FREDERICK STREET MEADOWFIELD

COUNTY DURHAM DH7 8NT

Dr Khalli  Memon (RC)

Transferred from Ash Villa Sleaford Elizabeth was placed on Pippin Ward

Elizabeth was taken there on 28 June 2023.

Ash Villa, Sunday 25 June 2023

Turned up without scheduled appointment as I was unexpectedly in the area. Elizabeth was still in her nightdress nightdress late afternoon.  I had brought her Mexican food.  When I arrived at one point I sat in the foyer and heard that a nurse/deputy manager had alleged she had been pushed but there were varying contradictions on account of what actually happened.  Elizabeth claimed to be in her room at the time and the nurse said she was sitting on a chair however Elizabeth’s account of what happened was very different to what the nurse said. I was informed by Elizabeth the following comments were made:

“I am coming into your personal space and do not give a s**t”.

That would have been provocation and I know this goes on, especially at this institution run by LPFT where I was approached in the grounds outside by several patients who had informed me Elizabeth was being picked on and abused and frequently injected and put in seclusion and that they, the patients were doing the safeguarding. She was certainly treated very differently to other patients as though she was on a DoLs and like a restricted prisoner. Then I found out for 20+ months this facility was being provided and paid for by Enfield, my former area where we could no longer stand living there.

Police were apparently informed. So I made sure when I got home I called the Police myself to ensure they heard Elizabeth’s account of what happened and I got a reference number myself. Each time I asked Elizabeth to repeat what happened, her words did not differ. The alleged incident led to Elizabeth’s abrupt transfer to PICU Unit Cygnet Appletree, Durham completely out of the blue.

Arrival – Cygnet Appletree 28.06.2023

Elizabeth had her phone at Cygnet Appletree to begin with on arrival.  She texted me on arrival.

At 03.03    26.06.23 Elizabeth stated:

“sorry Mum they sprang it on me and I had to leave the hospital to go to PICU”

She then texted me to stated “Meadowfield.”

She then texted me to say “I’ve got a nicer room here at least”

“I got treated to a big mac and fries and chicken nuggets” – message at 03.05

“I have passed on your phone number and they will contact you in the morning”.

“When r u coming to see me?”

“I would like some money”

26 June 2023

“Can you pl buy me some shorts and bring them when you next come plus some sungod sunglasses renegades”

She repeated she wanted some Sungod renegades sunglasses from youtube.

She also asked me “hello when are you coming”? at 16.07.

She had asked for money but when I phoned the hospital they do not have a deposit account for patients.   I ordered a pre paid card as being in hospital would not like actual bank card to go astray.

Elizabeth had not picked up any messages since Wednesday 28^th June at 16.08.

I did get a call from someone the next day but it was very brief.  Just to say she had arrived safely but no further information given.    That is the last I heard from her.

Telephoned Cygnet 01.07.2023

Spoke to nurse HANNAH BROWN Pippin Ward.

I asked if Elizabeth had her phone with her and that I could not get through.  I was told  “sorry I cannot give you any information”

I told this nurse that we pay a contract for the phone.  Again she could not give any information.

I asked about visiting hours and was told to call back in the week.

I felt distinctively like they were deliberately not allowing me to speak to Elizabeth and that her phone had been taken away as she had been asking me to visit. In fact I later found out her phone was confiscated because she had called Police in desperation.

I was informed by this nurse she had to hang up and could no longer continue to speak to me any more as she was the only nurse on duty and there was an alarm going off.   When I questioned her being the only nurse on duty she then reported that there was another nurse there but she was in a meeting.

I was told to ring back in the week.

04.07.2023   Telephone call to Cygnet Appletree

Spoke to Kim – reception who told me there was no direct line to ward or ward phone number to ring on.

She then transferred me to ward – no answer at first so was holding on a long time.

Then spoke to Aaron – Support worker

Then spoke to Adrian – a nurse

Finally spoke to Keeley, Ward Manager who told me Elizabeth had her phone but I questioned this as no messages had been picked up via WhatsApp since since 27 June.

Because I am no longer nearest relative (only Power of Attorney) no one would speak or give me any information but I was not asking for any information.  They would not say how she or allow me to speak with her directly.   Elizabeth has been sent a long distance from home right now – at least 3.5 hour journey there and another 3.5 hours back.

I told Keeley that I needed to speak to Elizabeth as she had asked to see me and I wanted to discuss something with her. I was told that they would pass on the message and if she wanted to get in touch she would. I felt as though contact was being deliberately denied.   I said that I would telephone every day until I spoke to her, that way I would be building up a record as I felt sure that they were depriving contact by not allowing her to have her mobile when other patients were allowed in fact.  Keeley admitted some patients were allowed their mobile phones whilst others were not.   I said surely that was discrimination so she said that it depends on the risk level.   What risk exactly?  I am 3.5 hours away now and cannot visit and this was the one thing Elizabeth enjoyed ie my regular visits whilst at Ash Villa.   So I have decided to ring every single day to build up a picture before deciding upon what action to take.  I have already been told that I could not visit at this stage.  At Ash Villa I was aware Elizabeth had no solicitors and other patients were trying to help her appoint them. On a couple of occasions Elizabeth picked up the phone herself but solicitors did not bother to come and see her or respond. There is no saying whether Elizabeth has got any solicitors acting for her at Cygnet either or whether her nearest relative was helping in this regard or even aware of where she had been placed.

05.07.2023   12.40  Another family member spoke to  Catrina, a  Support Worker on Pippin Ward.  She said she would take Elizabeth to a room so that she can make a call back but no call back was ever received.

Subject: Re: Elizabeth’s Move to Cygnet Appletree

“It is of course the case that the MDT have every right to refer Elizabeth to the PICU and the medical & social work professionals will be the final decision-makers on these issues.  It is PICU policy however that the patient in a PICU is “Nothing about me without me”.  That means that the patient effectively has the last word. No they dont! certainly not to frequent torture of rapid tranquilisation.  No patient can be compelled to take part in the OT and psychotherapy so a simple refusal to do so means they will not be forced.  If they maintain this position they will be returned to the psychiatric hospital. No psychological input given whatsoever just like at Ash Villa and Charlesworth Ward Lincoln. 

Cygnet and Ash Villa can of course transfer Elizabeth back to Ash Villa if she does not respond to interventions or if she tells them she wants to go back there.  Patients are not compelled to remain in the PICU and can be returned to adult care wards.  This often happens within the first six to eight weeks if the ICU interventions don’t work or the patient will not engage.  Elizabeth did not want to go back to Ash Villa and as for interventions every few days it would appear she was injected. I have now requested to know how many times.

The advantages of the PICU over the acute adult care ward are obvious, the presence of a psychopharmacologist alone is miles better than that seen on wards.  Not helped one bit – frequent rapid tranquilisations given.

It is my opinion that the visits will be limited in the early stages of Elizabeth’s stay at this place.  They need time & space to commence the interventions and as I have just said if it doesn’t work they will transfer her back to Ash Villa indefinitely. Never got to visit because of distance but was planning to. Absolutely nothing whatsoever has worked because of no psychological input.

Sent: 01 July 2023 19:00
To: susan bevis
Subject: Re: Catalogue of events

The treatment period in ICU/Rehab is between one and two years.  It involves psychotherapy, work regimens and other time consuming interventions as well as monitored medication. Nothing but rapid tranquilisation.

It is possible that Lincolnshire Social Services have been in touch with the PICU regarding the recent litigation.  It is social services that are responsible for paying for the s.117 aftercare not the NHS Trust. This is not aftercare it is a hospital facility well and truly out of area and must be costing I assume LPFT an absolute fortune.

It is unlikely this will be permanent as there is case law preventing the exclusion of family but they will certainly want to exercise close control since rehabilitation involves far more intensive involvement between staff and patients.  Elizabeth is undergoing exactly the same process in a similar unit.  She is given more leave and the accommodation and food are a major improvement on the acute admission unit.   Never got to have leave as she has now been transferred back to Boston today 05.08.2023.

The major problem is the loss of the NR status which means they do not have to communicate with you regarding Elizabeth’s care.  This is unacceptable as a carer you should be communicated with. The MHA 1983 negates the medical provisions of any POA so you cannot invoke that.  To recover the NR status  would require a challenge to ******* again.  It is exceedingly unlikely that would succeed. That is because the whole court process should be open, transparent and honest.  This is public money and Elizabeth like myself want this to be made public. I have therefore requested that this is done. There needs to be accountability in evidence.

On Saturday, 1 July 2023 at 18:32:04 BST, susan bevis <susanb255@outlook.com> wrote:

DR MEMON CALLED FROM CYGNET –  HE SEEMED VERY NICE AND SEEMED TO GENUINELY LISTEN.  HE WAS INTERESTED IN SEEING THE PRIVATE MRI SCAN RESULTS I HAD DONE ON ELIZABETH BUT I SAID I NEEDED HIS EMAIL ADDRESS TO SEND THIS AND OTHER INFORMATION.  STILL WAITING FOR THIS ON 10 JULY 2023.  I MENTIONED TO DR MEMON THAT NOW ELIZABETH WAS A LONG DISTANCE AWAY FROM HOME AND AT LEAST 3.5 HOURS JOURNEY AND I ASKED HIM WHAT FLEXIBILITY COULD BE OFFERED IN TERMS OF VISITING HOURS.  I MENTIONED THAT ELIZABETH DID NOT HAVE HER PHONE AND WE HAD NO CONTACT AND HOW AWKWARD IT WAS TO KEEP IN CONTACT NOW AS I WAS USING WHATSAPP TO MAKE CALLS AND SEND PHOTOGRAPHS OF HER CAT.

THURSDAY 6^TH July  CALL AND VOICE MAIL MESSAGE FROM KEELEY, WARD MANAGER OF CYGNET APPLETREE AT 18.07

MONDAY 10.07.2023     16.14

Received a voicemail message from Elizabeth – first time I have heard from her since moving to Cygnet Durham on 28 June.  

At 16.15 just had the phone put down on me by a member of staff at Cygnet who refused to give her name and said she would pass my call on to her manager.  The Manager of the ward is namely Keeley.   Elizabeth did not sound good on the phone at all and sounded quite distressed.

