested a Sensory Room and I think it is about time more money was spent locally to avoid someone like Elizabeth being sent away time and time again from home.

My other suggestion is care farms – care farms are far more therapeutic than acute wards and Elizabeth likes animals – why is there no facility like this in Enfield or the surrounding area?

When you think how much money is wasted on private/public PICU settings that are wrong environment this is bad. Elizabeth came back even more traumatised and put back on the acute ward that is volatile and noisy it is apalling that there is no other option in Enfield.

Reading back on the files from the very beginning the child-like behaviour of my daughter was apparent dating back to 2008 and absolutely nothing after all this length of time has been done to tackle this apart from give drugs.

The Paliperidone depot is clearly not working as it is not stopping Elizabeth’s reactionary behaviour and in fact she has deteriorated. Why give a drug when it is of no benefit whatsoever and particularly when the RC herself has put a line through it previously to acknowledge she was allergic to it. It is contraindicated and against manufacturer’s instructions to prescribe it when it is contra-indicated.

Today I spoke to someone in the Pals Department and I recognised him from way back when Elizabeth went missing from the Day Hospital with an in patient who was on a criminal charge who should have been escorted everywhere.

So much has happened to my daughter under the care of BEHMHTNHS yet they refused to acknowledge the full report by Dr Bob Johnson of complex PTSD and fail to provide any effective treatment to help her. Having provided private care for four months I know it is possible and she was actually getting better but coming back home to this area of Enfield was the worse thing that could have happened and was not planned either.

The other thing I would point out is that the way you are spoken to by some members of staff is condescending and patronising. I’ll give you some examples of things said to me:

I am a mother I know how you feel

“Are you a professional?” – when it comes to the drugs. “no I am a mother” in other words nothing in their eyes however “I as a mother have turned to experts on the drugs and in research” In other words I can prove what i say.

I do not like the way staff wear name badges back to front and when you ask their names they become defensive.

I do not like the way staff lie when things go wrong or when there is noone who wants to speak to you on the phone.

Elsyium just like Cygnet have been given details of Elizabeth’s sister being NR.

It must have been planned this transfer as when I turned up she had gone.

Once again I am having to travel to visit an area I have never been to before, drive, book accommodation etc. Visiting times are not long and there is always the risk they will refuse at the last minute like they did at Cambian having driven several hours in the car and told to come back the next day.

In desperation I contacted Mencap because Elizabeth is being deprived a proper assessment and not treated fairly under Enfield despite a whole team at Huntercombe said “Aspergers – high spectrum” – this team say low intelligence and emotionally unstable personality disorder and schizophrenia which we totally disagree with. Many other doctors disagree also in the files and this is why a proper assessment needs to be done by a completely independent organisation such as Mencap – it is not independent to get another hospital paid for locally to back them with their diagnosis. An independent assessment should be completely independent.

I previously wrote about my recent declined visit by the RC of Castle Ward that Elizabeth was too ill to see anyone the day after I spoke to her when she was clearly looking forward to my visit and asked me to bring her things.

I am pleased to inform everyone that Cygnet did eventually facilitate my visit. I drove to Sevenoaks and decided to stay over just in case there was sudden change in plan.

Only I was allowed in to see her as I was lucky and so fortunate to have some witnesses on hand.

I was taken to the visitor’s room and at first surrounded by staff and had to wear a face mask though not all staff wore facemasks and I was told I must wear it at all times.

I saw a psychiatrist and Responsible Clinician as there is always more than one involved but the overall responsibility for care lies solely with the Responsible Clinician who is in charge of everything.

Elizabeth was not allowed out and it was a lovely sunny day but when I explained I was staying a bit longer the RC granted three hours leave which was nice.

The visit to Elizabeth was not unpleasant. Staff were nice to me. I had come to check out Elizabeth’s phone as none of us could contact her and it turned out it was broken but Cygnet to be fair took liability and I took her out to the town buying her lunch and trying to get some more clothes as the clothes she was wearing were too small. She had ballooned in weight.

I wanted to take Elizabeth to see the deer in beautiful grounds nearby but just the lunch and trip into town took too much time and I thought I would then go on to visit the beautiful house and grounds of nearby Chartwell Winston Churchill’s former family home.

Chartwell – Wikipedia

https://en.wikipedia.org/wiki/Chartwell

I wanted to take Elizabeth back there the following week thinking she would be at Cygnet for up to 3 months.

With three hours leave a day I was happy as I had not seen Elizabeth for weeks on end. Also trouble getting through on the phone was upsetting but now I was there and able to sort out the phone which had been broken I felt happier.

There is so much to see and do in the surrounding beautiful area of Sevenoaks I now had something to look forward to and proposed to visit the following week with Elizabeth’s sister.

Meeting the team was good as communicating over the phone is not always the best thing but there was one person who stood out, that being Tom Higa who communicated well with me and took on board my comments and actually listened to what I had to say which is very rare.

The visit the following week did not take place because Elizabeth was brought back to Suffolk Ward once again very late at night. It is from Suffolk ward that Elizabeth has been transferred all over the place, most recently to St Pancreas Hospital Ruby Ward, Camden and then Cygnet Sevenoaks and Elizabeth being autistic but deprived of a formal assessment to have such changes in a short space of time is most traumatic for her.

I had hoped that Cygnet would do a proper assessment on Aspergers and take a look at her complex PTSD, already diagnosed in an expert witness report but dismissed by all at BEHMHTNHS except for their clinical psychologist Kajori Mukherjee. I doubt an assessment was carried out.

Back on Suffolk Ward I thought at least she would be nearer home but felt very uneasy because of past treatment my daughter has received on this ward under the Responsible Clinician still in charge and it seemed like instead of tackling her trauma they used punishment on the wards ie lengthy seclusions of nearly a week, following which transfer onto PICU settings, identified as being entirely unsuitable by the RC’s of the respective wards where she had been sent because when you look at environment, how can this be good for a trauma victim when noisy and volatile. Elizabeth was on 15 minutes watch and 1-1 which was very restrictive at Cygnet. Now back on Suffolk Ward she is held in seclusion.

The RC is still the same one who goes back years and who sticks firmly with her belief of “paranoid schizophrenia” and “emotional unstable personality disorder” – the latter I see as most stimatizing and unscientific, considering the extent of all the terrible abuse Elizabeth has suffered whilst under care in the community etc. Most accurately, yet dismissed, Elizabeth has a full report from Dr Bob Johnson, a very experienced Psychiatrist, who states she has “complex PTSD going back to 2010” to which we as a family all agree. This report has been ignored locally together with his recommendation of “intensive trauma therapy” which is why Elizabeth has deteriorated and not got better. No therapy of such description has ever been given to Elizabeth. As for Schizophrenia this is an unscientific umbrella diagnosis for other causes and in Elizabeth’s case the causes are physical as I have proven but thanks to advice from the wonderful Psychiatrist Dr Joanna Moncrieff, as I follow advice from doctors and Professors who are truthful and honest I took my daughter to see an Endocrinologist which proved my point. Another point to note is that I am not stating I know better than Doctors who come across as arrogant in many cases and treat you like you do not exist and there have been many abusive comments stated in the files behind my back so I am not trying to say I know better than these doctors but would comment that I have gone to the very top – to Professors and pharmacologists for advice on the medication to find out the true facts based on research. There are many doctors who take an easy and cheap option of drugging and of continuing to stick with a diagnosis they see fit, ignoring so many other doctor’s professional opinions for which I have reports and the treatment of prescribing therefore does not work when underlying physical health conditions are ignored for instance. Then when you read about the tragic case of Oliver McGowan it is dreadful to think that no lessons have been learned resulting in further deaths as I see Elizabeth’s case has similarities and see that her life is currently being put at risk because of the Palilperidone Depot Injections being prescribed on Suffolk Ward Chase Farm Hospital Enfield.

Right now, my daughter is being held in seclusion on this beautiful sunny day as a punishment by Doctors and the Doctor in charge goes way back to 2014 Ct of Protection case where professionals from her team allowed infiltration by the COMMUNITY MENTAL HEALTH TEAM PARK AVENUE so that could report nastily for court purposes behind my back but thanks to the COURT OF PROTECTION they saw through this despite me not having any representation in court. I will be forever grateful to this Court who treated us fairly as otherwise Elizabeth would have been forced back to Phoenix House Stepping Stones Northampton where she had no food at the weekend. Previously the current RC did not answer my request for leave for a holiday and money was wasted as I was told otherwise. The holiday was with Working to Recovery Summer Camp that would have benefitted Elizabeth. It is definitely punishment not care and this today has been confirmed in no uncertain terms in my conversation just now with a nurse called Ada. The conversation is typical of the way many professionals respond defensively and came across as patronising.

I phoned to find out if Elizabeth was still held in seclusion and it was kind of like -you know the answer to that rather than a straight yes or no. So on this wonderful sunny day my daughter is being punished by Doctors and others who are knowingly given depot injections of Paliperidone she is allergic to. Instead of acknowledging this fact Ada commented on “bad behaviour” by Elizabeth. These accusations are commonplace and biased as bad behaviour is only ever mentioned in terms of the patient or their families – never themselves. So if you misbehave or in other words suddenly become distressed and act out your emotions of fear, you are thrown into a seclusion ward at Chase Farm Hospital Suffolk Ward and kept there for days on end before being transfer an expensive PICU ward far away from home, instead of someone trying to communicate kindly with the traumatised patient IT IS PUNISHMENT NOT CARE and the professionals justify this by stating “if your daughter behaved herself ………” or words to that effect. I could hardly get a word in – I wanted to know if she was still locked away like a prisoner for the third time, deprived of contact with family, phone taken away so that Police cannot be called for instance. This is why they do it. It is worse than prison for someone so badly abused like my daughter under the “care” of BARNET ENFIELD AND HARINGEY MENTAL HEALTH TRUST who have yet to respond to my complaint and who have tried to label me as Vexatious Complainant to which I responded with everyone’s comments showing how everyone has tried to cover up substantial failings and let one person in particular take the blame ie the Director of MH when in actual fact my complaint was addressed to absolutely everyone. I feel like featuring that, their responses and all the safeguarding minutes as an example of how professionals all stick together and bully you when things go wrong and no-one raises their hands to take any kind of responsibility because they are all too busy protecting their jobs/salaries and in a doctors case their licence is more important. That says it all doesn’t it. It is not about care but protecting themselves and their own backs.

Yesterday I requested a copy of the Code of Conduct for Seclusion ie I was curious to know how long it is acceptable to keep someone locked away ie punished for their so called behaviour for which I’m still waiting to hear. Could not even get through to Pals so I phoned Tracy, PA of CEO Jinjer Kandola who then said she would contact Pals herself.

So in Barnet Enfield and Haringey MH Trust it would appear to be “Policy” that there is no length of time for seclusions or is there simply no policy or code of conduct. The first time in seclusion was several days before transfer to St Pancreas Hospital as they tried against my advice to put my terrified daughter on a mixed ward. After that seclusion again whilst I get a text message asking me to call the Police on behalf of her and other patients who had barricaded themselves in a room. That led to an injection of course and more punishment of seclusion for about 4 or 5 days – the excuse as always is that someone’s behaviour is bad and that it is justifiable to punish in this way depriving phone contact which affects all the family before transfer to another PICU costing circa £13000 pw and the Doctors there just like Huntercombe state wrong environment. So who is responsible for providing such care and the beds that go with it? Why isn’t decent care/facilities provided in Enfield? Why are the voluntary organisations deprived of cash to help people in the local area of Enfield when there is money to burn by sending someone like my daughter far away from home and family? Again it comes back to why isn’t there better facilities in the local area and perhaps Jinjer Kandola CEO can explain to everyone why???

So whilst on the phone to Ada I asked for the name of the Ward Manager – His is name is Gyada Antwi – I think I’ve met him yesterday as I became entrapped in the double doors asking to speak to the ward manager because I wanted a copy of their Code of Conduct and in particular on seclusion. I was then confronted by three men, I think he was amongst them telling me to leave the premises then barely audible, the threat of “IF YOU DONT LEAVE I’LL CALL SECURITY” – what kind of communication is that! All I wanted was the Code of Conduct – if there is any such thing under Barnet Enfield and Haringey MH Trust and I felt both intimidated and threatened – once again faced with zero communication skills – if this is I was communicated with then this is how the patients are treated – like a piece of rubbish.

