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

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CHAPTER 2 – EVALUATION OF THE HEALTH CARE AND TREATMENT OF LOUISA OVINGTON 84 COMMENT In the almost two years leading up to Mr Hilton’s death, despite continuing problems resulting from Louisa <strong>Ovington</strong>’s alcohol misuse, Louisa <strong>Ovington</strong> was not involved with specific mental health addiction services. This may have been in part because she was thought to be doing an alcohol awareness course as part of her CRO. It may also have been in part because of her disinclination to address this issue. However, this will not have been assisted by the willingness of staff to minimise the ongoing problems. Staff should have tried to address her motivation for treatment (generic mental health staff should have an awareness of basis motivational interviewing) and should have closely monitored her alcohol consumption particularly in view of it’s (in her case) acknowledged association with aggression.
CHAPTER 3 – OUTLINE OF MENTAL ILLNESS AND PERSONALITY DISORDER Chapter 3 – Outline of mental illness and personality disorder There are three main categories of mental disorder: mental illness, personality disorders and learning difficulties. The disorders are defined and diagnosed, on the basis of the existence of specific clusters of symptoms. However, symptoms and signs of ill health are subjective: experienced, described and interpreted according to the bias of the patient and / or the clinician. There are very few symptoms that are pathognomonic of (i.e. relate just to) particular diagnoses: individual symptoms are common to numerous disorders and thus it is the existence of particular clusters and numbers of symptoms that is important. In addition, disorders evolve over time both in terms of their natural history (for example, psychotic symptoms becoming less pronounced in chronic schizophrenia) and in terms of the understanding of the individual and their clinician as to what the person is experiencing. It is, therefore, quite common for a person’s diagnostic “label” to change over time. Diagnosis informs management. The natures of specific mental disorders are well known and the risk factors, life histories, likely responses to treatment and prognoses are therefore reasonably predictable. Mental illnesses, such as post traumatic stress disorder, bipolar affective disorder and schizophrenia are easier to diagnose than personality disorders: in lay terms, persons suffering from such conditions are more clearly “mentally ill” than persons with personality disorders, because personality characteristics are present in all people, whereas symptoms such as hallucinations and delusions are not the norm. An individual’s personality dictates their characteristic lifestyle and mode of relating to themselves and others. These behaviour patterns tend to be deeply ingrained and enduring. A person with a personality disorder shows extreme or significant deviations from the way in which the average individual in a given culture perceives, thinks, feels and, particularly, relates to others. The behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning. They are frequently, but not always, associated with various degrees of subjective distress and problems of social performance. Personality disorders have historically been regarded as innate and untreatable. They cannot be “cured” by treatment with medication. It is only over recent years that specific psychological tests have been created to formalise the diagnosis of the disorders and that effective psychological therapies such as dialectical behaviour therapy and cognitive behaviour therapy have been developed. Historically, there was a hierarchy of diagnoses within psychiatric practice. Within this system, mental illnesses were regarded as more significant and worthy of investment than personality disorders, in terms of provision of resources for management, treatment and research. The diagnosis of personality disorder was effectively seen as a diagnosis of exclusion: patients with such diagnoses were seen as untreatable and 85
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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
Page 33 and 34: 93. The final report from the psych
Page 35 and 36: CHAPTER 1 - NARRATIVE OF KEY DATES
Page 37 and 38: surprised and told the panel that h
Page 39 and 40: • Consultant 9,in his evidence to
Page 43 and 44: 129. Although Louisa Ovington conti
Page 51 and 52: there was “some latitude” in th
Page 53 and 54: 61 14th offence 62 15th offence 63
Page 55 and 56: 176. Social Service staff did respo
Page 61 and 62: 78 21st offence 204. However Louisa
Page 63 and 64: hours. They did not have access to
Page 65 and 66: 210. CPN 2 also completed a risk as
Page 67 and 68: Chapter 2 - Evaluation of the healt
Page 69 and 70: CHAPTER 2 - EVALUATION OF THE HEALT
Page 71 and 72: During Louisa Ovington’s first ad
Page 73 and 74: Kneesworth House Louisa Ovington co
Page 75 and 76: The conclusion drawn by the psychol
Page 77 and 78: On 10 July 2001 Louisa Ovington att
Page 79 and 80: take part in several sessions of a
Page 81 and 82: COMMENT CHAPTER 2 - EVALUATION OF T
Page 83: CHAPTER 2 - EVALUATION OF THE HEALT
Page 87 and 88: CHAPTER 3 - OUTLINE OF MENTAL ILLNE
Page 89 and 90: CHAPTER 4 - THE CARE PROGRAMME APPR
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
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CHAPTER 9 - CONCLUSIONS AND RECOMME
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Some of the risk assessments from a
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• Recommendation 16. Trusts shoul
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f) Use of “talking therapies” C
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professional who had seen her withi
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i) Joint working CHAPTER 9 - CONCLU
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their procedures for formal contact
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LIST OF RECOMMENDATIONS • Recomme
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LIST OF RECOMMENDATIONS • Recomme
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LIST OF RECOMMENDATIONS • The pol
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Bibliography 1. Effective Care Coor
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INTRODUCTION 28 North East Strategi
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