Elizabeth was suddenly discharged from Suffolk ward, Chase Farm Hospital Enfield last week. I was not sure in the absence of any paperwork whether she was properly discharged. I have requested the discharge papers several times but to no avail. I have still not received the minutes from the CTR meeting. I knew when Section 3 was due to expire so I arranged a courier to take my standard letter as NR to the MHA office at Chase Farm Hospital Enfield. I was expecting the worst – yet another court appearance through barring. It was nerve wracking waiting but no Barring Notice was issued on this occasion. I see Sections as being nothing more than punishment and this has a knock-on effect that is most devastating on everyone in the family. As Nearest Relative I have been taken to court so many times and treated like a criminal. CoP threw the case out in 2014. Elizabeth was found to have capacity to decide on where she wanted to live. In 2017 I was taken to RcJ for displacement by an AMHP who went back to the time Elizabeth suffered extensive abuse at a local supported housing scheme but I acted as Litigant in Person as I did not see her as being suitable as NR having read her file notes previously. Besides it is a conflict of interest that an AMHP working for LB Enfield should be even considered as the nearest relative. Previously I was taken to Bromley Court (court papers sent to my work email address) deluged with phone calls re agreement to S3. It was attempted to displace me with her father who in their opinion was of best interest Elizabeth was at Bethlem Nat Psychosis Unit and her Section 2 had come to an end. I did not realise back then that I could have taken Elizabeth away from them but since I have gained knowledge as to how corrupt things can be and how vulnerable people can be hauled into hospital – sectioned unlawfully and all they get is £1 compensation and treated like criminals. I have a cheque for when I challenged the first unlawful section for just £1 which I have had framed. Since then another unlawful section has come to light. Why should a vulnerable person be treated any differently to anyone else. The system is a disgrace and works against the weak and vulnerable and their families. A system not fit for purpose where tribunals are a complete ordeal for someone like my daughter who has been misdiagnosed and has autism/LD. Some Tribunals can be biased and even threats of imprisonment are voiced by some Judges. Imprisonment if I dared to talk about the tribunal and I feel like doing just that because after all this is public money.
So now Elizabeth has been discharged without any paperwork but It is all thanks to Mencap, NAS and Access – without them she would undoubtedly have been sent to the Priory for six months in yet another locked facility out of area which she did not wish to go to.
This is the advice I have just received (my comments in bold)
“Firstly, it appears that Elizabeth should be eligible for s.117 aftercare services, separate to any duties arising from the Care Act; (After-care services mean services which have the purposes of meeting a need arising from or related to the patient’s mental disorder and reducing the risk of a deterioration of the patient’s mental condition (and, accordingly, reducing the risk of the patient requiring admission to hospital again for treatment for mental disorder); What mental disorder? Elizabeth should be under different care – she has a neurological condition not a mental disorder and this is recorded going way back as “Anterior Region Medial temporal compromise. I am not even a Doctor to know this is not a mental disorder and I checked everything with Headways. What does affect Elizabeth’s condition is the team themselves as all they can talk about is medicating and of her next depot injection and she has a fear of needles plus the depot has been given roughly where the needle has broken. Prone restraint and all men giving the depot. It should be called “aftercare abuse” in my opinion. The depot does nothing for her and does not even work.
Secondly, you have a freestanding right to a Carers Assessment under the Care Act s.10 even if Elizabeth does not want to engage with a Care Act assessment. This could be a good way to begin discussions on what support options there are and certainly of recording the impact on you in the absence of formal support. It is said in Elysium’s files that I was offered a Care Act Assessment but refused it. In fact this was a MHA Assessment but luckily I obtained the files and found out back in 2014. Luckily I did not go in the circumstances.
Thirdly, even if Elizabeth does not want to engage with a Care Act assessment, there may still be a duty to do one:
s. 11 Refusal of assessment
(1) Where an adult refuses a needs assessment, the local authority concerned is not required to carry out the assessment (and section 9(1) does not apply in the adult’s case).
(2) But the local authority may not rely on subsection (1) (and so must carry out a needs assessment) if—
(a) the adult lacks capacity to refuse the assessment and the authority is satisfied that carrying out the assessment would be in the adult’s best interests, or I do not like the word lacking capacity. From the files I have obtained it is obvious Elizabeth has FULL capacity and knows exactly what she wants. Best interest – this is some kind of joke to think that a best interest is a locked prison facility for a start.
(b) the adult is experiencing, or is at risk of, abuse or neglect. Elizabeth has said the abuse is from the Professionals forcing this kind of treatment on her that does not work.
(4) Where an adult has refused a needs assessment and the local authority concerned thinks that the adult’s needs or circumstances have changed, section 9(1) applies in the adult’s case (but subject to further refusal as mentioned in subsection (1) above).
(5) Where a carer refuses a carer’s assessment, the local authority concerned is not required to carry out the assessment (and section 10(1) does not apply in the carer’s case).
