From: ZB
Sent: Friday, June 10, 2022 11:32 am
To: susan bevis
Subject: RE: Elizabeth Bevis 12.02.1987 – Unlawful Deprival of Liberty

Hi Susan

I do not best placed to answer about Dr K but have asked the questions and will reply when I have the answers for you.

Our mental health nurses are qualified to undertake capacity assessments.

Informal capacity assessments can be done by anyone, for example if a patent needs help in finding something to wear we would assess what level of support is needed and help, this is a capacity assessment.

Formal Capacity assessment is for things more in-depth such as understanding rights under the section they are held at this point someone who is best placed  can undertake the capacity assessment. In most cases this will be done by mental health professionals from consultant to nurses.

I have received a message from Mr ….. and I will call him back when I have availability which should be this morning.

You have every right to call me based on me being your point of contact.

Elizabeth does not have set times in which she has her phone.

Elizabeth  is offered the phone intermittently thought the day, when she accepts her hour starts, Elizabeth is permitted 2 hours per day.

When Elizabeth sees her phone she will see any missed calls and messages you have sent and she will reply as she wishes.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

From: ZB
Sent: 07 June 2022 14:02
To: susan bevis
Subject: RE: Visit Tomorrow to Elizabeth

Hi Susan

I have spoken to the Doctor today and unfortunately he does not have any room in his diary to meet with you tomorrow.

The Doctor and myself will revisit this for you at the end of the week and allocate some time where possible.

I am not authorised to send paperwork you would need to go through the correct channels.

Please find attached the document you would need to fill in and send off to be able to gain access to the information.

I have spoken with the doctors regarding Mabop Celebrations and this will not be permitted on this occasion Elizabeth’s S17 leave will remain the same  which is 2 x 30 minutes ground leave escorted by 2 members of staff.

Kind regards

ZB

Ash Villa

Sleaford

From: ZB
Sent: 07 June 2022 12:17
To: susan bevis
Subject: RE: Visit Tomorrow to Elizabeth

Hi Susan

I do hope it will be a nice day for you, as today is.

Scan update is Elizabeth is still refusing to go, and I will need to ask about the endocrinology for you.

As far as I am aware other family members are aware we are monitoring phone use for a period of time.

Phone calls as well as phone use will be monitored for the agreed period of time.  

Our new RC  at ash villa is still Dr K but may change in the near future, I will advise when this happens.

Kind regards

ZB

Ash Villa

Sleaford

Working hours Monday to Friday 09.00-17.00 pm

From: ZB
Sent: 07 June 2022 12:17
To: susan bevis
Subject: RE: Visit Tomorrow to Elizabeth

Hi Susan

I do hope it will be a nice day for you, as today is.

Scan update is Elizabeth is still refusing to go, and I will need to ask about the endocrinology for you.

As far as I am aware other family members are aware we are monitoring phone use for a period of time.

Phone calls as well as phone use will be monitored for the agreed period of time.

Our new RC  at ash villa is still Dr K but may change in the near future, I will advise when this happens.

Kind regards

ZB

Ash Villa

Sleaford

Working hours Monday to Friday 09.00-17.00 pm

From: susan bevis
Sent: 07 June 2022 13:15
To: ZB
Cc: CONNERY, Sarah (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST); Heera, Anita
Subject: Visit Tomorrow to Elizabeth

This was done at Cambian.  Her phone taken away, kept charging in the office continuously, given a time slot for when I was allowed to phone.  The outcome was the phone had to be handed back immediately because it was found that legally Cambian were in breach of human rights and the law as are Ash Villa. The phone is Elizabeth’s phone and the contract is paid for by the family and therefore Ash Villa and the MDT are in breach of human rights law and I can forward you the letter from previous solicitors in this respect as it went straight to the CEO for court purposes.

Thanks for confirming that Dr K is still the RC with overall responsibility for everything that goes on under Ash Villa.

Elizabeth would not be refusing appointments for the scan if her family were taking her and so I would like some Section 17 leave to take my daughter for this essential appointment. 

Endocrinology is also an essential appointment and referral to a hormone clinic was recommended at a previous tribunal.   We want to know what the abnormal findings on the scan were so therefore when is the next MRI appointment in an open scanner which we dont mind paying the difference for so that we can be present.

Also I would like to request S17 to take Elizabeth to the Mabop celebrations on 19th June.  Can this be allowed?

Please forward a copy of the capacity assessment done by GJ that prompted you to say Elizabeth had no capacity as well as a copy of the minutes of the manager’s hearing that I was invited to by way of text message from Elizabeth and that I had been requesting for months on end as my right as the NR but then now it would appear that everything has changed in this respect.

Thank you

Regards

Susan Bevis

From: ZB
To: susan bevis
Subject: RE: Visit Tomorrow to Elizabeth

Good morning Susan

It has been recently discussed in Elizabeth’s MDT That phone access be monitored for a period of time.

It has been reported that the phone works fine and Elizabeth has not mentioned it needs to be repaired.    There is a cracked screen which Elizabeth agreed for me to get repaired but because I used to visit on a Sunday no shops were open.

Elizabeth has her phone twice a day 1 hour in a morning and 1 hour in the evening, at these times Elizabeth is able to call and text who she wishes. Elizabeth is just lying in bed in the mornings and in fact according to one nurse spends much of her time in her room isolated from everyone and refuses to join in.

The phone will not be permitted to leave the ward however her clothing will be ready for you to collect.  The phone belongs to Elizabeth so what rights under the law do they have to justify taking a phone away – her one contact with the outside world outside of that dreadful prison. Plus we pay for a contract on that phone so there is the human rights of her family who are accused (especially me) of phoning every day and bothering staff by zoe blake in an excessive manner.  This is an abuse of our human rights – the family and degrading treatment of the vulnerable patient.

I will speak to the RC and see if he has any room to see you tomorrow at 3pm however I cant commit to this as yet, I will feed back to you as soon as I can on this.

I will book your visit in for 15.00pm Wednesday.

Kind regards

ZB

Ash Villa

Sleaford

Working hours Monday to Friday 09.00-17.00 pm

From: ZB
Sent: Monday, June 6, 2022 10:20:17 AM
To: susan bevis
Subject: RE: Single Point of Access

Good morning Susan

I hope your feeling better.

I do not have the authority to advise anyone not to contact you and that includes the MHA office, however with that said, Due to the level of emails and calls staff members are receiving from you on a daily basis it was agreed that a single point of access would be the best way forwards for yourself and staff. (but what now???? we the family have no set times when we are allowed to phone and have no choice but to phone the office. Have requested copy of phone log as no way do I phone every day as you suggest)

This has been in place for some time now and will continue to be in place while Elizabeth is with us at ash Villa.

There is no *rule* as such more an understanding that anything you need Drop me an email or call and I will do what I can to gain the answers for you, likewise staff contact me to feed back anything to yourself.

This allows the nursing team to concentrate on the service users and allows you someone to speak with. But not now we have no access to Elizabeth as she is unlawfully being deprived of her liberty whilst held under S3 of the MHA for the past nine months. Now there are no set times when she has her phone that we pay for by contract and therefore we have no choice but to phone the ward only to be told “if she wants to speak to you she can ask for her phone back”. How very wrong you all are the MDT and RC Dr K of (……………….which Trust registered to??????) when noone has heard of him at LPFT??????? This all needs confirmation as to why not registered with the Trust same as previous medical director just resigned.

Elizabeth has an excess of clothes that are stored for her, These clothes are  to small for Lynsey, when you next Visit could you kindly collect them for Elizabeth. Couldn’t as nothing had been sorted out but was told she was short of summer clothes so bought her some more.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

From: ZB
Sent: 19 May 2022 16:00
To: susan bevis
Subject: Meeting Points.

Hi Susan

Please see meeting notes from todays meeting.

  • S17 leave has not changed and remains at 2 x 30 minutes ground leave escorted by 2 members of staff.
  • Risk was explained regarding why Elizabeth is escorted by 2 x members of staff.
  • Nursing advised that Elizabeth does see her advocate on a one to one basis however Elizabeth has refused from time to time.
  • Dr S advised the consultant would be available next week to be involved in the meetings. Why wasn’t he then?????
  • We discussed Takeaways and how these are becoming more frequent. And we discussed endocrine disorder and PCOS source of weight gain and the increased dosage of clopixol depot Elizabeth told the family about as discussed at the Manager’s Hearing I was not included
  • That you would like some inclusion. I have a right as both NR and POA to be informed of certain decisions and reasons why????
  • You was offered invitations to Carers support groups and you refused these.
  • You would like to continue with the weekly meeting with a consultant.
  • You wish to visit on a Saturday @14.00. And not a Junior Dr or any other staff acting as shields/protectors so as to avoid important issues such as S17 leave and as for the Carers Network – this is OK provided you do not post anything negative and lo and behold you get a ticking off in front of everyone lol!

I will look at booking next weeks appointment and forwards to you in due course.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA


Sent: 07 May 2022 20:21
To: susanb255@outlook.com
Subject: Re: Negligence

Susan

There is no tangible reason why Elizabeth cannot be given s.17 leave and the refusal to allow her some respite form permanent confinement is positively detrimental to her mental health.

In a nutshell they are institutionalising her by stealth.  This is a human rights issue and not one for half-assed tribunals.  I am quite prepared to help you put together a case if Elizabeth agrees.  The matter needs taking to the High Court on the grounds they are acting ultra vires. It costs £3800 pw for Ash Villa and £140000 has so far been spent roughly since September 2021 and she is declining and beginning to self harm because of their abuse.

This circumvents the institutional bias of the tribunals and involved decisions based on well establish law rather than the convenience of the staff at Ash Villa.  It is utterly absurd that she has not had some home leave in eight months. Even a restricted patient would have been allowed some leave.

 I as NR have been prevented from having a Manager’s Hearing or any contact with the MHA Office who no doubt have been instructed not to respond to be at all.

From: ZB
Sent: 24 May 2022 10:12
To: susan bevis
Subject: RE: Managers hearing

Good morning Susan

I hope your well.

As advised on many occasions I am your single point of access, others will not reply but I will seek to gain the relevant answers and feed them back to you.

You will not be sent the link to the managers meeting today, Elizabeth has not given verbal consent to any member of staff although we have tried to gain this on many occasions. You know very well that I had written consent as I told you so and could prove it.

Elizabeth has not been deemed to have Capacity to consent to your request on this occasion. Because of Capacity Assessment done by a nurse namely G J. Well that is interesting as I have POA in that case.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

Working hours Monday to Friday 09.00-17.00 pm

Now a capacity assessment has been carried out on my daughter and she was not informed about this.  As you can see from above person who is supposed to be my Carer’s Champion says Elizabeth has no capacity when I have a text message and even knew the exact time of this.

Meanwhile the MHA Office Manager S J. and staff continue to ignore me as though I do not exist.

This is not right at all unless Elizabeth been found to have no capacity but surely as the Nearest Relative you should be entitled to be informed of this.   The matter should therefore go to the CoP.

They have been trying to take away from me/her father the POA for Health and Welfare and we are under investigation right now by Anita Heera of the Public Guardian Office on account that we stopped or tried to stop the depot of clopixol when we actually tried to get this up and running but failed because no one helped.  For nine months my daughter has been held a prisoner.  Her physical health is declining and she has missed two physical health appointments and spends most of her time lying in bed trying to keep warm.

I have asked ZB if/why she is standing in the way of my contact with the MHA Office as NR as I wanted a Manager’s Hearing.   They clearly did not want me to attend the manager’s hearing and I am wondering if this could be the reason that the depot has been raised to max level decided by the Manager’s Hearing – putting my daughter’s life at further risk.   An expert of the drugs we know has recognised correctly that Elizabeth has an endocrinal disorder and is against the increase in drugs and he is an expert on the drugs and knows also that she is a poor/non metaboliser. Previous Endocrine tests done confirm and yet they negligently ignore and raise drugs to max level. I have got the care plan Elizabeth shared stating Ambulance/Fire involved – high risk of mortality.   Once again I am asking you to (CQC) intervene as my daughter is at risk of dying.

Regards

Susan Bevis  

Sent from Mail for Windows

How long is the “agreed” period agreed amongst MDT and RC for then?

As regards the Policy Documents, I already checked to see if DoLs was in place and was firmly told no, so you can be sure I am going to check the legality of all of this and all the breaches in Lincolnshire Partnership Trust’s Policy.   Elizabeth should be entitled to compensation for unlawful Deprival of Liberty per month of up to £5000.

It is not a matter of you or others deciding to take a vulnerable person’s phone away from them deciding who attends a manager’s hearing when Elizabeth invited me and I can prove it – what on earth is going on under Ash Villa?   

Elizabeth has told me all the information I needed to know plus shared her care plan with her family which she is quite entitled to do and we have copies of that and it would most certainly appear that “professionals” are now punishing her by depriving contact with her family who pay for a phone contract.   This is unlawful what you are doing.

Is that nurse who carried out the capacity assessment a trained “best interests assessor”?  If not she has no ‘capacity’ or authority to decide capacity of others.  Capacity is a matter for the Mental Capacity Act 2005 and its the duty of the assessor to presume capacity in just about all patients.  It would be a very difficult to suggest that someone did not have capacity to use a mobile phone and it is a fundamental breach of Art. 8 ECHR to deny family contact.  There seems no reason why private phone calls could be denied and you have a right to be informed of the details of any such decision should it occur.    

Deprivation of liberty is a high court matter as are ECHR breaches.  It is very easy to bring a human rights action as litigant in person and many people do so because legal aid is exceptionally difficult to get in these cases unless there is a public policy issue.  

And there is most certainly a public policy issue with Lincolnshire Partnership Trust as I have been reading the Policy documents.

I am also concerned for my daughter’s wellbeing as she looked distressed and had a bright red mark on her face and is resorting to self-harm again because of the stress of being held an absolute prisoner under Ash Villa with no end in sight and deprived of basic human rights.     I have today 10.06.2022 reported to Adults Safeguarding further concerns as they are investigating my daughter’s case right now upon my advice.

On Wed, 8 Jun 2022 at 12:11, MEDICALDIRECTOR (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.medicaldirector@nhs.net> wrote:  Re Dr K

***We do not have a doctor with that name and / or GMC number working at Lincolnshire Partnership NHS Foundation Trust.

Kind regards

Jacqui

JH

Medical Directorate Administrator

Lincolnshire Partnership NHS Foundation Trust 

From: ZB
Sent: 07 June 2022 12:17
To: susan bevis
Subject: RE: Visit Tomorrow to Elizabeth

Hi Susan

I do hope it will be a nice day for you, as today is.

Scan update is Elizabeth is still refusing to go, and I will need to ask about the endocrinology for you.

As far as I am aware other family members are aware we are monitoring phone use for a period of time.

Phone calls as well as phone use will be monitored for the agreed period of time.  

***Our new RC  at ash villa is still Dr K but may change in the near future, I will advise when this happens.

Kind regards

ZB

Ash Villa

Sleaford

Yesterday was the Manager’s Hearing I had been asking for on many occasions as Nearest Relative. You will not be surprised to learn that I was completely ignored as I have been for months on end by the Mental Health Office. It could be that the MHA office are told my only point of contact is as Carers Champion but what right do a MHA office have to ignore you as Nearest Relative who has called for a Manager’s Hearing. A full investigation needs to be undertaken.

I have had another patronising ticking off by the person who is said to be a “carers champion” in that I am supposed to go through her for everything. However this is just like a messenger service where you get no answers and the RC above has been one of 3 who have avoided S17 leave and a junior Dr is then put in charge of a meeting because the RC does not have the time of day for you. Therefore you do not get treated fairly. It is just delaying tactics.

I have found out that a capacity assessment was carried out on Elizabeth without her knowledge by a nurse called G only recently.

Clearly noone wanted me to attend yesterday’s manager’s hearing so what they did was they worked together putting up barriers and perverting the course of justice legally as I as Nearest Relative would be entitled to have a manager’s hearing but instead this was done behind my back and the only reason I knew about it was because Elizabeth told me even down to the time it was taking place and I had been invited by her.

There is such ignorance or blatent disregard to the MHA under Ash Villa it makes this facility not fit for purpose.

The other thing is that Elizabeth has shared with her family her care plan.

From reading this disturbing care plan is revealed the hopelessness of her situation in this dreadful institution – the worst we have ever come across and NHS run. There is no respect for carers and there is no respect for the patient and her life is at risk and I want everyone to know about it as Elizabeth has actually said she is going to die in there.

Time and time again we have asked for CQC intervention at this facility and nothing is ever done. They are due an inspection. I fear that this facility is unsafe. I have now turned to my MP, Victoria Atkins and Healthwatch Lincs. The matter is being passed on to the DoH.

The whole situation has led to me becoming very ill, to the point I cannot visit right now. Thought I had covid but yesterday’s test was negative so it must be flu but this is the effect on you as a carer when you read the care plan that highlights ambulance and fire brigade notified due to her being bariatric and high risk of mortality. They are also missing the point about takeaways – deprived of exercise and meaningful contact with family Elizabeth could be held prisoner under the MHA on the say so of completely unaccountable professionals for years and years on end – a prisoner deprived of all human rights under LINCOLNSHIRE PARTNERSHIP TRUST and what on earth is happening about our complaint? If someone is in bed all day trying to keep out of the way that person is missing meals anyway and if that vulnerable person happens to get up in the night and dares to ask for a drink then they get callously told to get back into bed. I have been subject to severe bullying to the point where a member of staff tried to say I had assaulted a member of staff and in a letter by ward manager accused of threatening behaviour and now I want everything on me under GDPR rules. I have now had to apply for all CCTV footage to clear my name – what could have justified 3 x police cars coming out? I was standing beneath CCTV cameras alone at the time. Not for the first time, this facility whose professionals completely lack communication skills resort in bullying tactics using the police as if they are not busy enough. Anything to blacken your character that is how bad it is and I would welcome a full enquiry.

