MORE ON CAPACITY ASSESSMENTS

• Principle 1: A presumption of capacity. … 
• Principle 2: Individuals being supported to make their own decisions. … 
• Principle 3: Unwise decisions. … 
• Principle 4: Best interests. … 
• Principle 5: Less restrictive option.

There has been a spate of about 5 capacity assessments done on Elizabeth recently and shockingly two of these have been by doctors, Dr AB and Doctor TS who was only a very short time at Ash Villa.

None of the capacity assessments have been done properly. It is very important for anyone in this position to question whether, based on the above principles the capacity assessment is done fairly and honestly and I am going to give some examples of dishonesty below. In Elizabeth’s case all the capacity assessments have been done with some internal connection from what I can see and when there are certain aims of the team such capacity assessments can be twisted to suit themselves in order to get the results of anything they want such as for instance placing someone into care against their wishes. This is why anyone affected should request a completely independent capacity assessment.

In my previous blog I have shown how wrong this person, a different doctor has got things. How this person has assumed Elizabeth had no capacity just because she did not wish to participate which was evidenced by her comments “no comment” and evasion of answering. This shows she has full capacity and far from being someone with a learning disability who you have to talk in short simple sentences Elizabeth was diagnosed by Huntercombe as being high functioning aspergers.

I am now going to highlight the other Doctor’s capacity assessment which came out against Elizabeth. All of them have been two stage capacity assessments based on assumptions and beliefs such as if the person’s behaviour suggests they may lack capacity and this is ticked. If the person’s circumstances suggest they may lack capacity another tick. Some else has raised concerns another tick. There have been capacity issues previously – another yes (Well I am afraid you have not looked at the files properly as there has never ever been an issue regarding capacity and I have all the past reports to prove it). It says she has a mental disorder. Again where is the proof when I have all the files going way back to the beginning stating autism/developmental and this is not a mental disorder. It is a neurological condition.

He then says she has no understanding of information when Elizabeth constantly phoned me to tell me about all these assessments and that she was NOT going to engage.

So he did not see Elizabeth alone but with a nurse who herself has tried to carry out a best interest assessment. Apparently there are so called formal assessments to decide upon what they think is best interest and then there are the numerous tick boxing not fit for purpose assessments carried out by members of nursing staff or social workers all because they want Elizabeth to say the right things so that they can manipulate process and with make every single decision in the book. However it has backfired on them all and I will go on to show you why.

“I asked if she had any questions to ask” – the answer “no questions”. This probably meant Elizabeth did not want to be asked any questions of the same nature time and time again. It says she did not wish to discuss the matter. That was under retention.

Use/Weigh up relevant decision/information – no had a tick against it with the comments she was not able to weigh up pros and cons or understand the information. This all sounds like some kind of con to me. I am laughing at this.

Communication:

“not able to relay it back to me as if she did not wish to discuss the issue any more. This says it all Elizabeth simply did not wish to participate yet the box was ticked with a No.

The capacity assessment had so called relevant documents attached by a consultant psychiatrist of the inpatient “care” and AMHP Report

And here is my verdict RUBBISH! AND SHAME ON YOU.

Next is another two stage capacity assessment by an AMHP KF – Again this is stating that Elizabeth has no capacity. This report has more wording to that of Dr S.

So KF had to see Elizabeth in the afternoon because the Team said she is asleep in the mornings – sometimes she is asleep all day! she stays in her room to avoid the noise on the ward which is unbearable.

Deputy Ward Manager KS was present who herself has carried out another similar capacity assessment all pointing to no capacity.

“When I asked questions I used clear simple language and offered some processing time to consider what we discussed returning to see her two hours later to see if there was anything she wanted to say. “ Well how patronising. All the time you think my daughter is “LD” – she fully understood and relayed everything to me later. Oh my God talk about coercion! I cannot go into the details but when a team want a decision of some kind they will go to any lengths to get it using and manipulating/coercing a vulnerable person to their own ends.