“Hi mum it’s me Elizabeth I’m not having a good day” please can you call me back on the ward.   She then gave me the number of the ward which is 0191 378 2747”  Now waiting for the ward manager to ring me back that is if I ever get to hear from her.   Time is 16.21    MONDAY       10.07.2023.

I had initially complained about the problems getting through on the phone. Here is the response I received:

Our ref: ENQ1-16584485228

Susan Bevis

Via email: susanb255

25^th July 2023

Dear Mrs. Bevis

Re: Service manager’s review of complaint dated 25^th July 2023

I would once again like to thank you for bringing your concerns to my attention. The investigating officer has looked into the concerns that you have raised and has shared the outcome of their investigation with me. iNCORRECTLY

I have considered the findings from the investigation and I set out below my response to each of the points that you have raised. You have told us that:

You are the mother of vulnerable 36 years old daughter, and 4-5weeks ago she was moved to new service Cygnet Appletree and daughter is under section 3. Caller stated she is autistic and cannot stand the noise and has been moved hundreds of miles away from family so you stated this is Article 8 of human rights breached. Not quite! I stated her phone had been taken away/that we could not get through on the phone. That is what I meant as being in breach of Art 8 HRA.

I have spoken to Dr Memon who confirmed that he had been in discussion with you regarding the care and treatment of your daughter. I will confirm what he has informed me by providing extracts from his email.

I have spoken to Susan Bevis mother of EB on 6^th of July and had a lengthy discussion around EB, reason of her admission to us and explained how we work and provide care to her daughter. I reassured her that we will try our best to provide best care possible to EB. We have recognized that the ward which is PICU can be noisy and we have continued to liaise with EB’s home team to repatriate her back to her home area as soon as our assessment completed. Since her admission, we have had meeting with her home team as well as home team attended ward round every week in order to get update EB’s progress.

For the past two weeks we were clear in our conversation that she can be transferred back to her home area whenever bed is available because of her being sensitive to noises and her being settled with her mental health,. We received an update from home team that she may be return back to her home area next week but it depends upon local bed availability. I tried to contact her mum on 14^th of July 2023 but call went on to voice mail and message was left to contact me. To sum up we already recognized and started liaising to her home team to transfer her back to nearby home area.

While we were waiting to hear from her home team around her transfer back to nearby home area, EB has been given section 17 leave to spend time outside the hospital and small radio as well as ear defenders have been given in order to reduce level of noise and has been given opportunities to involved in ward base activities. During the ward round on last Tuesday team discuss this with EB and she was very happy and appreciated the care she is receiving from Appletree.

Having taken into consideration the comments of Dr Memon I cannot uphold this part of your complaint. There was only one thing and that was being able to get through on her phone but now I have other much more serious concerns.

Second concerns around Phone: No it was about the phone and contact difficulties I complained about.

I have been informed and discussed in our multidisciplinary meeting that EB’s phone was removed because her calling to emergency services inappropriately and it was causing distress to Elizabeth, which can impact on her mental health. No again she was distressed on being so far away from home in a strange environment and she called police in desperation. She claims to be autistic and has sensory issues. It was her transfer and trauma of being transferred that led her to call police.

Following detailed discussion in the multidisciplinary meeting, the outcome was to commence two supervised periods of using phone within 24 hours till she becomes more settled. It was observed and noted that EB was using phone appropriately during twice supervised period and did not show any distress, therefore phone was return back to her on 14^th of July 2023 without any concerns.  I have personally spoken to Elizabeth and she was ok with it. Elizabeth had no say in anything. We were not happy as we pay a contract on the phone. She is no better and you have not provided any psychological input which is atrocious same with Ash Villa.

I am satisfied that no member of staff is preventing Elizabeth from calling you and therefore I cannot uphold this part of your complaint. When I called as I have accurately noted, it took several people before finally reaching the manager and this had nothing to do with confidentiality as we pay for a phone contract.

I appreciate you taking the time and effort to raise your concerns. Concerns raised

provide us with an opportunity to look at the care and treatment that we provide

and to learn lessons.

Whilst I am unable to uphold the issues that you have raised, I do accept

that they are valid concerns from your perspective. I hope that my responses

reassure you that I have given serious consideration to the matters that you have

brought to my attention. Nope I am not satisfied – eventually she got her phone back but it was distressing not being able to get through and having no contact.

If you have any concerns arising from the above, Dr Memon or Keeley Syed, Ward Manager, would be happy to discuss these with you. Alternatively, should you be dissatisfied with the response that I have provided the next stage in Cygnet’s complaints procedure is to request an Operations Director’s review. The Operations Director for Cygnet Appletree is Mrs. Frances Bergin. Cygnet Hospital Appletree. Frederick Street North. Meadowfield. Durham DH7. I shall be writing about wanting to know how many times my daughter was rapidly tranquilised as I know that this was being done very frequently as I had been keeping records of what Elizabeth told me. Also I wish for her new shoes that went missing to be replaced and so I will be sending you the receipt for reimbursement.

Should you request an Operations Director review please set out clearly the elements that you are dissatisfied with and the reasons why. Yes I had further concerns of an even more disturbing nature and requested to know how many times had Elizabeth been rapidly tranquilised following frequent moments of inconsolable distress? I am waiting to hear this.

Thank you for taking the time to make us aware of your experiences. Our experience has been appalling because it was most distressing not to be able to get through.

Yours sincerely,

Martin Graham

Hospital Director

Cygnet Hospital Appletree

This is the kind of thing I have heard numerous occasions “lessons learnt” Nothing is ever learnt so it would seem.

TRANSFER TO WARD 12 PILGRIM HOSPITAL BOSTON 05.08.2023

No-one in the family had been notified but this evening I got a call from Elizabeth to say she had been transferred to mixed ward Ward 12 at Pilgrim Hospital. I was far from happy as no-one informed us. Also this ward is highly unsuitable because it is a mixed ward and another dormitory ward completely and uttlerly wrong! She is now 1 hour’s journey away and now back under NHS “care” of Lincolnshire Partnership Trust. I am assuming they (LPFT) not Enfield are now funding hospital care in this area as previously Ash Villa was paid for by Enfield. No wonder why I was cut out of all the meetings etc. I bet the ward and facilities are nothing compared to private sector Cygnet that had ensuite to every bedroom. Surely that should be the basic requirement for any MH ward. A dormitory accommodation had previously proved to be totally unsuitable as per Charlesworth Ward.where Elizabeth tried to gouge her eyes out in distress because of the noise and had to be put in a side ward. However there is a patient occupying the side ward because of possible covid. It is also a mixed ward which will be quite teryfying

If you weigh up the risks Elizabeth would be better off at home. The annex has been built now. Nothing I can do right now but any changes and unfamiliar surroundings is like hell on earth for my daughter who now has frequent bouts of “inconsolable distress” and all thanks to her appalling treatment under LINCOLNSHIRE PARTNERSHIP TRUST. We moved to try to provide the right environment. We overlook the sea and beach. The area is beautiful and the people friendly. I am heartbroken that LINCOLNSHIre PARTNERSHIP PARTNERSHIP TRUST AND COUNCIL have treated us like objects and have failed in every way. The facilities are totally wrong for Elizabeth. A care farm or Camphill Community Trust would have been better. She has had food and water snatched and been subject to frequent rapid tranquilisation. When is this ever going to end. It is like a never-ending nightmare. Staff do not understand how to communicate with my daughter and choose to ignore her constant statements that she is autistic.

They have also failed to properly assess her for her physical health denying referrals to an endocrinologist but now I have the genetic tests which I managed to find. I now would like referrals to an immunologist/geneticist. I have had to pay privately for the MRI scan as this was being denied to her. Her discharge note states ONLY PHYSICAL “ABNORMAL FINDINGS ON SCAN POINTING TO CNS. WELL NOW I WANT TO KNOW WHAT THAT MEANS EXACTLY.

“It seems odd that after all this time that no progress has been made at all in Elizabeth’s recovery. My initial presumption is that she ‘s been medicated with drugs that she is treatment refractive to.  We have discussed this on many occasions.  If she cannot metabolise the drug it will not ameliorate her condition.

It seems we have gone back in time to the Victorian asylum model where Ash Villa is concerned.  

It is a terrible shame that some still want to lock patients away and throw away the key after all the progress that was made.  Some patients had been stuck on wards for years but it was amazing how rapidly they recovered with support in the community, some had jobs and looked after their own budgets and appointments. Presumably it is to do with the control of the aftercare.  They want to either discharge EB to sheltered accommodation or send her there on extended s.17 leave

EB is being kept for a ridiculous length of time on an acute ward.  That is now encroaching on the human rights issues, unwarranted deprivation of liberty, Art. 5 ECHR, in excess of what is necessary for safety and treatment, violation of Art. 8 family and privacy rights and of course the abject paranoia that has been directed towards Susan’s blog, Art 10 ECHR.

In the community the tests can easily be arranged.  Endocrine function is the province of immunologists and the limbic system the job of the neurologist.  A GP referral will of course be needed.

Ash Villa is a shambles and LCC and LPFT are struggling not very effectively to hide that.  The treatment of eLIZABETH is incompetent and the over zealous use of PRN and seclusion a human rights violation.  That is what they want whacking with.

The failure to carry out a proper capacity assessment and the refusal to properly investigate potential medical conditions interfering with the treatment is staggeringly unprofessional.  If EB has an endocrine disorder and she almost certainly does.  If she had inflammatory disorders they would interfere with the drug metabolism.  We already know she is a poor metaboliser but they continued nonetheless to treat her with medication that almost certainly would not work.  This should be thoroughly investigated and I suspect they do not want an NR that might insist on it.  

It is not ‘low dosage’ or ‘high dosage’, it is minimum therapeutic dosage.

The test is serum concentration and not daily/weekly/monthly dosage.

Maximum doses or anything like them are never justified.  If a patient is not responding within the therapeutic band it is extremely likely that they are poor or non-metabolisers. 

They are NOT treatment refractive.  A disgraceful attempt at making this a medical definition when it is a pharmacological one. 

If a patient is a poor metaboliser increasing the oral or parental dose will make no difference.  This is all to do with CYP450 cytochrome’s.

What I find absolutely staggering is that my 21 year old third year students understand this quite clearly while many 50 year old psychiatrists have not got a bloody clue. ” 

The greatest punishment is to send a vulnerable person hundreds of miles away from home and family and for contact to be virtually severed as we have experienced under Cygnet Appletree.