(7) Where a carer has refused a carer’s assessment and the local authority concerned thinks that the needs or circumstances of the carer or the adult needing care have change. At Elysium it was said I refused a Care Act Assessment when it was actually a MHA assessment! Never been offered a Care Act Assessment before.
Do you know whether a capacity assessment was done to assess Elizabeth’s capacity to make decisions about her care and support and/or where she lives? Many capacity assessments (in every case found to have capacity) have been carried out but it is disturbing when certain professionals turn to MDDUS when they do not wish to disclose the contents of the files in order to get the wording to respond to me on capacity. They were advised to say she had No Capacity so I then said that I had POA and that is where POA is useful. I have everything in writing so there is no excuse for the GP Surgery to decline under GDPR Rules.
I have spoken to Elizabeth and as you say she is presently reluctant to engage with a Care Act assessment. I have left it that I will speak to her again about this. However, as a first step, we have agreed that I will chase up the minutes of the Care Treatment Review and try to obtain a copy of her discharge plan. Such was Elizabeth’s distress she was up all night worrying about a visit from her Care Coordinator and no doubt it was triggering as she has not got over the last unlawful detention of around 5 days. Where is the warrant for this? I would like a copy for my records.
You are probably aware that the Mental Health Act Code of Practice, paragraph 33.13 says:
33.13 Before deciding to discharge or grant more than very short-term leave of absence to a patient or to place a patient onto a CTO, the responsible clinician should ensure that the patient’s needs for after-care have been fully assessed, discussed with the patient (and their carers, where appropriate) and addressed in their care plan. If the patient is being given leave for only a short period, a less comprehensive review may be sufficient, but the arrangements for the patient’s care should still be properly recorded. They have already seen that a CTO does not work. It is cruel and abusive to place my daughter on a CTO and I have a good mind to put the entire CTO papers for everyone to read from the last time as the Nearest Relative was documented incorrectly when in fact It was ME who was NR as I had taken back my role from the RcJ when I realised that I was in fact still the NR. The CTO papers were full of threats of recall and the contents were disgusting to read.
I have written to Dr M this morning for further information about the discharge plan and to ask whether capacity assessments have been completed.” There is no plan and most definitely capacity assessments SHOULD NOT BE CARRIED OUT BY PROFESSIONALS FROM THE TEAM AND NEITHER SHOULD AN AUTISM ASSESSMENT. THIS IS CONFLICT OF INTEREST.
All along Elizabeth has had FULL capacity and I would commend her from speaking up for herself at Elysium and Cygnet and saying she did not want to go to a locked rehab facility out of area for the fourth time. She missed her flat and her pigeons. Elizabeth adores animals and at Elysium asked to go to a care farm but this was ignored as the team had their own agenda and a CTR was originally refused until I produced substantial evidence to Mencap/NAS and Access on autism going right the way back to the very beginning in 2008.
Since Elizabeth has come out of hospital she has declined to such an extent that she relies on me to do everything. Without any support at all I ensure Elizabeth has food in, her bills paid, I go round in my car to collect her to bring her home as she has no shower and the bath is too small for her now. It is a struggle to get Elizabeth in and out of my car which is low down and the seat belt does not fit her. I ensure all her washing is done. I ensure the flat is tidy and clean, I try to encourage her to make her bed and do basic things but all too often nothing is done and this is not how she was when she first acquired the flat. Elizabeth relies on me to collect her – at least at home she can sit out in the garden and see her cat. Elizabeth adores the pigeons and birds she sees from her balcony windows. I have put netting up to ensure that the balcony is clean. Elizabeth has balance problems and clings to my arm whilst walking. We have no adaptions in the shower at home and I was trying to get all this in place. You would think that during the course of one year something could have been done about her flat and a shower put in but noone would deal with me at the GP surgery or council’s OT assessors because she had not been discharged from hospital. I will have to try this again now she is out of hospital and see the response. The autism assessment cannot be done immediately because there is a massive long waiting list. With the diagnosis in grave doubt and up in the air this means professionals can carry on with the distressing treatment of depot injections. I am determined that a better solution can be arrived at but cannot see that this can be achieved via a MH team in the community who do not have the experience of neurological conditions and I have advised Elizabeth all the time not to stop taking the drugs steeply but yet I understand her distress at the depot injection given every two weeks and if she was to refuse then what would the team do?
In the files it says “high risk of choking and mortality”. She was not like this going back to when first admitted but it is no wonder why when hospitals such as Elysium prescribe drugs at high levels ignoring STOMP and give face down restraint plus surely it is wrong to prescribe two antipsychotic drugs IM – these being Clopixol depot plus olanzapine resulting in Mews Score 2??? No wonder there are deaths in these institution as two IM antipsychotic drugs were not advised by the SOAD. Not one of these institutions has assessed her for autism properly and enormous amounts of money have been spent in one year that has made Elizabeth come out of the system more disabled than ever and totally reliant on me.
Despite all of the above I am still so happy that Elizabeth is not on a Section right now. I think they should offer her a reduction and slowly reduce this drug as it really does not work. The effect on Elizabeth is not good for her physical health.