Understanding – No

but in answer to her questions she said “my back is broken and I have got autism” Isn’t that easy to see and I am just a mother (a nobody to them) yet I understand that Elizabeth simply did not want to answer their intrusive questions. So KF goes on to say “just because someone has autism (noting this is not a formal diagnosis) although the very first doctor and several others have confirmed this “does not mean they do not have opinions or views about what they want to happen. Elizabeth was adamant she did not wish for involvement. This is really shocking but I must share this with all of you:

With regards to Elizabeth’s comments that her back is broken, KF then goes on to reason for this “I have checked with the care team and have been informed there is a likelihood that Elizabeth has injured her back when in periods of high distress and volacity (not to a significant degree other than sprain or strain) she is not known to have broken or injured her back to a similar level. I will describe what we witnessed like never before during a period of leave when it was time to see the crisis team the next day and similar excuses of broken back were being given. Elizabeth was throwing herself on and off the bed in the small ensuite constantly and screaming for an hour. She was shaking with tremors to her hands and all over her body. She was inconsolable. I have only ever seen that on one occasion and put it down to Akathisia due to the enormous dosage of drugs given. She has just been given a massive reduction of 100mg. I am not a doctor but I think this reduction may be a bit high as in Enfield it was 50mg every six weeks. For obvious reasons massive dosage of drugs given in the hope that Elizabeth would lose her capacity as she did at the Bethlem during which time they put her on a drug she clearly did not wish to take and did not even know she was on it. Again Elizabeth said she was autistic and could not do what this assessor suggested.

Retention: Again no.

“I can see there have been occasions when Elizabeth has been emotionally distressed and has expressed anger without prompting and has stated that LPFT does not have the right to *************”

“I do not consider Elizabeth is able to retain all the pertinent information.” was KF’s conclusion.

USE/WEIGH

Elizabeth is unable to weigh up all relevant information. Over the course of admission to Ash Villa Elizabeth has remained guarded with mistrust of professionals related to her mother. This guarded presentation and mistrust of professionals would be in line with paranoid beliefs as a facet of her paranoid schizophrenia diagnosis. They have done everything they can with my former local area of ENFIELD to deprive Elizabeth of an autism diagnosis and I want the world to know this. There is clearly no respect towards patient or carer under LPFT.

“Further to this during my assessment Elizabeth presented with active negative symptoms of schizophrenia including a flat affect, avolition, limited vocabulary and social withdrawal. These negative symptoms would have an impact on Elizabeth’s motivation and concentration relating to both engaging meaningfully in this assessment. ” I did not know KF was a doctor lol. I have looked her up – can you belief this KFG is Safeguarding Public protection and mental capacity practitioner registered social worker. She is supposed to be an experienced safeguarding and MCA specialist with demonstrated history of working in MH and social care. Skilled in forensic/criminal justice practice, MH car, public protection and both child and adult safeguarding. She has an MSc focussed in social work. She works for LPFT NHS. What I have researched is too long to write here but there is extensive experience and qualifications yet she has not done things right at all in her capacity assessment for Elizabeth and has shown nothing in terms of understanding, insight and is not even a doctor to assess medically. Elizabeth said she wanted no part in this. Doesn’t that signal capacity? When she tried to explore the reasons why Elizabeth said she had a broken back and has got autism Elizabeth closed down the conversation “LEAVE ME ALONE. I DONT WANT TO TALK ABOUT IT”.

KF is not qualified as a clinician and cannot adduce evidence of a clinical nature.  It is however interesting that since all of these symptoms are associated with dysfunctional endocrine functions in particular defective thyroid function that the clinicians at Ash Villa think it is necessary to examine this.  Rapid tranquillisation and seclusion are not recognised treatments for hypo or hyperthyroidism.  