I used to visit Elizabeth every week and my journey time took three hours in total but now it would take me 7 hours and require an overnight stay which is expensive if you visit regularly.

To send someone away hundreds of miles like this is cruel and even more cruel to take the phone away that we as a family pay for under contract.

We used to correspond by text messaging via WhatsApp but the last time Elizabeth picked up her message was on 28 June 2023.

When you phone Cygnet Appletree you get put through to a succession of people. There was supposed to be a meeting about contact following a call that came out of the blue by the Responsible Clinician of Pippin Ward. Nothing has changed because still the WhatsApp messages were last viewed on 28 June 2023.

Day before yesterday I had a voicemail message, the first message I have ever had from my daughter stating she was not doing well that day and was clearly struggling. I immediately phoned the ward and as usual got put through to several people ending up speaking to the ward manager, Keeley who said that Elizabeth did have her phone so I said in that case how comes her WhatsApp messages had not been picked up since 28 June? I asked for the phone to be given back to Elizabeth but this was not done. It was then admitted that the phone was charging. We pay a monthly contract on that phone.

Today I spoke to the ward secretary as she had contacted me as Cygnet Appletree want the private scan results but when I asked for the email address to send these to she asked me to send them to her email address. I did not have a pen handy at the time so I asked her to write to me so I had her email address. Just looked and no email received.

There are no plans as yet to visit and virtually next to nothing in contact with my daughter with former hospital having involvement. A former NHS hospital is responsible for sending my daughter far away namely Ash Villa. When this is done absolutely no consideration is made towards the carer and no assistance with any costs yet there is an abundance of funding towards a very expensive facility namely Cygnet Appletree where Elizabeth is now held and is clearly missing home, asking about her cat and when I will visit next. It would appear that smoking is allowed at this private hospital as Elizabeth has said she has started smoking again.

The Responsible Clinician actually sounded quite nice when he phoned me and promised contact would be reviewed but really nothing has changed. If things had changed then she would have her phone back and be able to pick up her messages.

Without any warning or communication from staff at Ash Villa Elizabeth has tonight been transferred three hour’s journey away to Durham but that will not put me off visiting. In fact I am looking forward to visiting Durham. Looks a nice area and very interesting too. Because I will be a frequent visitor I am interested to hear of anyone who can recommend places to stay and we live in a beautiful place too. If anyone knows people living in Durham I will be interested to hear from them. The only thing that has spoilt things has been our experience under Lincolnshire Partnership Trust and Lincolnshire Council who have seen fit to leave my daughter on an acute MH ward after 20 months to go downhill. I am even thinking of the possibility of working there in Durham as well as well as another area also to bring me closer to my relatives.

https://www.bbc.co.uk/news/uk-england-tyne-58323174

I do not know much about this hospital even though the above article concerns me as Elizabeth is of high risk of mortality and I hope that Durham PICU Unit at Cygnet Meadowfield will treat Elizabeth better than Ash Villa have rated “good” by CQC. I cannot comment yet it is too early but I have to say Cygnet has not been the very worst. The very worst has been NHS care who fail to provide proper facilities such as Ash Villa. For instance to gain accreditation you need to have ensuites. Also there was no psychologist. Also Ash Villa is in breach of serious health and safety failings with needle coverings left on Elizabeth’s table and a faulty bed. Elizabeth has given consent to the CQC to investigate and I intend to pass this on to the CQC as it was Elizabeth’s sister the nearest relative who has complained this time about the shocking facilities. Now under huge investigation Ash Villa have decided to transfer Elizabeth hours away but nothing is going to put me off visiting my daughter. I have to say that Cygnet have respected the fact that Elizabeth is a poor and non metaboliser of psychiatric medication in the past.

I would also point out to Cygnet Meadowfield that I had a private scan done when refused by Ash Villa and found there was inflammation of the brain. Therefore Elizabeth needs to be on minimal amounts of medication. There is also the P450 liver enzyme tests to consider as well as the genetic tests I had done and endocrinology that needs to be further investigated.

Elizabeth was being picked on by certain members of staff at Ash Villa befitting of Panorama. Having food and water snatched away for one, breaches of health and safety for which I have photos, rapid tranquilisation given frequently and seclusion in the absence of any physical healthcare, being left without dentist appointment though I believe this has just been done, being told that chiropody is not provided under NHS care which is a load of rubbish. Being misled in terms of the fact of whom is paying for the so called S117 aftercare which is the department run by Lucy Omezi of Enfield Community Rehab and waiting still for the care act assessment by AMHP Hannah kAJUE. What kind of system is this! There needs to be something urgently done. Until the system is changed nothing is any better. Abuse is rife and so is bullying and we have had our fair share.

I would like my daughter transferred back to Lincolnshire where we live now and would prefer her to be transferred to a very nice unit I visited that she liked so very much. I am going to put this to Sarah Connery and have just written to her. In the meantime my complaint has escalated to every single ombudsman including legal ombudsman and social work england. The PHSO have tried to say they did not receive consent to get out of investigating and that this would mean timing was not within the limits. However I managed to find in my records the consent authorisations that Elizabeth wants this to go forward which is well within the timings and so I do not accept their excuses. I would like a full investigation into my daughter’s horrific treatment and prolonged ordeal at Ash Villa, an acute ward with most unsuitable facilities and also into Enfield who failed to do a care act assessment and give S117 aftercare which was the reason why we moved. I have today written to the Commissioners to ask what arrangements are in place for me to be able to visit like I was doing before eventually. Bearing in mind at first Cygnet will not allow six hours unescorted until they get to know me so therefore the least LPFT not NCLICBENFIELD as previously thought who have money to burn can provide the necessary overnight accommodation as well as travel expenses as it is double the amount of journey I would be doing in Lincolnshire. It is on the borders of Scotland so I see but I am not put off by this journey. There has also been two unlawful sections under the MHA under Enfield for which I won £1 compensation but I am still waiting for compensation for the second unlawful detention which I have calculated is more. Dr Ilyas Mirza was the RC in the community in Enfield and he has actually recommended in one of his reports a Judicial Review. I will share that with you another time as I had solicitors appointed for this against Enfield and then this is why she was hauled in and unlawfully sectioned.

Anyway I have nothing to say as yet about Cygnet Appletree, Meadowfield Durham only time will tell.

Elizabeth knows about this blog and I have often asked for her comments.

So far I have heard positive reports from Elizabeth about her treatment at Meadowfield apart from one instance.

She was bought a MacDonalds and the food is nice. She has her phone and can keep in touch with her family. She has a nice room with ensuite shower. There is a wardrobe and shelves to put things away and keep the room tidy. I heard at Ash Villa there was no wardrobe and no ensuite.

After the long journey on arrival Elizabeth had one of her ‘episodes’ and unfortunately five members of staff pinned her down and injected her. I hope that frequent tranquilisations will not be given to Elizabeth as they were at Ash Villa (about 8 in a short space of time) on top of her regular depot. If she had been at home she would have settled without such intervention so this is the first injection given at Cygnet Meadowfield when she had one of her ‘inconsolable’ moments and this is something I see they have been criticised for in previous reports.

God knows how much this facility costs. I am very interested to know why nothing can be provided in the local vicinity. However having written to this department I now find out this facility is being funded elsewhere and I intend to find out exactly who is responsible for paying. It would seem that LPFT are responsible for paying then this is even more interesting as there is absolutely nothing provided in terms of care and services in East Lindsay which is not good. This is of public interest for me to find out especially when the cost of adaptions to the annex I have provided would be nothing in comparison.

Latest inspection summary

On this page

• Background to this inspection
• Overall inspection
• Acute wards for adults of working age and psychiatric intensive care units

Background to this inspection

Updated 20 January 2023

Cygnet Appletree is an independent mental health hospital based in Durham. The hospital is split over two floors and has two wards. Bramley ward (15 bed acute ward), and Pippin ward (10 bed psychiatric intensive care unit) for females of 18 years and over. The service was last inspected in April and May 2021 and ratings for the service were suspended. Enforcement action was taken which prevented admissions. These had been removed at the time of the inspection and we found that the hospital had made significant progress.

The hospital had a registered manager and a controlled drugs accountable officer. Controlled drugs accountable officers are responsible for all aspects of controlled drugs management within their organisation. Cygnet Appletree has been registered with the CQC since 26 September 2012 and has been managed by two other providers during this time. In March 2018, the provider of Appletree became Cygnet Behavioural Health Limited.

Cygnet Appletree is registered to carry out the following regulated activities.

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder, or injury

 Download full inspection report for Cygnet Appletree – PDF – (opens in new window)

Published 20 January 2023

Overall inspection

Good

Updated 20 January 2023

Our rating of this service improved. We rated it as good because:

• The service provided safe care and the ward environments were clean and well maintained. The wards usually had enough staff who assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service managed beds well so that a bed was always available to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• The design and layout of Pippin ward meant that there were areas accessible to patients that were out of sight of the nurse’s station.
• The hospital had some nurse vacancies which meant that not all shifts on Pippin had the required 2 qualified nurses.
• Care plans were repetitive and sometimes difficult to follow due to the amount of information in them.
• One patient did not have clear care plans outlining the use of pro-re-nata (PRN) medication and use of intra-muscular administration of medications or rapid tranquilisation. PRN medications are medicines that are used when needed.

 Download full inspection report for Cygnet Appletree – PDF – (opens in new window)

Published 20 January 2023

On the whole I have had positive response to this facility but it is early days of course.

Elizabeth had just arrived and had not ventured out anywhere yet but no pressure was put on her by staff to explore her surroundings.

I shall be featuring in contrast treatment under the NHS and comparisons to private institutions in due course.

Still not had the care act assessment from Enfield. What on earth is going on about this. I need to chase this up.

I wonder what happened to the idea of Elizabeth pointing to a map to choose where she wanted to live.

When I asked how long Elizabeth would be at Cygnet I was told short term. I have directly asked Sarah Connery CEO in this respect. Durham looks a nice area and I have never visited there before but it is such a long way and this leads me to think it might be good if I were to get a job in this area and maybe a job in another area too where another relative is based. When I asked Cygnet how long the stay was they emphasised short term. The longer this stay goes on the more I will have to write about as it is obviously causing problems as I am carer to someone else too.