It was a big mistake coming to this area thinking that MH care would be good and for a long time I kept quiet, not wanting to rock the boat. Right now I couldn’t care less any more as I want something done about the situation before it is all too late now that I have seen the extent of risk to my daughter’s life. There are too many cases of people dying in these institutions who deprive patients of basic human rights and exercise leaving them to go downhill.

What was decided at the Manager’s Hearing was to raise medication to 400 mg near maximum with complete disregard to the fact that Elizabeth is of high risk of mortality and adverse reaction as proven by genetic tests P450 liver enzyme. Even Cygnet respected this certificate but there is no respect at Ash Villa – a hospital that destroys lives.

I am now going to share with you some disturbing but educational information. Elizabeth now said to have no capacity in a capacity assessment conducted by nurse G.

From: b.

sent: Tuesday, May 24, 2022 1:28 pm
To: susanb ; Subject: Re: Managers hearing

Susan

You might be interested in the contents of this lecture, especially from slide 38 which explains the duties of Health Informatics Professionals.

As NR and with Elizabeth’s written consent you are entitled view the capacity report which must give full reasons for the decision on capacity.

Capacity is a legal construct and not a medical one.  As Elizabeth’s NR you can challenge the capacity report.  See the Bournewood case (also attached).

B. 

From: B
Sent: 24 May 2022 23:37
To: susanb255

Subject: Dosing and P450 metabolism

Very important paper on poor metabolisers

“If a patient on psychotropic medication develops symptoms of delirium or of akathisia, every psychiatry textbook I have been able to identify advises dose reduction or change of medication to one more suited to the patient. The problem occurs on change of dose up or down and has been associated along with other extra pyramidal side effects, as well as sensitivity”

“The half-life of the zuclopenthixol depot preparation is 19 days, so if it is given fortnightly, toxicity will eventually develop”. 

it is clear that Ash Villa staff have no idea about dosage and blood serum levels. they appear to be working on dosing regimes 20 years out of date

Clinical Case Studies and Reports

Clin Case Studie Rep, 2018 doi: 10.15761/CCSR.1000112 Volume 1(2): 1-8

ISSN: 2631-5416

The effect of CYP450 2D6*4 mutation on medication

response: Two cases with different outcomes

Yolande Lucire*

Forensic and medico-legal psychiatry, Pharmacogenomics and Personalized Medicine, Level 5, 203-233 New South Head Road, NSW 2027, Australia

Abstract

This paper describes different outcomes for genetically similar persons bearing the mutation CYP450 2D6*4. They were treated with the same drugs; their condition

was called “schizophrenia” and in both cases the exclusion criterion essential for that diagnosis was ignored

*Correspondence to: Yolande Lucire, Forensic and medico-legal psychiatry,

Pharmacogenomics and Personalized Medicine, Level 5, 203-233 New South Head

Road, NSW 2027, Australia, Tel: 0411158246, E-mail: lucire@ozemail.com.au

Received: August 07, 2018; Accepted: October 25, 2018; Published: October

31, 2018

Substance/general medical condition exclusion: The disturbance is

not due to the direct physiological effects of a substance (e.g., a drug of

abuse, a medication) or a general medical condition [1].

These cases support the notion that treatment of cannabis-induced

disorders with drugs that have been tested for schizophrenia and

bipolar illness may be counterproductive [2].

The paper highlights a need for doctors to diagnose to the criteria,

and to be aware of (a) the DSM decision tree for the differential

diagnosis of hallucinations, (b) the principles of pharmacogenetics, (c)

the high prevalence of diminished metabolic capability for cytochrome

P450 metabolised drugs, and (d) symptoms of neuroleptic toxicity,

including akathisia [3,4]. It points to the need to seek advice from

pharmacologists and pharmacogeneticists and not from peer clinicians

who may also lack relevant expertise.

Patient C

C, 33, a university graduate, intermittently employed, had mild

brain injury at birth and chicken pox encephalitis at 20. (Brain

injury can cause akathisia and remains a risk factor for akathisia [5].

He smoked cannabis rarely. He was unable to say why he had been

prescribed fluvoxamine by his general practitioner (GP). He soon

developed a variant of erotomania (a side effect of all serotonergic

antidepressants, reported thus in the Physicians’ Desk Reference) in that

he became preoccupied with a former girlfriend, ruminating on what

might have been had he married her. He also harassed a friend of the

former girlfriend, driving in his street and breaking windows [6].

Charged with a stalking offence, he presented for an s32 report

under the NSW Mental Health (Criminal Procedure) Act 1990 that

encourages diversion from the criminal justice system of persons

suffering from a mental illness or condition. He was diagnosed with

“paranoid schizophrenia,” by his account in a 20-minute interview.

Olanzapine was added to fluvoxamine and when he became increasingly

depressed, restless and violently suicidal it was increased to 30 mg

daily while fluvoxamine was increased to 200 mg, and he continued to

deteriorate. Zuclopenthixol depot was added to 200 mg fortnightly and

cigarette smoking increased to 40 a day. There was no improvement

in his behaviour, so he was imprisoned on a certificate that called his

illness schizophrenia but held him responsible for his actions [7].

On release, he continued to drive obsessively in his quarry’s street

(indicative of both organic obsessional disorder and erotomania) and

was about to be imprisoned again on his treating psychiatrist’s certificate

attesting to his intentionality, when he made a suicide attempt and was

hospitalised with deep vein thrombosis [8]. He had 35 mg diazepam

daily added but it gave no relief. Warfarin was added to the above for

the deep vein thrombosis. Zuclopenthixol was suspended in hospital.

The author diagnosed akathisia and erotomania and wrote a Section

32 report, and this avoided his receiving a second prison sentence. Four

years later, fully recovered, on no medication and showing no sign of

schizophrenia and working in three jobs, C described his mental state

at that earlier time:

I figured I had nothing to live for. I was feeling like I had no future

and I did not want 40 more years of this. I thought of hanging myself or

slashing my wrists. I do not know how often. I also thought of crashing

into a truck or jumping in front of a train. I was never suicidal before I

had fluvoxamine. I smoked heaps.

I had the injection because I thought it would keep me out of jail.

I could not sit and read, I could not focus on anything, I was restless,

and I could not sit down. The last five days in jail were hard. I could not

sleep at all, that carried on after I went out of jail. I could not do anything,

could not sit down and watch TV. I had to get up and pace around, a

hundred times a night. After I got out of jail, the world completely

changed. Home to me has always been a haven. For those eight months,

I had hell inside.

On legal advice, the author advised C’s mother that three

psychiatrists, one of whom was a personal friend of C, shared her view

that he had did not have schizophrenia or anything like it. His mother

researched akathisia on the Internet and requested a change of doctor

in view of a total breakdown of the doctor/patient relationship.

Lucire Y (2018) The effect of CYP450 2D6*4 mutation on medication response: Two cases with different outcomes

Clin Case Studie Rep, 2018 doi: 10.15761/CCSR.1000112 Volume 1(2): 2-8

Frustrated by administrative inaction, the mother made a

complaint to the Medical Board of NSW (MBNSW), which declined to

investigate it. However, the Board chose instead to pursue the author for

holding this allegedly minority view through a Professional Standards

Committee (PSC).

The PSC found the author to have “inappropriately” destroyed

the mother’s confidence in the treating doctor, notwithstanding that

the mother gave evidence that she and her son had none. The author

was criticised for having insufficient respect for the diagnoses of her

colleagues and this was based on peer reviews, of peers who did not

acknowledge product information (PI).

The PSC unilaterally, without giving notice, decided to publish its

report where no such PSC matters had ever before been publicised. The

author was publicly humiliated as having “insufficient knowledge” and

as lacking respect for her colleagues’ diagnoses. This decision was based

on the author’s holding what the PSC considered to be a “minority

view” concerning antidepressant side effects and interactions, even

though four files of evidence that antidepressants induced psychosis

and suicide in some people were provided, together with PI and

relevant public health advisories. The MBNSW recommended that the

author seek the counsel of a colleague. The decision was misreported

in The Sun Herald to the effect that the author had been “ordered into

treatment by the Medical Board”.

C was allowed to reduce all his medications slowly. Four years

later, C works in three jobs and shows no signs of schizophrenia. He is

stigmatised by his criminal record and traumatised by the experience of

the painful mental state of some duration, but relieved to know that he

had suffered from a medication side effect rather than a mental illness.

Patient A

While a 16-year-old schoolboy in 2004, smoked cannabis, used

other illicit drugs and experienced hallucinations. He was prescribed

risperidone and deteriorated [11]. Olanzapine was added at both

variable and increasing doses. This produced worsening depression

and continuing hallucinosis. Fluvoxamine was added, and he became

violently suicidal.

Soon added in series and parallel were benztropine, haloperidol,

chlorpromazine, lithium, risperidone and its depot, consta, quetiapine;

previously ineffective treatments were recirculated in escalating doses.

Patient A remained violently akathisic, intensely suicidal,

aggressive and intermittently homicidal. He was seen tramping along

the motorway at night in the rain before he made a homicidal attack on

his stepfather in 2005. He spent four months in an interstate clinic. He

assaulted his psychiatrist in January 2006 and was imprisoned.

He made many suicide attempts and repeatedly complained that

his medication made him feel suicidal. His unremitting death wish was

recorded as “I cannot function on this medication. It makes me want to

kill myself ”. He continued to smoke cannabis, insisting it helped him,

and his tobacco use increased [10].

Zuclopenthixol depot was reinstated in prison at 400mg fortnightly

in the face of his protests and history. After his release it was increased

to 600 mg on one occasion and enforced by a Community Treatment

Order (CTO).

His penultimate suicide attempt from a cliff a day after his release

from hospital on a CTO caused police to return him to hospital where

the diagnosis of schizophrenia was amended to “antisocial personality”.

Two days later and after 4 years of treatment, he was found dead at the

bottom of the same cliff, in December 2006. No root cause analysis was

provided for the relatives.

The coroner gave the author very limited access to clinical records

and treatment sheets and refused permission to make copies. He

determined, on a report from police, that A had not committed suicide

at all but had been “skylarking”. On that basis, he declined to hear expert

evidence prepared for an inquest and did not respond to a suggestion

that genetic testing for CYP450 activity was needed. The issue of the

coroner perhaps having a conflict of interest was raised with both the

Chief Coroner and the Judicial Commission because, as a magistrate,

the coroner had previously been involved with A and because he was

involved with that health service on a daily basis. Both found that no

conflict existed.

Commentary

CYP450 testing revealed that both patients had a “null” metaboliser

gene 2D6*4 (in the case of A, after exclusion of his parents’ genotypes).

Both had received multiple interacting drugs that compete for

CYP450 2D6, a metabolising resource that is finite and may be limited

by genotype or P450 inhibitors or other health problems. When

a metabolic pathway is already in limited supply, lower doses are

recommended because the drug is likely to reach blood levels above the

“therapeutic window of opportunity’ for each drug” [11].

Both polypharmacy (endemic in Australian psychiatry) and the use

of higher than recommended doses are counterproductive. Akathisia

and other organic neurotoxic states supervene, and patient does not

recover. Standard doses of a single substrate accumulate in diminished

metabolizers and lead to blood levels higher than the therapeutic

window. The concurrent use of Cytochrome P450 inhibitors hastens

that process. More frequent dosing than permitted by the half-life of

each drug results sooner or later in neurotoxic state and hallucinatory

delirium.

Both C and A were taking, simultaneously, several drugs requiring

the 2D6 pathway, in larger than recommended doses: olanzapine at 30

mg daily is 15 times the normal starting dose, fluvoxamine 200 mg is

4 times, zuclopenthixol injections at 600 mg fortnightly is 8 times the

standard dose. Eli Lilly does not guarantee the safety of olanzapine over

20 mg.

The notion that patients who have not responded to antidepressants

are ultra-rapid metabolizers (UMs) underpins the practice of increasing

a medication or adding another. However, it is many times more

likely that such patients are poor (PMs) or diminished metabolizers

(DMs), and as such need to have the dose decreased. From 5% to 14%

of Caucasians are PMs of 2D6 and a further 20% have diminished

metabolism. PMs may experience potentially lethal side effects within

days, whereas the slower metabolism of intermediate metabolizers

(IMs) causes a slow build-up of blood level while the chemistry of the

brain tries to follow. Rapid changes of psychoactive substances cause

violent mood and behavioural shifts, confusion and delirium in IMs.

UMs comprise only 1-10% of Caucasians [12].

If a patient on psychotropic medication develops symptoms of

delirium or of akathisia, every psychiatry textbook I have been able to

identify advises dose reduction or change of medication to one more

suited to the patient. The problem occurs on change of dose up or down

and has been associated along with other extra pyramidal side effects,

as well as sensitivity.

Lucire Y (2018) The effect of CYP450 2D6*4 mutation on medication response: Two cases with different outcomes

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Akathisia is a subjective desire to be in constant motion. A

manifestation of drug sensitivity, it may be confused with psychotic

agitation and incorrectly treated by increasing the dose of the offending

medication. The symptom subsides promptly when the offending

medication is discontinued and replaced by another one better tolerated

by the patient [13].

The subjective distress resulting from akathisia is significant and

can lead to non-compliance with neuroleptic treatment. Akathisia may

be associated with dysphoria, irritability, aggression or suicide attempts.

Worsening of psychotic symptoms or behavioral dyscontrol may lead to

an increase in neuroleptic medication dose, which may exacerbate the

problem. Akathisia can develop very rapidly after initiating or increasing

neuroleptic medication [14].

Substrates of 2D6 also include tricyclics, tetracyclics, amphetamines,

chlorpromazine (which has other pathways as well), fluvoxamine,

haloperidol, risperidone, quetiapine and, in part, olanzapine.

Cannabis, involved in both these cases, is metabolised by

cytochromes 3A4, 2B6 and 2C9. It is an inhibitor of 3A4 and induces

1A2. It remains in the body for up to 2 months, depending on the

amount used. Like tobacco, which induces IA2 and caffeine induces the

metabolism of psychiatric drugs as well as producing is own euphoric

neurotoxic state [15,16].

Pharmacogenetics

Pharmacogenetic theory and data provide an arena in which

adverse drug reactions can be explored, understood, theorised and

ultimately predicted [17]. The development of pharmacogenetics has

ushered in a paradigm shift of massive proportions in medicine and,

particularly, psychiatry. It is predictable that this shift is resisted [18].

Pharmacogenetics has featured in American textbooks of psychiatry

since 1999, but it has not been taught in Australia until very recently

[19]. Australia is the last of the U.K., Canada and the U.S. to inquire

into the potential of pharmacogenomics, by means of a report that,

unaccountably, expects a lead period of 10 years to full implementation

[20]. “One size does not fit all” appears to be its theme.

Delay in implementing this education will result in more hospital

admissions for adverse drug events, already a major source of costs

in the U.S., as well as prolonged stays, misdiagnoses and unnecessary

deaths and medication-induced suicides and homicides [21-24]. No

psychiatrist can practise safely without this knowledge.

It may be that lack of this knowledge accounts for psychiatry’s

insatiable demand for resources, and for the increasing suicides, suicide

attempts, homicides and violence committed by patients under mental

health care [25,26]. Providing more resources for psychiatry without

questioning the source of this epidemic of seemingly intractable mental

ill health is unlikely to resolve the problem [27,28].

Metabolic pathways

Nearly 90% of drugs are metabolised by the cytochrome CYP450

family of enzymes, 1000 enzymes determined by 40 genes [29]. They

transform “exotoxins” into products that can be metabolised further

(stage II metabolism) and prepared for excretion by the kidney or

liver. Diminished capacity to metabolise drugs results in blood and

brain levels above the sometimes-narrow therapeutic window. These

concentration-dependent adverse effects manifest as neurotoxic

Drug Therapeutic window [31] Metabolism/transport site Enzymes/process inhibited Enzymes Induced/

chlorpromazine 30-300 ng/ml 2D6, 1A2, 3A4, UGT1A4, UGT1A3 2D6a

clomipramine 175-450 ng/ml 1A2, 2C19, 2D6, 3A4 2D6, 1A2, 2C19

cannabis 3A4, 2B6 and 2C9. 3A4 1A2 and 2E1

carbamazepine 6-12 μg/ml 3A4, 2B6, 2C8, 2E1, 2C9, 1A2, UGT2B7,

ABCB1 ?2C19 3A4, 1A2, 2B6, 2C8, 2C9,

UGT1A4

clonazepam 20-40 ng/ml 3A4, acetylation

clozapine 350-600 ng/ml 1A2, 3A4, 2D6, 2C9, 2C19, FMO3 2D6c

diazepam 300-400 ng/ml (incl. metabolites) 3C19, 3A4, 2B6, 2C9, glucuronidation

doxepin 50-150 ng/ml 1A2, 2D6, 2C19, 3A4, UGT1A4, UGT1A3 1A2, 2C19, 2D6

fluphenazine 0.5 – 2 ng/ml 2D6a, 1A2 2D6a, 1A2

clopixol >2 ng/ml 2D6

fluvoxamine # 150-300 ngms/ml 2D6, 1A2 1A2a, 2C19a, 2B6b 3A4b, 2D6b, ABCB1

haloperidol 5-17 ng/ml 2D6

lithium 0.5–1.2 mmol/l

lorazepam 10-15 ng/ml UGT2B7, ?other UGTs

olanzapine #

half-life 21-54 mean 30 hrs. 9-25

ngms/ml [32]

100 ngms/ml.

1A2, 1A4 partly by 2D6 and UGT3A4,

UGTs, ABCB1 None known

paliperidone # ? 2D6, 3A4 None known

perphenazine 0.6 – 2.4 ng/ml 2D6, 3A4, 1A2, 2C19 2D6, 1A2

quetiapine # 70-170 ng/ml 3A4, sulfation, ABCB1

risperidone 20-60 ng/ml (including 9-hydroxy) 2D6, 3A4, ABCB1 2D6b

risperidone consta ditto ditto ditto

temazepam UGT2B7,? other UGTs, 2C19, 3A4

valproate 50-100 μg/ml Complex: 2C9, 2C19, 2A6, UGT1A6, 1A9,

2B7 2D6, 2C9, UGTs, 1A4, 1A9, 2B7, 2B15, epoxide

zuclopenthixol 4-50 ngms/ml 2D6 ? 2D6 (European drugs are less well researched than

those used in the U.S.)

