Lousia Ovington independent investigation report ... - NHS North East

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CHAPTER 9 – CONCLUSIONS AND RECOMMENDATIONS 142 appropriate opportunities exist for clinical supervision, peer and case review and to instigate procedures if not. v. Clinical issues a) Provision of inpatient care Prior to 1998 Louisa Ovington was appropriately managed in relation to her psychotic illnesses and whilst her emerging personality disorder was not treated it was recognised as an issue. From June 1998 to January 2000, Louisa Ovington was detained in a psychiatric intensive care unit, a forensic medium secure unit and finally a specialist personality disorder ward in an independent sector hospital. She was treated for symptoms of mental illness at each institution, but whilst her personality problems were recognised at all three, at none did she receive adequate treatment for these. This appeared partly to be due to her being placed in units that did not feel equipped to work with her (the Tony White Unit and St Nicholas’ Hospital) and in the case of Kneesworth House, because they concluded that she suffered only from personality disorder traits and in any event Louisa Ovington declined to engage in therapeutic work. It appears that there was little attempt to motivate her in this. • Recommendation 15. The panel recognises the pressure that may force psychiatrists to rapidly admit a patient to hospital where there is an urgent need for treatment. However the appropriateness of the placement should be kept under close review and trusts should ensure that the responsible psychiatrist is supported in finding an alternative placement when clinical need, or the safety of staff, is an issue. Trusts should also ensure, wherever possible, that choice of hospital is motivated not by expediency but by matching the patient’s need to the care that can be offered. b) Use of psychometric tests The psychologists at Kneesworth House concluded that Louisa Ovington was not suffering from personality disorder. This conclusion was based in part upon Louisa Ovington’s answers to self-reported questionnaires and it contradicted the clinical opinion of other psychologists who had worked with Louisa Ovington previously. This conclusion underpinned the decision of the consultant not to recommend any further detention. The panel heard from clinicians from other hospitals that psychometric testing should not be used to diagnose personality disorder, in isolation from clinical judgement.
• Recommendation 16. Trusts should review clinical practice to ensure, in relation to psychometric tests, that they are only regarded as an adjunct to clinical judgement to inform diagnosis. They should not, on their own, be regarded as diagnostic instruments. c) Personality disorder services When Louisa Ovington was transferred to St Nicholas’ Hospital she was thought to be suffering from a personality disorder (possibly psychopathic) and mental illness (possibly schizophrenia or bipolar disorder). By the time she was transferred on to Kneesworth House, there was less evidence that she was suffering from a mental illness but staff were clearer that she was suffering from a personality disorder. However, when she was finally discharged back into the community there was still no clarity as to her diagnosis. The discharge report from Kneesworth House stated that she had a “past history” of mental illness and that she “could not be said to have a personality disorder”. Inconsistently, the staff from Kneesworth House stated at Louisa Ovington’s post-discharge care planning meeting that they felt she needed a condition of treatment attached to a probation order, but they did not specify whether she needed treatment for illness, personality disorder, or both. This lack of clarity about diagnosis meant that no appropriate treatment plan was formulated. It appears evident to the panel that thereafter Louisa Ovington’s mental health difficulties were not taken so seriously and there was at times reluctance from services to be involved with her because she was not regarded as mentally ill. • Recommendation 17. The trusts need to be clear where the remit for working with people with personality disorders falls. It needs to be recognised that personality disorders can be as serious as illnesses such as schizophrenia in terms of their negative impact on the individual and the society around them. Appropriate, ideally specialist, services need to be provided for such patients and the professionals working with them need specific training and support. d) Use of forensic services CHAPTER 9 – CONCLUSIONS AND RECOMMENDATIONS Louisa Ovington was followed up in the community by general adult mental health services; the CMHT, the addictions services and, at times, the CRT. Given her history of violence and her detention in conditions of medium security, following her discharge from Kneesworth House she should at least have been discussed with, if not taken on by, the forensic services, which the panel were told would have been willing and able to work with her. 143
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REPORT TO THE NORTH EAST STRATEGIC
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Contents CONTENTS Page Preamble 6 I
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Introduction and terms of reference
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The panel met on 14 occasions, tota
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CHAPTER 1 - NARRATIVE OF KEY DATES
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This opinion was referred to by man
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20 May 1998 to 12 January 1999 CHAP
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60. As was common in 1998, there we
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women. Registrar 1 prepared a very
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77. One of the major components of
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visit to see him. A little later, o
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93. The final report from the psych
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surprised and told the panel that h
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• Consultant 9,in his evidence to
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129. Although Louisa Ovington conti
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there was “some latitude” in th
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61 14th offence 62 15th offence 63
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176. Social Service staff did respo
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78 21st offence 204. However Louisa
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hours. They did not have access to
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210. CPN 2 also completed a risk as
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Chapter 2 - Evaluation of the healt
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CHAPTER 2 - EVALUATION OF THE HEALT
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During Louisa Ovington’s first ad
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Kneesworth House Louisa Ovington co
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The conclusion drawn by the psychol
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On 10 July 2001 Louisa Ovington att
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take part in several sessions of a
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COMMENT CHAPTER 2 - EVALUATION OF T
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CHAPTER 2 - EVALUATION OF THE HEALT
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CHAPTER 3 - OUTLINE OF MENTAL ILLNE
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CHAPTER 3 - OUTLINE OF MENTAL ILLNE
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CHAPTER 4 - THE CARE PROGRAMME APPR
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Page 97 and 98: The essence of CPA is to ensure car
Page 99 and 100: Chapter 5 - Involvement with police
Page 101 and 102: 89 ibid The guidance states that th
Page 103 and 104: DS1 told the panel bluntly that, in
Page 105 and 106: and social care agencies. The panel
Page 107 and 108: CRO with a condition of psychiatric
Page 109 and 110: COMMENT The probation officer estab
Page 111 and 112: CHAPTER 5 - INVOLVEMENT WITH POLICE
Page 113 and 114: COMMENT CHAPTER 5 - INVOLVEMENT WIT
Page 115 and 116: CHAPTER 6 - RISK ASSESSMENT AND MAN
Page 117 and 118: CHAPTER 6 - RISK ASSESSMENT AND MAN
Page 119 and 120: • South West Durham Mental Health
Page 121 and 122: CHAPTER 7 - PROVISION OF MENTAL HEA
Page 123 and 124: The policy changes were driven by t
Page 125 and 126: • Past psychiatric history; • S
Page 127 and 128: CHAPTER 8 - USE OF THE MENTAL HEALT
Page 133 and 134: Given the multiplicity of agencies
Page 135 and 136: CHAPTER 9 - CONCLUSIONS AND RECOMME
Page 139 and 140: Some of the risk assessments from a
Page 141: CHAPTER 9 - CONCLUSIONS AND RECOMME
Page 145 and 146: f) Use of “talking therapies” C
Page 147 and 148: professional who had seen her withi
Page 149 and 150: i) Joint working CHAPTER 9 - CONCLU
Page 151 and 152: their procedures for formal contact
Page 155 and 156: LIST OF RECOMMENDATIONS • Recomme
Page 157 and 158: LIST OF RECOMMENDATIONS • Recomme
Page 159 and 160: LIST OF RECOMMENDATIONS • The pol
Page 161 and 162: Bibliography 1. Effective Care Coor
Page 164: INTRODUCTION 28 North East Strategi
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