Today I spoke to Cygnet Appletree about visiting but I was told that it was unlikely to be granted so soon. I still have not got an email address to share information which might be helpful to them as nothing in the files seems to be very accurate and I have very accurate records.

It would seem I got it wrong about Enfield ICB paying for the facility of Cygnet Appletree so I am now assuming it is the ICB under LPFT of which John Turner is CEO. I will check on this and have written to them for confirmation. I am always interested to know how much such a facility costs per week. If only there was proper communication especially where carers are concerned when the person they care for is sent out of area there should be proper support in place and assistance in terms of travel expenses and you should just be able to resume your weekly visits as per before.

From: SEED, Daniel (NHS NORTH CENTRAL LONDON ICB – 93C)
Sent: 29 June 2023 15:09
To: susan bevis
Cc: MCKENZIE, Joy (NHS NORTH CENTRAL LONDON ICB – 93C); nclccg@nhs.net <nclccg@nhs.net>; ROBSON, Jon (NHS NORTH CENTRAL LONDON ICB – 93C); victoria@victoriaatkins.org.uk; Christopher Reid;
Subject: RE: Cygnet Appletree Durham

Good afternoon, Mrs Bevis,

Thank you for your email, and very sorry to hear that your daughter has been placed so far away from you.

I’m very sorry but we are not the commissioners of her current inpatient stay at Cygnet – I assume she has been transferred to Cygnet from her current inpatient stay in NHS Lincolnshire Foundation Trust.

I would advise it is best to speak to the NHS Trust in Lincolnshire to see if there is any way for you to reclaim costs – apologies I am unable to confirm if this would be possible though.

I have however located the below advise from NHS.uk which has further details on travel costs.

https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/

I hope this helps and, am hopeful that your daughter can be repatriated closer to home soon.

Kind regards

Daniel Seed

 
Head of Mental Health

Complex Individualised Commissioning

Chief Nursing Officer’s Directorate

NHS North Central London Integrated Care Board

Email: d.seed@nhs.net 

Team Email: nclccg.cicmh@nhs.net

Tel: MSTeams

Working hours: Monday – Friday 09:00 – 17:00

Web: nclhealthandcare.org.uk

From: susan bevis
Sent: Thursday, June 29, 2023 12:17 PM
To: SEED, Daniel (NHS NORTH CENTRAL LONDON ICB – 93C) <d.seed@nhs.net>
Cc: MCKENZIE, Joy (NHS NORTH CENTRAL LONDON ICB – 93C) <joy.mckenzie4@nhs.net>; nclccg@nhs.net <nclccg@nhs.net> <nclccg@nhs.net>; ROBSON, Jon (NHS NORTH CENTRAL LONDON ICB – 93C) <jon.robson1@nhs.net>; victoria@victoriaatkins.org.uk; Christopher Reid <Chris.Reid@parliament.uk>;
Subject: Cygnet Appletree Durham

This message originated from outside of NHSmail. Please do not click links or open attachments unless you recognise the sender and know the content is safe.

For the Attention of Daniel Seed and Joy McKenzie

Dear Mr Seed and Ms McKenzie

I have had a call from my daughter Elizabeth Bevis who is placed now at Cygnet Appletree in Durham.  As you can appreciate this is a 3.5 hour journey away for me to do and then another 3.5 hour journey back.  My daughter has asked me to visit her.  I have been visiting on a weekly basis so far.   I also have another relative in hospital 1.5 hours away from me but not sure if funding comes under Enfield or elsewhere.   Perhaps you can kindly confirm this.

In order that I can visit my daughter in Durham I would like to know the procedures for claiming back travel expenses and hotel accommodation in the case of Durham.

I am sure you will agree that Elizabeth has the right to a family life under Art 8 and she is asking to see me.  I was visiting on a weekly basis and since you have placed my daughter far away from home yet again I would like to know what measures you have in place for families like myself.

I tried to telephone your office today but was told you do not have phone numbers.  

I look forward to hearing from you the procedures to claim expenses since you are responsible for the funding and I have been guided to yourselves by Cygnet.

Yours sincerely

Susan Bevis    

DEPRIVAL OF CONTACT

“It is unlikely this will be permanent as there is case law preventing the exclusion of family but they will certainly want to exercise close control since rehabilitation involves far more intensive involvement between staff and patients.”

“The major problem is the loss of the NR status which means they do not have to communicate with you regarding Elizabeth’s care.  The MHA 1983 negates the medical provisions of any POA so you cannot invoke that.”

Elizabeth has not had her phone since 28 June and that was the last time she picked up WhatsApp messages yet staff say she has her phone and then contradict themselves by stating it is charging in the office. It has been obvious for some time now that contact has been deliberately denied and that contact should be via her phone which the family pay a contract for.

I did have a call from RC Dr Khalli Memon who promised a meeting to discuss contact with me. Today I have been through several members of staff until finally the ward manager namely Keeley who I had a lengthy conversation with and who promised to look into giving the phone to Elizabeth but despite promises nothing was done.

Here is the message I received:

“It is Elizabeth here. I am not doing well today please can you call me back” so I did. Had the phone put down on me by a member of staff then called back a second time and asked to speak to Elizabeth – the outcome I did not get to speak to her.

I have today phoned the Bed Management Team of LPFT whose Head of Services is namely Gareth Price who have sent my daughter so far away most probably with approval of the MDT of Ash Villa as a leading nurse said about me not having contact for six months from Ash Villa discussed with the NR who displaced me. It seems like this is the plan because the phone is not with Elizabeth that we pay a contract on. With the short three line letter from Bed Management is a lot of carer’s information.

“What is a carers assessment?” Never had one and Enfield have not carried one out. I thought Hannah Kajue from Enfield Community Rehab Team was supposed to be carrying out this assessment but nothing has been done.

The booklet goes on to list the Carer’s Charter and it is important that all carers read this charter. It is all too easy for professionals to disregard carers and treat them like they were invisible and play on confidentiality but I had the phone put down on me when I explained what information could be shared. “carers are encouraged to ask questions and time must be made available by the team to answer”

Professionals will involve carers in treatment plans and in major decisions about the service users care as far as they can.

There is a good practice checklist.

To go and visit Elizabeth needs a lot of planning and also the risk of a lengthy journey and stay overnight only to be refused a visit. I discussed this today with Ward Manager Keeley.

I chose to visit Elizabeth on Sunday as I felt that crowds might have been too much for her on Saturday for Coronation celebrations.

I arrived at Ash Villa around 11.00 am but Elizabeth was not up so I said I would wait longer. Quite often she is tired in the morning as she cannot sleep at night because of noise on the ward or because she is awake all night having slept all day. It was around midday by the time Elizabeth came out with a smile on her face but I noticed bruising and red marks over the side of her face. I then asked Elizabeth about the bruising and she said that she had banged her head through sheer distress of the noise on the ward. Elizabeth is situated near the seclusion room where it is particularly noisy. I have asked countless times for her to be moved but nothing has been done. I then asked a young healthcare assistant if I could speak to a nurse in charge. I was astonished by the response. It was not the fact the senior nurse was too busy but she had commented that Elizabeth scratched herself. However I then said it was the bruising that concerned me and when I went on to explain how the bruising happened after having already heard Elizabeth’s account and that I was prepared to wait for the senior nurse her response was “your time starts NOW!” (time meaning leave) I then said “Oh not it doesn’t”. We waited about half an hour but gave up in the end as no-one came out to see us. My concern is before moving to this area Elizabeth was NOT self-harming. This is the effect of 19 months of shocking incarceration where she has been treated like a restricted prisoner under Lincolnshire Partnership Trust who have put other things as top priority that sadly I cannot write about as much as I wish.

We did not leave until 12.30 am. I was taking Elizabeth to Coronation celebrations I knew she would enjoy. I had read about the event on line held in a small village called Wellingore. It started at 2.00 pm and commenced with the fabulous (Foss Dyke Band) and thereafter three other groups. It was organised by Matt Gardiner, Chair of the Wellingore Memorial Hall and what a fabulous event it was. There was a BBQ and hog roast, bar, ice cream stall, cake stall, WI cake stall and various others. There was also somewhere where you could buy oriental food. More and more people began to arrive and we had to move to a quieter location as Elizabeth was not feeling comfortable in the crowds. Elizabeth went to buy food from various stalls and was very happy. We could not stay long but my first thoughts were how well organised it was and I would say well done to all of those involved/who contributed to this brilliant event.

I then drove back and dropped Elizabeth off. I did not bother to go in and to speak to any staff of my concerns. Instead, I wrote to the two commissioners from each area ie Joy McKenzie and John Turner of my concerns. This is what they are providing.

Elizabeth’s face lit up seeing the small children running around and the dogs brought by families and before we left we bought cakes to share with the friends and food to take back.

On a more serious note getting back to the self-harm, Elizabeth told me that there is a sharp edge somewhere in her room she is aware of. For anyone so distressed like Elizabeth this seems to me a health and safety risk in terms of the facility. It does not seem to be safe but when I drew attention to health and safety at home on the 5 March since then all leave home has been cut. Whatever is the point of this when I requested a few adaptions to make things safer and still nothing has been done so perhaps whoever is responsible for funding – is this Joy McKenzie by any chance? could get matters in place so that Elizabeth can resume her home leave as it is getting warmer now and the annex has its floor down. Still a few things to finish but not one single person from social services has got in touch which shows complacency. If things are so very complicated surely they could communicate effectively to her family and explain the situation but no, this is too complicated for social services in Lincs. If it is not their responsibility then I need to know is it Enfield’s to provide these adaptions but at least say one way or another.

As for the Care Act Assessment at the CPA former area care coordinator HK attended and something about a map and pointing out where Elizabeth wanted to live was discussed. That sound’s interesting a map when there has been talk of a locked rehab yet again. However when I pointed out that “a home of her own” being suggested would be a home owned by someone else Elizabeth understood perfectly as after all she has full capacity. The annex would be a home of her own but requires a few adaptions which would be a darn sight cheaper than a locked rehab which would cost circa £200000. I will get to the bottom of who is paying for this you can be sure and I think it is of public interest.

