Report of the Inquiry into the circumstances of the Death of Bernard ...

impulsivity; difficulty forming relationships; in close relationships, fluctuating intensity of
emotional involvement; exaggeration; risk of violence; threatening, abusive behaviour”.
12.19 As regards medication, Dr Wright advised that it was unlikely either at that time,
or currently, that there would be consensus regarding the prescription of antidepressants
and anticonvulsants, in this situation. Dr Wright commented that the healthcare plan
devised on 28 June at Garth prison was appropriate and encouraged fostering a strong
therapeutic alliance and encouraging involvement of Mr Lodge in daily living activities.
He considered such interventions more important than medication in conditions of
personality disorder and adjustment reaction. Dr Wright concluded that, in the absence
of a clinical consensus in the mental health field about the use of prescribed medication
for personality disorder, the decision by the prison doctor at Garth to withhold antiepileptic
and antidepressant medication was within common and acceptable practice. He
was impressed by the quality of the doctor’s examination recorded when Mr Lodge was
admitted to Garth and noted, also, that when he was admitted to Manchester the
medical officer appeared to have conducted a clear and purposeful interaction with Mr
Lodge to try to gauge how much he was at risk.
Psychiatric follow-up
12.20 The inquiry noted that the psychiatrist at Warrington Hospital had recommended
psychiatric re-assessment and the doctor at Garth recommended counselling. The
inquiry asked Dr Wright whether he was satisfied that there was appropriate continuity of
care for Mr Lodge’s mental health.
12.21 Dr Wright said that, until about three years ago, personality disorder was a
”diagnosis of exclusion”, that is a condition whose presence cannot be established with
complete confidence from examination or testing but is derived from elimination of other
reasonable possibilities. The term was used to explain antisocial behaviour that could
not be explained by a diagnosable form of thought disorder that could be treated and it
therefore meant that patients so labelled received no mental health service.
12.22 Thinking changed in 2003/2004 with a landmark document published by the
Department of Health (DH) 1 . Current practice identifies therapeutic approaches and
1 Department of Health: Personality disorder: no longer a diagnosis of exclusion - policy implementation
guidance for the development of services for people with personality disorder (January 2003)
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