Ada was telling me that another Doctor – Dr Varsha was due to see Elizabeth today. I really don’t need any explanation and excuses for decisions made when there is only ONE RESPONSIBLE CLINICIAN IN CHARGE who I have clashed with in asking for extended leave so I can take Elizabeth on a short break – the excuse was “what about the risks” – Absolutely no risks now they have drugged her up like a zombie to the point she has to hold onto my arm, she could not keep food down, she kept crying all the time. I AM SO BITTER TOWARDS BARNET ENFIELD AND HARINGEY MENTAL HEALTH TRUST WHO HAVE DESTROYED MY DAUGHTER’S LIFE AND MINE. There might be some kind people working within the Trust however the majority stick together like glue from what I can see defending one another including a Responsible Clinician they go along with for sake of their jobs but they all know from the notes that they could be killing my daughter which is why I want this all made public and transparent as I see similarities here to the case of Oliver McGowan ie Doctors who care more about their Licence than whether a patient has a bad reaction they put down to bad behaviour they can punish – they look at that person and patronisingly point the finger accusing that person of bad behaviour knowing full well they are causing that person to behave that way by THEIR TREATMENT and choosing to ignore other Doctor’s professional diagnoses but even drugs charts they themselves put a line through re allergy.

I always look further and question why someone might behave differently or show aggression or lash out in fear. This person needs to be in the right environment and not any NHS ACUTE MENTAL HEALTH OR PRIVATE SECTOR PICU WARD. When you look at the remarkable campaign on Twitter by Jeremy, Bethany’s Dad (she was fed through a hatch) unfortunately many others are treated in the most apalling manner and completely misunderstood by so called professionals who stick together and defend one another and will never admit blame – this is why it is so important to be transparent open and honest.

It is like calling someone a liar when a professional spins lies by trying to convince the patient that they have a certain diagnosis that this professional believes in and overrules other professional opinions. What needs to be done is in such instances in cases where there is massive dispute like in Elizabeth’s case are for external assessments to be undertaken and the one thing I would praise Huntercombe for is that they differed from the opinion of the local area.

If a diagnosis is wrong then so is the treatment and the vulnerable person suffers by punishment after punishment after punishment and becomes a revolving door case.

It is absolutely heartbreaking to hear my daughter talk since coming home and ending up the dreadful local area and now I fear for her life because of their treatment. I’m too upset to type her comments but when I sent her to stay with kind humane professionals in 2016 for the first time she came back well and even wanted a job.

It is also upsetting to read all the lies – it is stated “clozapine was helpful” when it caused injury and tachycardia and Mews Score 3.

It is upsetting to read that she was “forced” to go and stay on the Isle of Lewis with the wonderful professionals Working to Recovery- these comments remain in the care plan along with the most disturbing comments of “alleged sexual abuse to a child” WHERE IS THE EXPLANATION TO THIS I AM FED UP WITH WAITING BEHMHTNHS. IVE DONE A PUBLIC DECLARATION REQUEST AND I WANT TO HEAR YOUR RESPONSE RIGHT HERE ON TWITTER AFTER ALL THE ABUSE MY DAUGHTER HAS RECEIVED. So many harmful lies to discredit both vulnerable person and their families and I am only too happy to reveal this dishonesty and pack of lies right here for everyone to see as I am not alone.

I highlight below the very sad case of Oliver McGowan. RIP Oliver. It makes me sad as no lessons will ever be learned unless Doctors are made more accountable.

My daughter Elizabeth is currently being forcibly drugged under Barnet Enfield and Haringey MH Trust Suffolk Ward right now on drugs previously found to be allergic to/contraindicated to her underlying physical health conditions – pinned down by up to six members of staff and injected with poisonous chemicals they know full well previously found to be allergic to.

I am hoping that Oliver’s family will at long last get the justice they deserve with a criminal investigation underway. I have decided to notify Police of my concerns right now and would urge other parents to do likewise. When a Doctor ignores everything (even putting a line through the drugs chart acknowledging previous allergy) in other cases where physical health conditions are ignored then these doctors should be made accountable after all, Drs should do no harm. Other members of staff who knowingly administer medication when drawn to attention the facts of contraindications and allergy where diagnosis is in enormous doubt should likewise be held accountable when things go wrong. It is not a matter of “please take your medication as my licence is at stake“. When Drs knowingly prescribe such enormous quantities of drugs above BNF level then there needs to be accountability as they put lives at risk. More people should be challenging this important issue.

In Elizabeth’s case she was found to be a poor/non metaboliser through the unique p450 liver enzyme tests I had done. I have to say some Doctors have respected this but NOT UNDER BEHMHTNHS. There are some areas like Enfield where anything goes and physical health conditions needing referral to Endocrinology, Neurology is ignored in favour of a MH label which some Doctors choose to stick by, ignoring and disregarding other doctor’s professional opinions. This is how death and injury can occur.

I highlight the shocking sad case of Oliver McGowan as an example of this below:

https://www.bbc.co.uk/news/uk-england-bristol-53255043

https://www.independent.co.uk/news/health/oliver-mcgowan-death-autistic-anti-psychotic-medication-nhs-training-a9184686.html

https://www.bristolpost.co.uk/news/bristol-news/police-investigate-death-oliver-mcgowan-4281745

https://www.bristolpost.co.uk/news/bristol-news/southmead-hospital-doctor-who-gave-1473915

https://www.england.nhs.uk/2019/08/nhs-announces-top-clinician-and-independent-expert-to-oversee-review-death-of-oliver-mcgowan/

https://www.bristolpost.co.uk/news/bristol-news/family-oliver-mcgowan-cover-up-2338438

I cannot wait until the mandatory training is in place https://www.skillsforcare.org.uk/Documents/Topics/Learning-disability/Mandatory-training/ITT-open-Feb-2020.pdf

As a parent, I have become accustomed to being bullied, ignored, deprived of contact, excluded and ridiculed and the most nasty defamatory comments are written behind your back when the team in desperation stick together to try and cover things up when on numerous occasions things have gone wrong under care. A patient is humiliated, gaslighted and coerced and in the end the truth is revealed. This is care under the NHS and I am featuring my local area of Enfield. It is enough to put you off seeing a Dr for life when you look at the overprescribing done under Enfield MH in the past causing Akathisia. Care under the NHS in my local area has no boundaries in terms of spending and under the MH the CCGs waste enormous public funds by not providing the right kind of care leaving a patient more traumatised than ever before. How many times has she been sent to a PICU ward because the care/environment on Suffolk Ward is totally inadequate and there is no support in the community because so much money is wasted by the community MH team on legal action trying to get rid of the nearest relative. Under a PICU she was held most recently on Cygnet Godden Green Sevenoaks – this along with St Pancreas Hospital, Ruby Ward Camden, Huntercombe Roehampton had been used simply for rapid tranquilisation, not care by Barnet Enfield and Haringey MH Trust but at least Huntercombe diagnosed her as having High Spectrum Aspergers which the current RC chose to ignore.

Today I received phone calls from my daughter looking forward to seeing me and coming off the ward as the only way patients can come off the ward now is being escorted by staff but this was not allowed today. Firstly I was told by Elizabeth there was an exercise class on the ward but apparently noone came and knocked on her door to remind her of the time so she did not attend – that is if the class even took place. Then there was some kind of buffet meal provided by the GMC apparently which Elizabeth would have found quite overwhelming being autistic, especially if there were lots of patients in the same room. So I turned up at Chase Farm Hospital and this was the first I heard she was once again placed in seclusion. I am sick and tired of Barnet Enfield and Haringey Doctors putting blame on a patient’s behaviour when they are knowingly and unaccountably drugging that patient on medication previously found to be allergic to and contraindicated to their physical health. It is never ever blame on their part. It is always blame on the patient and their family but let’s face it, Elizabeth instead of getting better under their care has got worse and worse and sent from pillar to post all the way to Wales (Cambian), Bethlem where she had a mews score 3 critical and was prescribed 2 x bnf levels of drugs plus developed tachycardia. She was sent to Huntercombe Roehampton, to a care home in Northampton where she had no food at the weekend, then to St Pancreas Ward and most recently Cygnet Godden Green, the third of Cygnet placements. This Trust (Barnet Enfield & Haringey MH Trust) clearly has money to burn and yet provides nothing decent in the community.

I have just written to the Rt Hon Feryl Clark MP for her help in this matter as we as a family were having difficulty in getting through on the phone to my daughter who was recently sent a long distance away. This is her response:

“Dear Susan, 

We are writing in response to the voicemail message you left asking for an update on your case. 

We note you refer to the complaint you have raise against health services and understand, from our correspondence with Barnet, Enfield and Haringey Mental Health Trust (BEH MHT) that your complaint is still being investigated. Please be advised that we have not raised a separate complaint. 

With regards to the enquiries we have raised, we received a response from Enfield Council but are yet to receive a response form BEH MHT. We will contact you once we have received both responses as this will enable us to provide you with an update which encompasses the wider picture. 

In the enquiries we have raised, have asked the relevant bodies for reassurance that they are aware of Elizabeth’s situation and are working to provide her with both the social and medical care and support she urgently requires. So where is such care under this brutal area – it is punishment not care when the treatment and facilities for care are totally wrong and inadequate. It is an area where they have money to burn on private sector PICUs instead of improving the quality of care on the acute MH wards where a patient’s physical health is overlooked because a doctor who is in charges chooses to ignore and overlook and carry on prescribing drugs previously found to be allergic to.

As we have advised you previously, sadly we are not in a position to comment on medical diagnoses therefore we are sorry that we are unable to assist you with this aspect of your concerns and wish you the best in your pursuit.  Then you need to address this important issue in Parliament because young vulnerable people like my daughter are dying as a result of care and treatment provided under MH where certain Doctors choose to totally ignore a patient’s physical health and wellbeing knowing full well that a drug found to be previously allergic to is prescribed and parent’s advice are ignored. I am not even a Dr to state that what is going on is wrong and I WANT THIS MATTER ADDRESSED IN PARLIAMENT BECAUSE IT AFFECTS LOTS OF OTHER PEOPLE.

To date, we have received a high volume of information from you and appreciate you sharing your concerns with us however, we would greatly appreciate if you could, in a clear and concise email, set out exactly what you would like us to do to assist Elizabeth whilst considering the representations we have made thus far and our stance on some of your concerns. We hope you will understand and agree that due to the complex nature of this case, we require this email as a steer moving forward.   I want everything addressed in Parliament as here is a good example of the most abusive care in the UK – drugging a patient – with drugs prev allergic to and contraindicated putting their life at risk and blaming their behaviour on wrongly treatment. and neglect when the diagnosis is completely and utterly wrong and other Doctors say so not me. The amount of money wasted by providing the wrong kind of care in PICUS far and wide should be made accountable to the general public as it is after all public money when I spent a fraction of this money on decent humane care only to left without a scrap of support in Enfield on my daughter’s return. The other area is tribunals and bullying the Nearest Relatives when paperwork is drawn up unlawfully time and time again by unaccountable professionals who go out of their way to avoid blame and try to put blame on the parents/families and patients instead of apologising.

THERE IS NOTHING COMPLEX IN THIS CASE. IT IS A CASE THAT SHOULD BE LOOKED UPON AS TOPICAL RIGHT NOW AND THAT LESSONS NEED TO BE LEARNED WHEN VULNERABLE PATIENTS DIE AS A RESULT OF DRs PRESCRIBING DRUGS KNOWN TO BE CONTRA INDICATED AND ALLERGY RELATED AND THERE NEEDS TO BE ACCOUNTABILITY AND THIS SHOULD BE ADDRESSED IN PARLIAMENT AND ALSO THE MANDATORY TRAINING MENTIONED IN THE LINK ABOVE IS PUT IN PLACE.

MY DAUGHTER WANTS AN AUTISM/ASPERGERS ASSESSMENT AND THE CURRENT RC IS IN DISPUTE WITH MANY OTHER DOCTORS AND THEREFORE NOT PROVIDING THE RIGHT KIND OF CARE AND TREATMENT AND SENDING ELIZABETH ALL OVER THE PLACE WHICH IS MORE TRAUMATIC FOR SOMEONE WHO HAS A DIAGNOSIS BY SO MANY OF COMPLEX PTSD AND ASPERGERS/ DEVELOPMENTAL DIAGNOSIS.

