High Court Ruling over boy detained in Greater Manchester hospital highlights ‘acute’ lack of care placements

The detention of a 12-year-old boy with “complex medical and behavioural issues” at a hospital in Wigan highlights “an acute lack of appropriate resources for vulnerable children”, a High Court judge has said.

He said: “It would border on the obscene to use a protective jurisdiction to continue the boy’s current bleak and dangerous situation simply because those with responsibility for making proper provision for vulnerable children in this jurisdiction have failed to discharge that responsibility.”

The child, known as Y, was physically and chemically restrained in hospital last month and, at points, was handcuffed and guarded by as many as 13 police officers, the court heard.

Other seriously ill children were moved to alternative hospitals across the north west of England due to the disruption and elective surgeries were cancelled.

Judge Mr Justice MacDonald, who overturned an order authorising the deprivation of the boy’s liberty on the ward, said that he demonstrates “challenging, violent and increasingly self-harming behaviour”. 

He has been diagnosed with epilepsy and “it is possible, although not definitively established” that he also has ADHD and autistic spectrum disorder.

The boy, who has been known to children’s services since 2011,  was taken to A&E after attempting to harm himself and threatening suicide at his children’s home, the court was told.

“On arrival of the child and adolescent mental health services (CAHMS) practitioner at the emergency department Y was in full restraint with several police officers and staff. His legs were strapped together and his face covered with a guard to prevent him from spitting and biting. On the advice from the CAMHS practitioner, Y was given IV lorazepam following a discussion with the psychiatric consultant. Y was admitted to a paediatric ward,” the judge said.

Three days after his admission, Wigan Council received the court order authorising the deprivation of the boy’s liberty on the ward.

However, it was overturned by MacDonald just two days later.

He said: “It would border on the obscene to use a protective jurisdiction to continue the boy’s current bleak and dangerous situation simply because those with responsibility for making proper provision for vulnerable children in this jurisdiction have failed to discharge that responsibility.”

The council was told to find a specialist community placement for the boy.

He added: “Within this context, the adverse impact of the lack of appropriate provision that the courts have to wrestle with week in and week out in cases of this nature is now also impacting on the health and welfare of children and families who have no involvement with the court system.”

“Whilst the focus of this court is, and has to be, on the welfare of Y, it cannot be ignored that the situation that has arisen in this case by reason of an acute lack of appropriate resources for vulnerable children in Y’s situation has impacted severely on many other children and families,” the judge said.

A copy of the ruling has been sent by MacDonald to Education Secretary Gavin Williamson, children’s minister Vicky Ford, Ofsted, chief children’s social worker Isabelle Trowler and chair of the Care Review Josh MacAlister.

See full article here

Source: Children and Young People Now, 13th August 2021

Hertfordshire mental health patients treated as far away as Durham and Greater Manchester

An out of area placement is defined when someone with acute mental health needs who requires acute inpatient care is admitted to a unit that does not form part of their usual local community mental health service, and where the person cannot be visited regularly by their care co-ordinator to ensure continuity of care and effective discharge planning.

Patients in Hertfordshire admitted with acute mental health concerns have been treated as far away as Durham and Bury, according to new data.

The figures also revealed that the responsible NHS Trust in Hertfordshire has spent more than £2.5million on inappropriate placements for people needing mental health treatment.

The figures, published on August 12, revealed how many organisations had active ‘out of area placements’ in May 2021 in relation to acute mental health treatment.

Hertfordshire Partnership University NHS Foundation Trust said they have placed the patients with acute mental health concerns “because a suitable bed has not been available for them closer to home”.

The data has been published every month for five years after the Government committed to eliminate ‘inappropriate’ out of area placements by 2020-2021.

However, the figures reveal that the trust responsible for mental health services in Hertfordshire has spent more than £2.5million on around 140 inappropriate placements in the first six months of 2021.

The newly released information also includes which trust or operator received patients from the Hertfordshire trust. It reveals that in May patients were treated in County Durham, Greater Manchester and West Yorkshire.

Full article here

Source: Hemel Today, 24th August 2021

‘Wonderful’ teacher, 29, struggling with mental health during lockdown found dead two weeks after being told to wait for psychiatric help

A teacher was found dead two weeks after he was told he would have to wait a month for a psychiatric assessment, an inquest has heard.

John Curran, 29, was deemed as not posing an immediate risk of self-harm during an assessment on March 24, despite only being discharged from an Italian hospital five days earlier, following a suicide attempt.

He went missing from his parents’ home in Francis Road, Irlam, on April 6 and was found drowned in the Manchester Ship Canal, off Cadishead Way, three days later.

John had a telephone consultation with Dr Sam Johnson on March 23.

Dr Johnson told the court that he was concerned that John was experiencing ‘significant delusions’ and said that he believed him to be ‘acutely unwell’. He assessed John as being at high risk and referred him to the community mental health team, with a face-to-face meeting set up for the following day.