The signal lack of interest in pathological causes for psychological dysfunction is a blight on psychiatry and every reason why all psychiatric patients should have regular endocrine function tests and neurological scans for dysfunctions in the amygdala hippocampus and pre-frontal cortex.  It is a blindingly obvious (except to many psychiatrists) precaution that pathological disorders should be screened for. Hope you get to read this KF and any other AMHP who carries out flawed capacity assessments as part of their job. Did you not get that KF with all your qualifications and experience even I as a mother would know when someone wanted to be left alone. It is cruel that you have tried to coerce answers out of my vulnerable daughter which was upsetting to her and relayed to me as she hates questions and I honestly think you and other AMHPs should be on Oliver McGowan’s training course both in Lincolnshire and Enfield.

Negative comments from KF about me now and I was not even present to defend myself but I will here:

“There are wider safeguarding concerns about mother that Susan has been noted to speak over for and about Elizabeth in her presence.” Well you are a fine one to talk aren’t you. You have been doing just that in this assessment.

“Elizabeth is highly emotionally distressed following visits from Susan” “It has been recorded within records a history of similar concerns in relation to Susan’s control and coercion of Elizabeth shared to the Trust by Elizabeth’s previous care team (PREVIOUS LOL THEY ARE STILL VERY MUCH INVOLVED!) and have been all along. There is a Care Act Assessment taking place on Friday by them – the first I can ever remember in so many years.

“As a result longstanding controlling and coercive behaviour would significantly impact on Elizabeth’s ability to make decisions and there have been occasions when Susan has visited but has declined to see her.” There was one occasion and something very strange happened. I was told not to visit the ward but did not pick up the message as I was driving that there was covid on the ward but I had asked for leave as it was Elizabeth’s Birthday. Elizabeth was looking forward to her Birthday cake as she had texted me the day before very excited but staff stood in the way of her coming out even in the grounds for just 5 minutes so I could not give the presents “it’s evil to keep her from her mother on her Birthday” comments from a nurse on duty that day. Suddenly Police were called and I requested a welfare check by them but this was refused by Ash Villa staff and response from the Police: “leave it to the professionals to do what they do best” or words to this effect. Police in Lincolnshire do not feel it their duty to argue in respect of seeing a vulnerable patient even if that vulnerable patient tries to reach out to them by phoning emergency services.

How very nasty – KF goes on to say about me “Susan has been witnessed calling Elizabeth from the car park and insisting she consent to her visit in a hostile manner which Elizabeth then agreed to” . Given the above, I consider that Elizabeth would be unable to weigh up information free from duress or apprehension about Susan’s response to this“.

She then goes on to say that Elizabeth has demonstrated “inability to tolerate lengthy conversations regarding her care and treatment. She can be passive aggressive in her interactions with staff and will frequently close down conversations by staring at staff or demanding they “leave me alone” using verbal, para – verbal and body language to communicate in a hostile and aggressive manner.”

COMMUNICATION

No! “I dont want to participate” and also constant expression of unhappiness towards LPFT.

Then KF goes on to say that “KS who is Deputy Ward Manager was in attendance and in agreement with my judgement that Elizabeth lacks capacity. Although this is the first time I have met Elizabeth I have been involved in her case advising the ward from a safeguarding and MCA perspective since January 2022 so am fully aware of the background and context of her admission, presentation and wider safeguarding concerns pertaining to her relationship with her mother.”

In addition to the above capacity assessments various other capacity assessments said to be in best interest have been carried out by GJ and KS – deputy ward manager. Elizabeth said she was not even informed she was undergoing a capacity assessment by GJ.

All along it has been a campaign of bullying, an abuse in process and professionals who have behaved in the most appalling manner particularly in relation to safeguarding.

Several patients have come up to me in the grounds raising safeguarding concerns that Elizabeth is being over-drugged. At times we could hardly hear her speak as she spoke with a slurred accent. In light of the fact she is a poor/non metaboliser and of high risk of mortality in accordance with a care plan she shared with me I am going to publicise every time I get to hear of her being rapidly tranquilised as the next thing she could be dead in there then the same thing would be sticking together regardless.