The sad case of Oliver McGowan should be noted and lessons learned but that is not being done in Enfield under Chase Farm Hospital. My daughter is once again in seclusion on Suffolk Ward. She was not allowed out with me today. A proposed short break has not been agreed by the current RC. Elizabeth who I saw yesterday could not stop crying. Elizabeth could not swallow her food without being ill. Elizabeth was walking like she did when they forced Clozapine on her and now on Suffolk Ward once again yet more brutal treatment is being dished out and you as an MP should address this treatment. I want everything made public on Twitter as this is affecting many people in other areas too and I want everyone to learn from ENFIELD BARNET AND HARINGEY MH TRUST and the COMMUNITY TEAM I have featured in my story “Get Her Back We Are Paying for that”.

I note that you feature comments supporting George Floyd well I too support those comments but I wish to further draw to your attention the fact that vulnerable people of all ethnic backgrounds who suffer from MH and LD/autism are being dreadfully abused by their treatment much of which goes on under the NHS acute MH wards themselves and then someone within the Trust spends £13000 pw on private ATUs – this is enormous money to spend on a totally wrong environment and I would like an explanation as to why this money is not being spent on care in the community to prevent people like my daughter being incarcerated in such dreadful places as acute wards where behind closed doors terrible treatment goes on. I would also appreciate your assistance for my daughter to be properly and independently assessed because there is huge conflict on the diagnosis the hospital RC sticks to against so many other Doctors opinions.

We look forward to your response.  AND I LOOK FORWARD TO YOUR RESPONSE RIGHT HERE ON TWITTER SO THAT I CAN FEATURE THIS IN MY NEXT BLOG. IF NOT THEN I WOULD LIKE TO HAVE A MEETING WITH THE RT HON FERYAL CLARK

Yours sincerely, 
On behalf of the Office of Feryal Clark
Member of Parliament for Enfield North 

Westminster Office
House of Commons
London
SW1A 0AA

Tel: 0207 219 6607

Website: https://www.feryalclark.co.uk/

Last of all I asked for a copy of the Code of Practice when it came to length of seclusions under Barnet Enfield and Haringey MH Trust – I am most interested to hear how long a vulnerable patient is held and abused in this way as Elizabeth was held for than just a few days and deprived of fresh air and exercise.

—— Original Message ———- From: Nnennaya Aitalegbe DEPUTY WARD MANAGER<NnennayaAitalegbe@cygnethealth.co.uk>
To: Susan Bevis <
Date: 04 July 2020 at 14:26
Subject: RE: Visit – Tuesday 7 June 2020

Good evening Mrs Bevis

Thank you for your email.

Following our conversation, I have spoken with the responsible clinician she has confirmed that attending ward round at this present moment will not be ideal  as LB is currently very unwell. ******** currently reports that everything seems too much for her and she is worried about your  proposed visit. She is being supported on the ward and encouraged to remain focused.

Best wishes

Nena

I spoke to my daughter yesterday who sounded a bit happier on the phone yesterday. Not once has she phoned on HER phone. She told me she had made a couple of friends but they were all starving and could I bring some food with me so she could share with her friends. I asked if she wanted me to visit and she said “yes” – I asked her more than once and I mentioned that I had requested to come to the ward round and asked whether Nnenna had spoken to her about it and she said “no”. The letter above is in stark contrast to what I was told. Nnennaya Aitalegbe is the Deputy Ward Manager of Cygnet Godden Green Sevenoaks who is saying that Elizabeth does not want me to visit and THAT IS NOT TRUE AND I HAVE WITNESSES.

I told Nena that I would be coming anyway as I had promised to as I had agreed to bring her food. Never before has a Cygnet Hospital treated me this way or my daughter and this needs looking at. There seems to be different rules here at Cygnet Godden Green, Sevenoaks to other Cygnet hospitals. I am most concerned by the way Nnennaya is trying to deprive access to seeing my daughter just like Cambian did with RC Allyson Witts stating she was not well enough to come for Xmas yet she was brought down flanked by two nurses who were ordered to stay all the time with her.

I telephoned Cygnet Godden Green yesterday and spoke to Deputy Ward Manager Nnenna Yaaitalegbe and I am waiting to hear as to whether my visit will be agreed next Tuesday for ward round. She said she would have to ask Elizabeth and arrange with Dr Ruvini Senesinghe, the RC (Responsible Clinician). As yet I have not heard anything.

Elizabeth has been at Cygnet Godden Green 2 weeks now. Dr Ruvini Senesinghe said it would be Ok to visit and to contact the Ward Manager to facilitate. Normally Cygnet would have a visitor’s room so I enquired whether this could be booked as it is a long way to travel. When I asked whether an advocate could be present Nnennay commented that Elizabeth already had an advocate but I explained that the advocate was for me as Elizabeth’s sister could not come as planned. I am waiting to hear back from Nnenna. Mencap know of Elizabeth’s situation and were very helpful. They put me in touch with an organisation called access charity.

Access Charity

https://www.accesscharity.org.uk

The above organisation deals with:

Access to justice and enforcing the right to social care. We have set up a Legal Network to ensure that people get the social care that they have a right to so that they can live fulfilled lives in the community.

It has been social care that has failed. “there is no structure in the community” said Elizabeth, her days filled aimlessly with going out shopping alone, nothing to do, no mentor, no support worker, which I know in some areas is provided. Elizabeth has never had help in the community despite living alone in a flat so I had to help her clean the flat, cook healthy meals and not been able to shield as the Government recommended.

Yesterday was distressing hearing Elizabeth say she felt like she was going to die after the forced Paliperidone injection. She described 6 members of staff pinning her up against a wall and said for the next two days she felt so ill that she couldn’t move from her bed.

This injection should be given once a month only at the now lowered dosage of 100mg from 150mg previously prescribed by Suffolk Ward. However I am concerned that this has been given more frequently by Castle Ward as it sounds as though from what Elizabeth has told me this been given twice already and she has only been there 2 weeks. This is why I would like to go to the Ward Round. I have heard from leading experts that the administering of this particular drug is extremely specialised requiring a great deal of caution. I was led to believe the dosage had been lowered but from what Elizabeth told me it sounds like the injection is being given more frequently in which case it is in fact being increased.

I am in touch with those who have expert knowledge on drugs and I have welcomed opportunity for Elizabeth to be included most recently in the research by Professor Philip McGuire on CBD. However I was told by Dr Ruvini Senesinghe this would not be possible as not recommended by NICE. The only option was to put her back on a drug previously found to be allergic to because NICE have not examined the success of Professor Philip McGuire’s research. On section 3 there is nothing you can do to challenge treatment – of great concern is NICE do not seem to take enough into account harm done by their recommendation of such drugs known to cause harm, going through lawsuits in the US, some here in the UK. Doctors ignore their NICE guidelines and ignore manufacturer’s instructions/contraindications.

I was initially excluded from Elizabeth’s recent tribunal by video link from St Pancreas Hospital Ruby Ward on the grounds I disagreed with treatment. The team tried to use the usual excuse that Elizabeth did not consent. However Elizabeth had in fact given consent and I then had to be included at short notice. At the Tribunal I was asked was “are you a professional who has knowledge of the drug treatment” to which I replied “no” I am a mother but have sought expert opinion backed by research from more than one expert on the drugs in order to conclude Elizabeth’s treatment was wrong. It is not as though I as a mother know better than the doctors but had sought scientific research and gained knowledge from this via experts. Drug treatment is an area CQC should be concentrating on most of all (yet say their inspectors have no knowledge on drugs) as wrong prescribing can cause injury and death and here is an example of such:

PRESCRIBING AT CYGNET

Below medication prescribed by a different branch of Cygnet to just 1 patient.

Regular Medication: Sertraline 200mg mane; Depakote 750mg BD; Mebeverine MR 200MG BD; Metformine 1G bd; Atorvastatin 40mg OD; Omeprazole 20mg mane;  Furosemide 50mg mane; Dapaglifozin 10mg mane; Diazepam 5mg TDS; Colecalciferol T OM; Kwells 300mg TDS; Clozapine 225mg BD .

PRM Medication: Ibrufen 200-400mg up to QDs; Epipen 0.3mg up to 0.9mg; Cyclizine tab 50mg up to 150mg;  Procyclidine 5mg PO max in 24 hrs 10 mg; Olanzapine 2.5-5mg max 200mg (PRN + regular); Promethazine 25-50mg max dose 100mg in 24 hrs;  Salbutamol 100mcg; Glucogel/Glucsgon T; Corsodyl ; Lactulose;  Stat dose of Clopizol Acuphase given on 3 occasions since admission – forcibly injected.

Surely on this level of drugs someone could suffer enormous injury and this could lead to death?

CQC I do not agree! If I as a mother can take time and trouble to contact pharmacologists/experts on the drugs then so can the CQC and that is exactly what I would do if I was an inspector with the CQC – if there was anything I did not know then I would find out about it by experts.

It is apalling Tribunals and courts take the same attituded “we are not experts on prescribing”, trust the doctors and brush aside scientific evidence backing prescribing at huge levels as above. The MHA criteria is “risk to self and others” – this should take into account the risks to the patient from faulty prescribing. I as a mother have accumulated vast scientific evidence on prescribing and if it was up to me I would have patients tested to see if they could metabolise the drugs first as Elizabeth has had the P450 liver enzyme test done which stated “poor/non metaboliser”, I had to appoint a private GP to analyse the test results carried out by world’s leading experts Erasmus in Rotterdam. This is disgraceful as the tests should be available to everyone on the NHS in all GP surgeries because in the long term, these tests could save money by less prescribing, resulting in less injury inflicted upon patients who suffer adverse reactions which are not symptoms of so called “illness”.

” It is utterly appalling that her life is being taken away and that at only 33 she has lost all the aspirations she should have enjoyed.

Yes, very true, Elizabeth once wanted to be a chef. She went to college, had a job, was learning to drive and wanted to travel. Her life and mine have been ruined by the NHS. She once looked like a model but is now a size 20. Doctors under NHS have worsened her condition by reckless concomitant prescribing at max levels experimenting whilst ignoring underlying physical health concerns. They all back one another and involve other doctors to support them when they do not want it to look like they are directly involved. So they send someone away from the local area and pay huge sums of public money in order to get backing. Elizabeth has been sent all over the country far and wide “we are guided by the local Trust” said the RC of Ruby Ward St Pancreas – they are instructed, and stick together on opinion.

 To: susanb25
Date: 22 May 2020 at 13:03
Subject: Re: Xeplion (Palperidone)

Potassium levels below 3,0 mmol/l cause significant Q-T interval prolongation with subsequent risk of torsade des pointes, ventricular fibrillation and sudden cardiac death

YES, ELIZABETH’S POTASSIUM LEVELS ARE LOW AND I HAVE EXTENSIVE TESTS DONE TO PROVE THIS.


To: susanb25
Date: 22 May 2020 at 12:47
Subject: Re: Xeplion (Palperidone)

Who should not take Paliperidone Palmitate Syringe?

The following conditions are contraindicated with this drug. Check with your physician if you have any of the following:

Conditions:


  • Who should not take Paliperidone Palmitate Syringe? The following conditions are contraindicated with this drug. Check with your physician if you have any of the following:Conditions:
    • breast cancer
    • diabetes
    • a high prolactin level
    • excessive fat in the blood
    • low amount of magnesium in the blood
    • dehydration
    • low amount of potassium in the blood
    • overweight
    • very low levels of granulocytes
    • a type of white blood cell
    • low levels of white blood cells
    • low levels of a type of white blood cell called neutrophils
    • confusion
    • suicidal thoughts
    • a type of movement disorder called parkinsonism
    • tardive dyskinesia
    • a disorder characterized by involuntary movements of the face
    • mouth and tongue
    • neuroleptic malignant syndrome
    • a reaction characterized by fever
    • muscle rigidity and confusion
    • a low seizure threshold
    • a heart attack
    • angina
    • a type of chest pain
    • torsades de pointes
    • a type of abnormal heart rhythm
    • chronic heart failure
    • abnormal EKG with QT changes from birth
    • a disorder of the blood vessels of the brain
    • orthostatic hypotension
    • a form of low blood pressure
    • compression of the esophagus
    • priapism
    • a prolonged erection of the penis
    • seizures
    • weight gain
    • susceptible to breathing fluid into lungs
    • pregnancy
    • decreased blood volume
    • problems with food passing through the esophagus
    • metabolic syndrome x
    • dementia in an elderly person
    • diffuse Lewy body disease
    • cataract surgery
    • floppy iris during eye surgery
    • abnormal muscle movements
    • chronic kidney disease stage 2 (mild)
    • chronic kidney disease stage 3A (moderate)
    • chronic kidney disease stage 3B (moderate)
    • chronic kidney disease stage 4 (severe)Allergies:
    • Risperidone Analogues


      https://www.netdoctor.co.uk/medicines/brain-nervous-system/a8793/xeplion-paliperidone/
    • “As for lesions in white matter there is evidence of this causing psychosis but this is normally in older adults or those that have suffered cerebral infarctions.  The Journal of Neuropsychiatry and Neuroscience does advise clinicians to scan for frontal lobe lesions in patients presenting with psychosis and the endocrinology journals advise examination of the thyroid and parathyroid, since lesions in the parathyroid can also cause psychotic symptoms.  Late onset psychosis is often associated with this type of injury.