On March 24, John told community mental health team assessor Natalie Vassilou about the phone calls he believed to have made and his concerns that the recipients of those calls wanted to kill him.

No evidence of any such threats or phone conversations have ever been discovered.

Miss Vassilou told the court that John had told her he did not want to take his own life in Italy and had only done it to prevent these people coming after him.

She said that she did not believe him to be at immediate risk of self-harm, citing protective factors such as being back in his home country, living with his sister, and the relationship with his parents.

Miss Vassilou added that she did not think John presented as being acutely unwell and made a judgement that he did not require immediate hospital treatment.

After consulting with a colleague, a decision was made that he did not meet the criteria for home-based treatment either.

John was told he would have to wait until April 20 to be assessed by a psychiatrist but that he should ring the crisis team if his condition worsened and he felt as if he needed to be reassessed by the community mental health team.

Despite ringing up on March 29 to tell a member of the team that his anxiety levels had increased, he was not reassessed.

Miss Vassilou told the court that she was on holiday at the time, which is why she did not deal with it.

Asked why her colleague did not reassess John, Miss Vassilou said: “I don’t feel like I could comment on someone else’s conversation because I wasn’t there.”

Dr Ayaz Qureshi, a consultant psychiatrist, said that there is no set criteria on deciding what makes a patient high risk and described it as ‘a very objective judgement’.

He was also asked why John was not reassessed despite informing the service of his increasing anxiety levels.

Dr Qureshi said: “[That member of staff] is not here so I can’t say how she was feeling at the time.”

He admitted that psychiatric assessments can be brought forward if there is urgent need to do so, but that due to John not being deemed high risk, this was not done.

Just over a week after telling mental health services that his anxiety levels had increased, John went missing from his parent’s house on April 6.

Following a search by Greater Manchester Police (GMP) some items of clothing belonging to John was found next to Manchester Ship Canal. 

He was later retrieved from the water but was unresponsive.

Pathologist Dr Chandran carried out a post mortem and drowning was recorded as the cause of death.

A toxicology report found there was no alcohol or illicit drugs in John’s system, just therapeutic levels of anti-anxiety and anti-psychotic medication.

See full article here

Source: Manchester Evening News, 26th August 2021

Non-pharmacological alternatives to PRN psychotropic medication

Psychotropic medicines are used frequently in mental health settings; however, concerns have been raised over the safety and lack of evidence of effectiveness of this practice. Greater Manchester Mental Health Trust conducted a survey exploring the non-pharmacological interventions used by nurses to support agitated service users. It used their responses to create a clinical aid that maps out suggested interventions under the themes of physical health, relaxation, distraction, environment and psychological health.

The survey by GMMHT explored non-pharmacological interventions as alternatives to pro re nata (as-required) psychotropic medication in mental health settings. This article explores its results, which have been developed into a clinical aid suggesting possible interventions.

A total of 34 distinct non-pharmacological interventions were identified, which fell under five themes: physical health, relaxation, distraction, environment and psychological interventions. Our analysis of the free-text comments revealed how the interventions and themes interacted and overlapped, which enabled us to develop a thematic map of nurse-led interventions as an alternative to PRN psychotropic medication (Fig 1). This is a visual schematic map for use by both staff and service users to allow them to identify non-pharmacological interventions that could be used in a moment of crisis, as well as to identify those interventions that the service user would not find helpful. We discuss the map’s five themes below, with reference to both survey responses and supporting literature.

See full article here

Source: Nursing Times, 22nd February 2021

Adult social care and mental health services to be ‘streamlined’ in Trafford

Agreements have been struck between the NHS and Trafford Council to improve mental health services and care for vulnerable adults across the borough.

One Section 75 partnership agreement has been signed between the local authority and Greater Manchester Mental Health NHS Foundation Trust (GMMHFT). 

Another is due to be signed off between the council and Trafford Clinical Commissioning Group (CCG).

Both agreements are aiming to pave the way to better, more streamlined care for residents.

The arrangement for mental health provision in the borough is an update on the current agreement between GMMHFT and Trafford council.

The deal between the council and the CCG for streamlining adult social care is also an updated one and is due to be signed off at Trafford council’s executive meeting on Monday July 26.

It solidifies the adult social care in Trafford under one management system, continues to simplify and improve services in the borough and allows the use of council funding by the CCG and vice versa from a collective funding pot.

Coun Jo Harding, Executive Member for Adult Services, said: “The importance of good mental health is finally being recognised and this agreement makes sure the systems are in place to make sure people can get the right treatment at the right time.

“For the council, a major priority is enabling people to live as independently as possible. This agreement is a key part of delivering on that priority.”