Table 1. Drugs metabolic pathways, inducers and inhibitors (of drugs used in these cases) from several sources [30]

a Potent inhibition of enzymatic pathway. b Moderate inhibition c Mild inhibition. Inhibition is also dose-related; mild inhibitors in high doses act as strong inhibitors. # Not licensed for use

in children or adolescents by the United States Food and Drug Administration (FDA) or its Australian equivalent, the Therapeutic Goods Administration, (TGA.

Lucire Y (2018) The effect of CYP450 2D6*4 mutation on medication response: Two cases with different outcomes

Clin Case Studie Rep, 2018 doi: 10.15761/CCSR.1000112 Volume 1(2): 4-8

brain syndromes. Many psychiatric patients are prescribed more than

one drug, with each drug increasing the risk of a pharmacokinetic

interaction. Table 1 shows metabolic pathways inducers and inhibitors,

and it has been brought up to date from primary sources.

There is an argument that patients would benefit from CYP-based

genotyping prior to the prescription of these drugs. Up to 79% of

islanders from around Vanuatu have PM status at 2C19 and around

25% of Caucasians have “diminished metabolism,” at 2D6, and for

them a drug metabolised by that pathway is likely to be or becomes

problematic and might be lethal [33]. East Asians have a 50% prevalence

of the IM gene P2D6*10, as well as up to 35% prevalence of the PM

gene 2C19*2, putting that population at a huge risk from antidepressant

therapy. Testing for CYP450 2D6, 2C19 and 2C9 costs less than $150.

Basic knowledge of the ethnicity-based prevalence of mutations

is essential to counter a common belief among psychiatrists that

worsening depression and suicidality in a patient indicate a lack of

response, and that the patient is therefore a UM. Such reasoning leads

to more and more medication being given. In fact UMs are rare, often

cited in Caucasian populations as 3%.

Most adverse drug reactions occur as a result of simple over-dosing

of genetically normal persons whose cytochrome metabolism has been

inhibited or induced, leading to undesirable bloods levels. There are six

patterns of drug–drug interactions and some are described below [34].

The first effect of making testing available might be to make prescribers

aware that adverse drug events are both explicable and avoidable.

Conditions affecting metabolism include co-prescribed medications

that induce or inhibit the enzymatic pathways, age, nutrition, stress,

liver disease, hormones (natural and extraneous), the sequence in

which medications have been prescribed or taken away, the route of

administration, the range of half-life in any population, the potential for

multiple metabolic pathways, the size of the therapeutic window within

which the drug may be effective and outside of which it is ineffective or

toxic or both, the duration of therapy and duration of inhibition which

may persist after discontinuation [35]. This paper does not deal with the

genetics of transporter and receptor systems.

3A4 is the “workhorse” of the P450 system, which means that

many drugs are substrates of it, and there are many inhibitors and

inducers. There are no PMs but there is 10–30-fold variability in the

efficacy of its functioning. 1A2 metabolises psychiatric drugs and is

induced by tobacco smoking, which also hastens the metabolism of

other psychiatric medicines not known to be metabolised by these

cytochromes. This seems to explain why patients on psychiatric

medications increase their tobacco use: to more quickly metabolise

medicines that have unpleasant or intolerable adverse effects.

Information grows and changes daily. All three are involved in the

metabolism of common antidepressants and antipsychotics [36].

Table 2 is compiled from research done by health insurers Blue

Cross Blue Shield who have found such testing to be cost effective. The

table lists the effects of genetic polymorphisms of CYP450 enzyme genes

on drug metabolism and describes relationships between genotype and

phenotype, as relevant for psychiatric drugs, many of which inhibit the

enzymes required for their metabolism [37-39].

A more useful concept adopted by the Diversity Health Institute

(DHI) at Cumberland Hospital is to describe both PMs and IMs as

having “diminished CYP 450 metabolism”. This is because the inhibition

or absence of one cytochrome may divert into metabolism by others,

which may or may not be available in any given individual. There can

be 1,000% variance in the metabolism of 2D6 drugs between PMs and

UMs and a 30-fold variance in metabolism by the enzyme cytochrome

3A4 [44].

Metaboliser status Metaboliser

status

Metaboliser

status Genotype Phenotype Expected drug effects Prodrug concerns

2D6 2C9 2C19 2D6

PM

(poor) *3, *4,

*4XN,

*5, *6, *7, *8,

*11, *15, *19,

*20, *40

PM

*2 and *3

PM

*2, *3

PM Homozygous or

compound heterozygous

for deficiency alleles.

PM

“Standard” doses may lead

to toxic drug concentrations

and serious adverse reactions,

including suicide and

homicidal behaviours [40].

May not reach therapeutic levels of

active drug, i.e. does not convert

prodrugs into the analgesic morphine, so

they are ineffective. Conversely removal

of a 2D6 inhibitor may lead to rapid

conversion and toxicity and death (the

Heath Ledger phenomenon)

IM (intermediate)

*10, *10XN,

*17, *17XN,

*9, *29, *36,

*41, *41XN

IM

*1 and *2

or *3

or *3/*3

IM

Homozygous for

two reduced activity

enzyme genes alleles

or heterozygous for an

inactive allele and a

reduced activity allele.

These may become PMs or

diminished metabolisers in the

presence of specific inhibitors.

A reduced dose of a single drug

is recommended, and IMs are

unable to metabolise multiple

drugs requiring that pathway.

Higher doses may lead to toxic

levels.

May experience some consequences

of PMs.

EM (extensive)

“wild type”

*1, *2, *35

EM

*1, *1

EM

19*17 [41]

Two copies of active

enzyme gene alleles.

Up to 80% of EMs at 2D6

become PMs in the course

of treatment with strong

inhibitors such as paroxetine

[42], fluoxetine and sertraline

and with mild inhibitors in

high doses.

Standard doses lead to

expected drug concentrations

and response.

Expected response to standard dose.

UM (ultra-rapid)

Only 2D6 has

UMs *AXON,

*2XN,

*35XN

More than two active

copies of active enzyme

gene alleles.

May not reach therapeutic

levels of active drug due to

rapid clearance.

May reach higher than expected

concentrations of active metabolite,

which may cause adverse reactions,

including death from morphine.

Notes: Genotype refers to the genetic makeup of the subject; phenotype refers to the way that the genotype manifests under a variety of conditions [43].

PM = poor metabolizer; IM = intermediate metabolizer; EM = extensive metabolizer; UM = ultrarapid metabolizer. Prodrugs such as tramadol, oxycodone, codeine need to be activated,

i.e. catabolised to morphine by 2D6.

Table 2. Genotypes phenotypes and predictions

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Mutation P450 2D6*4 was found in more than one third of 30

persons tested at the author’s request because they had experienced

severe violent akathisia, suicidal behaviours, homicidal aggression,

behavioural dyscontrol, delirium with hallucinosis, and cognitive

impairment on standard doses of antidepressants (to be reported

elsewhere). The most publicised of these is Melbourne mother and

student Rebekah Beddoe, who published her harrowing account of

three years on antidepressants and antipsychotics, prescribed and coprescribed

by psychiatrists who failed to recognise her problems as side

effects [45].

Drugs relevant to these two cases

Olanzapine

Side effects are listed in each drug’s PI, easily accessible through the

website of the U.S. FDA [46]. PI published in the U.S. is substantially

larger and more detailed than that available in Australia. It categorises

“frequent” adverse events as occurring in at least 1/100 patients,

“infrequent” events as occurring in 1/100 to 1/1000 patients and “rare”

events as occurring in less than 1/1000.

By that standard, in clinical trials that were presented to the U.S.

FDA to get olanzapine licensed, death and suicide on olanzapine

occurred at a rate of 1 in 208, which is “rare.” No deaths occurred on

placebo. Khan et al. counted the suicides in antipsychotic trials 2001

but this paper failed to alert the psychiatric community [47].

A rate of 27% akathisia in a trial of olanzapine 10 mg was balanced

by an equally high incidence of akathisia on placebo [49]. This

indicated that Eli Lilly either did not know what they were talking

about (as akathisia is always a medication-induced phenomenon), or

the participants had not fully recovered from whatever they had been

taking before entry to the trial. This been the subject of successful

litigation for fraudulent promotion of olanzapine, such as USA vs. Eli

Lilly which rewarded the whistleblowers with US$800 million [50].

The half-life of olanzapine ranges from 21 to 54 hours (5th to 95th

percentile; mean of 30 hr), and apparent plasma clearance ranges from

12 to 47 L/hr (5th to 95th percentile; mean of 25 L/hr). This means

that sooner or later more than 50% of users will become toxic on it if

the dose is not reduced. The half-life and clearance of olanzapine varies

among individuals on the basis of smoking, status, gender and age.

According to Eli Lilly Australia the therapeutic window of

olanzapine is 9-25 ngm/ml, but other figures are mentioned elsewhere

[51].

In drug company terms, “frequent” refers to adverse events affecting

more than 10% of users. The following effects are listed in the 2007

Olanzapine PI. (Olanzapine is licensed for bipolar disorder.)

Nervous System — Frequent: abnormal dreams, amnesia,

delusions, emotional lability, euphoria, manic reaction, paresthesia and

schizophrenic reaction;

Infrequent: akinesia, alcohol misuse, antisocial reaction, ataxia, CNS

stimulation, cogwheel rigidity, delirium, dementia, depersonalization,

dysarthria, facial paralysis, hypesthesia, hypokinesia, hypotonia,

incoordination, libido decreased, libido increased, obsessive compulsive

symptoms, phobias, somatization, stimulant misuse, stupor, stuttering,

tardive dyskinesia, vertigo, and withdrawal syndrome;

Rare: circumoral paresthesia, coma, encephalopathy, neuralgia,

neuropathy, nystagmus, paralysis, subarachnoid hemorrhage, and

tobacco misuse.

Australian PI is incomplete, but it does inform that hallucinations

are “very common” (≥ 10%). That is, they occur in more than 1 in 10

users.

Eli Lilly was fined $US 1.42 billion in the United States for criminal

and fraudulent promotion of the drug, with the judge raising the issue

of racketeering [51]. There are many lawsuits, settled and ongoing,

against Eli Lilly by State Attorneys General, as well as class actions for

suicides. With Eli Lilly reaping US $6 billion annually from olanzapine,

these fines and settlements are apparently insufficient to encourage the

company to change its promotional practices and have made no impact

on the behaviour of the company in Australia.

Four major studies (HGAD, E00, HGAJ and E003) were reviewed by

the U.S. FDA for the purpose of establishing the efficacy of olanzapine in

the treatment of chronic schizophrenia (acute exacerbation). According

to the U.S. FDA reviewers, the studies failed to establish any significant

effectiveness for olanzapine. Two thirds of clinical trial subjects dropped

out without completing 6 weeks. Even after they dropped out, 20 died,

12 by suicide. Concomitant drugs were permitted in these trials.

American PI also discloses that 67 of 3,100 subjects (including

a trial rejected by the U.S. FDA) took overdoses of olanzapine, but it

is silent on whether these patients were considered to be suicidal or

confused. As “only one” died (of the overdose) these numbers are put

forward as evidence of olanzapine safety in overdose. However, a courtordered

investigation of Eli Lilly archives disclosed the deaths and

suicides in the five clinical trials that were presented to the US FDA to

get it licensed [52]. The figures are shown in Tables 3 and 4.

One in every 145 clinical trial subjects for risperidone, olanzapine,

quetiapine, and sertindole died, a total of 36 deaths, most by suicide

[53]. Yet these deaths are not mentioned in the scientific literature nor

in PI. These deaths occurred even though two thirds of the olanzapine

subjects, nearly half of the risperidone subjects and 80% of the

quetiapine subjects did not complete the trials because the drugs were

poorly tolerated [54]. A rate of 27% akathisia in a trial of olanzapine 10

mg was reported, balanced by an equally high incidence of akathisia

on placebo [55]. This indicated that Eli Lilly either did not know what

they were talking about (as akathisia is by definition a medicationinduced

phenomenon), or the participants had not fully recovered

from whatever they had been taking before entry to the trial. Serious

adverse events affected 84 subjects who took risperidone.

None of this information appears in promotional material. Indeed,

47 serious adverse events in 87,000 users of olanzapine injectable in

Drug Number of Trial

Subjects Suicides Suicidal Acts

Olanzapine

2500 (5000 started

and did not complete

6-week trials)

12 Not disclosed#

Comparator 810 1 (2) Not disclosed

Placebo 236 0 (1) Not disclosed

# However, U.S. PI (2003) states that 67 subjects out of 3100 overdosed on olanzapine but

does not disclose if these overdoses were due to suicide attempts or delirium, and “only 1

died”.

Table 3. Incidence of suicides and suicide attempts in antipsychotic clinical trials drawn

from U.S. FDA license applications [48]

Drug Patient No. Suicides Suicidal Acts

Risperidone 2607 9 43

Comparator 601 1 5

Placebo 195 0 1

Table 4. Antipsychotic Drugs, FDA Trials: Source FDA, David Healy [64]

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clinical trials included eight deaths. We are assured that the deaths

were not related to the olanzapine but, given the number of suicides

and deaths associated with the oral preparation, this seems to be

improbable. The U.S. FDA issued a “black box” warning about sudden

death from the new antipsychotic medications (including quetiapine

and aripiprazole) but only for the elderly, in spite of evidence that all age

groups are adversely affected [56,57].

Fluvoxamine

Fluvoxamine is metabolised by 2D6 and 1A2. 1A2 is induced

by cannabis and tobacco, so smoking both gives relief from toxicity.

Fluvoxamine is best described as a pan inhibitor as it is a potent

inhibitor of 1A2 and 2C19 and a mild to moderate inhibitor of 2B6,

2C9 and 3A4. Fluvoxamine was used in both A and C with olanzapine,

in the face of advice against this combination in PI.

Fluvoxamine, a CYP1A2 inhibitor, decreases the clearance of

olanzapine. This results in a mean increase in olanzapine Cmax following

fluvoxamine of 54% in female nonsmokers and 77% in male smokers.

The mean increase in olanzapine Area Under the Curve (AUC) is 52%

and 108%, respectively. Lower doses of olanzapine should be considered in

patients receiving concomitant treatment with fluvoxamine.

Fluvoxamine was the drug prescribed to one of the children

who perpetrated the Columbine High School massacre. Most school

massacres have been perpetrated by children taking prescribed

antidepressants or medications for ADHD [58].

The “atypical” antipsychotics: Risperidone and Consta, its

depot

Risperidone is metabolised by 2D6, has a shorter half-life than

olanzapine and may need twice daily administration. In trials presented

to the U.S. FDA, two thirds of subjects did not complete. Those subjects

have never been mentioned in PI or the scientific literature, but this

information is available at http://www.lillytrials.com and was summarised

by Grace Jackson for litigation against Eli Lilly in Alaska [59]. None

of the dropout rates, suicides and attempts is disclosed to prescribers

and patients. As a result, treating doctors, not knowing or expecting

these drugs to be poorly tolerated because they were misinformed

about clinical trials, organise for Mental Health Review Tribunals to

enforce them, by injection, to persons who cannot tolerate them orally,

as happened with Patient C. Coroners, if not willing to examine the

activities of hospitals where they are deployed several times a week, can

create a situation where regulatory agencies cannot be made aware of

this epidemic.

The FDA trials and 52 subsequent studies evaluated in 2000, by

John Geddes of Oxford University demonstrated no clear evidence

that atypical antipsychotics were more effective or better tolerated

than conventional antipsychotics [60]. Thirty-six, that being one in

every 145 clinical trial subjects for Risperdal, Zyprexa, Seroquel,) and

Sertindole died; most by suicide, yet these deaths are never mentioned

in scientific literature or prescriber information. These deaths occurred

even though two thirds of Zyprexa, nearly half the Risperdal and 80%

of Seroquel subjects did not complete the trials because the drugs were

poorly tolerated [61]. A rate of 27% akathisia in a trial of Zyprexa 10 mg

was balanced by an equally high incidence of akathisia on placebo [62].

This indicated that Eli Lilly either did not know what they were talking

about (as akathisia events including suicide and homicide are always a

medication-induced adverse drug event or, alternately, the participants

had not fully recovered from whatever they had been taking before

entry to the trial. Serious adverse events affected 84 subjects who took

Risperdal.

Zuclopenthixol decanoate

Zuclopenthixol depot has been associated with mental health

homicides, but invariably in combination, with other drugs that are

substrates of 2D6, as in the two cases presented here. The author has

personal experience of admitting patients homicidal on zuclopenthixol,

often co-prescribed with antidepressants and atypical (new generation)

antipsychotics. Several reports of this combination causing violent

attacks and homicidal behaviours were dismissed by the MBNSW, and

her report about patient C was turned into a complaint about her. As

did patients C and A here, many were experiencing akathisia, with

homicidal as well as suicidal ideation and acts [63-65].

The half-life of the zuclopenthixol depot preparation is 19 days, so

if it is given fortnightly, toxicity will eventually develop.

Summary

Patients C and A are but two of 48 people from the author’s clinical

and medico legal practice for 2D6, 2C9 and 2C19. Of the people tested,

42 were found to be poor or intermediate metabolizers and the rest

were overmedicated by PI standards. They were tested because they

experienced violent, homicidal and suicidal akathisia on standard

doses of antidepressants; one of them committed suicide, most had

made many attempts and three committed homicide on single doses of

antidepressants after 3 days, 2 weeks and 6 weeks on drugs that genetic

studies showed they could not metabolise; none of these three had a

psychiatric illness before or since, nor any history of violence. Only six

had normal CYP450 cytochromes, but they had either been given large

doses or had inhibitors in play. They had experienced many years of

counterproductive psychiatric treatments.