Elizabeth had a cyst – how can this suddenly disappear? Also I appointed a private Endocrinologist who did extensive tests which revealed underlying physical health conditions that should have been monitored but HAVE NOT BEEN under the NHS – conditions such as thyroid/PCOS – she is also insulin resistant and this is why I cannot agree with the diagnosis. I know there is something that is physically wrong and I am not even a Doctor. Doctors stated throughout the files “lets rule out anything organic” – so what is happening in my opinion is that Doctors look for a quick and cheap solution and when a patient such as Elizabeth complains they do not feel well then this is simply ignored – they just carry on prescribing knowing full well that what they are doing is harming someone’s physical health and wellbeing and a Doctor should do NO HARM.

As for the ‘diagnosis’. The definition psychosis is not in itself a medical diagnosis but refers to presentation of behaviour the patient.  This can be delusions, hallucinations and agitated or violent outbursts unconnected with immediate environment.

 If Elizabeth presents with any of this kind of behaviour it will be described as psychosis.  It is for the purposes of immediate medical intervention irrelevant what the underlying cause might be.  The first intervention has to be directed at attenuating the behaviour and then it is possible to look for potential causes.

There is bias re the first paragraph above as the team who made home visits prior to the CoP case tried to make out home environment was wrong by nasty reporting – in actual fact it has been questioned at one tribunal as to why Elizabeth remained problem free whilst at home. Whilst I reduced the Clozapine that gave her heart problems and NMS she revealed the full truth about the abuse she had suffered under care which showed the diagnosis to be completely wrong. I only sought private help at enormous cost in Kent when Elizabeth developed a nasty cough – this was an anticholinergic reaction so I was told. My search for private help revealed there was no facility in the UK who could help someone who had suffered injured and come off prescribed drugs which was so wrong as I had proved Elizabeth’s condition to be trauma and not schizophrenia – in fact she spoke clearly and said “eleven years of my life ruined – eleven years on these drugs” . Facilities need to be provided in the UK to help with drug withdrawals and assessments particularly when the diagnosis has been proven to be wrong as in Elizabeth’s case.

  • As I have explained before section 3 MHA1983 is a legal mechanism for treating patients without their consent, informed or otherwise.  There is no necessity to obtain a patient’s consent on section 3, the criteria for treating without consent are simply to save life, to prevent a serious deterioration, to alleviate serious suffering and to prevent the patient from behaving violently or being a danger to self or others (as long as the treatment represents the minimum interference necessary).

The above wrong. Why are people under the MH treated like second-hand citizens? This is not saving life – lives are being ruined. Who can honestly say no harm is being done when you look at what doctors are prescribing as per example above that can lead to death. To alleviate serious suffering is wrong too – this has increased suffering to Elizabeth and I have proven that with the right care in the right environment Elizabeth could get well at a fraction of the cost. I would rather Elizabeth be sent far away to get the right treatment in the right environment which is not a PICU/acute ward. Also it is not recommended hypnotherapy under NICE Guidelines but when I sent Elizabeth to Susan Hepburn of Harley Street this worked brilliantly. I now know why the team tried everything to persuade Elizabeth not to go and that was because this could have revealed everything she suffered under a certain scheme in the community whereas my intention was to speed up the process of provision under the Person Centred Approach which had been going on 6 months and provided nothing for her to do in the community as her days consisted of aimless shopping – chores expected to be undertaken in her home – a studio flat within a MH scheme. On 800mg Quetiapine “how can anyone function on this level of drugs in the community?” This led to Akathisia and on Clozapine, Neuroleptic Malignant Syndrome. In other words more harm than good.


To:susanb25
Date: 12 June 2020 at 20:47

The informed consent legislation does not apply to psychiatric medications administered under s3 MHA 1983.  It only refers to non-related physical treatments so even Metformin can be given on the grounds it is related to the psychosis. ”

Well this needs to be changed! a

Xv Finland 34806/04 [2012] ECHR 1371, [2012] MHLO 128 …

www.mentalhealthlaw.co.uk › X_v_Finland_34806 › 04_(2012)_ECHR_1371,_(20…

Mental Health and Mental Capacity Law Blog, ‘X v Finland – Are we in trouble?’ (18/7/12). This article argues that ‘[i]t is at best highly doubtful that the approach in the Mental Health Act 1983, where compulsory treatment flows from detention automatically and with limited distinct procedural and substantive safeguards, is consistent with Article 8 of the ECHR’.

The above highlights total inequality between mental health/physical health and wellbeing and that treatment given is the cheapest option under mental health keeping someone drugged for life regardless of physical health is for convenience with diagnoses given on observation of so called “symptoms” rather than question of underlying causes.

This is completely wrong and to place people like Elizabeth on a PICU ward is wrong too “I will never get well in this place – I may be coming out in a body bag” Elizabeth’s most recent words at her distress of being on yet another PICU where she is on 1-1 and cannot even make a phone call without staff listening to every word. She is followed around everywhere. This is the most restrictive care ever that Elizabeth has had but could be ordered by the local area (Enfield) for all I know who are paying vast sums of money for a stay up to 3 months. Whatever happened with “least Restrictive Care” – I attended their conference at Royal College of GPs.

When are Doctors going to take note of:

Coincidentally Risperidone is also associated with raised serum aminotransferases which in effect has the same consequences as alcohol induced fatty liver.  
 

On the last point talking therapies and hypnotherapy do have some degree of success but they take years and enormous discipline on the part of the patient. ” 

Not necessarily many would opt for this rather than drug treatment for life. Choices are not given and there is inequality under MH as compared with physical health care.


Date: 16 May 2020 at 10:11
Subject: Brain damage caused by PTSD

  • Using data from the Swedish National Patient Register and other nationwide health registers, investigators in this population-matched and sibling cohort study identified individuals first diagnosed with stress-related disorders between January 1, 1987, and December 31, 2008.
  • Exclusion criteria were history of neurodegenerative diseases, conflicting or missing data, lack of data on family links, or age 40 years or younger at study end. 
  • A matched cohort design allowed comparison of 61,748 individuals with stress-related disorders (PTSD, acute stress reaction, adjustment disorder, and other stress reactions) with the general population (595,335 matched unexposed individuals).
  • A sibling cohort allowed comparison of 44,839 individuals with stress-related disorders with their 78,482 unaffected full siblings. 
  • Follow-up began at the later of age 40 years or 5 years after the diagnosis of stress-related disorders, and concluded at the first diagnosis of a neurodegenerative disease, death, emigration, or the end of follow-up (December 31, 2013), whichever came first. 
  • The National Patient Register allowed classification of neurodegenerative diseases as primary or vascular, as well as separate analyses for AD, PD, and ALS. 
  • Median age at the start of follow-up was 47 (interquartile range, 41-56) years, and 24,323 (39.4%) of individuals with stress-related disorders were men.
  • Median duration of follow-up was 4.7 (interquartile range, 2.1-9.8) years. 
  • Risk for neurodegenerative diseases was 57% higher in persons with a stress-related disorder than in unexposed persons (HR, 1.57; 95% CI, 1.43-1.73) in Cox proportional hazards regression models, controlling for multiple confounders.
  • Risk increase with stress-related disorder was greater for vascular neurodegenerative diseases (HR, 1.80; 95% CI, 1.40-2.31) than for primary neurodegenerative diseases (HR, 1.31; 95% CI, 1.15-1.48). 
  • Risk was statistically significantly increased for AD (HR, 1.36; 95% CI, 1.12-1.67), but not for PD (HR, 1.20; 95% CI, 0.98-1.47) or ALS (HR, 1.20; 95% CI, 0.74-1.96). 
  • Findings in the sibling cohort confirmed those in the population-matched cohort.
  • Sensitivity analysis showed some attenuation of the associations after additional adjustment for cardiovascular diseases diagnosed before the end of follow-up.
  • On the basis of their findings, the investigators concluded that stress-related disorders are associated with substantially increased risk for neurodegenerative diseases later in life.
  • There was a statistically significant association of stress-related disorders with AD, but not with PD or ALS, which may partly reflect the relatively young cohort and the low incidence of PD and ALS at a younger age.
  • The observed associations were independent of multiple confounders including familial factors, based on similar results in the population-matched and sibling cohort analyses. 
  • The stronger association for vascular than for nonvascular neurodegenerative diseases suggests a potential cerebrovascular pathway.
  • The lead investigator told Medscape Medical News that finding strategies to lower the risk for cardiovascular diseases in patients with stress-related disorders may also lower future risk of developing neurodegenerative diseases. 
  • Biological mechanisms may underlie the association between stress and neurodegeneration, as chronic, repeated, or intense stress may impair the hypothalamic-pituitary-adrenal axis and alter stress hormone levels.
  • Stress increases cortisol level, which may induce microglia and astrocyte activation, overproduction of proinflammatory cytokines, and oxidative stress, potentially causing chronic neuroinflammation and subsequently increasing the risk for neurodegenerative diseases.
  • Similar mechanisms may also explain the link between psychological stress and cerebrovascular impairments, and cardiovascular diseases are known to be long-term physiological health consequences of stress-related disorders. 
  • Vascular factors may therefore explain the association of stress-related disorders with neurodegenerative diseases and the relatively stronger association with vascular neurodegenerative diseases than with primary neurodegenerative diseases.
  • Vascular factors may also worsen symptoms and accelerate progression of AD; AD and vascular dementia often occur simultaneously and are difficult to distinguish clinically. 
  • Another factor contributing to the observed associations may be lifestyle changes after the diagnosis of stress-related disorders, such as increased smoking and alcohol use, substance abuse, or sleep disorders, which could increase risk for neurodegenerative diseases.
  • An expert commenting on the study for Medscape Medical News noted that poor lifestyle choices such as these could significantly affect brain and vascular health. 
  • That expert highlighted the potential for identifying those at risk for dementia based on stress disorders earlier in life, which might allow earlier interventions to try to change the brain and body’s physiological and behavioral response to stress. 
  • Educating the general population regarding these findings and their significance could help them seek the appropriate treatment for chronic stress or trauma. 
  • Study limitations include reverse causation and surveillance bias, as cognitive impairment, depressive symptoms, and other symptoms of stress-related disorders may be early signs of dementia and PD, or stress-induced decline in cognitive function may result in earlier dementia onset among patients with stress-related disorders. 
  • However, the 5-year lag time in all analyses argues against reverse causation or surveillance bias.
  • Other limitations include possible underestimation of the real association between stress-related disorders and neurodegenerative diseases, lack of validation studies for the diagnoses of stress-related disorder in the Swedish National Patient Register, insufficient statistical power for analysis of rarer outcomes such as ALS and PD, and potential residual confounding. 

Clinical Implications

  • Stress-related disorders are associated with substantially increased risk for neurodegenerative diseases later in life, based on a Swedish population-matched and sibling cohort study.
  • The stronger association for vascular than for nonvascular neurodegenerative diseases suggests a potential cerebrovascular pathway.
  • Implications for the Healthcare Team: Finding strategies to lower the risk for cardiovascular diseases in patients with stress-related disorders may lower future risk of developing neurodegenerative diseases.

The above should be taken into account when placing someone like Elizabeth who has complex PTSD on either acute ward or PICU wards which are noisy, volatile and stressful for the patient. In contrast, a care farm would be the answer – a natural environment with animals then it would be not necessary to restrain and inject causing further trauma to the patient. Consideration should be given in the UK to providing correct facilities such as this. Camphill Community Trust have good facilities where people who have learning disabilities and autism can learn new skills and work with specialist staff in therapeutic environments. Why should facilities such as this be deprived to MH patients who are misdiagnosed.