There are staff shortages on the ward and I look out for this. When Elizabeth first arrived in a caged vehicle in a very distressed state there was only 1 male nurse on duty who urged me to complain.

The last thing I wanted to do was complain in a new area but now have had to turn to those at the top of Trust and Council which I will feature another time.

So as you can see none of these assessments have been done fairly or correctly by professionals who should know better and let every other professional down by their dishonest approach. This gives their profession a bad name.

All along they have tried to carry out safeguarding on me but I found out. I welcomed the idea of safeguarding by way of a S42 meeting. Of course I have the minutes of the S42 meeting in Enfield that Elizabeth kindly gave me. The result was both Enfield Council and BEHMHTNHS had to apologise because of the Ombudsman’s findings.

This time the safeguarding concerns came from patients who were concerned that staff at night were picking on Elizabeth and some slept with their doors open “we know when she is in seclusion as we hear her screaming non stop” “we cannot safeguard her when she goes into the seclusion room. She goes in with a tray of difference sized needles” So I said “I thought it was a De-escalation room” “same thing – seclusion” said the patients. Based upon what I heard I complained as any parent would and there was no way I could dismiss what these patients were saying when I heard very clearly some of the things that were going on. When I asked if there was any staff members in particular that were picking on her the patients said the vast majority of night staff. This of course would be denied or played down. When someone is asleep for most of the day they will be awake at night but she has been told to get out of the dining room and not to sit in front of the TV in the lounge but to go back to her room. It is at night that Elizabeth would be wide awake because she would be spending most of the day in her room. It is at night she would be plagued with trauma and nightmares none of which has been tackled at Ash Villa as there has been no psychologist in 19 months. She is placed in a part of the ward that is very noisy near the seclusion room. I have asked if she can be moved. She was also left to lie on a faulty mattress and sent me the picture of it but this was dealt with the minute I showed evidence of this. Does this not show that my daughter has capacity.

The common law test on capacity is the Masterman Lister v Bruton & Co https://www.casemine.com/judgement/uk/5b46f1f52c94e0775e7ef161

Capacity assessments need to be done independently to the treating team who clearly have their own agenda and are not fit to be qualified in this respect.

Capacity assessments do not need to be done by psychiatrists, they are done by qualified best interest assessors.  Capacity is NOT related to diagnosis, there are many reasons for lack of capacity and it is nothing to do with schizophrenia, PTSD or autism.  People with those diagnoses can have capacity and many do.  Autistic people get doctorates in nuclear physics and lots of practicing psychiatrists themselves have severe mental illnesses.  Are we to suppose that they don’t have capacity to work as doctors? 

The LCC and LPFT are trying to do an end run around the MHA 1983, the MCA 2005

As regards treatment:

There appears to be a complete lack of monitoring of the treatments being given to her.  Dosages are increased without checking serum levels and ability to metabolise the drugs.  There is no clear knowledge of why Elizabeth is treatment refractive but the most likely reason is she is a poor metaboliser or that polypharmacy is interfering with the treatments.  It is most likely that the Zuclopenthixol is within the therapeutic band but without a serum test that is impossible to determine.  If she is a poor or non metaboliser increasing the dose will not result in any improvement and tests in the past have indicated she is a poor metaboliser of typical anti-psychotics.    

Any patient presenting with inflammatory conditions needs close monitoring to avoid ADR’s and dose modification is almost certainly necessary.  It should be noted that inflammatory conditions are commonly seen in patient with endocrine disorders.  

The capacity assessments are all totally flawed and it is self evident that Elizabeth has capacity.  It may be said to be limited but not to the extent, or anywhere near the extent they are suggesting.  If she gets out of an institutionalising environment she will regain what she currently lacks.  It is the environment itself that is causing the inhibited capacity.