I am not happy that those at the top of the Trust/Council whether it be social services, ICB or the Trust are keen to allocate others to answer complaints directed to them. Then you get unsatisfactory answers and so in good communication I decided to write to all of them at the top in one email copying in everyone. I will feature this if I get no response or if I get any more unsatisfactory responses.

Last of all Elizabeth shared something with me that it would appear that I am a joke to the majority of staff. Well I have a good sense of humour and it is not that I cannot laugh at myself at times however I would like to hear these jokes in order that I can share them and then everyone can have a good laugh. I then asked Elizabeth if I was joked about in a nice way and then she said “no” but nevertheless I would still like to hear these jokes so anyone from the team who wishes to respond to this please do – let’s hear these jokes lol!

Today I attended a family meeting but not everyone was present for some reason.

I attended in person alongside Dr TG, ward nurse and “carer’s champion”.

I brought some papers which I will share with you. Elizabeth attended this meeting but it was distressing to us both to hear what they “the team” thought was best when it was decided totally against at the CTR back in Enfield where for the first time ever Elizabeth was listened to and she made it clear then and now that she did not wish to go to any locked rehab.

I arrived early and went straight to the ward. I had offered to take Elizabeth out to get her hair done but she said she was too tired. She had been asleep when I arrived and after some time came to join me in the foyer of the ward and meeting room. I noticed a member of staff standing outside and commented. I had thought that practise had ended by now – it is of no help to me or to Elizabeth to have someone standing there outside and surely due to staff shortages this is not good. It felt intrusive and pointless especially when they are not there to supervise external leave for up to six hours which is now the current entitlement, all home leave now stopped.

The meeting began at 3.00 pm and started off OK. One family member attended virtually. I was expecting to have news at this meeting as to plans discussed behind our backs at MDTs which we are not invited to.

Apparently staff have undergone the Oliver McGowan training programme but I do not know if this included the doctors or just nurses or management or just a select few because there clearly is no change/difference in attitude despite the training sadly.

After 19 months Elizabeth has shown no improvement whatsoever in this highly expensive acute ward facility where she has been held a virtual prisoner and treated as though she was on DoLs with phone and visiting restrictions and no leave whatsoever. It is hardly surprising that Elizabeth refers to herself as “I am not a person”. Staff now finally recognised and commented that this is now felt to be a wrong place for Elizabeth but it has taken them 19 months to reach this conclusion. Noone seems to understand some of Elizabeth’s comments except me. If you are treated in a humane manner by people and respected as a human being (not an object) that would be different but staff clearly do not understand the comments “I am not a person” and choose to ignore the fact Elizabeth constantly says she is autistic. This was discussed and there is no official fair assessment – plenty of screenings but I would like to see Elizabeth listened to and referred to Dr Simon Baron Cohen. They have chosen to divide the family in such a way I cant go into as much detail as I would like, you end up feeling like an object or criminal yourself and there is so much written to run you down behind your back. I know exactly how Elizabeth feels as I feel this way too. I feel that I have had extensive bullying under Enfield originally and then under Lincolnshire Partnership Trust. I did not want to complain at first and was keen to get on with a new team and make a fresh start but none of this has been possible. Around Xmas I would out that the S117 was still with my former area and thought that things had changed since then upon my request to transfer the care over. The former care coordinator HK from Enfield Community Rehab who goes back to 2014 CoP case of DoLs recommended the MHA assessment to LPFT and then steps in several AMHPs from this area who had acquired files full of inaccuracy that we tried to get changed before we left the area. Not only that, they tried to go down the capacity route but failed miserably. The drugs (Clopixol depot) was raised to enormous levels from 300mg fortnightly to 400mg weekly plus another 10mg in tablet form and according to other concerned patients frequent rapid tranquilisations and seclusion several times a week at night which did not even coincide with my visits that they could warrant the excuse of taking away her phone because the mother’s contact was the cause of distressed behaviour – a phone the family pay a contract on taken away and put in the locker. How nasty can you get and also S17 leave was totally deprived.

I did not think today’s meeting went well at all but this was all along their goal so I could see.

The subject came up on home leave, now cancelled. We had experienced one incident the day prior to seeing the crisis team which was a frequent occurrence on the ward where she would be placed in seclusion and rapidly tranquilised but in that state Elizabeth was totally inconsolable after so many months of being treated worse than a restricted prisoner. I mentioned that during this one incident at home all she was doing was rolling on and off the bed but she was shaking with tremors and screaming and that prompted me to ask for some adaptions to the annex – a detached bungalow I had built specially in the back garden especially for Elizabeth. Not a scrap of help from any area and I believe ENFIELD are responsible still for the S117. So who would be responsible for providing such adaptions. I would assume Enfield? What is needed are hand rails as Elizabeth can sometimes get dizzy so I had to be there to watch every time she had a shower. Another useful thing would be strong bed that does not come apart. Also some padding on the wall. I have given everything I have to Elizabeth and some these “professionals” at the top of Trust and Council earning more than the prime minister cannot be bothered to get in place simple little adaptions. How much is padding on the walls going to cost or a handrail in the wet room. Or how much is a strong bed going to cost? How much in comparison to a locked rehab in Lincoln? Elizabeth started to get very upset and snapped at Dr TG as well as others in the meeting. She was so distressed she had to go out to calm down. She clearly does not want to go to the locked rehab but feels she is being forced to go there and made it very clear that she has no intention of joining in/engaging. Locked rehabs are nothing new. They have not helped in any way in the past and this seems to be the trend to dump someone elsewhere when they decide after 19 months it is about time to move someone on. How disgraceful is that! Questions were fired at Elizabeth that she will not respond to unless on a 1-1 basis as she generally hates meetings. Going to a new place is traumatic for Elizabeth and she said clearly she was going nowhere except her room which has been her only sanctuary in that unsuitable hospital paid for by the ICB all this time and even then it is so noisy that she cannot stand it as she is placed close to the seclusion room where other patients are screaming and there are some very noisy patients on the ward and they recognised (as discussed) that she has sensory issues. I had asked for leave home as there are lovely celebrations going on in my new local area in the East Lindsay District but Elizabeth is not allowed to come home. I am therefore going to ask if it will be allowed for Elizabeth to stay with me at the wonderful Thomas Centre in Louth where unlike Lincolnshire Partnership Trust, people can be themselves without punishment and sanctions. After the incident at home where no-one was hurt and no-one was attacked – it was like watching someone have a fit, we see it as punishment that leave since then has been sanctioned but now is 6 hours a day.

During the 5 hours I had asked to be able to take Elizabeth to a wonderful place where there were horses. The last leave was on Sunday and in Spalding. Spalding is a lovely place and there is a garden centre “Baytree” and I took Elizabeth to see the baby owls. She was so thrilled. I have promised Elizabeth an owl when she comes home. Elizabeth has a cat but she can have other pets too if she comes home. We also went on the river taxi. No pets would be allowed under supported housing/living scheme or care home or locked rehab. It is animals Elizabeth responds to. Therefore a care farm would be much more suitable but these commissioners have no idea. These minor adaptions/provisions would cost next to nothing unlike a locked rehab which has been a complete and utter waste of money in the past and there have been several such facilities namely Cambian, Somerset Villa all of which failed to tackle any underlying issues and trauma just as Ash Villa have failed to do for so long without any psychological input. The question needs to be asked of the commissioners (now called the ICB) as to why there is only one qualified male psychologist and only one trainee female psychologist on the acute ward Ash Villa and why the commissioners have done absolutely nothing up until now with talk yet again of a locked rehab. None of these people are considering what Elizabeth wants and it is because none of them like me that I feel they want to put a wedge between myself and my daughter and keep her over an hour’s journey away making contact difficult. This is all because of non provision of any decent MH/LD/Autism care and facilities this side of Lincolnshire ie East Lindsay. I did not know things were so bad here but we had come from an area equally bad where we had experienced nothing but bullying and costly litigation which is top priority of the AMHP department rather than work together with family and to check their facts before they write a pack of lies that goes before courts.

Elizabeth had to go out of the room for a while to cool down and then re-entered and sat there for the rest of the meeting. They did not seem to understand that though Elizabeth had not got an official diagnosis this is what she is certain she has and I went back over past years to emphasise that autism traits were not immediately recognised. It was at secondary school that there were times when there were problems and avoidance of going to school and at the time I did not link this or suspect that this was anything possibly to do with autism. However now I have a much greater insight and none other than Elizabeth has given me this insight. Inspite of the many times she has mentioned “I’m autistic”, noone listens under Lincolnshire Partnership Trust – just the same with Enfield until I produced all the evidence going way back to get the NAS on board and Access Charity and unfortunately the NAS has turned their backs since Elizabeth has been sent to Ash Villa and of course it has been impossible for us to get through on the ward let alone anyone else when the phone was taken away for months on end with all blame put on me as a mother. Now I am told that in so many words that I should not be defensive in thinking everyone is against me but to be fair, I have read what has been said behind my back. Safeguarding was instigated against me on two wards based on “hearsay”. When I asked for safeguarding in the form of a S42 meeting this was not thought necessary despite a group of patients confronting me in the grounds outside Ash Villa stating their concerns. This is not a transparent open organisation like Sarah Connery CEO states. Far from it, it is a secretive organisation who have come to the decision of a locked rehab behind our backs and who have totally dismissed requests for the simple things that need to be done in the annex. I am not standing in the way of staff providing care and visiting. The premises are separate to my house. The high rise block of flats was discussed and how there was a murder outside and just round the corner and that Elizabeth was vulnerable there. We have moved to a lovely area and overlook the sea and beach, surrounded by wildlife reserves. Elizabeth appreciates what none of us appreciate looking at the birds in the sky, ordinary birds and seeing people out with their dogs and of course to be able to see her cat. None of this will be possible now thanks to LINCOLNSHIRE PARTNERSHIP TRUST and I cannot sure whether ENFIELD COMMUNITY REHAB attend and recommend what these strangers see as “best interest” for someone who has FULL CAPACITY and does not wish to go to a locked rehab called The Vale.This is provided at hundreds of thousands of pounds by the ICB who have dismissively failed to answer my complaint instead telling me to contact PHSO. The Chief Executive is called John Turner. He has passed my complaint already dismissed to someone called Sammi Vanplew. Then I have turned to Glen Garrod who is mentioned by the Tax Payers Alliance. I have already made it crystal clear to Mr Garrod that I am not happy that he passed my complaint to someone else to deal with. When you purposefully contact those at the top it is extremely disappointing that they cannot be bothered to answer and since I have had an unsatisfactory response from Mr Garrod I have had no choice but to write back to him and ask for a proper response. The rest including Ms Connery and Mr Turner I found it quicker to write just one email with referral paragraphs to each and every one of them.