CQC logo

Cygnet Hospital Godden GreenCQC overall ratingRequires improvement4 July 2019See the report

CYGNET, GODDEN GREEN SEVENOAKS, KENT TN15 0JR

RC DR RUVINI SENESINGHE

RC OF SUFFOLK WARD CHASE FARM HOSPITAL DR HELEN MOOREY

TRANSFER DATE 25TH JUNE 2020

Having been held in seclusion since 7.00pm Saturday 20 June, Elizabeth was finally released from seclusion by Suffolk Ward this morning (24th June) following calls from myself /other family members and friends who had no luck in getting through to her. We knew nothing about what happened – someone apparently set fire to Suffolk Ward. This incident was not caused by Elizabeth. When I got to hear I was told by MH Reception member of staff that “noone was hurt” – it was just a little fire”. Around this time Elizabeth had complained that had been was cooped up on the ward for two days without fresh air and mentioned some patients had barricaded themselves into a room on Suffolk Ward and that staff wanted to inject them. Here is her exact message: “We’ve barricaded ourselves into the bedroom on ward with friends please come and call the police”. Elizabeth’s sister visited Suffolk Ward that evening to bring with her hot barbeque food but was not told her sister was in seclusion. Now we know Elizabeth did not get the food and no doubt this was thrown in the dustbin. No-one informed us about the incident of fire or the barricading by patients in a room but this all needs to be investigated by the CQC . Furthermore they need to speak to my daughter Elizabeth because I have seen nothing but error and distortion of truth by professionals in file notes and records by BEHMHTNHS (Barnet Enfield and Haringey MH Trust) that I have now had time to study in detail. They state that Elizabeth got into a fight but serious incidents that have occurred under their care through lack of observation in the past have been covered up. It is wrong to cover matters up as the truth always comes out in the end. It is best to be honest and open and I would have respected this. I am asking for Barnet Enfield and Haringey MH Trust’s Policy on seclusion. I thought seclusion should be no longer than 72 hrs? Elizabeth was in seclusion from Saturday 7 pm until sometime this morning and I would like to know how long? They knew Elizabeth has been multiply abused under MOTI VILLA THE RIDGEWAY ENFIELD EN2 where crack cocaine was being dealt and captured on CCTV a 2 hr ordeal for my daughter all covered up and the way this is done is to drug someone. We all know now so why cover things up? The other thing is they have taken her phone away and she has been without a phone for days at Enfield. Cygnet’s Policy is no phones at Sevenoaks but this was not the case at Cygnet Stevenage or Beckton. I am very concerned and I think that the CQC need call at Cygnet Sevenoaks to interview Elizabeth and check she is OK after her ordeal under BARNET ENFIELD AND HARINGEY MH TRUST. Whilst talking about Barnet Enfield and Haringey MH Trust I would point out they have two male wards and only 1 female ward – the other ward is mixed and they wanted to put Elizabeth on mixed Dorset Ward whose RC is Dr Greenside. This had already been tried before but Elizabeth reacted in terror – they all know this! – how can you put someone who is terrified of men on a mixed ward without any due consideration and why is there no other ward for solely females? If she had intensive trauma therapy in the first place she would not have gone downhill.

Due to lockdown since her admission we have not seen anything of Elizabeth as no visitors are allowed on wards however in light of lockdown special allowances should surely be made to let patients have access to their phones. I will be speaking to Cygnet Sevenoaks tomorrow about this. In terms of privacy and dignity special allowances should be made. These PICU settings can be very noisy and volatile and all they did at the previous PICU was forcibly drug her by depot (Paliperidone) metabolite of Risperidone previously found to be allergic to. They all knew this at Barnet Enfield and Haringey MH Trust and the RC of Suffolk Ward had indicated this fact on a drugs chart she signed previously.

ending my daughter a fair distance away is nothing new to Enfield as they have sent her all the way to Wales and worked together to restrict contact between myself and Elizabeth. It is cruelty and brutal punishment, not care and the environment is totally wrong. My blog Meds at Cygnet shows that disregard is been given to a patient’s well being and I am in touch with parents and relatives affected and know of those whose relative has died under Cygnet.

This expensive facility is all being paid for by the NHS and funded by Enfield Commissioning CCG as far as I know and I will find out the exact cost but it is bound to be at least £10000 per week? – correct me if I am wrong. Some people end up in facilities for life like this but Elizabeth has family and she has a flat and bearing in mind the review on this branch of Cygnet close scrutiny will be given I hope. I telephoned Cygnet today as I found out about the move third party – a nurse called Ade had phoned me on my old telephone number as they had not updated their records.

I presume this expensive facility is being paid for by:

NORTH EAST LONDON COMMISSIONING SUPPORT UNIT OR ENFIELD CCG?

I thought the NHS was short of money but it doesn’t appear to be the case. When a patient is sent away from out of area the local team are well and truly involved. I can prove it. Elizabeth is under the local team of BEHMHTNHS who are in close liaison with CYGNET CASTLE WARD and as Dr Sarker told me he was being guided by ENFIELD.

Elizabeth is being sent away for rapid tranquilisation and forced drugging second time in a short space of time by ENFIELD. ST PANCREAS HOSPITAL PICU RC DR NEIL SARKER drugged her with Paliperidone, contraindicated to her physical health conditions. So why send her so far away to a very expensive private hospital Cygnet Sevenoaks, Kent and how much is this costing. Perhaps Jinjer Kandola (CEO) will have the answers to this question and especially as to how much this is costing Enfield and why there are no decent facilities for someone who has been so badly abused and traumatised for people like my daughter.

https://www.cygnethealth.co.uk › locations › cygnet-hospital-godden-green

Cygnet Hospital Godden Green to open new PICU service for women. Castle Ward, our new 12 bed female PICU service at Cygnet Hospital Godden Green near Sevenoaks in Kent, is due to open on Monday 4th November 2019.

  • Location: Godden Green, Sevenoaks, Kent, TN15 0JR
  • Godden Green, Sevenoaks TN15 0JR · 01732 763491

 Cygnet Hospital Godden Green – Castle Ward – Specialist PICU Service for Women

Written by a member of staff14th September 2019

The nursing staff, (including ward managers and team leaders) MDT, Kitchen, Maintenance and doctors here are utterly wonderful, kind heroes. I had the pleasure of working with them. However they are sorely let down by the senior management (clinical/hospital manager and above). Cygnet is clearly more interested in profits than care. They treat their staff like dirt under their feet and take our their stress and anger on them. The CEO turned up to visit in a Ferrari! Well done care staff. Keep going. You guys are incredible.Recommend.

 Written by a carer21st November 2017

My child was drugged up to the eyeballs. After discharge, CAMHS were shocked at the amount of medication my child had been prescribed. I questioned the doctor during my child’s stay but was fobbed off; after all the professionals know what they are doing… My child did not engage much in the therapy offered and was not encouraged to. My child self harmed during stay, should have had stitches but was just given steri-strips. My child was there as an NHS patient, maybe if we were private my child would had had better treatment. Having said that, nurse Alice was lovely. There have been cases of theft; could only have been staff. Lack of communication- I always had to phone for information and updates.

Castle Ward – Specialist PICU Service for Women

Castle Ward is our new 12 bed female PICU service at Cygnet Hospital Godden Green and accepts emergency and crisis admissions. Referrals are accepted from all areas, including acute and prison services.

Our aim is a short, rapid intervention to help service users regain a sense of control and order in their lives, so they can move to a less restrictive care setting and ultimately return home.

The service will provide expert, intensive, short-term, individualised care for women detained under the Mental Health Act. Service users will present with increased risks that require them to be assessed and treated in a PICU environment.

Our service user profile:

  • Women, aged 18+
  • Detained under the Mental Health Act
  • Experiencing difficulties that present a risk to the well-being of themselves or others that cannot be treated in an open environment
  • Diagnoses may include:
    • Acute mental illness
    • Acute depressive illness
    • Psychosis
    • Schizophrenia
    • Bi-polar disorder
    • Personality disorder
    • Dual diagnosis
  • May present with co-morbid presentations:
    • Self-harm
    • Substance misuse issues
    • Complex needs

Sevenoaks Cygnet Hospital rated good after ‘care concerns’

  • 8 May 2018
Cygnet Hospital
Image captionThe CQC said significant but necessary improvements had been made

A mental health hospital in Kent that was criticised about its care standards has been rated as “good”.

The Care Quality Commission (CQC) inspected Cygnet Hospital amid concerns over ward environments and incidents affecting patients’ welfare.

Inspectors said the NHS provider in Sevenoaks had made significant changes.

Cygnet Health Care said it had taken “all necessary steps” to allay concerns raised and the wellbeing of people using its services was “top priority”.

In February, Anya Auckland, 17, criticised the care she received at the hospital in Godden Green.

Natasha Sloman, from the CQC, said concerns were raised over the ward environments, the number and severity of incidents affecting the health, safety and welfare of patients in children and adolescent mental health wards and a failure to report incidents to external bodies.

Anya Auckland
Image captionAnya Auckland said she was ignored and not supported

She said: “Cygnet Hospital has worked hard to make the significant but necessary improvements required to ensure the safety and well-being of its patients, including changes to the management.”

Nicky McLeod, Cygnet’s chief operating officer, said: “We have taken all necessary steps to allay previous concerns raised, including implementing extensive learning development programmes for all staff and establishing a specialist management team.”

She said Cygnet would continue to work collaboratively with the CQC and NHS.

‘Disgusting’ treatment at Kent mental health service

  • 19 February 2018
Anya Auckland
Image captionAnya Auckland said she was ignored and not supported

A 17-year-old mental health patient has described the care she received at a Kent hospital as “disgusting”.

Inspectors recently criticised the Cygnet Hospital in Sevenoaks, and issued three warning notices.

Anya Auckland was admitted last year and said patients aged between 12 and 18 were secluded, sometimes for weeks, to “control” them.

The head of Cygnet Health Care said they are looking at ways to “improve procedures, protocols and training”.

‘Worthless’

The Care Quality Commission (CQC) carried out an urgent inspection after concerns were raised over the safety of young people.

Inspectors found patients were not protected against abuse and “seclusion and segregation was used to control and contain young people in the absence of other behaviour-based approaches”.

Miss Auckland was admitted after feeling suicidal, but said staff made her feel “worthless”.

She recalled seeing a patient “dragged along the floor” because they were in the wrong corridor.

Cygnet Hospital in Sevenoaks
Image captionConcerns were raised over Cygnet Hospital in Sevenoaks

She added: “One time a girl was in seclusion in a room for one or two weeks.

“Once she was out, we were playing outside… The ward manager came out and said to her, ‘you’d better stop or you’re going to go back to where you belong’.

“You’re stuck in this world, which makes everything much more intense. When your words aren’t being taken into account, you work together.

“The most support I had was from other patients.”

Nicky McLeod, chief operating officer at Cygnet Health Care said: “We recognise we have not always dealt with issues raised around the care we offer as comprehensively as we might.

“But as a responsible mental healthcare provider we take any comments on our hospitals very seriously.”

Ms Auckland met with the new manager of the centre and director of nursing to give feedback, and the service is being re-inspected to check progress.