In the decade a following the introduction of the first of these

drugs, fluoxetine, in 1990, the population under mental health care in

Australia doubled and it has continued to increase. This is reflected in

Australian psychiatry’s vastly increased demands for resources [66].

Many ‘second generation’ drugs have followed this. The treatment of

schizophrenia with new drugs has increased mortality so care needs

to be taken before that diagnosis is applied, along with its remedies

[67-69]. Patients C and A are typical of persons under mental health

care who were not schizophrenic before they used drugs or received

treatment that induced symptoms similar to those of schizophrenia. Yet

testing for CYP450 mutations is available, for $140.00. That is the start

of appropriate personalised medicine.

Cannabis, its metabolites and 2D6

Cannabinols are metabolised by P3A4 and also inhibit it while

inducing 1A2. Sohayla et al. investigated the role of genetic factors in

cannabis dependence (hashish smokers) by CYP 2D6*4 genotyping of

46 habituated volunteers. Their findings suggest that genetic factors may

determine a person’s attraction to the effects of cannabis and other illicit

substances, but the mechanism is not obvious from existing research.

Diminished metaboliser status may cause cannabis to be experienced as

pleasurable, and if so, a propensity to substance-induced mood disorder

is a possibility. Cannabis smokers are said to have a tendency to become

psychotic later in life, but the mechanism is also obscure. Drug clinics

generally yield higher proportions of diminished metabolizers, for

reasons that have not yet been researched.

The common mislabelling of cannabis effects and other toxic

states as schizophrenia mania, major depression or bipolar disorder

Lucire Y (2018) The effect of CYP450 2D6*4 mutation on medication response: Two cases with different outcomes

Clin Case Studie Rep, 2018 doi: 10.15761/CCSR.1000112 Volume 1(2): 7-8

is counterproductive. The diagnostic criteria for all those disorders

contain an exclusion criterion for substance or medication use.

Misdiagnosis of mental and behavioural disorders as being attributable

to psychoactive substance use appears to contribute to the furphy that

cannabis causes schizophrenia.

Clinical prescriptions are available at F10-F19 “Mental and

Behavioural Disorders due to psychoactive substance” of the ICD 10,

still Australia’s official diagnostic system.

Drug clinic and cannabis users

The role of diminished P450 metabolism, specifically 2D6*4,

in cannabis smokers and the prevalence of mutations in drug clinic

populations generally bear further examination. One possibility is

that in diminished metabolism, 2D6 capacity may increase both

the pleasurable effects of cannabis and maybe other drugs and the

tendency to medication-induced psychotic phenomena. It may be that

they are already taking medication and are using cannabis to moderate

it. Suspicion of a high prevalence of diminished metabolizers at 2D6

among cannabis smokers might caution against the use of medicines

demand that substrate.

Misdiagnosis of mental and behavioural disorders due to

psychoactive substance use appears to contribute to the furphy that

cannabis causes schizophrenia.

Although ecological studies report an increase in schizophrenia

and bipolar illness, detailed analysis of such cases suggests that the

population that becomes psychotic on cannabis also develops neurotoxic

syndromes on olanzapine and risperidone, as well as antidepressants,

particularly those metabolised by 2D6.

References

1. Diagnostic and statistical manual of mental disorders: DSM IV (1992) Washington

DC: American Psychiatric Association 1994. And ICD International Statistical

Classification of Diseases and Related Health Problems ICD 10. Tenth Edn. Geneva:

World Health Organization.

2. DSM-IV-TR® Handbook of differential diagnosis (2007) Ch. 2. Differential diagnosis

by the trees american psychiatric publishing.

3. De Leon, J Scott, Armstrong Cozza, Kl Med-Psych (2006) Drug-drug interactions

update. Clinical guidelines for psychiatrists for the use of pharmacogenetic testing for

CYP450 2D6 and CYP450 2C19 Psychosomatics 47:1.

4. Sachdev P (1995) Akathisia and restless legs, Cambridge University Press. Cambridge.

5. Physicians Desk Reference Oradell New Jersey: Medical Economics Company 2003.

6. Hálfdánarson Ó, Zoëga H, Aagaard L, Bernardo M, Brandt L, et al. (2017)

International trends in antipsychotic use: A study in 16 countries, 2005-2014. Eur

Neuropsychopharmacol 27: 1064-1076. [Crossref]

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metabolizer phenotype may be associated with risperidone adverse drug reactions and

discontinuation. J Clin Psychiatry 66: 15-27. [Crossref]

9. Zullino DF, Delessert D, Eap CB, Preisig M, Baumann P (2002) Tobacco and cannabis

smoking cessation can lead to intoxication with clozapine or olanzapine. Int Clin

Psychopharmacol 17: 141-143. [Crossref]

10. Bauman P, Hiemke C, Ulrich S, Eckermann G, Gaertner I (2004) The ANGP-TDM

expert group consensus guidelines: therapeutic drug monitoring in psychiatry.

Pharmacopsychiatry 37: 243-265. [Crossref]

11. Ingelman-Sundberg M (2005) Genetic polymorphisms of cytochrome P450 2D6

(CYP2D6): clinical consequences, evolutionary aspects and functional diversity.

Review. Pharmacogenomics 5: 6-13.

12. Kaplan HI, Saddock BJ, Freedman AM (1980) Comprehensive textbook of psychiatry.

Baltimore: Wilkins and Wilkins.

13. Diagnostic and statistical manual of mental disorders (DSM-IV) (1994) American

Psychiatric Association. Drug Induced Akathisia.

14. Cannabis is metabolised by 3A4, 2B6 and 2C9. It is an inhibitor of 3A4 and induces

1A2. It remains in the body for up to two years depending on how much was used.

15. Shirley KH, YY Penzak, SR Lam, YWF Spratlin, V Jann MW (2003) Correlation

of cytochrome P450 (CYP) 1A2 activity using caffeine phenotyping and olanzapine

disposition in healthy volunteers. Neuropsychopharmacology 28: 961-966.

16. Cozza KL, Armstrong SC, Oesterheld JR (2003) Drug interaction principles for

medical practice: cytochrome P450s, UGTs, P-Glycoproteins. Arlington, Va, American

Psychiatric Publishing.

17. Refinetti R (1997) Philosophy of science and physiology education. Am J Physiol 272:

S31-35. [Crossref]

18. Hales R, Yudofsky S, Talbot, JA (1999) Textbook of psychiatry. Third ed. Washington

DC: The American Psychiatric Press.

19. Improving the quality use of medicines in Australia: Australian centre for health

research realising the potential of pharmacogenomics (2008).

20. Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in

hospitalized patients: a meta-analysis of prospective studies. JAMA 279: 1200-1205.

[Crossref]

21. Schulte JL (1985) Homicide and suicide associated with akathisia and haloperidol.

American Journal of Forensic Psychiatry 6: 3-7.

22. Healy D, Herxheimer A, Menkes DB (2006) Antidepressants and violence: problems at

the interface of medicine and law. PLoS Med 3: e372. [Crossref]

23. Breggin PR (2003) Suicidality, violence, and mania caused by selective serotonin

reuptake inhibitors: A review and analysis. Ethical Human Sciences & Services 5: 225-

246.

24. Yolande Lucire (2005) New Drugs, New Problems. Australian Journal of Forensic

Sciences 37: 19-25.

25. NSW Mental Health Sentinel Events Committee. Tracking Tragedy: A systemic look at

suicides and homicides amongst mental health inpatients (2004).

26. Healy D, Whitaker C (2003) Antidepressants and suicide: risk-benefit conundrums. J

Psychiatry Neurosci 28: 331-337. [Crossref]

27. Whitaker R (2005) Anatomy of an epidemic: psychiatric drugs and the astonishing

rise of mental illness in America. Ethical human psychology and psychiatry. An

International Journal of Critical Inquiry 7: 23-35.

28. Tanaka E, Hisawa S (1999) Clinically significant pharmacokinetic drug interactions

with psychoactive drugs: antidepressants and antipsychotics and the cytochrome P450

system. Journal of Clinical Pharmacy & Therapeutics 24: 7-16.

29. Oesterheld, JR Cozza, K Armstrong SC, Neil B Sandson (2007) Drug-drug interactions:

a compendium of case vignettes for the practicing clinician. American Psychiatric

Publishing

30. Letter from Eli Lilly Australia, cf Bauman, opp cit.

31. Communiqué: mayo reference services. Cytochrome P450 enzyme genotyping:

optimizing patient care through pharmacogentics. September 2005.

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Psychosomatics 44: 255-258. [Crossref]

33. http://medicine.iupui.edu/flockhart/table.htm; and http://www.pharmgkb.org

34. Sandson NB (2007) Drug-drug interactions primer. A compendium of vignettes for the

practicing clinician. American Psychiatric Press.

35. Blue Cross Blue Shield Association (2004) Special report: genotyping for cytochrome

P450 polymorphisms to determine drug-metabolizer status. Technology Assessment

Program 19: 1-34.

36. https://www.labcorp.com/pdf/Cytochrome_P450_2C9_LabCapsule.pdf

37. https://www.labcorp.com/pdf/gen_Cytochrome_P450_2C9_LabCapsule.pdf

38. Cassidy vs. Eli Lilly http://www.prozactruth.com/prozaccases.htm also http://www.

namiscc.org/News/2002/Fall/ProzacSuitSettled.htm

39. Wynn GH, Oesterheld, JR Cozza, K, Armstrong SC (2009) Clinical Manual of Drug

Interaction Principles for Medical Practice. American Psychiatric Publishing Inc.

40. Zourkova A, Hadasova E (2003) Paroxetine-induced conversion of cytochrome P450

2D6 phenotype and occurence of adverse effects. General Physiology & Biophysics

22: 103-113.

Lucire Y (2018) The effect of CYP450 2D6*4 mutation on medication response: Two cases with different outcomes

Clin Case Studie Rep, 2018 doi: 10.15761/CCSR.1000112 Volume 1(2): 8-8

To: ZB
Cc: PALS(LPT) (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST)
Subject: FW: Endocrinologist

Dear Z

Being deprived of meaningful contact with my daughter through her not having any section 17 leave which has been avoided for months on end – there is no greater punishment than that.  It is in effect having a drastic effect on my physical health.

Knowing my daughter is getting no better and never will under Ash Villa and held a prisoner in bed most of the day is heartbreaking.

It is hard knowing the true reality that we should never ever have come to this area where I wanted so much to provide the right living accommodation and support in the community.   That clearly is not happening and never will because it costs £4000 thereabouts to hold my daughter under Ash Villa a prisoner.   She will never get off the section whilst staff write negatively and constantly do so and all the time my daughter is lying there in bed during the day and becoming weaker and weaker physically.  Mentally she has capacity and is sharing information with me which I then share with the rest of the family in accordance with her wishes.

I do not expect a penny or any support from this area.   Such restrictive punishment in deprival of Section 17 leave is not conducive to recovery and is having a knock-on effect to my physical health and is of great upset to all my family.

My daughter was not seen as a risk to others in the former area otherwise she would not have been released without a Section in place.  She was also complying with treatment.

Regards

Susan Bevis

From: ZB
Sent: 19 May 2022 16:00
To: susan bevis
Subject: Meeting Points.

Hi Susan

Please see meeting notes from todays meeting.

  • S17 leave has not changed and remains at 2 x 30 minutes ground leave escorted by 2 members of staff.
  • Risk was explained regarding why E …… is escorted by 2 x members of staff.
  • Nursing advised that Elizabeth does see her advocate on a one to one basis however Elizabeth has refused from time to time.
  • Dr S advised the a consultant would be available next week to be involved in the meetings.
  • We discussed Takeaways and how these are becoming more frequent.
  • That you would like some inclusion.
  • You was offered invitations to Carers support groups and you refused these.
  • You would like to continue with the weekly meeting with a consultant.
  • You wish to visit on a Saturday @14.00

I will look at booking next weeks appointment and forwards to you in due course.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

ZB

Working hours Monday to Friday 09.00-17.00 pm

From: B
Sent: 16 May 2022 18:05
To: susanb255

Subject: Re: stress induced psychosis

Susan

They recognise that Elizabeth has stress induced psychosis but signally fail to recognise that they are the cause of much of the stress.  Do they not realise that being deprived of liberty is about as stressful as it gets.

Oh, and nasty tastes are an effect of the anticholinergic effects of the drugs.  Odd they don’t recognise that either.

B

Susan

Ask for a detailed explanation of why Elizabeth cannot be given s.17 leave.  Including a full appraisal of her current state of mind.not some utterly inadequate reference to outdated diagnostic criteria.  Section 17 leave is part of the rehabilitation programme and patients do not get better permanently locked up in a bizarre setting with hostile staff.

It is patently obvious that if Elizabeth does not want to engage with the staff in Ash Villa that they need to make better arrangements.  She clearly needs one to one psychotherapy with someone she can trust and who can break through the barrier that these mental health professionals themselves create.

No amount of incarceration in a locked ‘rehabilitation’ ward will improve her quality of life and all it will do is make her more determined to reject their interventions.  The idea that rehabilitation can be achieved in a lock-up is bloody ridiculous in any case.

As for schizophrenia I would suggest that the nurse needs to do some CME training.  Virtually no-one considers this an organic condition anymore and even where it is recognised as a disorder it is syndromal and not a condition with either aetiology or prognosis.  Thousands of those accused of being schizophrenics recover if properly treated.  Millions of others are simply drugged and locked up for convenience.  

I think that Elizabeth would show signs of recovery if she was given seven days leave and later attended as a voluntary patient.  If they cannot see that her defiance will not subside after this length of time they need to reconsider their chosen professions.

B  

From: : ZB 24 May 2022 10:12
To: susan bevis
Subject: RE: Managers hearing

Good morning Susan

I hope your well.

As advised on many occasions I am your single point of access, others will not reply but I will seek to gain the relevant answers and feed them back to you.

You will not be sent the link to the managers meeting today, Elizabeth has not given verbal consent to any member of staff although we have tried to gain this on many occasions.

Elizabeth has not been deemed to have Capacity to consent to your request on this occasion.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

Email: ZB Friday 09.00-17.00 pm

From: ZB
Sent: 10 May 2022 11:45
To: susan bevis
Subject: RE: EB

Good afternoon susan

To be clear Elizabeth does not have unlimited ground leave  ground leave is 2 x 30 minutes a week

However we have a locked garden which elizabeth can access this does not fall under leave.

Hope this clarifies for you.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

Email: ZB Working hours Monday to Friday 09.00-17.00 pm

From: ZB
Sent: 09 May 2022 16:22
To: susan bevis
Subject: EB

Hi Susan

Thank you for your email.

To be clear on the garden, we have a private garden on the grounds and Elizabeth has full use of them when ever she wishes to have some fresh air.

This has been mentions on a couple of occasions.

As you are aware Elizabeth is held on a section 3, this went to tribunal and was upheld.

The professionals in the meeting have agreed this is the right things for Elizabeth at this point in her recovery.

All next possible steps will be considered for Elizabeth moving forwards.

Kind regards

ZB

Ash Villa

Sleaford

NG34 8QA

Email: ZB

Working hours Monday to Friday 09.00-17.00 pm

From: B Sent: Saturday, May 7, 2022 8:21:34 PM
To: susanb
Subject: Re: Negligence

Susan

There is no tangible reason why Elizabeth cannot be given s.17 leave and the refusal to allow her some respite form permenant confinement is positively detrimental to her mental health.

In a nutshell they are institutionalising her by stealth.  This is a human rights issue and not one for half-assed tribunals.  I am quite prepared to help you put together a case if Elizabeth agrees.  The matter needs taking to the High Court on the grounds they are acting ultra vires.

This circumvents the institutional bias of the tribunals and involved decisions based on well establish law rather than the convenience of the staff at Ash Villa.  It is utterly absurd that she has not had some home leave in eight months. Even a restricted patient would have been allowed some leave.

B  

—–Original Message—–
From: susan bevis <susanb
To: B
Sent: Sat, 7 May 2022 18:32
Subject: RE: Negligence

I will try and do that tomorrow but doubt this will be allowed.  They are totally avoiding the issue of leave.  One doctor after another.  I am not racist but they seem to be and do not seem to care one bit.  I have not spoken to elizabeth for several days.  Cannot get through on the phone.

What they are trying to do is isolate and keep her away from her family as they have their own agenda clearly and none of us agree with that.  Why should my daughter have to go to another locked prison instead of coming home in accordance with her wishes.

This area is an absolute disgrace when it comes to mental health and the facilities are not fit for purpose.

I thought Enfield was bad enough.  Elizabeth has been held now a prisoner deprived of contact and leave now since September.

Regards

Susan

PTSD and Complex PTSD can seriously affect the default mode network in the brain and cause faulty neuronal connections that can lead to psychotic symptoms.  The failure to perceive this as an injury rather than a disease causes bio-psychiatrists to employ medications that cause further injury to this complex structure of inter brain communication, which consequently causes cognitive dysfunction and psychosis.  

Bob Johnson has focused on this and the concomitant decreases in oxygenated blood in the brain.  

Neuroleptics will not treat PTSD but merely depress the more florid symptoms of it.  The problem is that they also cause the disruption in the DMN to get worse.

Bob’s comments on the effects in Broca’s area of the brain is fascinating.  This is the centre for language processing and damage there might account for the word fixation that is seen in some patients incorrectly diagnosed as psychotic.  

“Dr Richard Ngomba and I are also looking into disruptions in the mesocortical pathways potentially caused by brain inflammation.”  Decreases in oxygenated blood may well cause the triggering of inflammation in the temporal horn.    We saw in Martin Harrow’s study that neuroleptics have caused a marked decrease in cognitive function in patients prescribed these drugs long term.   Precisely what you would expect in patients with damage to neural pathways (mesocortical pathways) 

Professor Roderick Orner, who is an international authority on complex PTSD is in our research group.  

Subject: What is complex PTSD? – Mind

https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/complex-ptsd/


Disruption in the default mode network (DMN) has been implicated in numerous neuropsychiatric disorders, including posttraumatic stress disorder (PTSD).

