A person with Paranoid Schizophrenia who is non concordant with prescribed medication is a high risk if not medically supervised in the community. PS means the degree of paranoia is unpredictable and behavioural responses also. In this case it appears [from the edited report of a non medically - qualified journalist] that the patient was in relapse and very ill.
My questions would be -
1. Was the patient being supervised in the community by a Qualified practitioner [CPN]?
2. Did she have an up to date Care Plan?
3. When was the last point of contact?
4. How did she reach the stage where she was clearly receiving medication as prescribed but wasnt concordant with her medical regime?
5. Were Senior Managers made aware of any concerns?
6. Check patients ongoing records. When? Where? Who with? Why?
There are 390,000 people in the UK with Severe Mental Illness - the majority cope with support and access to services through their GP and Community Mental Health Teams. Its unfortunate that media highlights tragic cases like this one - but says little about very vulnerable people with SMI who have experienced savage cuts in community support facilities, such as drop-in centres and advice services.
Community Mental Health Teams have become the Police Service of Mental Health patients in a crisis: the beds are not available in secondary Mental Health Services. Rehabilitation and Therapeutic Intervention services have been closed. People with SMI are often left alone to fend for themselves. We are talking about poorly people - patients - who are a potential risk to themselves and others.
The threshold criteria for intervention by Mental Health Teams is now so high - compared to even 10 years ago - due to severe cuts and closures - there are high risk patients in the community who would previously been supported in hospital, community settings with open access to support, supervision and monitoring.
Imagine if we treated cancer patients in the same way, or stroke patients, or people with neurological conditions - and only intervened at the point when they were experiencing extreme crisis, acute pain, had lost control of their motor-capability or were on the verge of death?
"We" [the public] wouldnt consider locking up a cancer patient or some one who was violent due to dementia. But SMI such as PS is an illness - which cannot be cured - only managed and contained. The potential risk of harm is greater, but the solution isnt behind prison bars. Strict criteria determines when a patient with SMI will be deprived of their liberty under the criteria in law related to the Mental Health Act - whilst others under section 37 of the Mental Health act may have a Restriction Order [41] placed upon them. Its known as a 37 / 41.
99.9999% of people experiencing severe long term mental health issues dont commit acts against the public - in fact they are more likely to hang themselves, swallow bleach, take overdoses of any medication they can find, cut their arms, legs, groin, wrists and other acts of self harm. Any person who is of such high risk does not deserve to be locked up or offered sympathy: they deserve care, support, compassion and investment in health services to promote independence and a decent quality of life.