.0Team and EnvironmentStaff Nurse (Former Employee) – Sevenoaks, Kent – 3 May 2020Chaotic,disorganised, and not particularly friendly.
The staff employed are often those with extraordinarily little to no experienced taken on by those already working at the facility.
This is true of agency healthcare assistant – some may never have worked in such environment but is more often taken on because of who they know.
You are left very much to do a lot by yourself with those who are supposed to support having very little themselves to no experience in dealing with a crisis and is often finding excuses to do something else leaving you to carry the burden if mistakes are made.
The most enjoyable part of the job is when it is time to leave the premises, when you have finally finished certain aspect of the work that those scream at you, putting pressure on you to do the things that they themselves can do when it should be a shared experience.Pros Free lunch, either for the lunch time or evening, not twice a day when on duty. Cons You don’t exactly use the skills you begin the job with, and you never finish work on time. Was this review helpful?YesNoReportShareOfficial response from Cygnet Health Care7 May 2020Hi,
Sorry to hear about your poor experience with us recently, but thank you for providing detailed feedback.
Obviously, we’re keen to improve on any failings – could we speak to you, in confidence, to find out more details?
If could you send your contact details to review@cygnethealth.co.uk<mailto:review@cygnethealth.co.uk> – we will get back to you ASAPOfficial response from Cygnet Health Care7 May 2020Hi,
Sorry to hear about your poor experience with us recently, but thank you for providing detailed feedback.
Obviously, we’re keen to improve on any failings – could we speak to you, in confidence, to find out more details?
If could you send your contact details to review@cygnethealth.co.uk<mailto:review@cygnethealth.co.uk> – we will get back to you ASAP
Thanks for the positive feedback, really appreciated.Official response from Cygnet Health Care7 May 2020Hi,
Sorry to hear about your poor experience with us recently, but thank you for providing detailed feedback.
Obviously, we’re keen to improve on any failings – could we speak to you, in confidence, to find out more details?
If could you send your contact details to review@cygnethealth.co.uk<mailto:review@cygnethealth.co.uk> – we will get back to you ASAP
Thanks for the positive feedback, really appreciated.2.0

Poor ManagementSENIOR PROCUREMENT OFFICER (Former

Employee) – Sevenoaks – 8 November 2019

Management with no people skills or ability to Communicate and Manage staff properly.
Management that was given a position over a pint.
And many other issues they lack of as an organisation.
If they change those individuals, would be ok place to workWas this review helpful?Yes8NoReportShareOfficial response from Cygnet Health Care18 November 2019Hi,
Sorry to hear about your recent experience with us but thank you for providing feedback.
Obviously, we’re keen to improve on any failings – could we speak to you, in confidence, to find out more details?
If could you send your contact details to review@cygnethealth.co.uk – we will get back to you ASAP2.0

Management do not value their staffHCA/Support Worker (Former Employee) – Sevenoaks, Kent – 4 September 2019

Not a place to work if you want to progress further skills as a HCA
Only recognise nursing
No recognition for their hard working staff. And low moral within staff throughout the hospital which has an impact on young person’s progressWas this review helpful?Yes15NoReportShareOfficial response from Cygnet Health Care6 September 2019Hi,
Sorry to hear about your experience with us recently but thank you for providing feedback.
Obviously, we’re keen to improve on any failings – could we speak to you, in confidence, to find out more details?
If could you send your contact details to review@cygnethealth.co.uk – we will get back to you ASAP4.0

Last night I participated in an interesting Zoom discussion organised by http://www.bringingustogether.org.uk.

I, along with other parents with relatives locked away under the UK’s cruel, abusive system took part and had the opportunity to voice our opinions and discuss openly, all of which will be put forward to NHS England.

“Bringing Us Together is an independent and proactive voice for families. We are quick to listen and respond to the needs of our family members through our forums, web chats, resources, news and blog items on topics that we know are important. Our projects aim to move things on and change attitudes by highlighting concerns, show what good looks like, and raise awareness of important topics. We work together with family members, professionals and other parent led organisations to drive up quality and standards by addressing the real issues and barriers impacting our families. We are passionate about making the world a place where our young people are loved, respected, have an equal voice, rights, and opportunities. We want all our young people to grow up feeling strong, happy with their relationships with family and friends, positive about themselves and part of their communities. We actively encourage everyone to become a member so they can share details of events, consultations, surveys, news and resources in our forums. Only registered members can see all of these forums.”

It awaits to be seen if NHS England will take note and most importantly act upon this discussion.

Ray James: My priorities as NHS learning disabilities director

https://www.themj.co.uk › Ray-James-My-priorities-as-NHS-learning…

17/04/2018 · Ray James: My priorities as NHS learning disabilities director By Ray James | 17 April 2018 We all share a desire to help people with learning disabilities or autism to live the lives of their choosing in their local community and, at the same time, to reduce the use of in-patient settings.

I remember Mr James whilst at Enfield when Elizabeth had been dreadfully abused under her scheme. I had tried to get her referred to Integrated Learning instead of mental health who had tried to cover up extensive abuse suffered under Moti Villa, The Ridgeway, Enfield.

No-one took a blind bit of notice. An AMHP later appointed as “nominal NR” stated Elizabeth’s constant hospital admissions were “because of her mother” – however her mother did a thorough investigation to reveal the extent of abuse, joined the police and revealed what was really going on under that scheme, situated in one of the best areas of Enfield. Then you turn to those at the top, such as Mr James whose PA dismissed everything like rubbish in a desperate attempt to cover things up. File notes confirm conditions in Elizabeth’s flat were sub-standard, in breach of health and safety, yet social services will never confirm this to your face. Mouldy food, bins overflowing and I took photos to prove it. How can anyone function on this c800 mg Quetiapine, an enormous quantity of drugs in the community?

The reality was she was trying to avoid drug dealing on the premises – A 14 year old child drug dealer and crack cocaine was being supplied. Elizabeth was afraid of the drug dealers, as demonstrated by her behaviour so was constantly admitted to Chase Farm Hospital where she felt safe. However this was no safe place as Psychiatrists raised Quetiapine to 800mg together with other drugs. All the time Elizabeth was suffering from PTSD due to multiple abuse – CCTV went missing and so did all her possessions. MOTI VILLA – was that scheme.

Anyway, last night’s discussion was very good and great to get things brought out in the open. Sadly I am far from alone as a parent who is extremely concerned by the “treatment” given to their relative in the name of “care” leading to decline and injury. I was not the only one to mention over-prescribing but who listens to a parent? However I have sought advice on the drugs from leading professors backed by research and even then Doctors do not listen. If Doctors are continually allowed to prescribe away without due recognition of prescribing guidelines and contraindications to vulnerable patients then they should be held accountable but instead parents are having to fight for justice at inquests. This is pure evil what is allowed to go on in the UK to so many. This matter concerns me more than Covid 19.

Some parents who took part yesterday commented they were afraid to speak out for fear of what might happen to their sons/daughters under care if they did. However I take a very different view because when a doctor knowingly prescribes a drug previously found to be allergic to and one that is contraindicated, especially in light of Paula McGowan’s son Oliver, then this needs to be brought to everyone’s attention and openness and honesty is the way forward. I spoke about open dialogue last night and also my concerns on prescribing and in general how it feels to have someone locked away, not allowed to see that person or have any contact and no-one communicates effectively then you find out about incidents, some serious and that patients are not allowed fresh air for several days and things have gone missing so no-one bothers to ring, you are treated like nothing as a parent/carer – it is as though you do not exist.

I remember once a church service I attended at Mary Mother of God”, Ponders End where the Priest would talk of every day life situations in relation to God’s words. I will never forget his mention of speaking out openly and honestly against evil and not remaining silent or going along with things that are wrong and against God but this is happening all the time under mental health care of the UK, where staff are ordered by the RC and allowed by UK law to forcibly restrain and drug vulnerable people, such as Elizabeth who have been badly abused under the care of the local area which in this case is ENFIELD. There is plenty abuse going on in the UK which is against God under a mental health system not fit for purposes and in care homes, hospital settings and supported living. This abuse and cruelty goes on behind closed doors by unaccountable professionals and under lockdown even more control and deprival of liberty by a Government who have no idea and compassion.

I greatly sympathise with the mass protests in respect of George Floyd who suffered brutal treatment in the US. However it is not just the Police who give such treatment. In Elizabeth’s case it has not been the Police of the UK at all but professionals under mental health care who forcibly drug and restrain a patient face down – they are just doing their job and obeying orders from the RC but what they are doing is against God. There is also racism so I’ve noticed judging by the ranks of those employed from cleaners to the very top with two white psychiatrists/RCs presiding over them giving the orders that everyone has to obey or else lose their jobs or be threatened with bullying but what they are doing is wrong. Then you look to the very top o with the likes of Boris Johnson who I have previously written to about MH care and this shows how little they care. They allow abusive practices to go on under the law. Nothing has been done to enforce NICE Guidelines, with drugs prescribed at dangerously high levels leading to death and injury, with patients being used as human guinea pigs and experimented on. In Elizabeth’s case the Doctor knew full well that the drug Risperidone was previously recorded as being allergic to and has even signed a drugs chart to this effect.

I would also describe my daughter’s treatment at North Mid Hospital as degrading but the shocking thing is that had she died as a result, there would be no crowds, no demonstrations – nothing. Imagine being held down face down by several so called professionals who possess no communication qualities for a quick solution and use this abusive tactic allowed under UK law. Employees of all races/ethnic cultures are just doing their job but if someone dies then no-one wishes to be accountable and they cover everything up. In the next room Elizabeth could hear staff talking about resuscitation – face down restraint can be life threatening and the treatment brutal – these people are carrying out their orders from those at the top. When you look further you can see who is responsible and that is a Government whose leader Boris Johnson, Health Secretary Matt Johnson and others who sit back and allow for such abuse. The Government go on and on about Covid 19. Abuse under MH and LD being covered up because people have their eyes shut due to Covid 19 and abusive cruel treatment of those with LD, MH and autism if rife and something needs to be done about this urgently.

I have not seen Elizabeth for weeks on end and I am not alone. Many parents spoke of their distress regarding this.

Yesterday I phoned Suffolk Ward, so did other family members but none of us could not get through. Apparently Elizabeth was held in seclusion and her phone taken away. Noone was keen to speak no doubt fearful for their jobs and claimed to be bank staff with noone present on the ward other than bank staff last night.

I’m going up to Chase Farm today as I have given information to the RC on Professor Philip McGuire’s research at Kings College London on Medical Cannabis as well as research papers regarding the links below. No comment regarding this. I would not be sitting here writing this if I as a mother had at least been listened to and communicated with effectively. It is all to easy to push someone aside because it is too much effort to communicate with that person who might have a very valid concern. The way they speak to you over the phone is not good. You are spoken down to and dealt with in an evasive manner, staff keen not to disclose any information to you.

Here is some information and this shows that some Doctors show consideration to their patients – there has been promising results with the research of Professor Philip McGuire and this should not be dismissed by NICE.

  1. Access Medical Cannabis in the UK | Cannabis Access Clinicshttps://cannabisaccessclinics.co.ukThe Clinic Cannabis Access Clinics provides UK patients with access to specialist doctors with experience prescribing cannabis based products (also known as medical marijuana). Cannabis Access Clinics are focussed on helping doctors and patients navigate the regulatory pathway for prescribing medicinal cannabis products in the U.K.
  1. https://academic.oup.com/eurheartj/article/35/20/1306/2293020

Finally, I’ve just received a standard letter from Dept of Health all about Covid 19 and shielding which I have not been doing from the very beginning. Elizabeth was dumped into the community by Suffolk Ward without any care provided whatsoever so I was helping her from the start. Besides I am not afraid of Covid 19 neither do I trust mainstream news.

As for risk! I am more likely to suffer a heart attack because of the lack of decent humane care being given to my daughter and the reality of how past “care” and “treatment” has damaged her beyond recognition. So it says from 1 June shielding guidance slightly relaxed and they suggest you may wish to spend some time outdoors away from your home once a day. Here is what I think RUBBISH! some of us have been unable to do what the Government orders because of caring responsibility and lack of any provision. Now suddenly the Government are relaxing their decisions. Mention was of food boxes but whilst I was thrilled to received a call about this as I have never been offered any support under Enfield before so I offered my services to deliver the food parcels but never heard anything more as how could I shield when I had Elizabeth in need to help not provided. I see that the food parcels and medicine deliveries will be continued until end of July but because I have been going out shopping etc for Elizabeth this is something I have not received. During the time of shielding I had taken Elizabeth to the Chiropodist for an emergency appointment as she was in a lot of pain and I was helping her in general but no support of the kind needed to those who are carers.

The last paragraph of the standard letter states “it is normal during these uncertain and unusual times to feel anxious and low. Well that does not apply to me as I am far more concerned about the prescribing and injury caused to vulnerable people under MH/LD. The people shielding does affect are vulnerable people like Elizabeth who wanted an MRI scan and was upset when this could not be done and I was looking to pay for it privately then she got admitted and had again turned to phoning Police desperate for conselling and support not given by Enfield Community Treatment Team.

Elizabeth was discharged from hospital prior to the Covid crisis, but had no support in the community. She is now back on Section 3 which in the UK is for treatment of antipsychotic drugs, when she needed support in the community. So many others are in a similar situation because of lack of community care.

