VISIT BY THE COMMUNITY RC

As NR, in a letter sent by courier to the Hospital Managers at Chase Farm Hospital Enfield I discharged Elizabeth from S3. This was due to expire on 1 June and I was expecting the usual ie., that dreaded call from the AMHP asking for my objection to S3, to then be barred and then dragged to court, or for Elizabeth to be placed on CTO, previously ineffective and used to bully and force her to engage with the community team or else be recalled to Chase Farm Hospital. Now the difference is Elizabeth is trapped by fortnightly depot injections and the team would know instantly if she refuses to take it. I never received that dreaded call but instead, a letter from the MHA Office stating Elizabeth is no longer subject to Section 3 as the Responsible Clinician Dr HM decided the section should be rescinded on 28 May 2021. So Elizabeth was told on the spur of the moment she was “free” to go but no discharge papers were given and so we were not quite sure what was going on.

The discharge papers have only just been received with an official discharge date of 5th June. As NR I was not given a copy other than through Elizabeth.

Under Principal Diagnosis (ICD10 Code) it is disturbing reading:

No mention of paranoid schizophrenia or autism (for which Elizabeth is awaiting a proper assessment). Instead the focus is on physical health.

“Other abnormal findings on diagnostic imaging of central nervous system

Other and unspecified symptoms andsigns involving cognitive functions and awareness

Pruritus, unspecified.”

Under specific risk and safeguarding it says N/A

Then there is a list of contacts in the Crisis Plan:

Mind Crisis Line

Saneline

The Maytree

NHS 111

North Mid Hospital

Barnet Hospital

Emergency Services

ENABLE COMPASS

IAPT

Anxiety UK

Samaritans

Elizabeth was discharged back to her flat under Enfield Crisis Resolution and Home Treatment Team service who phoned her every other day and visited only twice. Then care was transferred back to ECRHT, responsible for instigating court case after court case including CoP, RcJ – county court displacement of NR and even Section 42 meeting.

The only care currently in place is the fortnightly depot and her care coordinator visited recently to adminster the Clopixol at 400mg.

Elizabeth got completely worked up prior to the depot being administered and also when the Home Treatment Team phoned and wanted to visit. No doubt this was all very triggering for her.

Yesterday, a surprise visit from the Community RC, Dr IM – I was not advised other than through Elizabeth. He brought with him an AMHP well known to us as a family. They came yesterday afternoon- I wondered why Elizabeth appeared so stressed out. The community RC stated he was there because of her mother’s request. On reading the discharge files I had requested something be done about Elizabeth’s medication. Due to what appears to be too high a dosage, Elizabeth is just lying around with no energy, fit for nothing and has come out of hospital so disabled to the point she is no longer venturing out alone and is a shadow of her former self. She has balance problems, blurred vision, breathing difficulties particularly noticeable when walking and she has trouble swallowing/choking. He asked for input but was only interested in Elizabeth’s input. When I mentioned side effects this did not go down well and I was told he only wanted to hear from Elizabeth her comments.

Not sure if we were being recorded as the social worker (EJ) kept fiddling around with her phone in her handbag. The AMHP asked Elizabeth if she remembered her to which Elizabeth replied “no” and I replied “yes”. How can I ever forget The CoP and attempted DoLs to force her return to a care home where she had no food at the weekend ie Phoenix House Stepping Stones rated good by the CQC. This was also when the Clozapine was deprived for four days prior and in the first instance “Deprival of Medication Community Care”.

The community RC then announced his proposed titration of Clopixol down to nothing starting starting with 50mg which I am not sure is too high but I will check. It is only when Elizabeth has tried to stop taking the drugs too steeply there has been problems caused by this and not relapse of so called “illness” Now only physical conditions mentioned on the discharge notice so I can see.

It was questioned why Elizabeth was so quiet, glum and guarded but noone stopped to think why. “you wasn’t like this last time and how was you whilst in hospital in comparison?” Any kind of questioning Elizabeth absolutely hates. I told them that since coming home from hospital at least she was sleeping well but the problem is Elizabeth is highly sedated and sleeping during the day and constantly having to take a rest. This surely is not right.

I mentioned I had acquired the latest files of shocking content in which is stated “of high risk of mortality and choking”. Whenever Elizabeth gets stressed out she seems to have excess saliva which was evident during their visit.

In the past, reductions of medication have been refused but the RC stated he had reduced Risperidone down from 2mg to 1.5. I advised I had reduced it from 1.75 to 1.5 as Elizabeth could not cut a small tablet into four and neither could staff at her supported housing scheme Reservoir House. I also mentioned how Elizabeth should never have been prescribed this drug previously found to be allergic to that had lines put through countless drugs charts. The drug, Risperidone is subject to Class Action yet recommended by CQC’s SOAD as was Paliperidone, depot form in addition to plus drugging at max levels, except not recommended was the two antipsychotic IM injections given at Elysium. It is no wonder people with LD/autism die early – you only have to look at the files “Mews Score 2 /3” – that is serious and then look at the drugs prescribed against STOMP even above BNF level. I have all the proof of what goes on in these institutions.

It was also discussed that when the drug is reduced to very low level this is when care needed needs to be taken as this is when there is risk of “relapse” (withdrawal syndrome). I then commented to the effect of injury as per the comments on ICD10 diagnosis on physical health.

For safe reductions there are no facilities other than locked acute wards that are noisy and untherapeutic. When there is risk of “relapse” during drug reduction surely there should be the right kind of help given and in particular a facility that specialise in research in respect of drug withdrawals not an acute ward or PICU.

It was discussed about the CTR minutes and the fact that no minutes had been received by anyone. I have tried to chase these up as they are overdue.

After they left Elizabeth was visibly upset. She spoke of her life being ruined, not wanting to live and wanting to be free. She used the word “abuse” several times and that she wanted to be left alone by professionals but there is no chance of that now whilst she is on a depot and this is the only “care” in place right now.

In terms of risk – absolutely nothing is mentioned apart from N/A.

In terms of health and safety – no mention either but I would comment that since December’s lockdown Elizabeth had spent a great deal of time in her bedroom on the ward not venturing out. She was phoning me constantly asking me to bring things but I could not visit and she was not even allowed a fresh air break. She says she is amazed she is still even alive but comments that life is not worth living. I can see what she means by that and it is very hard to hear such comments. The situation of the lockdown led to her physical health being neglected. Tomorrow is the XRay appointment regarding her breathing and next week are more appointments re her eyes which are troubling Elizabeth. Totally dependant on me as her carer with no help in place these appointments fall on me in order to take her.

Worse still, Elizabeth has gained enormous weight from no exercise over so many months of incarceration and as a result, she can no longer get in and out of her bath and there is no shower so I have had to bring her back home for this purpose.

I have never seen Elizabeth come out of hospital quite so disabled and she appears to have agoraphobia and worse still breathing difficulty which is quite noticeable at times.

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