My work has focussed on trauma recall.
This is blocked 100% in severe, untreated cases.
If the DMN is “autonomic’, then it is less significant clinically, than
voluntary, or insight driven cerebral
activity.

DMN abnormalities in patients with severe PTSD symptoms
are characterized by decreased overall inter connections.
Absolutely – but especially, as mentioned in Broca’s area, and the
frontal cortex. Decrease is an understatement – the blank look on the
faces is underpinned by Kolk’s PET scans when trauma tapes are played.

Those decreased interconnections are another potential reason why
patients incorrectly diagnosed with psychosis who are actually suffering
from PTSD are treatment refractive.
2 points –(1) beneath every psychotic symptom I have examined, there is a
fiercely blocked trauma. In one transcribed dialogue a 40 year old
verbalises the difficulty she has thinking. PTSD in spades.
(2) If the treatment envisaged is neuroleptics, then, as Harrow showed,
it makes things worse. In my view it does this by blocking even the
beginnings of reactivation of frontal cortical blockage, which is intimately
linked to Broca. Drug induced zombies cannot begin to pull themselves
together.

The decreased interactions will interfere with the uptake of psychopharmaceutical medications by creating an effective block in neurotransmitter receptors in the mesocortical pathways.
Is the assumption here that better uptake is clinically beneficial? Clinical
evidence does not support this, though bio-psychiatrists swear by it.
And, yes, the blockages noted by Kolk were arterial, oxygen supply related, I
imagine, which implies the whole frontal area shows decreased activity.
DR Bob Johnson Page 2 of 2 Your 6 points – 1MAY22

New Responsible Clinician Dr S I

Responsible Clinician Dr H M S

Ward Manager A B

Carers Rep ZB

Dr I has only recently taken over from Dr S and Ward Round is changed to Thursdays.

Last weekend’s visit followed everywhere by two members of staff all around the grounds.

CCTV installed outside Elizabeth’s room.

Still waiting to hear from MHA Office Manager regarding link to Tribunal as Elizabeth wants me to attend.

Have requested CCTV footage from FREEDOM Fire and Security regarding alleged assault in grounds whilst standing next to CCTV cameras on 3 April. FOI request also submitted to Trust Records. Still waiting to hear.

Turned to Adults safeguarding as most concerned regarding Elizabeth’s welfare re lack of exercise and fresh air and also now possible cancer on waiting list for Oncology when I could have provided the necessary tests privately.

Paid £38 for chiropodist to visit Ash Villa as Ash Villa cannot cater for this leaving patients in pain.

From: ZB
Sent: Friday, April 8, 2022 4:49:43 PM
To: susan bevis <susanb255@outlook.com>
Subject: Sundays leave

Good afternoon Susan

It has been raised that you wish for 1 hour ground leave on Sunday

This will not be granted.

The Section 17 leave that is in place is for 30 Minutes twice a week.

30 minutes has been taken today the reminder can be taken on Sunday.

To be clear you have 30 Minutes ground leave booked in for Sunday at 14.00pm

Kind regards

ZB

Carer Champion

Ash Villa

Sleaford

NG34 8QA

Working hours Monday to Friday 09.00-17.00 pm

The Visits are barely worth coming to flanked by two members of staff. Vicious threats to arrest me for assault on a member of staff. My daughter’s complaints to CQC not dealt with.

An inspection urgently needs to take place at Ash Villa Lincolnshire Partnership Trust.

MY DAUGHTER IS BEING ABUSED BY THIS HOSPITAL AND HER LIFE IS PUT AT RISK. IT IS HEARTBREAKING THAT SUCH PROFESSIONALS WORKING WITHIN THE NHS CAN GET AWAY WITH SUCH CRUELTY AND NOTHING IS DONE ABOUT IT.

THIS IS PUNISHMENT NOT FIT FOR PRISON

Yesterday’s ward round took place and again my request for Section 17 leave refused. Elizabeth will neither be able to come home at Easter or spend any time with family unsupervised. Instead she will spend much of her time inside as I did not realise she had so little entitlement for fresh air and exercise. Whilst other patients are allowed out in the grounds alone Elizabeth is not and staff (someone called Helen) tucks her into bed during the day and she spends most of her time in her room, trying to keep warm. She has caught covid on the ward and nobody bothered to tell us as we are regarded as nothing in this institution. She wears pyjamas during day and night and now struggles to walk. I am concerned about the extra injections of prn which Elizabeth thinks are given in punishment for I/C. To give such injections straight afterwards sounds to me like she could be right. During my shortened visit which was only allowed outside due to covid, Elizabeth was cold and had to go back inside to get a coat. Elizabeth sat on a bench with me, witnessed by a ‘family friend’. I managed to sort out WhatsApp for her. Her phone was dead but I brought a charger with me. WhatsApp is where I send photos of her cat who she misses so much as well as home. No idea how much per week this unit costs but would not be surprised if it was over £5000 pw and not benefitting her at all. There seems to be staff shortages on the ward and sometimes only male nurses on duty. Elizabeth complained about her toe nails hurting which was pointed out to staff supervising but nothing done so I understand. Elizabeth was pleased to see me but the visit was cut short due to a CPA which apparently did not take place. I thought my visit was for one hour but I have only just found out just how restrictive a prison this facility actually is. I thought at least 30 minutes a day was allowed but I was wrong as the carer’s rep mentioned 30 minutes twice a week which is nothing. Elizabeth looked pale and overweight. The new coat I bought her for her Birthday did not fit around her stomach. Through lack of exercise and fresh air Elizabeth did not look at all well and complained she could hardly walk – not surprisingly. The only thing she looks forward to is my visit bringing her a few nice things – healthy treats and some money. Her breathing is not good at all and this was pointed out by the previous care coordinator in former area but nobody under this team has anything to say about this or the discharge note stating all physical health concerns and now possibly breast cancer. It has now been 6 months of imprisonment under Lincolnshire Partnership Trust (because of failure by the NHS to get the depot in place in the local area where we now live) and to be frank she would have been treated better in prison. I had visited the golf club nearby to buy something nice to eat for her and her friend to share. Elizabeth was ordered into the building by staff stating there was a CPA which she did not even attend or took place without her. Absolutely no consideration is given to carers who have to drive a fair distance to visit and now I do not even feel comfortable to visit alone after nurse (FB) accused me of assaulting a member of staff last week and they called Police again on me. This morning I wrote to Pals and added my concerns regarding the awful event last Sunday and I requested CCTV footage not just for this but for the in respect of the Ward Manager’s letter sent Special Delivery accusing me of threatening intimidating behaviour. All evidence would have surely been recorded one way or the other because you simply cannot go by a word staff say having read court papers and especially after last Sunday’s visit. I have nothing to hide so let’s see the evidence. All this is done to destroy your character and undermine you as an unfit parent/carer by NHS personnel who are desperately trying to protect themselves and they do this by discrediting you which amounts to bullying, all of them sticking together and protected by the carer’s rep so it would appear who is acting like a shield and defensive towards the staff not acting in your interest or speaking up for you as a parent and carer.

I am so concerned at the way my daughter is being treated that I recently raised a safeguarding and it was then I discovered that I was not under any safeguarding myself which I thought I might have been due to the restrictions towards me on visiting.

Staff at Ash Villa advised that such restrictions are in line with their Policy and that my daughter was on a different section that warranted such restriction but whilst I am still Nearest Relative, I should be entitled to know such information but no-one wishes to say a word. The MHA Office has failed to respond to my emails when I requested the link to the last tribunal which my daughter wanted me to attend.

There is no doubt Elizabeth’s physical health is declining under this dreadful institution, the worst we have ever come across.

As per the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Ash Villa is in breach of the following:

Ensuring the privacy of the service user;

Supporting the autonomy, independence and involvement in the community of the service user;

A health service body must act in an open and transparent way with relevant persons including NR’s in relation to care and treatment provided to service users in carrying on a regulated activity.

Severe harm, moderate harm or prolonged psychological harm to the service user.

ASH VILLA’S AGENDA

It was revealed by Dr S. that no Section 17 will be granted, no explanation given. The only entitlement is thirty minutes in the grounds twice a week supervised only so straight away this is not going in accordance with the Health and Social Care Act 2008 above in bold. This is punishment not care and even if there was dislike towards me there is no excuse to treat Elizabeth in this manner and deprive exercise and fresh air to her. I had not been writing a blog or publicising anything to do with care here. I had hoped it would be possible to make a fresh start.

It was revealed that Rehab was considered best option rather than discharge home so no note has been made of the previous CTR and the fact that Elizabeth had backing to come back home though nothing in the way of support was put in her independent flat. No respect for Elizabeth wanting to come back home or for her family.

We are so fed up with the NHS that we as a family will be prepared to provide everything privately including the depot so she could in fact come home as after 6 months of not benefitting by restrictive prison style facilities, surely something can be provided for her in the community and if they can’t then I will. The excuse they make seems to hinge upon Elizabeth’s return back to their facility after a successful stay with her family over Xmas. They say now their plans have changed as a result and this is all very wrong because on return to Ash Villa she was thrown into meetings and Tribunal which was overwhelming for her. They do not understand autism one bit and choose to ignore the fact that whilst Elizabeth’s screenings for autism have all come out positive, she does not have an official diagnosis.

Physical health appointments have had to be cancelled, she is placed on a waiting list as an urgent referral for cancer tests, MRI scan previously refused for Limbic System plus no blood test done, (though on this second occasion) she did refuse. The scan should come first in any case which was flatly refused previously.

Several doctors have left, replaced with new doctors.

The ward round was short, distressing and achieved nothing other than confirmation of their future plans for rehab which the RC said everyone agreed on. I do not think some members of staff are that happy about what is going on under Ash Villa but feel that this is a culture thereunder rife with bullying as I have been bullied myself by nursing staff and Management of Ash Villa to such an enormous extent where I have had to request CCTV evidence to support me.

I hope safeguarding done on Ash Villa will scrutinise thoroughly recent events and what goes on behind closed doors as I have nothing whatsoever to hide otherwise I would not be writing openly.

Ash Villa seen to have adopted their own policy, code of conduct and rules where no human rights exist and no Dignity or Respect towards patients and carers as evidenced. They are most certainly in breach of the Health and Social Care Act 2008, MHA law and human rights law but how many more institutions such as this are failing vulnerable people like my daughter whilst focus is on Ukraine right now. Thought should never be ignored about the abuse going on towards the weak and vulnerable in care homes and institutions throughout the UK especially when the UK is offering to take in migrants from Ukraine who may be badly traumatised. God forbid if they end up under the UK’s failing mental health facilities.

Meanwhile builders are getting on very well with demolishing the old garage and we now have the comprehensive plans to provide/build a separate living accommodation but this team at Ash Villa do not want her to come home in accordance with her wishes and have no respect towards patients or carers alike in contradiction of their Charter.

As I feel so unrepresented and unsupported I have had to seek advocacy myself.

On this lovely sunny day I made the usual journey to visit my daughter at Ash Villa, Sleaford. I takes me over an hour. Elizabeth was excited and happy about me visiting as I always bring her some nice things. I give her money for the week also. She had made a list of things she wanted me to bring her.

Here are some of Elizbeth’s most recent messages:

“There is a man in Ash Villa and his comments were not nice to women”

Is that right what you told me that J injected you for incontinence “yes” pls report this.

“Can you bring a bike for me to ride around here”

“I’m still awake cant get comfy I wanna ride a bike through Sleaford Forest.”

“K one of the young girls who helped me on the shower said we’re nice here – duno what she means”

“K says you are lovely to be around when you are well”

“they are nasty and spiteful”

“The chaplain came see me he had a ??cat.”

“Can you bring me a picture of fluffy.”

“I’m so looking forward to seeing you ag”

I took the email below as permission to visit Ash Villa today at my usual time and assumed that if there was any problem I would have been advised by the Carers Champion, my only point of contact. I had written to her below following Ward Road but heard nothing and I would always ask permission and visit on a Sunday at 2.00 pm which is over an hour’s journey for me so I make a day of it.

From: Shahpesandy, Homayun (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST)
Sent: 01 April 2022 14:56
To: susan bevis; safeguarding@cqc.org.uk; Enquiries;

Subject: RE: Ward Round 01.04.2022

Dear Ms Bevis,

I have just left the meeting, and have another in 5 minutes.

I am happy to consider s17 for Sunday in hospital grounds.

I will respond to the rest of your questions next week. You could also liaise with Z as she is very well informed about the outcome of the meeting just finished.

Best wishes

Dr H Shahpesandy

From: susan bevis <susanb255@outlook.com>
Sent: 01 April 2022 14:38
To:ZB(LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) shahpesandy, Homayun (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <homayun.shahpesandy@nhs.net>
Cc: PALS(LPT) (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.pals@nhs.net>; safeguarding@cqc.org.uk; Enquiries <Enquiries@cqc.org.uk>
Subject: Ward Round 01.04.2022

Dear Z/Dr Shahpasandy

Due technical problems on the part of Ash Villa and ward round commencing late and time being short I wanted to make the following points and confirm what was agreed.

First of all I am hoping to visit my daughter on Sunday 3 April and wish to book ground leave at 2.00 pm.  Please confirm?

It was discussed, following discovery of lump/s on Elizabeth’s breast that an urgent referral has been made to Oncology for an assessment,  appointment to take place within two weeks.   I had offered to pay privately for an immediate appointment but this you declined.

It was discussed about the MRI scan –  the scan, previously refused by you has now been agreed but I am unsure whether a referral has been made?

I could not hear what was being said about the blood test re Limbic System.   Elizabeth agreed to this when I explained what it was for so I would like your confirmation that this has been done.

I still have received no answers as to Section 26 – an explanation to me as NR why I am not allowed leave with Elizabeth other than supervised.

Safeguarding was mentioned at last ward round to be going on against me but as I am excluded from such meetings surely this is against natural justice?   There therefore needs to be a Section 42 meeting with Police/everyone present.  This could ruin career chances for me and my dbs.   I won the previous Ombudsman case when safeguarding went on secretly behind my back previously.  Please therefore ensure that a Section 42 meeting with entire family present is arranged

You confirmed the Manager’s hearing would be in April.   I am referring this to the CQC as I am still Nearest Relative and have been ignored by the MHA Office and feel like I am being bullied out of my role as NR by threats of legal action re displacement and not only that, in the case of our Power of Attorney.  I have been bullied and threatened so many times with legal action that if this is the route if I end up in court representing myself again the good thing is I did a very thorough job and this will bring about openness and transparency regarding everything Ash Villa or the  community MH resource centre or similar department is doing behind my back.

You said the plan had changed since Xmas in terms of release.  When I asked what the latest plan was you declined to answer.  Following successful leave at home without any problems, Elizabeth came back to your ward unsettled.  Well it was no wonder why.  She had started to settle down at home and was happy to be at home then had to come back to your ward and be faced with Tribunal and meetings which she absolutely hates.   Her presentation on her return back to your ward has been used as an excuse in terms of justification for her still being incarcerated after all this length of time, being held just like a prisoner.

Talking about punishment that is what we see you are doing by depriving any S17 leave and treating my daughter like a prisoner.  As I said at the ward round you are in breach of Art 8 and 3 of the Human Rights Act.  

I also feel as though there is discrimination against Elizabeth’s religious rights to go to church and to have a visit from Georgina Machell.  I have notified my concerns to Reverend Georgina Machell.  I am notifying the local churches how I feel my daughter is being deprived/discriminated against in this respect.

As regards delegation of my role as NR I have no intention of doing so until a Manager’s Hearing is called which you said would be end of April.  I have explained to Elizabeth who has had enough of being on your ward held a prisoner on such lengthy detention with such restrictive practice and this is not what she wants.  You have already said the matter of legal action against us as Attorneys is being dealt with separately.  Everything is being done to discredit us as parents and I want this thoroughly looked into.

After all this time, still nothing in place in the community so behind the scenes there are clearly other plans that you do not wish to disclose which is why I wanted that Manager’s hearing which comes under mental health law.  I as NR am entitled to call such Manager’s Hearing which request on my part is something that S.J in charge of the MHA office has avoided response to which I will get the CQC to look into as I feel that my daughter’s human rights are being abused under Ash Villa and she wishes to come home.  She has told you that on numerous occasions.

I am also concerned that B. the advocate from Voiceability should be allowed to see Elizabeth alone without any members of staff being present and this has not been the case at all from what Elizabeth has told me.  

Regards

Susan Bevis

I arrived early in Sleaford at St Andrews Church, Kelby. The history of this church is impressive, 12C parish church with 13th and 14th C additions nd tower/spire rebuilt in 1850. dating back to 1850. It is a Grade 1 Listed Building. It is a shame this church has been neglected in terms of condition. The service was very nice and I updated Reverend Georgina Machell on the latest re Elizabeth and said I would be visiting her later. I voiced my concern that the Carer’s Rep ZB had contacted me to say they had to refer Elizabeth for urgent Oncology tests due to a lump or lumps on her breast. I told her that restrictions were still placed against me visiting the ward and seeing my daughter other than supervised visits much like in prison and I voiced concerns that my daughter has told us the family that she is being abused.

After this I went swimming and then made my way to see Elizabeth.

When I arrived at Ash Villa, my usual time of 2.00 pm, I was confronted by two members of staff at the front door and I explained that I had permission to visit Elizabeth. The acute nurse FB said they knew nothing about my visit and that no visits were allowed because of yet another case of covid. It is not surprising that covid spreads easily in this facility because there are no ensuites and shared bath/shower rooms. Elizabeth has told me she has had to change rooms a few times. The member of staff accompanying FB was a HCA (VL). When I looked at her name back she tried to cover this up with her hand and I found their approach towards me as quite intimidating as all I wanted was to hand the things I have brought to Elizabeth as I wanted to make sure she had got them.