Treatment in the past has been Prozac, Risperidone (found to be allergic to), Aripiprazole, Olanzapine at max dosage, Quetiapine plus Haloperidal, Zopical, Lorazepam, Clonazepam, Promazine. When the drugs failed to work Doctors optimized the dosage. That didn’t work either. I then had the P450 liver enzyme which proved she was a poor/non metaboliser. Diagnosis states Aspergers/developmental and Learning disability and complex PTSD but Doctors under Enfield stick with paranoid schizophrenia which we dispute.

Doctors now wish to start depot injections and I am concerned because the drug they wish to inject Elizabeth has previously been found to be allergic to. I feel they should make referrals to experts in the field of Endocrinology and Neurology for necessary scans before treatment goes ahead. For the past month or so Elizabeth has been in seclusion for several days due to shortage of beds then sent to St Pancreas Hospital Ruby Ward where she was forcibly injected with Paliperidol twice. Bearing in mind during titration of Clozapine in 2012 she scored a Mews Score of 3 (critical) and developed tachycardia I feel that what they are about to do is very wrong. Under mental health law of the UK vulnerable people, (inc. LD, autistic) regardless of race can be treated brutally treated, pinned down with face down restraints like George Floyd and injected/restrained by as many as 6 members of staff and no one cares if they die. It is covered up and there is a wall of silence. Families have to fight for justice. These vulnerable people can be locked away, fed through hatches and denied contact with their families. Coercion and gaslighting is rife. Bullying can also be extended to the family if they dare to challenge. Then reports are written behind the vulnerable person’s back making them and their families look bad. At the Royal Bethlem Hospital that is supposed to be world-wide renowned, not one ECG machine was working and Elizabeth was critically ill. I sent an email yesterday along the following lines:

“I am not against treatment but feel that when there are risks of death, in light of evidence attached within the files, Elizabeth needs to be thoroughly assessed first by referrals to specialists such as Neurologists for MRI scans and ultrasound/ Endocrinologist to check on organic pathology.   In Dr A-B’s report it says “kindly exclude any organic pathology” but this should now be included and thoroughly looked into due to past allergies. After all, adverse reaction could lead to death. 

I therefore wondered if you could consider a safer alternative that the whole family would support in terms of treatment in her case where the Bethlem identified her as being “treatment resistant”.    It is Professor Phillip McGuire who is the top person for research on cannabis oil and psychosis based at King’s College London   https://kclpure.kcl.ac.uk/portal/philip.mcguire.html  “CBD could be “new class of treatment” for psychosis.  King’s College London researchers found that CBD could hold promise as a treatment for psychosis, according to reasonable benefits seen in a clinical trial. 

Please can Elizabeth be referred to Professor Philip McGuire (Institute of Psychiatry, Psychology and Neuroscience).  Please can Elizabeth be involved in the research.

https://www.kcl.ac.uk/academic-psychiatry/about/departments/psychosis

https://www.openaccessgovernment.org/treatment-for-psychosis/64091/.&#8221;

  Read More

https://bnf.nice.org.uk/drug/palperidone.html

Palperidone:  

For Schizophrenia, psychotic or manic symptoms of Schizoaffective disorder

Cautions:

Blood dyscrasias, cardiovascular disease, conditions predisposing to seizures, depression, diabetes (may raise blood glucose), epilepsy, history of jaundice, myasthenia gravis, Parkinson’s disease (may be exacerbated) (in adults); photosensitisation (may occur with higher dosages) prostatic hypertrophy (in adults) severe respiratory disease, susceptibility to angle-closure glaucoma.

Cautions – Further information

Cardiovascular Disease  –  An ECG may be required particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or in cases where the patient is being admitted as an inpatient.

RARE   – SUDDEN DEATH – WITHDRAWAL SYNDROME NEONATAL

ELDERLY

For all anti-psychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms)

increased risk of stroke

for use as a hypnotic, unless sleep disorder is due to psychosis or dementia – risk of confusion, hypotension, extrapyramidal side effects and falls.

for patients prone to falls (may cause gait dyspraxia, parkinsonism)

The above just some of the things listed.

Side Effects:

Agitation, amenorrhoea, arrhythmias, constipation, dizziness, drowsiness, dry mouth, QT interval prolongation, rash, seizure tremor vomiting, weight increased, movement disorders, insomnia

Agranulocytosis, embolis, Neuroleptic malignant syndrome  Sudden death withdrawal syndrome neonatal  Yes I have seen Elizabeth suffer Neuroleptic Malignant Syndrome on Clozapine.

appetite abnormal, asthenia, anxiety, cardiac conduction disorders, cough, depression diarrhoea, fever, gastrointestinal discomfort, headache, hyperglycaemia, hypertension, increased risk of infection, joint disorders, laryngeal pain, mood altered, nasal congestion, nausea, oral disorders, pain, skin reactions, vision disorders., sexual dysfunction, vertigo, oedema, muscle weakness, palpitations……etc etc

PREGNANCY –  Extrapyramidal effects and withdrawal syndrome, agitation, hypertonia, tremor, drowsiness, feeding problems and respiratory distress

FOR PALIPERIDONE  USE ONLY IF POTENTIAL BENEFIT OUTWEIGHTS RISK  =  toxicity in animal studies.   YES THERE ARE SUBSTANTIAL RISKS AND THE DRUG IS BEING PRESCRIBED AGAINST COTRAINDICATIONS

Manufacturer advises to consider long acting nature of formulation – Palperidone is detected in plasma up to 18 months after a single dose.

CHILDREN  – regular clinical monitoring of endocrine function should be considered when children are taking an antipsychotic drug known to increase prolactin levels.  This includes measuring weight and height, assessing sexual maturation and monitoring menstrual function.

Risk of relapse if medication stopped after 1 – 2 years.  Withdrawal should always be gradual and closely monitored to avoid risk of acute withdrawal syndromes or rapid relapse.  Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse.

  • Dr Neil Sarkar is RC on Ruby Ward
  • Dr Helen Moorey is RC on Suffolk Ward Chase Farm Hospital

The “care” is being provided by local area ENFIELD at a cost of circa £450 a day to stay on a NHS ward  (or it may well be more as this is a PICU ward) or £900 a day on a private ward.   The care is not to assess Elizabeth’s underlying physical health conditions but purely put her on a power dangerous depot injection and try to justify themselves for doing that.   I had begged that she be sent to a brain trauma injury ward for assessment but ENFIELD MENTAL HEALTH have chosen to ignore the physical health of my daughter.   How many more I wonder have been affected in this way?   So they use facilities like Ruby Ward but they are the ones dictating behind the scenes as to the care as this is being provided by ENFIELD.

“Dear Ms Bevis,

Thank you for your e-mail.

I have read it carefully and appreciate you sending us information which you believe will help in your daughter’s care.

I cannot fully comment on all the points you raised, but will certainly investigate as much as possible. I will try to obtain some of these reports, especially the opinion from the National Psychosis Unit.  I have all their files of shocking content.

The Opinion of “Treatment Resistance” identified by Royal Bethlem has been dropped by ENFIELD despite the P450 liver enzyme test results.   The Opinion on diagnosis by several other doctors differs but I feel the correct opinion is Complex PTSD by Dr Bob Johnson and Selyes Generalised Adaptational Syndrome which has been completely ignored.   She has gone back to being a young teenager. Elizabeth was severely abused under Moti Villa scheme in the community going back to 2010.  She has a Learning Disability;  she has a brain injury noted by Dr Diane Caine in 2009 which has been ignored.  You cannot treat a brain injury with antipsychotic drugs.  Metformine was prescribed off label at Royal Bethlem – only an Endocrinologist should prescribe this off label.   Tachycardia was contracted on titration of Clozapine. 

  1. We do not have Elizabeth’s consent to discuss her case with you and we are not allowed to share information about her with you. However, we can receive information from you. Elizabeth has given her consent so now you can discuss and share.   

Elizabeth is likely to only be under our care on Ruby Ward Women’s PICU for a short period of time until any aggression and risk has been reduced. This is on average 2 weeks, but can be even less.  Noted.   However just look at the side effects of this drug agitation is noted as a side effect and skin irritation SO A DRUG LIKE THIS CAN ACTUALLY CAUSE AGITATION – HOW DOES THIS WORK THEN???

However I thought her time spent with you was to assess her properly.   She needs to be assessed by a Endocrinologist;  Neurologist.    

 When I spoke to my daughter on the ward phone yesterday she sounded very distressed about these injections.  She was complaining of chest pains yesterday.

Please confirm and also why you have not referred her to the Psychodynamic Psychotherapist for assessment.

https://www.psychologytoday.com/gb/blog/advancing-psychiatry/201904/chronic-schizophrenia-put-remission-without-medication

Overall responsibility for her care will be under ENFIELD mental health services thereafter and we need to work in close conjunction with them throughout.   How interesting – they have chosen to ignore “Anterior Region Medial Temporal Comprise back in a 2009 report.

Regardless of Enfield, you have duty of care for my daughter and better resources at your hospital than Enfield.                        

Enfield have neglected her physical health leading to her going downhill time and time again.   It was suggested at a previous tribunal that full hormone checks be done..   Neither referral to Endocrinologist or for MRI scan has been made.

Physical health should be paramount.  I am referring this fact to my local MP and The Rt Hon Kier Starmar.  My  daughter has suffered injury because her physical health is being ignored.

We therefore would not be making any major changes to her overall care, but just trying to stabilise her in the short term and then referring her back to Enfield services. I am very disappointed to hear this because you have something good on your site ie psychodynamic psychotherapy.   It would seem…

  1. I will pass on your e-mails with Enfield services, so they are also aware of your concerns and opinion, as your daughter’s long term care will be with them.   Then perhaps Elizabeth will only be treated fairly and not neglected in terms of her physical health if she moves away from Enfield.

I hope you can understand our position. I do not understand how any Doctor can ignore underlying physical health conditions documented in reports no matter what because every Doctor should have a duty of care.  The matter of mental health being on par with physical health therefore needs to be addressed.

The other reason I object to depot injections is the fact that Elizabeth is “treatment resistant” and a poor/non metaboliser. 

Prolongation of the QT Interval can cause heart arrhythmia to someone who has low blood potassium and at risk of a heart attack.

So what level of Potassium is the result? 

Potassium levels below 3,0 mmol/l cause significant Q-T interval prolongation with subsequent risk of torsade des pointes, ventricular fibrillation and sudden cardiac death.   
Elizabeth has had all the tests done years ago through  Peter Bennett of Rehealth which reveal “low”

 

What are the magnesium levels also and the prolactin levels?   –  magnesium also recorded as “low”

My daughter should not be having this drug because it is contra indicated and i am particularly concerned about the prolongation of the QT Interval. Throughout the files Elizabeth is recorded as having an irregular heart arrhythmia.  Also who exactly is responsible for the very specialised administration of this expensive  drug.  Risperidone was previously found to be allergic to but this has been ignored by ENFIELD? so Palperidone – metabolite highly dangerous to someone low in Potassium – prolonged QT interval – risk of heart attack.   WHY IS THIS DRUG BEING PRESCRIBED ENFIELD especially in light of the following contraindications noted in bold.

 

Who should not take Paliperidone Palmitate Syringe?

The following conditions are contraindicated with this drug. Check with your physician if you have any of the following:   Yes Elizabeth does have as highlighted in yellow.