Claire Fraser, head of operations for Trafford Mental Health Services at Greater Manchester Mental Health NHS Foundation Trust, said: “We have welcomed this opportunity to review and renew our partnership with Trafford residents.

“In Trafford there has been and continues to be an unwavering commitment to improve our collective approach to neighbourhood and partnership working, building on some of the excellent work that already exists.

“It has been a constant discussion point for years and some amazing progress has been made in terms of integrated and multi-disciplinary neighbourhood teams and this commitment to Trafford residents ensures mental health care and well-being is connected to the wider health and social care system.

See full article here

Source: Manchester Evening News, 22nd July 2021

New Crisis Mental Health Hub Open at North Manchester General Hospital

A new mental health facility, based at North Manchester General Hospital’s Emergency Department, is welcoming patients who are in need of urgent mental health care.

Manchester Evening News, 4th August 2021

The joint programme between the North Manchester General Hospital (NMGH) and Greater Manchester Mental Health NHS Foundation Trust (GMMH) repurposed an area adjacent to the Emergency Department to divert people in mental health crisis away from the busy A&E into a more appropriate area, staffed by mental health professionals and offer urgent appointments as part of the GM Urgent Care by appointment scheme. 

‘The Green Room’, is a new facility which accepts patients who are experiencing a mental health crisis. They will be cared for in calm environment, away from the Emergency Department, which can often worsen crisis mental health situations.

Individuals needing critical mental health care are treated and supported by the most appropriate mental health professional. This has obvious benefits for the patient in crisis who receives timely care in the right place, but it also frees up staff in the Emergency Department to treat people who have urgent physical health needs.

Full article here

Source: Manchester Evening News, 4th August 2021

Three young people have died at Prestwich mental health hospital in the last nine months

“We are deeply concerned to see a pattern of deaths of young people in this hospital. Families expect that their children and loved ones are in the safest place possible when they are a mental health inpatient.”

Jodie Anderson, caseworker at the charity INQUEST

Three young people have died in a nine month period at Prestwich Hospital.

Rowan Thompson, 18, died at the mental health hospital in Bury, in October, followed by Charlie Millers, 17, in December, and Ania Sohail, 21, in June.

The series of deaths has led campaigners to call on the Care Quality Commission to ‘urgently inspect the service’.

In response, the Care Quality Commission told the Manchester Evening News they were reviewing ‘the information available to us and considering what actions’ to take.

In a 2018 CQC report Greater Manchester Mental Health Foundation Trust, of which Prestwich Hospital is part, was rated ‘good’ overall.

But Paul Elliot, Deputy Chief Inspector for hospitals and lead for mental health said there were ‘areas for improvement’, adding: “We have made it clear that the trust needs to focus further on safety.

“In acute wards for working age adults and psychiatric intensive care units, staff were not following the trust’s policy in relation to rapid tranquilisation and in child and adolescent mental health wards, checks to ensure that equipment was safe to use had not always been carried out.”

The Trust has 13 locations with 875 beds across 59 wards.

A CQC report published in January 2020 again rated the Trust ‘good’ overall, but the category of ‘Are Services Safe?’was said to require improvement.

Jodie Anderson, caseworker at the charity INQUEST, which is supporting the families of Charlie and Rowan, said they were ‘deeply concerned’.

“Families expect that their children and loved ones are in the safest place possible when they are a mental health inpatient. Yet too often, this is not the case,” she said.

“We await the inquests into these premature deaths, which must ensure the utmost scrutiny. However, we cannot wait for action on this hospital. In light of these three very recent deaths of young people in concerning circumstances, we call on the regulators the Care Quality Commission, to urgently inspect this service and ensure other young people in mental health crisis are kept safe.”

In response, Brian Cranna, the Care Quality Commission’s head of hospital inspection (and lead for mental health), said: “We can confirm, that we are aware of the deaths of three patients at Prestwich Hospital in Manchester, which is run by Greater Manchester Mental Health NHS Foundation Trust, and our thoughts are with their loved ones.

“We are reviewing the information available to us and considering what actions we may wish to take.

“Our priority will always be to ensure consistently safe, effective and responsive care for people using health and social care services.”

Full inquests will be held into the deaths of Ania, Rowan, and Charlie at Rochdale Coroner’s Court. No dates for the hearings have been set yet.

See full article here

 Note: NHS trusts investigate deaths in their own mental health facilities, with no independent body looking into the death.

The charity Inquest provides support to bereaved families of those who have died in state custody. It said in 2015 the lack of an independent investigation into deaths in mental health detention is a ‘glaring disparity’.

A later report in 2016, submitted to the Care Quality Commission in the wake of Southern Health’s disastrous handling of patients’ deaths, warned the ‘approach to investigations and investigation reports are inconsistent across trusts and mainly very poor in quality’.