I knew I would not be allowed on the ward to visit so I then said what about her entitlement to come out in the grounds for 1 hour (Elizabeth had not been allowed out that day) I had driven for over an hour to visit. The answer was a firm no. No intention to allow me Elizabeth out in the grounds not even for 5 minutes. I noticed several other patients outside in the fresh air unescorted so I enquired why could Elizabeth not come out in the fresh air for her 1 hour break obviously keeping a distance away from me. I was again told no which was very upsetting. Elizabeth wanted me to visit today. I was then advised to come back again during the week but they just do not appreciate how expensive it is to drive all that way, not to be allowed even 5 minutes just to pass over the things I brought and be assured Elizabeth has them. I found staff to be intimidating and threatening towards me. They wanted proof so I had showed them the email as above from her doctor but this made no difference. I then asked if I could hand my daughter’s things to her. They had by this time led her to a room where the sash window was very slightly open and I was advised Police had been called. Sure enough several police cars turned up . I could just about see Elizabeth through the small opening in the window. FB accused me of assaulting a member of staff. This serious allegation made Elizabeth flare up and yell at staff to “get away from her” and she said “no my mother has not assaulted a member of staff”. I said in response to the slanderous accusations that there was CCTV all around. I later obtained a reference number from Police just in case matters got escalated. There was a male nurse present also in the small room busy writing some kind of report. I wanted to help Elizabeth with WhatsApp as she is unable to receive photos of her cat I had sent her but the phone battery was quite dead so before I left the premises I asked Police if they could ensure it was charging and I explained staff put the phone in her locker making it difficult for family to have contact. The situation at Ash Villa is becoming more disturbing and something is going on behind my back that is for sure.

I just feel alone and unsupported – I get to hear through Elizabeth her distress of several letters going missing.

I was asked by Police to remove my car which I did.

I then drove back home.

I was advised I should get an advocate to look into what was going on behind my back. It is not very nice at all when so many are against you and I cannot think of a better way to describe their actions as bullying.

When I first arrived FB (acute nurse) said she was sorry for the mis-communication as I had shown her the email. The same degrading thing happened at Ward Round which is virtual. I could not get into the meeting on the link already sent which did not work then received an email stating “can I please join the meeting” However, I waiting to be admitted and noone was allowing me in to this meeting. It narrowed the time down to virtually nothing. It was supposed to be 30 minutes but more like 10. Because I hardly got to say what I wanted I put everything in writing afterwards and the response is above.

It is a horrible when a whole team of “professionals” gang up against you, holding secret meeting and slag you off behind you back under safeguarding for which you are excluded. There was another member of staff hanging about outside and because I was so concerned they would all back one another alleging I had assaulted a member of staff I made a point of telephoning police when I arrived home and getting a reference number.

Lincs Police were professional in their dealing towards me. I was always looked upon sympathetically in the former area by Police who my daughter regarded as her friends. She would call police and ambulance because she was lonely as they never provided any care in her independent flat. This is why we moved hoping to be treated better in this new area but everything has been a disaster. I have had all this work done to my house just to benefit Elizabeth and am now beginning to commence the building works for Elizabeth’s separate living accommodation.

Elizabeth said she saw the Chaplain but he was not allowed to see Elizabeth alone. She told him that she was very unhappy at Ash Villa. She said he was going to visit her again.

It is the same with the advocate of Voiceability. I always thought it was unlawful for a member of staff to be present and listening to a private meeting with her advocate, correct me if I am wrong here. I thought the idea of an advocate was to see a patient on their own but not even the dignity of this is allowed by staff at Ash Villa.

I have been sent an article “Importance of ‘I’ in IMHA by Catherine Pease Consultant Solicitor of Peter Edwards law about the independence of advocates and how mental health professionals view and treat IMHAs. One advocate said “I have been asked on numerous occasions what my view is in relation to someone’s treatment or asked to attend professionals meeting without the service user present. I am staggered at the lack of understanding by some professionals as to my role as an independent advocate and their surprise that I do not hold a clinical view on their required treatment.” Apparently a social worker/care coordinator had asked this advocate to contribute towards a social circumstances report for Tribunal who was very surprised when the advocate declined wanting information to strengthen an argument in favour of the patient’s ongoing detention. This shows how awful professionals behave and another advocate said she was asked to attend meetings in the absence of the patient and not to tell them about forthcoming ward rounds or inform them about their care and treatment plans in case they get upset and cause trouble on the ward.

I will have to feature more on this topic on another blog together with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the contents of which are very interesting. “Service users must be treated with dignity and respect.” Dignity and Respect – None whatsoever exists at Ash Villa. Elizabeth has not even got her care plan and cannot find any of her letters she said were from her solicitors. I can only assume these were on her detention continuing. Perhaps the tribunal went on behind her back but she was in fact given the excuse the care coordinator could not attend for some reason and the tribunal was adjourned. I have since asked for a Manager’s Hearing as I am still the Nearest Relative and Elizabeth agrees with what I have done.

The other interesting article I have seen is https://www.medscape.com/viewarticle/971481?src=

Medscape is the leading source of clinical news, health information and point-of-care tools for healthcare professionals. Medscape offers specialists, primary care doctors and other health professionals the most robust and integrated medical information and educational tools.

Medscape Education (medscape.org) is the leading destination for continuous professional development, consisting of more than 30 speciality-focused destinations offering thousands of free C.M.E AND C.E courses and other educational programs for doctors, nurses and other healthcare professionals.

Very interesting article featured:

“United Lincolnshire Hospitals NHS Trust ordered to pay £111,204 in fines and legal costs after pleading guilty to failing to provide safe care and treatment to an elderly patient, causing them avoidable harm, following a sentencing hearing on Friday 25 March at Boston Magistrates Court.”

The case was taken by the Care Quality Commission (CQC) under regulations 12 and 22 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

I do not feel my daughter is safe under Ash Villa with covid case after covid case and having to wait for an appointment that we as a family would have provided immediately for an urgent oncology assessment in light of the lump on her breast. She was expecting a visit from Junior Dr RM about the blood test on Friday morning but Elizabeth said she did not turn up as expected. I have been told by a leading expert in any case that the scan should come first and this is what has been consistently denied to Elizabeth by her Doctor who says a scan is unjustified, yet it is HIS research and study into the Limbic System that is being denied to Elizabeth which is surprising.

I think that Section 3 has been renewed and at ward round it was discussed about the Manager’s Hearing being end of April.

I will finish this blog with Elizabeth’s most recent comments “I am desperately waiting to come out of this dreadful hospital”.

Today’s ward round took place this morning delayed by technical problems meaning whereby I could not join the meeting despite having the calendar link and had to re-join using another link.

I heard yesterday that it has been discovered Elizabeth had a lump/lumps on her breast and my first thought was about long waiting lists for such assessments due to covid. I therefore offered to pay privately but this was dismissed as being unnecessary and they tried to reassure me that her appointment would be within a couple of weeks. I do not feel reassured as I have no idea how long the lump/s on her breasts have been evident but was told this was only recently discovered. I then enquired regarding the MRI scan previously refused by Dr Afolafi when I offered to take her back to London. Dr Shahpasendy also had refused a blood test for his own Limbic research but hopefully this can now go ahead too. This was the reason why Elizabeth was admitted to hospital in the first instance under S136 when she called into her GP surgery in the former area demanding an MRI scan. No she did not smash up the surgery or jump over the desk as documented. There is a pack of lies documented in file notes regarding this incident. It is hard to trust a single thing that the NHS does in light of this and when you ask for corrections to be made this is ignored.

Section 17 leave was discussed and once again refused by Dr Shahpasandy and team so Elizabeth continues to be held in the most restrictive manner like a prisoner without even the most basic human rights. How degrading is it to drive for over an hour for a meeting just for half an hour, the to call Elizabeth in for five minutes to accommodate the other half an hour allowed. I was advised that the entire Disciplinary Team were in agreement with this to make it look like it was everyone concerned but I doubt this is true and have seen evidence this is not the case but there is clearly a culture of bullying under Lincolnshire Partnership Trust.

I only saw a few present at today’s meeting but here is an example of how many “professionals” you are up against who are invited as a matter of course.

There are 4 other doctors, some of which are trainees.

Afolabi Temitope

Auty Charlotte

Middleton Rachel

Patel Ashishkumar

I dont know who half these are but they are perhaps on video link:

FB

SG

GJ

MJ

SM

SM

JP

CS

G J S

KS

JT

JH

JF

LOUTH CMHT

ZB

KB

AB

There is just myself invited from family but excluded from the main part of the meeting which is conducted in secret as they do not want to reveal their true agenda, secret meetings held by a multi disciplinary team to discuss their plans against us as a family. Safeguarding would appear to be continuing behind my back. It is all about protecting one another, plans to get rid of me as a Mother, carer and Nearest Relative who they use bullying tactics against – I can’t think of a worse punishment than restricting contact in the way they are doing.

When I tried to discuss Section 17 leave Dr Shahpasandy said that there would be no change – supervised escorted grounds visits only. I told him that this was in breach of Art 8 and 3 but he responded that everyone was in agreement because of their collective concerns against me but I sense this is not true. He refused to discuss S26 MHA when you as nearest relative are entitled to explanation as to why such restrictions are in place. We see it as punishment.

To deprive someone of their religious needs and going to church is discrimination and then when Reverend Machell tried to contact confidentiality was being played upon and it is impossible to get through sometimes on the phone.

CODE OF PRACTICE

Treat people in places that are safe and help them get well  – “I will never get well in here” Elizabeth stays in her room most of the day according to male nurse called Fred.    She has not been in any trouble. She lies in bed a lot to avoid noise and seems to be up late night as this is when I get her calls.  Elizabeth has also phoned to say she was freezing but Dr Shahpasendy denies this. She says the bed in uncomfortable and her back hurts. I brought blankets for her to the ward but was told these are not allowed from outside the ward. I had to advise staff as Elizabeth finds it difficult to ask for things. She often tells me that “the doctor/or staff are putting words in her head”. If you dont ask you do not get in that facility.

Think about patient’s physical health as well as their mental health.   Elizabeth has been refused various physical health appointments – one most recently in London by Dr Afolafi which was a Neurologist appointment in London recommended to attend by the new GP.    (“it is a doctor’s absolute duty to investigate abnormal findings on a scan as mentioned on Discharge note from previous hospital.

The scan was consistently refused by her doctor who has only just reconsidered this now that I have pointed out re his research into the Limbic System.

Work together to give you good safe mental health services and the right support when you leave hospital.   No this is the not the case at all. Quite the opposite as you are up against so very many all backing you. This facility is very distressing to Elizabeth which is probably why she spends much of her time in her room.  She cannot stand noise and has sensory issues.  Their plans have changed since Xmas as Elizabeth returned to the ward distressed. The leave was a tremendous success but she was distressed at going back and being thrown into meetings and tribunal now everything has changed and the restrictive visiting rights are most probably just the tip of the iceberg and I assume leading to even more restrictions and banning of contact. This has been done to me before. I thought doctors were meant to do no harm. In fact it puts you off ever seeing a doctor again as there is no thought, no compassion towards you as a carer or towards a family who are trying to provide a decent living accommodation that is safe and comfortable and all they can think of is to get rid of you. After all these months nothing has been provided by the community MH team whose agenda is to gang up against you and take you to court to get rid of you. They are situated in Stamford and Lincoln from what I can see.

Patients’ Rights The Code says patients should have a say in their care and be treated with dignity and respect  –  Voiceability are supposed to the advocates but are never there to support Elizabeth at meetings. Even when her advocate did telephone a member of staff, namely Katy remained present at all times so even advocates are only allowed supervised contact at Ash Villa by the sound of it. Elizabeth finds meetings stressful especially where she is constantly questioned. She is refusing to attend such meetings and when she has done, she has stormed out because staff fire question after question at her – same questions all the time about where she wants to live.  Constantly she says she wants to come home.  What dont they understand but perhaps this is not their agenda and they know nothing about the family. There is no dignity and no say at all. Only a CTR in the former area provided Elizabeth with a chance to say what she wanted and be listened to but not under Lincolnshire Partnership Trust where it is like going backwards.

Work together to keep patients in hospital for as short a time as possible  This is definitely not the case. All this length of time, going back to September and still nothing provided in the community. Elizabeth has been detained in facilities totally wrong for her due to noise, extreme restrictive practices and deprived not only of her liberty but fresh air and exercise with physical health appointments dismissed and ignored that should have been dealt with from the very start of detention. In addition, she has been deprived of having quality time with her family except for just a few days at Xmas which was a great success but on her immediate return to Ash Villa she had a tribunal and meetings which greatly affected her to which she reacted.  This put back her discharge back as it was originally planned for her to come home but now there seems to be other secret plans going on behind our backs and care homes have been mentioned more than once. There is currently an attempt to get rid of myself and Mr Bevis as Power of Attorney and we are being investigated right now.  I am being accused of stopping/encouraging to stop treatment which is not true and I can prove it. They are also slating my character detrimentally in other ways and in general trying to discredit me in particular. They are also trying to get rid of me as NR, stating Elizabeth does not want me as such and denying me having a Manager’s Hearing and displacing me with my younger daughter. What kind of a system is this!  

Services must stick to laws about treating people equally and fairly.   There is no fair treatment under Ash Villa because not only are visiting rights totally restrictive, she is not allowed out for fresh air whilst during my visit. It is so degrading to have two members of staff stand over you in the same room listening to every word of conversation treating you like a criminal and it is not a nice experience for Elizabeth either.

§  The Code says patients should have a say in their care and be treated with dignity and respect.   There is no dignity as per the above Code and with such restrictive practices akin to Dols there is no respect either for carers or patients alike. Their Charter looks good on the surface but you are not treated accordingly so why even bother to display this on the wall.    You are treated in a condescending, patronising and degrading manner, made out to be someone who is rude and aggressive by some staff members. You cannot always get through on the phone, a patient is denied religious rights to go to church which is discriminative. Elizabeth has been denied fresh air and exercise also.   With the excuse of covid, the little dog that brought much joy to Elizabeth is now no longer allowed in the visitor’s room.   All my daughter has is the window of her bedroom to look out at the outside world and the birds outside where she spends most of her time indoors like a prisoner.  She has named all the birds. She has asked to go swimming and asked me to get a costume just in case but this is denied and even going out around the grounds has been denied on my visits as mother and carer at times.  It takes me over an hour to drive for just 1 hour’s visit and the visits are very upsetting because my daughter has said “I will never get better in this place”.  

If you are treated under the Mental Health Act and do not have capacity, your Attorney or Deputy can make some decisions for you. HOWEVER ELIZABETH DOES HAVE CAPACITY AND HAS PUT A PRAYER ON LINCOLN CATHEDRAL’S WEBSITE BEGGING GOD TO ALLOW HER TO COME HOME.   With such restrictive measures in place I believe they are either trying to go down the DoLs/ MCA route because Elizabeth does not like the depot as she has a fear of needles unsurprisingly, having been dragged from one end of a former ward to another by four male nurses and forcibly injected and has had needles broken in her by rough treatment under Elysium.  They are trying to blame us as attorney’s for encouraging her to stop taking the depot or from stopping it. It could also be safeguarding to make me, her father look out to be unfit parents and they want to put my younger daughter in place of me as NR and are threatening all kinds of court action which is bullying. With regard to compliance they fail to note Elizabeth did not refuse their treatment in the community in London previously and there was never a problem and she was not on a CTO either.  She was being slowly and gradually reduced off the Clopixol by the former area of Enfield who produced a letter detailing this as well as a discharge note pointing only to physical health conditions.

There are some times where hospital managers may restrict visitors, refuse to let them in or ask them to leave. Managers should have a policy (plan) for the times when they can limit visits to patients.   Covid being the excuse.   I am restricted with no answers given as to why but they are trying to make out I am threatening and aggressive.   There seems to be a culture of bullying under Ash Villa.  I did hang around on her birthday, not expecting to visit the ward due to covid but since Elizabeth was out of isolation I just wanted to hand her the Birthday presents. She did not know I was there and now states she was upset at being kept a prisoner.  Unfortunately they called Police and I was not even parked in their car park at the time. Nobody could get through to Elizabeth several days later.  I had dropped her cake in and dropped the presents in that were just dumped in a store room and Elizabeth says now that she did not know I had waited outside just to hand her the presents.   She was apparently not feeling well enough to go out anywhere as she was recovering from covid and felt weakened.   I was not pressurising her to go out but not even a phone call –  no one else could get through to her for several days and she did not know about the presents and card I dropped in.

I have asked for the reason for my restrictive visiting rights under S26 MHA but no-one will give a reason.   When Police were called I asked if Police could do a welfare check on my daughter as she seemed to be really upset and was looking forward to my visit the day before and she was acting out of character but Police said they were not allowed on the ward.

I have also been refused information as to whom the Hospital Managers are. I have received a letter from AMHP Andrew Morrans about getting rid of me as NR and displacing me with my younger daughter but I want a Manager’s hearing first and so does Elizabeth as I have explained this to her.

Policy:   This should be clearly displayed on the ward so staff and patients can read it.  All there is displayed on the wall is a Charter and unfortunately Ash Villa do not act in accordance with their own Charter.  

They have to write down why they stopped the visitor coming and show there is a good reason for this.   Hospital managers must check when staff are stopping visitors. They should have a policy on when visits are not allowed.  This is not done. However I have had the phone put down on me and been treated with rudeness myself.  I have not always been able to get through as her phone is charging or switched off.  I have then called the ward to see if her phone is charging and the Policy is to put the phone down as I should only have 1 point of contact. They will say they ” i will see if she wants to speak t or not.”   I have had the phone put down on me more than once but I am never threatening or swearing towards staff but they are trying to make me out to be this way.  It is because I am asking for information and they have been told not to give it.  The Carers Champion firmly states she is my only means of contact and I get a 15 minute slot only but in that 15 minute slot the only answer I got was “no” to the Neurologist appointment in London and that it was not necessary.

The hospital manager must make sure the patient and their family can be involved and understand what is happening

This is not being done.

Services have to think about these safeguards if they give you any care or treatment that deprives (takes away) a person’s liberty. This means where you are not free to leave and where you may be watched or controlled all the time.

This is what I think they are doing as she is not even allowed outside of the grounds and is watched and controlled at all times and it is so utterly degrading.