Anyway, we get the feeling that such a move will take place soon and will cause Elizabeth huge distress as well as to her family who have gone out of their way to provide a nice living accommodation and it is not our fault that there is such failure here in Lincolnshire that only one side of Lincolnshire has care facilities re MH and nothing this side. Every week I visit. It is expensive to travel that far and it amounts to 3 hours per week roughly. This is simply not good enough for me because there needs to be places all over Lincolnshire where you can go to be assessed. Dr G said his treatment would not be any different if Elizabeth did have autism. So I then turned round and said that it was very clear on the discharge note that Elizabeth had “abnormal findings on a scan pointing to CNS” central nervous system. So what does this mean? which CNS condition does Elizabeth have. I then spoke about the scan. The scan had been refused by Elizabeth who is claustrophobic but I offered to take her myself for the scan and I was not allowed anywhere near Elizabeth when Dr Shahpasandy was the RC. This is the doctor who did research into the Limbic system and found that a patient had in fact got inflammation of the brain and so I asked for that research to be carried out on Elizabeth and he refused and to this day scans have been refused and so have neurologist appointments and endocrinologist appoints refused. This is to me highly negligent of any doctors to ignore and here are the doctors:

Dr Ismail

Dr Shahpasandy

Dr Kumar

Dr Islam

Dr Suleyman

and now Dr G ( I am not naming him fully as he is the only doctor out of all of these above who has allowed any leave). Dr Suleyman carried out a flawed capacity assessment not fit for purpose and not in line with the Masterman Lister case. Dr Shahpasandy refused his own research. Dr Ismail wrote some dreadful things in certain papers. Dr Islam refused to meet me and Dr Kumar did nothing. I think it was during his reign that I was excluded from the Management hearing and he raised the drugs enormously.

As for the SOAD – they are a complete and utter waste of time. They do not read the files or do anything properly. They do not have any understanding of the unique tests I had done at Liverpool university which should be mandatory.

Whilst I think the Oliver McGown training is a good thing I think in this area and Enfield they need a year’s training if not more because they are totally oblivious of the harm they are doing or else just complacent.

After the meeting Elizabeth just wanted to go back to her room. She said in front of everyone I am not leaving my room. I wish to die. This is the effect of months and months of so called restrictive imprisonment under Lincolnshire Partnership Trust and the facilities they provide are also not right for people who have sensory issues. Then again everyone needs to look at the ICB and what they provide with taxpayer’s money when I have seen my daughter go downhill rapidly and am quite disgusted.

So I am going to start off by sharing with you an email that was sent as a pre-protocol letter to the Trust at the time I was seriously considering taking out a human rights case which I had discussed with Elizabeth indepth who asked me to do so. Then they stopped the restrictions and started to allow time with the family so conscious of the money involved in taking out a High Court case I decided not to but I have not ruled this out in the future if necessary and I think what is needed is one case to cover every single vulnerable person incarcerated in the UK for years on end in unsuitable facilities used as a dumping ground by those who earn more than the prime minister who are failing the weak and vulnerable and need to be made accountable instead of passing the buck when they are asked to look into matters personally.

Pre Action Protocol Letter

“Dear Ms B and Mr H

“Under the provisions of the overriding objective of the Civil Procedure Rules I hereby give notice of intended proceedings under the Human Rights Act 1998 for violations of the Rights of Miss EB currently held under S3 MHA 1983 deprivation of liberty at Ash Villa, an institution under your management.

The cause of action is as follows:

Ms B has been detained in an acute admission facilities for 9-15 months (now 19 months) and has not made any appreciable improvement. She is not receiving appropriate treatment in such a facility because they are failing to take account of the inability to metabolise the drugs they insist on giving her (in spite of clear evidence they are not working).

This is causing her unnecessary suffering as she is being inflicted with all the ADR’s from the drugs with no efficacious benefit.

She is receiving no recognisable treatment for complex PTSD which her former RC Dr H Shapasandy acknowledged was part of her diagnosis. Therefore she is not receiving appropriate treatment. It can be strongly argued that she has not seen any improvement because she is being given inappropriate treatment that seems to have the sole purpose of restraining her rather than addressing the aetiology of her diagnosed condition.

This is in violation of her rights under Art 3. ECHR and represents inhumane and degrading treatment as in Slawomir Musial v Poland (2009) and Raffray Taddei v France (2010).

Incidentally the ECHR has ruled that whatever obstacles the patient may have put in front of the treatment team that did not dispense the state from its obligations to protect their human right to being protected from inhumane and degrading treatment, ClaES v Belgium (2013).

The failure to give her appropriate treatment for a condition she has been diagnosed as having creates a situation where she is subjected to inhumane and degrading treatment.

Deprivation of family rights is a consequence of this. They try to say she is dangerous but have done nothing to address that, apart from to subject her to close surveillance at all times.

Depriving her of rights to S17 leave to have visits in the garden is depriving her of rights to take pleasure in visits to see animals and birds, a pastime that would be undoubtedly therapeutic in itself. This represents an abuse of the detention criteria under Art 5(1) (e) ECHR and is cruel, unnecessary and oppresive, a further example of inhumane and degrading treatment.

Preventing her communicating with her family and friends by depriving her of her mobile phone is also not only a violation of Art 8 but extends to Art 3 inhumane and degrading treatment.

NHS patients are supposed to be allowed their phones and to have private conversations with family members.

I am bringing the action as Litigation Friend under the ruling in Re L (By his Next Friend GE) (1998) 3 aLL er 289, HL & HL v The United Kingdom (2004) 5th October. Since the removal of Ms Bevis’s mother as Section 26 MHA 1983 NR and your deliberate obstruction of an active litigation friend this detention has had no procedural safeguards.

It is not in accordance with procedure prescribed by law, in particular her recent capacity assessment was carried out contrary to the provisions of Section 4 MCA 2005.

Her maximum deprivation of liberty which extends to be being prevented from having private conversations and intimate family relationships with her mother is established on imprecise and structurally incorrect concepts of best interests and necessity and is in breach of her Art 8 ECHR rights and per se in breach of Art 5 (1) ECHR.

In the spirit of the overriding objective in Part One of the CPR I am willing to enter into discussion with you on the most appropriate way to proceed in Ms Bevis’s best interests.

If I hear nothing from you in 14 days from the receipt of this communication, litigation may commence without further notice.

Yours faithfully

REPLY FROM THE TRUSTS SOLICITORS BROWNE JACOBSON TO THE ABOVE:

Our Ref AW1L02/050021.39183

13 October 2022

As you will see from the above LB was appropriately detained and a First Tier Tribunal authorised the extended detention on 22.04.22. Section 6 (1) of the HRA provides that a public authority must act in a way compatible with the European Convention of Human Rights (ECHR).

Art 5 (1) of the ECHR provides that persons may be detained and deprived on their liberty if the detention is lawful and/or the person has unsound mind.

Under Surrey County Council v P (2014 the acid test is met. The detention is authorised by the lawful procedure and Section 5 of the Mental Capacity Act (MCA) therefore provides protection to the Trust against any civil liability or non-criminal and non-negligent acts done in connection with EB’s care or treatment.

The deprivation of liberty applicable to EB meets the authorisation under Sch A1 of the MCA.

The detention has always been lawful so the Art 5 rights are lawfully interfered with and protected.

The fact EB is detained under the MHA provides the Trust with the legal framework to authorise her detention including restricting access to the telephone/family/outdoors.

The Trust has complied with the MHA Code of Practice to provide treatment for EB’s mental disorder.

LEGAL \ 58035244c1

Causation

We deny there is any causation argument made out. You say that EB is not receiving appropriate treatment. This is wholly denied. If you intend to pursue this argument then please send medical evidence and clinical opinion to support your allegations.

The treatment is clinically appropriate and can be authorised under the MHA where treatment for mental disorder can be given even where there is no consent and this can include pharmacological restraint.

Please specify what financial loss you allege LB has suffered if you intend to pursue this matter.

Litigation Friend

We have not seen any evidence that EB has requested you to be her litigation friend. Please send such evidence if you intend to pursue this matter.

We therefore confirm that liability, causation and quantum are all disputed and your client will be put to strict proof if you continue with this claim.

We look forward to receiving confirmation that you will not be pursuing this claim

Yours faithfully

BROWNE JACOBSON LLP

Conclusion:

A very interesting read Browne Jacobson and all this information supplied yet you are not even sure that the writer is EB’s litigation friend and there had been a change in this but very useful information thank you for this Browne Jacobson.

Lack of interest in pathological dysfunction is a blight on psychiatry and every reason why all psychiatric patients should have regular endocrine function tests and neurological scans for dysfunction in the amygdala hippocampus and pre-frontal cortex. It is blindingly obvious (except to many psychiatrists) re: precaution that pathological disorders should be screened for.

To rob a vulnerable person of fundamental rights as a person in effect turning her into an object rather than person.

Over zealous use of PRN and seclusion – human rights violation

To ignore underlying conditions and continue treating with antipsychotics

For a doctor to decline MRI scan when the discharge note points to all physical – “abnormal findings on scan pointing to CNS (central nervous system).

To ignore research that the doctor did on another patient who had the label of “schizophrenia” but all the time had inflammation of the brain and needed a different kind of treatment.

For any doctor to ignore endocrine disorders – especially in Elizabeth’s case when results indicate just that.

To ignore the P450 liver enzyme tests Elizabeth had done under Liverpool University

To raise the drugs to enormous levels and prescribe contra indicated drugs off label

For those significant number of patients who are non-metabolisers or poor metabolisers like Elizabeth this will cause wide variations in the effective dose of many drugs and some will not work at all.

There are many cases when psychosis is caused by endocrine problems. A defective thyroid and hypothalamus can manifest themselves in psychosis and the brain itself is a part of the endocrine system.

Hypothyroidism can result in dehydration and dehydration can cause brain inflammation, the very thing they will not test for.   