Source: Manchester Evening News, 26th July 2021

Hearing Voices | Seeing Visions | Making Zines with Liv Winter and Voice Collective (September 2021)

Do you want to help people understand what it is like to be a young person who hears, sees, or senses things that others don’t?

Join artist Liv Wynter for a series of online zine-making workshops to explore experiences of hearing voices and seeing visions! Open to anyone aged 16-25 with lived experience of voice-hearing. No artistic skills necessary!

The digital zines we make at the workshops will be shared on Understanding Voices ­– a website containing information about different ways of understanding voices and supporting people who are struggling to cope.

Hearing the Voice is collaborating with Voice Collective and artist Liv Wynter to run a series of online zine-making workshops for young people (aged 16–25) who hear voices or see visions that others don’t.

It’s an opportunity to …

  • Share your story
  • Explore how voice-hearing intersects with other aspects of who you are
  • Meet other young people who hear voices
  • Make some zines!

The workshops will take place on Zoom over four weeks in September on the following dates:

  • Thursday 9 September 2021, 6.30–8pm (BST)
  • Thursday 16 September 2021, 6.30–8pm (BST)
  • Thursday 23 September 2021, 6.30–8pm (BST)
  • Thursday 30 September 2021, 6.30–8pm (BST)

More information about the workshops and information on how to express an interest in participating can be found here

Long-covid mental health and psychological support service to launch by Pennine Trust

Recent research from The Lancet shows that an estimated 34 per cent of people diagnosed with Covid-19, go on to have a neurological or psychiatric diagnosis within the following six months

Pennine Care NHS Foundation Trust has received £593,000 in funding from Greater Manchester Health and Social Care Partnership to establish a new long-covid mental health and psychological support service.

The new service, expected to launch autumn 2021, will be based at Pennine Care’s existing
Psychological Medicine Service in Oldham; and will co-ordinate the care and support for people with mental health and psychological difficulties caused by Covid-19 in Oldham, Bury, Rochdale, Stockport and Tameside and Glossop.

Anna Dalton, long term conditions strategic and operational lead at Pennine Care, said, “Our innovative Psychological Medicine Service in Oldham already supports people with complex physical health problems and long-term health conditions who may also have mental and emotional difficulties.

Since autumn last year, we have helped more than 50 people in the borough who have had
on-going psychological difficulties and complications due to Covid-19. This new dedicated
service means we can help people across all our five boroughs in Greater Manchester receive the mental health help and support they need.”

See full article here

Source: About Manchester, 19/07/2021

Pennine Mental Health Trust failed young musician due to gap in provision

Self-taught drummer James Theophine was reported to the police in April 2019 and his mum Melanie Theophine said that the allegations ‘rocked his world’.

James became dependent on alcohol and died from multi-organ failure in October 2020, aged 20.

The court heard that James slipped through a gap in mental health services in the run up to his tragic medical episode.

James, from Heywood, suffered a series of mental health issues throughout his life and relied heavily on his mum.

In 2007, he was diagnosed with ADHD and four years later, he was diagnosed with autism.

He had a severe form of eczema which was prone to infections, lived with OCD from a young age and struggled with bulimia later in his life.

Mrs Theophine said her son’s mental health suffered a blow in April 2018 when police investigated an allegation involving him – and while this was dropped, James had found the police’s handling of the case traumatic.

The court also heard that James slipped through a gap in mental health services in the run up to his tragic medical episode. 

The court heard that after his 19th birthday, James had struggled to access mental health services after getting too old for the children’s mental health team.

He was considered ‘too complex’ for the adults’ community mental health team and was referred to an organisation called Lanc UK, which was commissioned to run some mental health services.

But Mrs Theophine felt this would not help her son, and in January 2020 she spoke to Pennine Trust enhanced access nurse Gillian Fletcher, along with James.

Ms Fletcher told court that she referred James to Pennine Trust’s ‘open door’ team and arranged for a psychiatrist to see him.

By July, James’ case was discharged by the trust, as he had again been referred to Lanc UK.

Lanc UK director Dr Neil Rutherford told court that his organisation had already considered that James was too complex for the organisation to help him one month earlier – an issue his mum had previously highlighted.

Ms Fletcher said Pennine Trust had not been made aware of that, and would have found an alternative solution for James had it known.

Asked whether she believed there had been a gap in provision for James, Ms Fletcher said: “Yes.”

She added: “I’ve had a lot of time to reflect on James’ case. I did meet him twice. James did speak to me on his own for quite a good period of time.

“He was a very lovely person and a very gentle young man. On reflection I wish that we had also referred him to alcohol services. He was using alcohol and admitted to self-medication.”

A report into the care received by James was read to the court by Cheryl Henry – the community services manager at Heywood, Middleton and Rochdale Community Mental Health Team.

The report also concluded that there was a gap in James’ care.

See full article here

Source: Manchester Evening News, 24th July 2021