They must tell the local authority (council) and the Care Quality Commission (CQC) if they use the Deprivation of Liberty Safeguards so they can check what they are doing. Sometimes people have to decide whether to keep a person in hospital under the Mental Health Act or the Deprivation of Liberty Safeguards. Both cannot be used at the same time. It is as though this is being done at the same time although denied when I asked.

Elizabeth has called the CQC more than once herself stating she is being abused and has been unable to contact her advocate and they have not been helpful in this respect as the number would not work when she tried.  She was asleep on one occasion when the Advocate wanted to see her and on another a member of staff sat in and listened to the video linked meeting. There does not seem to be any contact with her and her advocate now as she is completely outnumbered in meetings and increasing of numbers of staff invited which is intimidating for both of us.

I think they are using both MHA and DoLs at the same time against Code of Practice though DoLs has been denied however they are in fact depriving her liberty and it should be the least restrictive care.    They are trying to get rid of her Attorneys (myself/her father) by saying they are not fit for purpose under Health & Welfare and depriving or encouraging deprival of her depot injection with a view to displacement and Guardianship under no doubt an AMHP.

The NHS should try to place patients as close as is reasonably possible to their home. If it is difficult for the patient’s carer or family to visit a patient because of the distance they need to travel, then the NHS should think about what support they can provide.

Elizabeth has in the past been sent all over the country even Wales but this journey is over an hour for just an hour’s visit and the visit is absolutely degrading and restrictive against human rights.   It is so upsetting that my daughter is being punished when she has been so badly abused and as someone who reviews MH services/carers rep myself, I have never come across anything as bad as Ash Villa.

People with learning disabilities or autism. A person cannot be detained and treated under the Mental Health Act just because they have a learning disability or autism.  Whilst said to be border-line LD – all screenings have come out positive re: autism but they do not want her to have an autism diagnosis.  There was enough evidence for NAS to get involved in the provision of a CTR that took place whilst back in London where the Independent Chair of that meeting commented “the whole thing stinks”.

People with autism can find changes difficult or upsetting. Being kept in hospital can be difficult for them so they need support from staff who understand autism. The staff should listen to carers and other people who know the person well and can say if they understand the decision.

“I am desperately waiting to come out of this dreadful hospital”

Firstly the former area of Enfield declined to admit Elizabeth was a multiple rape victim and they refused a CTR and autism diagnosis – nothing was done fairly and we moved in the hope there would be fairer treatment here.   Staff do not listen to carers and the information sent by myself does not appear to have been read or else dismissed such as the Discharge Notice indicating only physical health concerns along with the letter from former area detailing the reduction plan off medication.  Doctors are ignoring physical health and will not acknowledge the fact my daughter’s breathing is very bad –  will not give any answers but in past files she is noted to be of high risk of mortality and choking.   They have not once listened to me as a mother and carer and even got the dosage of the drugs wrong to begin with virtually calling me a liar when I said she was due a reduction down to 250mg.   My daughter finds it very distressing to be in that hospital. 

§  Doctors should think about the patient’s wishes when they plan their treatment and care.   They are not listening at all so thank goodness Access Charity are involved.  She says “the doctor keeps putting words in my head re care homes”.

§  In certain cases the Court of Protection may have a power to order that doctors must not give the treatment.   The CoP treated us both fairly in 2014 when Elizabeth was being forced back to a care home where she had no food at the weekend and where a CTO and DoLs was planned plus severance of contact.

care for patients in safe places that are not noisy or upsetting    Elizabeth says she cannot stand the noise on the ward at Ash Villa. She is clearly unhappy there so why isnt an entire team of “professionals” listening.

Think about physical healthcare and not just mental health.  Not allowed to take her to appointments or assessments re physical health and she has missed all her appointments which the new local GP recommended she attend. Now has possible breast cancer only just been discovered, an urgent referral has just been made.

Local authorities and clinical commissioning groups must make sure patients get the right care in the community after they have been kept in hospital for treatment. This is called after-care and the Mental Health Act says what this means.   Absolutely nothing is being done otherwise Elizabeth would not still be incarcerated suffering no end to the point where she has said she cannot stand any more of her life and that no one understands her.   She is missing fresh air and exercise.  She is missing her cat and her family.  She is becoming weakened physically.  She is in pyjamas all day long and sleeps during the day and all night awake judging by her messages. 

Guardianship:   The rules should not mean you are watched and controlled all the time. They should not stop you leaving the place where you live.   AMHPS from this area of Lincolnshire have already tried to put her under Guardianship and displace me as NR and even appoint the Official Solicitor over the head of her solicitors Ringrose Law and Dr Shapasandy said measures are being put in place to a get rid of me as NR and admitted safeguarding on concerns (by whom exactly?) – total breach of confidentiality has gone on to discuss my displacement behind my back which has got back to me.

If you lack capacity to make some or all decisions about your treatment and care, your doctor should think about whether to use the Mental Capacity Act instead.   Elizabeth clearly has capacity about where she wants to live and has said time and time again “home”.     Their agenda is into a care home or supported living and housing where no doubt her liberty would be deprived and so would contact with her family as has been done in the past.  Elizabeth has also suffered the most terrible abuse under past schemes which is why we as a family moved to provide a separate living accommodation for her so she can be independent and this has been architecturally designed and the environment of the surrounding area is perfect as it is quiet and peaceful and overlooks the sea.

Hospital managers’ discharge powers The hospital manager is the person or organisation in charge of the hospital. They can arrange for a panel (or group of people) to carry out their powers.   Have asked who the Hospital Managers are but have been refused that information. Have now called a Manager’s Hearing and explained this to Elizabeth who is in agreement but the Manager of the MHA has not got back to me and Pals are taking along the lines of code of conduct and my delegation of my role of NR.

§  Hospital managers should tell patients about their decision and the reason for them.   They are not giving information and playing on confidentiality and putting Elizabeth under pressure to sign papers but she is sharing information with her family. 

§  Attorney If you find it difficult to make some decisions for yourself, an attorney or deputy can help you. A Lasting Power of attorney is someone who you have said can make certain decisions for you in the future when you do not have capacity to make that decision. You must follow the rules in the Mental Capacity Act 2005 to create a lasting power of attorney. The person you choose is called an attorney.   As Deputies who they want to get rid of,  we are trying to provide everything so that Elizabeth is supported and looked after including a home of her very own.  We are not stopping contact with MH professionals and have not interfered with current treatment but have a letter stating that she was being taken off the drug in the former area and this is not being continued here in Lincolnshire as this has all been disregarded by professionals.

§  Deprivation of Liberty Safeguards (DOLs) Safeguards in the Mental Capacity Act for people who lack capacity are deprived of their liberty. Services have to think about these safeguards if they give you any care or treatment that takes away your freedom.    They tried to put me under safeguarding – I have had to inform my employers and called for a Section 42 meeting that was not granted.    The safeguarding is brought about through “concerns” by nursing staff who are maliciously accusing me of encouraging or stopping treatment which in this case is a depot and in fact all the time I have evidence to the contrary that I did everything to get this continued and in place. I have nothing against safeguarding but this should not be done behind your back as I believe is the case under Lincolnshire Partnership Trust. 

Anyway I did not get a chance to say all I wanted to say as this meeting was disrupted by technical problems.

I am now going to write to my one point of contact in this respect right now.

From: susan bevis
Sent: 31 March 2022 11:58
To: PALS(LPT) (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST); SJ (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST); ST (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST); safeguarding@cqc.org.uk; Enquiries
Subject: FW: HOSPITAL MANAGERS Ward Round Today Please can Elizabeth have her phone back if charging fao AW

Dear Ann

I have requested the Manager’s Hearing and I am still the Nearest Relative.  Whether or not the MHA Team assume I am delegating my role I have not done so yet and will not do so until I have that Manager’s Hearing.

I am not going to be bullied by anyone within the Trust.  

Please advise the date of the Manager’s Hearing just like I requested.

And as for Code of Practice pleased advise why human rights are being breached with regard to Art 8 and Art 3 HRA and Section 26 of the MHA.

I have plenty of concerns I wish to discuss at the Manager’s Hearing and perhaps an inspector from the CQC can be present to witness this.  

 I would therefore like a copy of Lincolnshire Partnership Trust’s Code of Conduct for my records.

Thank you.

Regards

Susan

Sent from Mail for Windows

From: PALS(LPT) (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST)
Sent: 31 March 2022 10:57
To: Susan Bevis
Subject: RE: HOSPITAL MANAGERS Ward Round Today Please can Elizabeth have her phone back if charging fao AW

Hi Mrs bevis

I have checked with the MHA team. They are aware that you are delegating your nearest relative responsibility . Please be assured that the hospital managers hearing is being scheduled in accordance with the code of practice and relevant people will be informed in due course

kind regards

A Munro

Patient Experience Lead

Quality and Safety Team email

Lincolnshire Partnership NHS Foundation Trust

Unit 9

The Point

Lion’s Way

East Road

Sleaford

Lincs. NG34 8GG

www.lpft.nhs.uk

facebook/LPFTNHS

Twitter: @LPFTNHS

Dear Dr Shahpasendy

Do you agree that ‘upregulation’ and ‘downregulation’ of dopamine might affect presentation of psychotic symptoms?”  

Please can I have some Section 17 leave so I can take Elizabeth to Kelby Church on Sunday morning.   Please can you increase the 30 x minute twice daily as she would like to see the ducks on the canal.  She might also like to come swimming.  I bought her a new swimming costume by the way.

Please note that as I feel her religious needs are not being met on your ward I have had to notify Georgina Machell, the Reverend in charge of all the churches in the vicinity of Ash Villa and she is more than happy to come and visit.   In fact she has already tried to make contact with Elizabeth but could not get through on the telephone.  Please ensure that the phone is with Elizabeth in her handbag and not in a locker.

I hope you have reconsidered the tests on the Limbic System re your brilliant research as I am sure you will agree this is extremely important and relevant and as a carer’s rep I feel it my duty to tell everyone about your brilliant research so that everyone can benefit.   The whole ward could benefit. 

It is not as if I am against treatment but it is wrong to prevent a proper examination and I am willing to pay whatever for any tests that are needed especially as someone from Lincolnshire Partnership Trust has reported me to the Public Guardianship Office and I am being investigated as an unfit Attorney on Health and Welfare plus as an unfit nearest relative you all want to get rid of when I have no problems with my daughter having the correct treatment.

I am also not happy that the bed is not comfortable, the room is cold and no blankets from outside are allowed, no visiting dogs are allowed –  you have to think that this is not a prison but a hospital and therefore patients should have nice things such as outings like in Lincoln Hospital “The Out and About Club” .   Ms Connery please can you intervene in making sure that the CCG provides everything that is recommended for Ash Villa in terms of funding and what is the point of having empty grounds, a netball court not being used and gardening facility abandoned.

I look forward to your confirmation Ms Connery that you are going to deal with the above as a matter of urgency and also I await your comments, Dr Shahpasandy and to hear about the S17 increased leave entitlement and exactly what stage are you at with the safeguarding against me as I will need to inform my employers.  

Look forward to hearing from you.

Regards

Susan Bevis

One last thing where is all the underwear I bought for Elizabeth?   Has this gone missing?  Does she need to be referred to an i/c nurse?  And where is the third blue blanket?    

MESOCORTICAL PATHWAY

“Elizabeth will feel worse because there is some evidence that she is a poor or non-metaboliser of Clopixol. A few years ago Susan Bevis paid for tests on some the common liver antigens (P450s) responsible for metabolising psychiatric drugs.  You might want to ask her about this.  

If I recall she was deficient in the two main enzymes mentioned below.  This can and often does lead to toxicity and or treatment failure.  So in a nutshell the drug will not treat the psychotic symptoms but can cause poisoning because the patient cannot evacuate the metabolites fast enough.  Dr Shahpesandy definitely knows the pharmacodynamics and pharmacokinetics here.  See page 47 of the attached slides.

In vitro studies suggest zuclopenthixol is metabolised primarily by CYP2D6 and CYP3A4. The clinical study supports this, demonstrating the impact of co-prescribed inhibitors or inducers. Guidelines should incorporate these interactions noting the potential for zuclopenthixol-related toxicity or treatment failure.

“I’ve read reports where there manufacturers tests these drugs on existing patients and ask them if it makes them feel better or worse.

Elizabeth says it makes her feel worse but Dr Shahpesandy isn’t listening.”

On Wed, 30 Mar 2022 at 19:30,

“The mesolimbic pathway is implicated in schizophrenia.  In paranoid schizophrenia fear and anger are magnified and distorted and might cause disruptions in the mesocortical pathways to the frontal lobe causing psychosis.  

Zuclopenthixol Decanoate (Clopixol) is a mesolimbic antagonist* on D2 receptors in the mesolimbic pathway.  Those with poorly expressed CYP2D6 (poor or non-metabolisers) experience significantly attenuated elimination of Clopixol leaving the drug active in the mesocortical pathways for longer an potentiating increased risk of adverse effect .   

*meaning it depresses the activity of dopamine receptors in the mesocortical pathway between the limbic system and the prefrontal cortex.  This is why it is important to know if there is any sign of inflammation or any lesion in those areas of the brain.  An MRI scan will give the first clue and a search for specific antibodies will conform whether there are any lesions or inflammation.  

It is also why it is necessary to determine if a patient is a poor metaboliser of Clopixol. 

Subject: Limbic Inflammation

“Here is a scan showing limbic related inflammation in the temporal region of the brain.

As you can the pale area on the left temporal area of this patient’s skull that part of the brain is inflamed.  That is the part of the brain where the mesolimbic pathways are found.  That inflammation might stop dopamine D2 signalling and affect thought process, especially anger and fear.

Clopixol is a D2 antagonist on that pathway too.  If a patient had an inflammatory condition it will likely affect neurotransmission and the metabolism of this drug.

Dr Shahpesandy is, from what I can see from his research well aware of P450 metabolism and the effect of inflammation and lesions on neurotransmission.  

Do the MRI and follow up with looking for inflammatory markers.  “simples” as Meerkats say.

B”

>
Sent: Thu, 31 Mar 2022 0:06
Subject: On a final note re; Mesocortical pathways

“That’s why the Martin Harrow study is so important.

That’s why patients on long term anti-psychotics have adverse effects on cognition and not improvements.”

Subject: Brain scan indicating inflammation.

 Further to the earlier comments.  The left temporal lobe of this patients brain is inflamed.  Note that the brain crenelations are closed up and the brain tissue is pale on the scan just before the eyes.  

Above this the mesocortical pathways extend to the pre-frontal cortex where our higher and abstract thoughts occur.   Interruptions in neurotransmission can be caused by this inflammation and interestingly some anti-psychotic medications also interfere with D2 (dopamine) receptors in the mesocortical pathway.  

Ask the doctor if he would agree that ‘upregulation’ and ‘downregulation’ of dopamine might affect presentation of psychotic symptoms.  I would be fascinated by the reply. 

If you look at the diagram of the mesocortical pathway from the limbic system to the pre-frontal cortex pathways (in red on attached diagram) you will see them moving forward of the temporal zones.  

Anti-psychotic medications down regulate those neurotransmitters, that is indeed what they are designed to do. 

B”

The court case that did not go ahead as although I did object to S2 I knew how hopeless it is to even comment but without comment or signature on documentation it was wrongfully assumed that I as NR objected to S3. My following comments show why there is a great need for reform under the MHA.

MB AMHP (Claimant) and E Bevis (Defendant) (By her Litigation friend, not yet appointed) In Lincoln County Court in the Matter of the MHA 1983

The litigation Friends were completely and utterly ignored in this matter.

No sooner had we arrived in Lincolnshire my efforts in trying to get a continuation of treatment in the community were failed by the NHS and instead of helping AMHP’s from Gervas House Long Leys Road Lincoln sectioned Elizabeth instead of assisting in getting treatment in the community ongoing for which I am being accused by various professionals of stopping/encouraging her to stop so the emphasis needs to be on what the role of such professionals should be in my opinion instead of bullying and threatening court action against you. As everything I had tried came to nothing, all that was needed was for the treatment to be ongoing – continuation of care and not sectioning lasting months on end and bullying by way of displacement.

The legal documents included a report AMHP by RM (a senior AMHP), First Tier Tribunal Decisions (I was not included in this Tribunal) a clinical assessment and risk framework plus Medical recommendation by Dr Ismail and Dr Turabee and AMHP MB.

This cost £332 to produce the paperwork issued on 20 October 2021.

Does your claim include any issues under the Human Rights Act 1998 and the box ticked in yes – lol! What Human Rights Act are evident under MH? That is a joke as they most certainly do not exist under MH and Lincolnshire Partnership Trust is a good example.

On document A1 there are lies and accusations that I avoided the AHMP with an assumption I disagreed with S3 because I had not agreed to Section 2 which went ahead anyway regardless. We had just moved and all I wanted was for the treatment to be continued in the new area. I had a letter from the former area and discharge note pointing to all physical health conditions. The Clopixol Depot was being reduced slowly and gradually by the former area and all I wanted was for this to be put in place. Paperwork was dated 20 October 2021, Section 2 ended 21 October 2021. Due to pressing time restriction the Claimant files this application to displace the Nearest Relative under Section 29 (3) (c) urgently. By filing the Application under S29 (4) the Act deems the current S3 detention will be automatically extended until such time that this application is finally disposed of by the Court. Statement of Truth is signed by Kyla Bailey Legal Representative of Lincolnshire Legal Services.

We had only just moved, had poor internet connection, we could not move into the house straight away as services not up and running. Despite this all I made every effort to get treatment in place and if this had been done there would have been no need for sectioning.

They turned up at the house unannounced so I was told but I in the shower, was already late and had to rush out to college. I did not know they were coming. They assumed I was avoiding them and that I disagreed with Section 3 and so immediately instructed their legal team to take action at a cost of £332 (court fee deducted from their PBA Account) Instead of sending the S3 papers by email or post, Had I have received them miscommunication and false assumptions would have been avoided. Their behaviour amounted to harrassment even hanging around and watching the house and noting a car had left. I had to be in college by a certain time and their visit was unnanounced. Instead of taking such heavy handed approach surely their role should be one of caring but sadly it is not. I cannot see any compassion in these people from shocking past experience of a previous area but so hoped that in the new area things would be better.