Today I wrote once again to the carer’s champion. I have been chasing the same thing for 19 months now: I wrote the following –

“as regards complaining to the Ward Manager and Pals all complaints have been shut down and matters are now with PHSO. I then asked the same questions as always. “there is something else wrong with my daughter. She has a Central Nervous System condition – could that be Parkinsons? No way should any MDT stand in the way of physical health pathology. I already have endocrine test results that state Elizabeth has an endocrine dysfunction yet consistently she has been deprived a scan since admission to Ash Villa. Elizabeth needs to see a specialist re Parkinsons to rule this out. There are also genetic tests that point to abnormalities too.

To say that a 2015 scan that came out normal will suffice is very wrong especially in light of the Discharge Note.

With the constant refusal of such tests I naturally feel they have something to hide. I hope I am wrong but the symptoms Elizabeth has displayed are as per below and she has balance problems.

I have offered to take Elizabeth myself to the scan as she is afraid of going under a scanner but what is so bad is that I am not sure whether it is the doctor or a team of others who are depriving Elizabeth of much needed pathological tests for their own convenience. It is highly negligent especially when I have the endocrine test results. It would seem that this, just like rapid tranquilisation is being done for their own convenience.

All of the symptoms below Elizabeth has displaced. The former area of Enfield produced a Discharge Note with no mention of mental illness/Code F20 schizophrenia and I have been met with a constant wall of silence every time I bring this subject up. In 19 months no endocrinologist referral or MRI scan by Ash Villa (run by LPFT).

What are the symptoms of Parkinson’s?

Common symptoms of Parkinson’s include:

• tremor
• rigidity (stiffness)
• slowness of movement
• mild memory and thinking problems
• sleep problems
• pain
• mental health problems, including anxiety and depression.

But not everyone gets these symptoms. People will have different experiences of how their condition changes or progresses. How Parkinson’s affects someone can change from day to day, and even from hour to hour.

You may hear Parkinson’s symptoms referred to as motor symptoms and non-motor symptoms. 

Motor symptoms affect your movement and balance. They include tremor, stiffness and slowness of movement. 

Non-motor symptoms affect you in other ways that may not be easily seen by other people. They include pain, sleep problems and mental health issues.

In an email to care coordinator MA copying in the Director of Psychosis I outline exactly how they operate:

From Johnson Norma

sent: 07 November 2012 10.23

cc Ahmed Monowara; Omezi Lucy cc Saunders Leigh

RE: REHAB PLACEMENT

Dear Monowara

I have no doubt that this patient would benefit from a hospital environment, if that is the desired plan from the MDT then what is required is that we need to demonstrate that the MDT has identified the exact needs and the expectation of what the MDT wants from a placement and the timescales for this to happen also what they want from the providers eg weekly report copies of all assessments, how often care coordinator will visit the patient also what will be checked on at each CPA etc.

What the panel do not want to see is that this aspect of identifying the needs and how this would be managed or not done by the potential placement. We need to skillfully set the agenda of what is required to bring about a change for the patient. Hence the request for a medical review in order to obtain a comprehensive plan regards to what medical input would be helpful that we cannot manage in the community. The same can be said regards to the assessment as to why 24 hour supported accommodation is not working either is staying with her mother.

We have to be much more robust regards to why institutional care would absolutely benefit this patient. In a nut shell it is about proving why your assessment as Care Coordinator is paramount in setting the agenda of care needs required.

My apologies for not directing you more clearly however my meeting with both Leigh and Malcolm has sharpened my understanding regards to what is required for a case to be successful at panel.

I hope you have found this useful

Kind regards

Norma.

Email from Ahmed Monowara

Sent 06.11.2012 at 12.33

To Johnson Norma

Rehab Placement

Dear Norma

I am familiar with the placement suggested by Olu.

Recently I have a client who has been discharged to this care home from Kneesworth Hospital. The placement was identified by Paul Gill.

Given the history of MM I do not think this care home would be beneficial for her. This could be a future placement after receiving support from hospital settings where her problem can be identified and find a way of management strategy how she can be managed safely in the community. Presently her life is at risk of severe self harming behaviour and getting into trouble with Police. She could be ending up Dead

Regards monowra.

It is sad reading the above especially when there are so many errors recorded in file records. Elizabeth has never self-harmed, apart from a few scratches to her face. They have failed to protect her under care, previously highlighted under 24 hr provision where staff slept through the night.

For four months, we, the family provided wonderful care through “Working to Recovery”. Taken from Elizabeth’s diary notes, this appears on Rightful Lives on-line Exhibition.

I was working full time but for the first time felt relaxed knowing my daughter was being treated like a human being and in a safe place and good environment. She stayed at the family home in Scotland before going on holiday to France and Spain with them. Considering so much time having been institutionalised, she was starting to show improvement as a result of being in a peaceful and healthy environment. I was so happy for her staying with a decent family, receiving the right care which included psychotherapy, art therapy, music therapy, home cooking, freedom to go out and not caged like a prisoner. Her confidence began to increase and after two months she requested to go on holiday with them which I was happy to provide. Instead of drugging to the hilt they worked with her and she started to open up and reveal her suffering under a scheme called Moti Villa. For the first time she was able to express emotions freely. She had company of around her own age staying in the family home and throughout France and Spain was not treated like a person, not an object. She went out and about by herself and even learnt to communicate in French. Ending up in Paris she attended a conference and was taken out for a meal with French psychiatrists who were apparently fascinated. When she came back to Scotland she was offered the opportunity to go to Australia and amazingly agreed. When the plane landed in Dubai Elizabeth was overwhelmed. I was so happy to receive a call from her saying she was in the luxury airport lounge and the food was fantastic. I believe they flew with Emirates and she got a glimpse of Dubai before boarding the plane to Perth, Australia. Single handedly a former MH nurse of many years experience accompanied Elizabeth on the journey to Australia and took her on holiday. It is all about how someone is treated and down to good communication skills. Unfortunately, so many professionals do not possess these skills or else staff shortages on the ward impact upon the ability to spare time to communicate and a quick fix of rapid tranquilisation of a patient means peace and quiet to them.

In the community schemes provided under Enfield Elizabeth was severely neglected. At the care home mentioned she was not on CTO but it became increasingly apparent this was being arranged. This care home was about an hour’s journey away but easier to get to than Wales. Whilst at Cambian, Wales attempts were made to get rid of me as NR and to sever contact by taking the phone away. Luckily at the time I had solicitors involved but now it is virtually impossible to get that kind of support.

The story “My wonderful Care” details a trip of a lifetime where Elizabeth worked with professionals both local and international as well as peer support workers, musicians and art therapists and everyone took part in chores etc. There was a graduation party before return back to the UK. How I wish she had stayed there in Perth and had not come back to a situation where there was no continuity and no provision whatsoever in the community. When she returned she wanted a job, she was able to express herself clearly. This was all back in 2016 just before Xmas and she was unrecognisable and not suffering from anxiety.

Prior to 2016 I was taken to Court of Protection. This was sprung on me at short notice whilst I was working. I can’t praise the Court of Protection high enough. The Judge showed Elizabeth around the court room before proceedings began. At the time Elizabeth had a fear of heights and lifts so in order to alleviate her anxiety I booked a therapy session with Susan Hepburn of Harley Street who she had seen once before and was able to really assist successfully.

“We recommend Mental Health Act assessment for the mother with the help of GP to be organised by the Rehab Team.

SOVA to be raised

Consider physically separating them through legal process, transferring Elizabeth back to Northampton.

Consider transferring Elizabeth’s care back to the Rehab team.

NB Staff to be aware that Elizabeth’s mother is documenting all visits by staff on her blog: psychiatric abuse UK.

Originator Jalonen, Esther

21 May 2014

T/c with HTT (Managed by Dr Helen Moorey) who went on to be RC of Suffolk Ward with an aim to request rehab team to accompany them today on their morning visit.

PLAN joint visits by HTT and Rehab Team and establish Elizabeth’s mental capacity.

I received a telephone call whilst at work that Elizabeth and her sister were hiding in a cupboard because social services were coming round and knocking on the door. “what shall we do Mum” – in the end luckily there was a friend of the family in the house who answered the door to say the girls were out.

Following decision by CoP Elizabeth was allowed to come home but prior to this was another case “Deprival of Medication Community Care” – Irwin Mitchell.

The whole experience of living under Enfield has been like hell on earth and during lockdown it made me think seriously about whether I wanted to remain in that area as I knew nothing was ever going to change. However little did I know that even in a new area the grass is not greener on the other side and sadly it doesn’t matter where you live in the UK there appears to be a culture of bullying throughout the NHS if you as a carer/parent dare to complain.

There is supposed to be a care act assessment taking place but I am excluded. They say they will take into account my comments on the Care Act assessment form. I found when completing this form that many of the questions did not apply. How can you talk about goals and education and work when someone has deteriorated to such a massive extent over 19 months held on an acute ward with no end in sight. Maybe the care act assessment has been forced upon my former local area who unknown to us are still responsible for providing the S117 aftercare.

I was blamed for stopping the depot when moved to the new area but was able to produce evidence to the contrary. I was then subject to lengthy investigations by the Public Guardian Office alleging neglect and abuse. However this went in my favour.

Who is going to listen to a parent when so many professionals back one another often contrary to their own Codes of Conduct. “it was not my decision but that of the MDT” – in other words no accountability. I have acquired extensive records and investigated everything thoroughly.

It is exhausting to constantly have to stand up for yourself in a culture of bullying and this is how I see myself as being treated as well as my vulnerable daughter who clearly wants to come home to the detached annex in my back garden.

There has been no assistance for adaptions and it would appear the MDT never had any desire to work with myself as mother/carer and it has become apparent that they wish to institutionalise her into care they provide and possible out of this area which would be very upsetting to everyone in the family.

On the ward it has been mentioned there have been “episodes” – seizures. The episodes are not of violence but triggered by extreme distress most probably cause by the enormous restrictions in place. I never encountered any violence at home whatsoever but the seizures could also be the cause of the cavernoma and lesions shown on private scans and noted as far back as 2007 . I attempted to get adaptions such as stronger bed but was told this was not possible as Elizabeth was still held in hospital after 19 months Elizabeth she is still stuck on an acute ward. Almost 30 people are recorded in invitations to attend an MDT meeting excluding family.