Conditions:

  • breast cancer
  • diabetes  – not sure – has PCOS and is insulin resistant – private Endocrinology tests 
  • a high prolactin level
  • excessive fat in the blood
  • low amount of magnesium in the blood
  • dehydration
  • low amount of potassium in the blood
  • overweight
  • very low levels of granulocytes
  • a type of white blood cell
  • low levels of white blood cells
  • low levels of a type of white blood cell called neutrophils
  • confusion
  • suicidal thoughts
  • a type of movement disorder called parkinsonism
  • tardive dyskinesia
  • a disorder characterized by involuntary movements of the face
  • mouth and tongue   – seen that on Clozapine
  • neuroleptic malignant syndrome
  • a reaction characterized by fever
  • muscle rigidity and confusion
  • a low seizure threshold
  • a heart attack
  • angina
  • a type of chest pain
  • torsades de pointes
  • a type of abnormal heart rhythm  –  (has suffered palpitations and tachycardia recorded in files of the Bethlem and Mews Score 3 critical)
  • chronic heart failure
  • abnormal EKG with QT changes from birth  Not sure – were complications at birth
  • a disorder of the blood vessels of the brain
  • orthostatic hypotension
  • a form of low blood pressure
  • compression of the esophagus
  • priapism
  • a prolonged erection of the penis
  • seizures
  • weight gain
  • susceptible to breathing fluid into lungs
  • pregnancy
  • decreased blood volume
  • problems with food passing through the esophagus
  • metabolic syndrome x
  • dementia in an elderly person   I have had extensive private tests done  genetic tests done that point to interesting results
  • diffuse Lewy body disease
  • cataract surgery  Has complained of pain to eyes and index finger/joint pains like Arthrytis
  • floppy iris during eye surgery
  • abnormal muscle movements  –  yes on Clozapine
  • chronic kidney disease stage 2 (mild)
  • chronic kidney disease stage 3A (moderate) –  thought I had seen this in the files 
  • chronic kidney disease stage 3B (moderate)
  • chronic kidney disease stage 4 (severe)

Allergies:  Used to have chronic asthma as a child

  • Risperidone Analogues

I look forward to hearing from you about my main concerns on contraindications because of Xeplion (Palperidone).

ACCOUNTABILITY
Before Elizabeth was suffering from chronic pain and had come off a powerful drug (Risperidone) 2mg  previously found to be allergic to that brought her out in a rash.   She was under the “care” of Dr Helen Moorey whilst this drug was being re-prescribed. However it wasn’t only Dr Moorey but other doctors in the community team under ENFIELD COMMUNITY REHAB and at Huntercombe that chose to ignore file correspondence stating that Elizabeth was previously found to allergic to that drug.   Huntercombe Roehampton prescribed enormous quantities of Risperidone and Clonazepam then diagnosed her as having Aspergers.
In the case of Paula McGowan’s son Oliver, a Doctor chose to ignore advice from the family that the drug Oliver was prescribed he had previously found to be allergic to.  So the reason that I am making this public is that under the mental health and learning disability many vulnerable people’s lives are being lost by Doctors who choose to ignore physical health and prescribe dangerous drugs knowing that these drugs are not going to cure them but in fact can lead to death and then try to defend their actions through “confidentiality” and backing one another’s actions.   There does not seem to be any accountability and there should be when it comes to prescribing.  At a recent Tribunal it was suggested that full hormone tests be done and that should have involved an appointment with an Endocrinologist. Nothing has been done.  A faulty Endocrine system can mean the entire pituitary glands could be affected but a psychiatrist does not bother to refer a patient to see an Endocrinologist or specialist in the field of physical healthcare as they are after a quick solution that does MORE HARM THAN GOOD.       A Doctor’s decision is rarely ever doubted or questioned but many mistakes can be made in prescribing when they choose to ignore underlying physical health conditions.  When death occurs and they say it is “natural causes” it is terrible that parents have to go through the traumatic experience of having to fight for justice whilst full representation in court goes to the professionals, the LA and Trust and something should be done about this awful situation.
Communication is the key and when a vulnerable person like Elizabeth has difficulty in communicating this can lead to dismissal and misinterpretation by professionals.  This is why it is important that the sooner the better, mandatory training is put in place for professionals involved in care for  people with LD and Aspergers like Elizabeth (who has been deprived a proper assessment by independent experts under ENFIELD).  I would like to draw people’s attention into how those vulnerable people are being injured and dismissed like rubbish by Doctors who choose to ignore drug contraindications, past medical history as well as physical health concerns and most importantly choose to play on confidentiality.
Elizabeth’s physical health has been completely ignored and damaged by the local area of ENFIELD.  It is stated throughout the files she has Aspergers/LD and complex PTSD.
I’ve lost count the number of times I have seen Doctors smiling smugly as they appear to be above the law.   The only I have seen the smile disappear off a Doctor’s face was when I told them that I had got into the Police.   It is the Police who have dealt with my daughter in the community when she has phoned distressed.  I cannot praise more highly the Police and the Ambulance services.
As for the Community MH Team, the GP they have failed to provide care in the community.  There might be Covid 19 but if a vulnerable person wanted an MRI scan they have responded by stating everything is at a standstill which is NOT TRUE.  It all comes down to money – the GP surgery arguing with the CCG that it wasn’t them who refused the funding and in the end it all became too much for Elizabeth who became very upset.  I was looking into providing that scan myself like I provided the Endocrinology tests.
Physical health should be paramount before mental health labels but this is not happening in the UK.  It is heartbreaking to watch someone decline because of Doctors neglect and iand the fact they dismiss anything to do with underlying physical health conditions and arrogance – the way they stick together with a diagnosis that is disputed by other doctors throughout the files and this is what is happening under my local area.   The amount of money that has been spent on court action and priority on getting rid of myself as nearest relative is enormous together with the bullying I have had like never before by social services under ENFIELD COMMUNITY REHAB TEAM.   The pack of lies written in records putting blame on home and family –  I’ll give you an example –  back in 2010 at Moti Villa scheme in the community something bad happened to Elizabeth –  I was working full time and on the Police training course at the weekend.  It is recorded by a social worker that her frequent admissions were due to my constant visits “to escape her mother” –  I was taken to RcJ for displacement of NR where the LA wanted to step in and take control.  When I saw who that person was representing the LA as NR I decided to represent myself in court.   They tried to dismiss Elizabeth like she was non-existent.  I was not given court details properly and whilst I arrived in court I was guided by the receptionist to the wrong court.   They temporarily succeeded in displacing me but on the second occasion I was there and had prepared court papers for myself and the judge wanted to meet Elizabeth.  I then was forced to delegate my role short term to Elizabeth’s sister who was approached and told “your mother is going to lose in court and get enormous costs”  Elizabeth had also been told the same “go for your sister as NR” .  I delegated my role as NR because I was threatened by ENFIELD COUNCIL for costs of £5000 in a consent order.   They never went back to court so I found out then I discovered that the underlying S3 was due to expire so I simply took back my role as NR and challenged the S3.
All the time Elizabeth has been let down by the care and was discharged from hospital to a flat that was barely up and running.   There were just carpets, nowhere to sit, no bed assembled, no cooker, no furniture.   That was in July 2019.  It was towards the end of 2019 that Elizabeth was starting to go downhill and then followed a hospital admission.  So between 2019 to date no MRI scan or Endocrinology tests carried out so physical health is ignored under ENFIELD and I believe this is all down to money.  In the community there is no proper help for someone living in their own independent flat who needs a support worker.   For the first time Elizabeth has nice accommodation.
When someone has been made disabled like Elizabeth and is living in the community in her own flat then some support should have been provided.  That support should have been:
A specially trained support worker for someone who is autistic or as I believe brain injured.   This is why I turned to Headway who said it was the wrong kind of brain injury.  The only brain injury they recognise is from car accident or from birth yet it clearly states “Anterior Region Medial temporal compromise”  in 2009.
Whilst it is terrible what is going on right now with Covid 19 and lives being lost under the NHS many lives are being lost and destroyed because of Doctors who choose to ignore underlying physical health concerns in favour of mental “illness” and instead of providing  therapy they provide mind altering drugs to mask the symptoms of injury that could otherwise be dealt with in the case of trauma by psychotherapy and by referral to experts specialising in endocrinal disorders and neurologists / mri scans.
It is no wonder Elizabeth has suffered injury and this has a knock-on effect as other family members can suffer from serious health problems such as heart attack and stroke thanks to the neglect of some doctors.
Today, despite being classed as “extremely vulnerable”  I will be going to St Pancreas Hospital to bring Elizabeth some things she has asked for.  No visitors are allowed not even a solicitor is able to visit because of strict controls re Covid 19 and Tribunals /meetings on video link.
Elizabeth has made a friend on the ward and I am going out shopping first to buy some nice things.
I have met the support worker who seemed very nice when I last dropped some things in for Elizabeth and I was dealt with nicely on the telephone but I cannot praise what they are doing right now with the drug Paliperidone especially when they have a Psychodynamic Psychotherapy department on site and this is the kind of treatment that worked for Elizabeth without any drugs whatsoever back in 2016 when I provided private care.  There is no justification in ignoring BNF contraindications whatsoever.

There seems to be a problem with Elizabeth’s phone.  She phoned me tonight on the office phone from Ruby Ward.  Sounded disorientated.  On such a lovely day it is so hard to think of my daughter and others cooped up on wards such as this and it has been some time now since Elizabeth has had fresh air.   If she was here now I would take her for a drive to the coast but feel in total despair particularly when I finally heard from her tonight talking about an injection.   I decided to phone the ward and it sounded like Haloperidal.   Either she had had an injection or was about to.   I’m glad I did phone the ward as I heard the plan was to put her on depot injections tomorrow apparently.  Elizabeth’s condition is complex PTSD.   Under NICE Guidelines the following is stated:

Drug treatments for adults

  • Drug treatments for PTSD should NOT be used as a routine first-line treatment for adults (in general use or by specialist mental health professionals) in preference to a trauma-focused psychological therapy.

Elizabeth has been crying out for therapy not drugs and was trying to arrange this herself in the absence of any care whatsoever provided by the local area of ENFIELD.   I cant believe that Ruby Ward is considering this especially when they know that Elizabeth is “treatment resistant” and cannot metabolise the drugs.

She has twice now been put in the community without any care in place.

She has been let down by the PRIMARY CARE in ENFIELD.

I am going to write to Dr Sarkar who is the Responsible Clinician to voice my concerns tonight.   I have seen better things on offer at this hospital than in Enfield for instance Psychodynamic Psychotherapy.

Up until now I do not think that Elizabeth has had any therapy and has been drugged up on Clonazepam to the point that you could hardly hear what she was saying,as she was talking in a slurred manner.

My concerns are that under Secondary care due consideration is not being given to a patient’s physical health and I would like something done about this.  Elizabeth needs a thorough check on her physical health and it is negligent of any Doctors to ignore this.  I have already proven there are physical health problems.

Before any thought of depot injections is given Elizabeth’s physical health concerns need to be addressed by Doctors who specialise in the field of Neurology and Endocrinology as Elizabeth has a full report by Dr Bob Johnson stating Complex PTSD –  Dr Mukherjee from Enfield had to agree to this following the Wonderful care I provided for Elizabeth in 2016 when she came back from Australia well.   So it is not drug treatment that is the right thing for someone with complex PTSD and I have seen that at St Pancreas Hospital they have the right treatment on site.  Never before has Elizabeth had EMDR but Dr R D Laing’s friend and former colleague wrote to me: Psychiatrists are usually just physicians and not trained psychoanalytically.  Denis Berke and R D Laing were psychoanalysts.  It might take longer to treat someone with psychoanalytical psychotherapy and without drugs but it is successful.  It is up to a psychoanalytical psychotherapist to assess someone as suitable for that NOT A PSYCHIATRIST.”  “I was once asked at Kings College Hospital London what drugs I used when treating patients with psychosis.  When I said that as a psychoanalyst I did not use drugs they were shocked.  I was shocked that they were shocked”.

Today was a meeting at the hospital which in the end I was included but what I find happens is that Doctors try to say that the patient does not want to share information.  On so many occasions Doctors hide behind “confidentiality” only this time there were witnesses to the contrary.   If only there was a better system over here like in Norway and Finland with Open Dialogue.   I’m writing about this at the moment in my book.  Transparency, openness and honesty are the key and inclusion rather than exclusion.

Elizabeth has been totally damaged by her treatment under the mental health and right now it is worrying as no visitors are allowed on the ward and meetings are on line.

I am going to write now to Dr Sarkar as it is therapy not drugs that is needed and referrals to an Endocrinologist and Neurologist.  You cannot treat someone with a physical health condition with psychiatric drugs of any description and therefore these physical tests need to be done first as primary care comes first or should do and this is certainly not the case in Enfield.

Finally the GP surgery locally had been stating that all non emergency appointments had been put on hold but when something is bothering someone so much like Elizabeth who was suffering from chronic pain this should be another matter.  No it is not true that no scans were taking place because I enquired and these could have been done.

The other thing is Elizabeth has constantly complained that no one understands her and I cannot wait until the mandatory training is put in place.  How many like Elizabeth are lumped together with MH and there is a language barrier.  This training can’t be soon enough as far as I am concerned.

https://www.learningdisabilitytoday.co.uk/prevent-avoidable-deaths-by-making-autism-and-learning-disability-training-mandatory

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