CHARLESWORTH WARD LINCOLN HOSPITAL SAFEGUARDING CONCERNS TOWARDS MOTHER SUSAN BEVIS Dr Ismail RC

After waiting in A&E Lough virtually all night to see a Doctor who failed to arrive eventually an ambulance came. I was told I could not accompany Elizabeth – they just took her away and sectioned her without any regard to the efforts I had made in just trying to get necessary treatment up and running in the community like before. Our move had turned into a disaster. I was advised by an expert to call 111 who advised A&E but instead of necessary help so that Elizabeth could have returned home immediately she was sectioned and it was obviously too complicated for the NHS to provide continuity of care in the new area. It was devastating, they just took her away, refused me accompanying her and then made her subject to yet more torture on locked acute wards but if they had read the notes properly they would have seen the discharge note and letter from former area detailing the reduction plan off the clopixol depot by the CMHRT RC.

Elizabeth sectioned to Charlesworth Ward Lincoln whose nursing staff accused me of all kinds of things ranging from neglect, incapabilities and psychologically controlling/abusing my daughter. As a carers rep who has a DBS I had to notify certain others that I was under safeguarding and they offered me support. I called for a S42 but this was never forthcoming then was told that the safeguarding had been dropped as I complained about this. The court bundle amounted to many pages but I am only going to feature some of it to reveal what is going on that I feel needs to be changed in the current system not fit for purpose.

On C1 of the court papers several errors: My daughter’s name spelt wrongly and GP Surgery completely wrong. It is bad for such errors to appear in court papers which should be accurate. More mistakes on P2 of 10 C2, name spelt wrongly and false reporting that she tried to commit suicide two days prior to sectioning which would have been whilst staying with me at a local guest house for which we had no end of witnesses. Even more errors appear on C3 3 of 10 “In Enfield she was supported by a range of services and lived in supported accommodation. That is not true in the slightest bit. There was not a scrap of care in place in Enfield apart from the fortnightly depot which was being reduced and she was not living in supported accommodation but an independent flat. I have been labelled as someone coercive and controlling towards my daughter and that I repeatedly phoned MH Liaison to find out the situation which is far from true. If this Hannah mentioned is the duty worker from former area of ECRHT who recommended the MHA assessment she is well known to us as a family and in the files reported in the most nasty and shocking manner then ENFIELD COMMUNITY REHAB TEAM tried to force return Elizabeth to Phoenix House Care Home by depriving her with drugs in our local area for four days. I kept an accurate diary of everything and took Elizabeth to Harley Street. Hannah would have been one of the AMHPs who came to the family home reporting nastily for the purposes of CoP.

Elizabeth was 6 days without the depot in the new area when I desperately sought help as I did not want her to go downhill but instead we got bullied again.

Documented in these court papers Elizabeth had explained she was Autistic and needed someone to talk to like a psychologist but all they thought about was medication but having said that, only a continuation of treatment as before was needed which was being reduced down anyway by our former area. The letter detailing that was given to the GP and MH services. Elizabeth stated she was not mentally ill and that her problems were physical – she is correct. Elizabeth also said she had been misdiagnosed in the past.

I am accused under C7 that I am “unable to see the inconsistency of requiring a depot if she believes Elizabeth has no MH problems.” I would comment that I tried to get the drugs up and running but her discharge note pointed to abnormalities on a scan twice and CNS Central Nervous System. No mention of mental illness so wanted this to be looked into.

The Report was written by Senior practitioner R M of Adult Emergency Duty Team and concludes that there was no viable alternative to an admission to restart her medication – well if this was so then now what excuse is there to this day then that still nothing in the community provided to continue this treatment as in the former area???

EXTRACTS FROM THE FIRST TIER TRIBUNAL REPORT “The patient shall not be discharged from liability to be detained. Featuring evidence from Dr I RC, Nurse A S and Ms Awosanya.

I was accused of weaning Elizabeth off Aripiprazole and this is not correct. This is a blatent lie.

They cut and past reports from previous area full of inaccuracy and lies. the subject of a family complaint where nothing had been done to make relevant corrections.

Most disturbing is the allegation that Elizabeth tried to take her life which would have been whilst in my company two days prior to admission. That is an absolute lie. It then goes on to say there were witnesses but they were not able to tell us what that attempt involved. Why put such blatent lies in court papers?

We were booked in a lovely little guest house just around the corner where Elizabeth was fascinated by the birds and animals therein. Elizabeth was happy and looking forward to a fresh start as I was after years of bullying under Enfield. We can soon verify such lies.

The report continues stating she was expressing ideas of suicide when Elizabeth was truly happy to have moved and to be starting afresh. The report says she wants to return living with her mother that she has the physical condition of PCOS and neurological condition of autism and has balance problems. She agreed to accept visits by a new MH team in the community but preferred tablet form to depot

One nurse who failed to comment in the same negative mannerism, Ms Awosanya, refused to express agreement about the need for detention. Well maybe Ms Awosanya observed things in the correct manner unlike everyone else but was criticised for her differing views.

The tribunal decision concluded the patient has a mental disorder and that the RC’s evidence was not contradicted by any other evidence – pity as if I had been invited I would have provided abundance of such evidence by way of file paperwork/reports. They then state Elizabeth lacked insight labelling her condition to be a disorder and blaming – “mother’s attitude to be cause of exacerbation of her disorder”. Also mentioned was a severe physical health condition (IC) that Elizabeth was noticed to have at this acute dormitory-style ward.

Nurse Skelton’s evidence:

Nurse S commented on diet and that on her shift there was an occasion where Elizabeth had several takeaways in addition to hospital food for which I was blamed. I telephoned Nurse S who denied writing any of this and she blamed admin staff for notes under her name. Nurse S had stated “on one occasion several takeaways turned up” however none of them came from me but this shows Elizabeth has capacity to order what she wants as I had refused to buy a takeaway stating only one a week was allowed on that ward. Elizabeth managed to get the takeaways through others. As usual I was blamed. Nurse Skelton assumed wrongly that her dietary concerns towards me would continue with risk to Elizabeth’s physical health if allowed in my company (IF SHE WERE NOT DETAINED) and in the community. Well this shows lack of insight and wrong assumptions on her part. When I phoned she completely denied writing such comments so who did in that case? They are done to discredit you and portray you in a detrimental light to the court in other words making out you are unfit as a mother which is really nasty. Who would think I would be reading these defamatory comments against me in the tribunal papers prepared by “professionals” for a tribunal I was not even included in. Also, because of Elizabeth’s physical health condition associated as a side effect of the current prescribed drugs (IC) that by releasing her from section this condition warranted nursing care and support. Well that doesn’t bother me as I did this all for my father with Alzheimers previously and he lived in the community for many years but died as a result of care meant for respite. Even more false allegations about the attempted suicide which would have been in my company prior to admission – what a pack of lies! Another reason or rather excuse for non-release was safety concerns and inadequacy of mother in addressing anything mentioned above whether it be diet, IC, my whole personality slated by strangers including this nurse that Elizabeth would be risk to family and healthcare workers. If Nurse S or whoever wrote these notes bothered to look into matters properly they would have seen that Elizabeth was released into the community without being on any section and was compliant with medication and living in independent flat in the community without a scrap of support apart from that given by her mother who used to visit every single day on her own. They simply haven’t got a clue and just write assuming things and if only there was something good in this area like Open Dialogue, none of these assumptions, allegations and false reporting would be evident in court papers. It makes me sick the constant mention of lack of insight towards Elizabeth and myself when it is the professionals themselves who lack insight and have no understanding into LD or autism or in communication

They wanted to carry out DASH assessments when I have no concerns. Obviously I sought help in getting treatment continued and realise that someone can go downhill if a steep reduction which is nothing to do with a relapse of mental illness but withdrawal syndrome. It states she was happy in the dormitory accommodation but only with a couple of people sharing. However they had to move her from one end of the dormitory accommodation to the other and then put her in a side room so that was not the case. She could not stand the noise and has sensory issues. She then expressed her wish to come home to Dr Ismail.

Then the report goes on to say “unkempt, hair unwashed, clothes unwashed and dirty, poor insight, fixated stare – answered questions with one word – quiet and reserved and presented as agitated and frustrated with questions being asked.

I am saddened at reading what these so called professionals have presented before a court by copying and pasting reports and alleged incidents from former area going as far back as 2008, all of this done to discredit both patient and relative and ensure that someone is detained in hospital for a long time and punished in this way.

It says in 2008 she broke a window with a chair – pack of lies.

Numerous criticism of inappropriate behaviour going back to 2008

They report she was charged with GBH – another pack of lies. No she wasn’t.

Caused extensive damage to a caravan – ANOTHER PACK OF LIES LINCOLNSHIRE PARTNERSHIP TRUST.

Offence of rape – I am finding it hard not to use inappropriate language on this blog as this is getting worse. What a lie!

Jumped over a desk at her GP Surgery. Oh no she did not – she pulled the phones out of their sockets and did not cause extensive damage as when I called to offer to pay I was told there was no damage. Elizabeth wanted an MRI scan in an open scanner and it was the height of lockdown. I was trying to sort this out privately for her myself at the time.

They have dug out every bit of dirt to discredit myself/my daughter to make us out to be bad and inadequate, none of the alleged events documented correctly – many either did not occur or are blown out of all proportion to justify longer detention and make someone look like some inhumane monster when those who are in such profession should be kind, caring and compassionate are clearly not so from what I have just read.

Under Lincoln Hospital’s facility we had little contact with Elizabeth except for a couple of visits supervised, only 2 x 30 minutes escorted leave given to Elizabeth in noisy unsuitable environment.

Oh my God they have not finished yet – the report goes on to describe other very nasty things and she has never been suicidal except felt that way whilst under the so called “care” of an inpatient setting where it was so unbearably noisy Elizabeth said she was so distressed she tried to gouge her eyes out.

The facility at Lincoln Hospital is not fit for purpose for someone who has sensory issues. They had to move her to a side ward.

They say she has a previous diagnosis of schizophrenia.

The meaning of the word “Abuse” to my daughter is the refusal of a takeaway or it could be a simple disagreement but professionals blow things out of all proportion leading to safeguarding which I personally would welcome. I believe safeguarding to be in progress at Ash Villa going on behind my back as this would explain the very restrictive current visiting rights and that is why it is important to investigate holding a Section 42 meeting which I have requested many times. What is so bad is the safeguarding is going on in secret behind my back so I believe. I too have safeguarding issues myself so all such issues should be discussed at a S42 meeting. Throughout the report Elizabeth states she wanted to come home but this has just not been listened to and we have witnessed the worst restrictive treatment and breach in human rights ever encountered under Lincolnshire Partnership Trust.

Nurse S Referral Details

Hostage taking and stalking – what a pack of lies!

Under Section 2 she was forcibly restrained and administered with depot. “Doctor thought this was best”.

Copying and pasting of reports going back to 2003???? drowning in the sink ????? Oh come on now!

Incidents completely wrongly reported and discrepancies in line with dates – just copying and pasting erroneous records from former area’s notes without checking for accuracy.

On page C34 last para completely wrongly reported and was not charged – please get things right before presenting absolute rubbish before the court.

More rubbish on Page C35.

She did call emergency services and thought the Police were her friends and the ambulance drivers and crew. She used to sing and play her guitar to the Police and ambulance drivers who I would thoroughly commend for their kindness, understanding and compassion unlike brutal MH professionals. She kept phoning them as she was lonely and had nothing to do in the community – nothing was provided.

The relationship between us is not volatile but there wereproblems when Elizabeth stopped the drugs “cold turkey” and so I would agree that a slow gradual reduction plan is therefore necessary but the problem is the NHS have never helped with such reduction plan prior to most recently in the former local area.

Having read nasty vile comments from various professionals who do not know us I want to say in defence of my daughter she loves animals, she is fascinated by pigeons in particular. She has received the most apalling treatment under the NHS and been sent to some absolutely dreadful places. It is no wonder she has complex PTSD and traumatised. She has suffered extensive abuse but none of this appears in any of these court papers other than intent to cowardly portraying us both in the most nasty manner you can imagine. We moved to try to provide the right environment but instead of help to get treatment ongoing we were faced with bullying yet again. I wish now I had sought private help instead of turn to the brutal NHS.

Charlesworth Ward had Safeguarding concerns regarding me as Mother.

Seems like Ash Villa also have Safeguarding Concerns.

Well I too have safeguarding concerns about my daughter and I have reported these to Adult Social Services yesterday.

I never even commented regarding S3 but they assumed objection and went for me by displacement of nearest relative and my blog documents the rubbish and lies produced before a court when such professionals think it best interest to get rid of the nearest relative without even obtaining proof of objection officially in writing. They assumed that I would object so just went for displacement. The abuse allegations were no doubt because I refused to buy a takeaway yet this is what I am being accused of by Nurse Skelton or whoever wrote those comments. Elizabeth said she would be reporting me for the refusal but showed full capacity in managing to get three takeaways in one day for which I was blamed.

Included in all this paperwork amounting to about 50 pages is a copy of the MHA 1983 “Compulsory Admission to Hospital and Guardianship Procedure for Hospital admission”. Sadly the law is supposed to protect vulnerable people like my daughter but it is not protecting them at all and with Corona Virus human rights have vanished and there is even more abuse going on behind closed doors.

I have received a letter amongst this paperwork from Legal Services Lincolnshire County Offices Newland Lincoln LN1 1YS. It says “as NR you had the ability to sign the papers for that second detention which would be under S3 of the MHA and would allow her to remain in hospital for up to 6 months”. Well actually I didn’t because the papers were not left or put through my letter box or sent by email or post.

“You have reasons to object to the continued detention of Elizabeth as you do not believe she has a mental health illness. I understand you have expressed your objection to Section 3 and have exercised your right as NR to make that objection.” No again because I did not receive any paperwork to object to S3 in order that I could either way make a decision as NR so do NOT make any assumptions therefore. The mental health illness my daughter has is trauma (complex PTSD) from years of abuse not by myself or her family but by professionals and others and she was a rape victim under care said to be consensual. This has only just been recognised because I obtained the files from Elysium. Yes you are right there are substantial underlying physical health problems that are not a figment of my imagination but fact and again I have the files to prove this as I had private tests done by doctors.

“As a result the legal position is that the approved mental health practitioner decided to instruct the legal team at the Lincolnshire Council Council (me) to file an application to the local Court asking for you to be displaced as the Nearest Relative for Elizabeth and to name the local authority (Lincolnshire County Council) as the nearest relative in place of yourself. ” So why did you not look into matters properly and see that in 2017 there was a case at Royal Courts of Justice where I represented myself. It was decided that it was a CONFLICT OF INTEREST FOR THE LOCAL AUTHORITY TO BE THE NEAREST RELATIVE. I was complimented by the Judge by the vast amount of evidence I gave to show how the Local Authority nominated NR who had tried to say that the rape and abuse of my daughter under Moti Villa was consensual WOULD NOT MAKE A GOOD NEAREST RELATIVE and when I saw who it was and had read all her nasty comments about me I decided to write corrections to everything and represent myself in court. There was so many mistakes in the court papers I had to re-do the reports to the County Court from the AMHP from scratch, correct everything before I even got started on my own reports. I did a good job of it to the point that Solicitors representing them could not tell the reports apart from their own due to me even copying their logo. The first Hearing took place without me, as I was given the wrong court details but I had the best experience of all meeting Lady Justice Roberts who went out of her way to help me as nothing was listed and I was not given the information correctly so a second hearing took place. The Judge quite rightly said he would like to meet Elizabeth to hear her views. It is a pity that AMHPS do not listen and treat vulnerable people, their carers and family with respect. instead they act in an intimidating threatening manner. An independent capacity assessment followed by a wonderful psychiatrist who confirmed Elizabeth had capacity. I only backed out when threatened with £5000 by Enfield’s Legal Services for their costs. However I enjoyed the experience of representing myself in court and exposing inaccuracies and lies in the reports. As you can see it is very wrong of you to replace me with someone from the Local Authority due to conflict of interest.

By doing this and filing the application papers at the Court which we have done on 20 October 2021 this then gave the hospital legal powers to continue to treat Elizabeth under S2 MHA and keep her safe

Safe???? What safety – to put someone on a dormitory not fit for purpose ward who has sensory issues is FAR FROM SAFE isn’t it!

I am not going to feature this all but the letter addressed to me is from K B (Lawyer) For Legal Services Lincolnshire. My daughter – first defendant, myself noted as second defendant. This is not the first time I have had to read such painful comments amounting to bullying and the reason staff play on confidentiality is to conceal what they write about you behind your back all geared to failing court hearings. This is just one example.

I have previously said I did not want a battle against professionals in the new area and hoped we could start again afresh but this has not been possible. To begin with I was impressed with the carers network. I liked the people here in my area which still stands but I was hoping that we would be looked upon afresh and not judged by file notes originating from the former area.

In the former area they were just starting to take her physical health seriously and there were no end of physical health appointments arranged.

Unfortunately now stuck on a MH ward physical health is disregarded even when you discover the most wonderful research done by none other than the doctor in charge this is denied. Physical health under MH in Lincolnshire Partnership Trust is denied in terms of a patient having appointments and not being allowed to attend.

Only observations are relied upon not scans which are considered irrelevant even when it is stated “abnormal findings on a scan” twice. I have even offered to pay for such scans.

As for the AHMP department I am totally disappointed. I am not even asking for anything provided except for the very basics and that is for her “treatment” of the depot to be continued as it was in the former area taking note that it was being reduced. What is so unreasonable in that and why spend hundreds and thousands of pounds of public money on taking people like me to court and slagging them off behind their backs treating them like criminals.

Lincolnshire County Council “Working for a better future”

A better future can only be obtained if there is honesty and transparency along with compassion – Open Dialogue is first and foremost the only answer towards working for a better future.

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