When complaints remain unresolved there is the option of Ombudsman/PHSO but I only have 1 positive outcome and that was on safeguarding under Enfield who held several section 42 meetings behind my back. Thankfully Elizabeth gave me the minutes which I reported to Police.

As for the Police and Ambulance services Elizabeth became one of the highest callers in the former area but trusted them and regarded Police and Ambulance personnel to be her friends. In the absence of any care in the community or provision such as direct payments which could have avoided all of this but was never offered and neither was a care act assessment in the former area.

I wish there was a system of openness and transparency within the MH trust with Open Dialogue instead of exclusion of family and carers. The MDT are exclusive to professionals and decisions based on best interest due to their conclusion of no capacity which is highly disputed.

• 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.

Ash Villa is a shambles and LCC and LPFT are struggling not very effectively to hide that.  The treatment of Elizabeth is incompetent and the over zealous use of PRN and seclusion a human rights violation.  That is what they want whacking with.

Robbing Elizabethof capacity is robbing her of he most fundamental rights as person and in effect turns her into a ‘thing’ rather than a person.

How true “I am not a person” “I wish I was never born” – This describes my daughter’s feelings and her treatment under the appalling NHS care – doesn’t matter where you live it is the same everywhere under mental health as we have unfortunately discovered yet hoped for something better. 

She has capacity to decide what is in ‘her best interests’ and that is categorically clear. 

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.  

There have been around 20 cases where patients were prescribed clozapine and had concomitant inflammatory disorders including those caused by pathogen infections and autoimmune conditions.  The inflammation increased the serum dose ratio and in 11 of the cases it was recommend to half the dose, in 5 others to reduce it by a third. Serum concentration is the major issue with this drug rather than dose and a high serum concentration can occur with a moderate dose.

It is this ratio that creates the problems with ADR’s and metabolism failure due to cytochrome P450 down regulation.   

The maximum dose in all cases had been 350mg and nowhere near maximum but still the serum dose ratio was adversely affected by the inflammatory disorder the patient had.  

s.117(6) Mental Health Act 1983 as amended by s.75 Care Act 2014.

Accommodation can only be provided where it meets a need related to the person’s mental ill health, and reduces the risk of the person’s condition deteriorating. At Ash Villa there are frequent bouts of inconsolable behaviour leading to seclusion and her being left to scream for hours on end. At home there has only been 1 incident and we are asking for adaptions to be made to the annex which we as a family have provided.

The person has the right to express a preference for particular accommodation. Social services must meet this preference provided it is: Elizabeth wants to come home and we as a family WANT HER HOME IN ACCORDANCE WITH HER WISHES.

·       of the same type that social services has decided to arrange – CARE IS ONLY ON ONE SIDE OF LINCS.

·       suitable for the adult’s needs THERE IS A VERY GOOD CHARITABLE SECTOR HERE WITH SO MUCH GOING ON THAT ELIZABETH WOULD BE INTERESTED IN.

·       available

·       affordable, using a ‘top-up’ if necessary

Applicable Principles and Requirements

The recent capacity assessments all been seriously flawed in terms of the requirements and principles of the Mental Capacity Act 2005, the Code of Practice, and indeed in the very philosophy underpinning the legislation.

The concept of best interests is founded on the most fundamental principles of human rights. Those principles are centred entirely around the welfare of the patient and never in the interests or expediency of ward management or those carrying out assessments.

The Mental Capacity Act 2005 at Section 4 requires that the patient is to be regarded as having capacity until evidence is ascertained as to how that capacity is impaired.  

No Proper Capacity Evidence

No proper, full, objective and admissible evaluation of capacity has ever been made at Ash Villa; and/or

• there has been bias in  assessment so materially affecting validity that none of the evidence on capacity is admissible.  

Elizabeth’s Responses

What is startling is that no account is taken of Elizabeth’s reaction to being, as she sees it, in an oppressive institutionalised situation in which she has virtually no right to privacy, family life or psychological and spiritual enrichment.  

It is hardly surprising that any person so deprived of the most fundamental of human aspirations is not so much lacking capacity but is self evidently being deprived of it.   

All of this is in breach of the letter and spirit of section 4, MCA 2005.  

The Prohibited Step

It is never allowed that the decision maker on best interest draws conclusions on capacity from a patient’s age or appearance on a condition of his/hers or an aspect of his behaviour which might lead others to make unjustified assumptions about what might be in his/her best interests by section 4(1)(a) & (b).  This is known generically as The Prohibited Step.     

Failures: Identification of Issues

Section 4(2) MCA 2005 requires that the decision maker should try to identify all the issues that would be most relevant to the individual who is asserted to lack capacity relating to the particular decision (para 3, Main Code of Practice)

Failures: Framing of questions/suggestions

The framing of questions/suggestions in closed form gave Elizabeth no opportunity to explain or include detail in her answers.  

It is a disturbing oversight on the part of those carrying out those interviews that the nature and framing of questions and suggestions, and their leading nature, made it impossible for her to express herself.  

Failures: Elizabeth’s Clear Responses

There is no evidence from the interviews that there was any attempt to determine the actual meaning of Elizabeth’s clear responses to questions/suggestions made by the interviewer.  

Failures to comply with Requirements

The capacity assessments were not conducted as required by section 1 of the Mental Capacity Act 2005.  

It is submitted that the capacity evidence is inadmissible as evidence of lack of capacity not only

because of logical and factual inaccuracies in the statements, but also for failure to apply the meaning of the statute, and the failures to follow the required steps:

Submissions on the Required s.4 Steps

The required steps, in summary, in s.4 of the Mental Capacity Act 2005, and appropriate related submissions, are:

To consider the likelihood of the person gaining capacity. There is no evidence that this was even considered by either first or 2nd opionion assessor or in the ‘off record’ intervention by KS, and thus never taken into account at all.

To promote and encourage the participation of the patient so far as possible.  There is no evidence that Elizabeth’s participation via appropriate dialogue was encouraged or ever taken into account at all. Indeed the first and second assessor treated her as someone with a severe learning disability rather than an educated woman with a chronic mental health condition.  They make reference to talking to her in “little chunks of three sentences”.  Nothing in Elizabeth’s diagnosis suggests that she is mentally retarded or incompetent and this approach is in clear violation of  The ‘Prohibited Step’ described in section 4(1) of the Act. 

To consider the persons wishes, beliefs and other factors the person would be likely to consider were they able to do so.  Once again this is not taken into account at all by either of the first and second opinion assessors.  None of Elizabeth’s wishes were considered in those interviews or were simply disregarded with scant attention.  No attempt was made to understand why she may have taken those positions, including of course that the oppressive nature of the interview with no independent observer present may have seriously deprived of any ability to explain in detail.  All contrary to section 4(2) and the main Code.

To take account of the views of named others.  This is perhaps the most obvious complete failing of all the assessment interviews and is a cause for serious concern.  The views of neither Susan Bevis, Elizabeth’s mother, or CB, her sister, or her father were taken into consideration or even sought.  

Conclusion:

The individual and accumulative effects of all of these failings make the statements by the assessors incapable of being relied upon at all.  

Comments on the Section D Assessments of the 1st assessor and second opinion assessor in red. 

Question 1. UNDERSTANDING: Does the person understand the information relevant to the decision?

Elizabeth frowned and stared at me. I added that according to her records, her mum does not believe that she suffers from the diagnoses listed. I explained that she believed that she had ‘autism’. She asked me what was going to happen about that diagnosis and I explained that she has been (or is going to be soon as we have agreed in last ward round) to be referred for a diagnostic interview but unfortunately, there was a long waiting time and when her turn comes up she would be assessed for it. 

‘as if’ is entirely speculative and inconclusive of Elizabeth’s lack of capacity.  It is also contradicted by Elizabeth’s response to the suggestion ************“Elizabeth frowned and stared at me”.  Such a response is self-evidently disapproval and indicates the capacity to make decision on this.  If indeed Elizabeth was expressing a refusal to discuss the matter further that cannot be ‘reasonably’ regarded as a lack of understanding of the issues and would just as likely show an objection to the suggestion ***********  Elizabeth’s mother’s beliefs are not evidence of Elizabeth’s capacity or lack of it.  

This is a logical fallacy. It is effectively asking Elizabeth to acknowledge her lack of capacity.  Logic clearly dictates that if she does not understand the information ‘given in little chunks’ she is not going to be able to determine her own lack of capacity. 

Question 2. RETENTION: Can the person retain the relevant information long enough for the decision to be made?

Answer: No

I asked her if she had any questions to ask and she said “no questions”. It is my reasonable belief that Elizabeth was not able to recall the salient points given to her to enable her to make a decision ******************t. It seems like she was able to retain the information for some time but she was not able to relay it back to me as if she did not want to discuss this issue anymore.

“I asked her if she had any questions to ask and she said “no questions”.”

“she was not able to relay it back to me as if she did not want to discuss this issue anymore”.

It is not a reasonable basis of belief that this indicates a lack of capacity and could just as easily represent defiance or resistance to a suggestion that Elizabeth found threatening or disagreeable.   It is also logically inconsistent.  If Elizabeth says “no questions” there is no reason at all why she would wish to relay back the discussion.   

2^nd Opinion Comments

1. UNDERSTANDING: Does the person understand the information relevant to the decision?

Answer: No

Elizabeth stated that she could not be involved in …………..because “my back is broken and I have got autism”. I did challenge Elizabeth on this stating that just because a person has autism (noting this is not a formal diagnosis for Elizabeth) – (no because it has been consistently deprived to her!) does not mean that they do not have opinions or views about what they want to happen, Elizabeth was still adamant that she could not be involved. I have checked with the care team and have been informed that although there is a likelihood that Elizabeth has injured her back when in periods of high distress and volatility, this has not been to a significant degree beyond strain or sprain and she is not known to have ever broken her back or sustained a similar level of injury. Elizabeth has frequent bouts of throwing herself off the bed onto the hard hospital floor in distress. Then we saw this on one occasion at home. All leave had been going OK up until then. That one occasion was on a new bed now broken but not a strong stable bed and all that is needed is a strong bed provided and nothing has been done about this since 5 March 2023.

On the balance of probabilities, I consider that Elizabeth does not understand all the salient information needed to be able to make such decision. When I tried to explain to Elizabeth that she could instruct a solicitor or tell the ******* what she wants, she was fixed in her view that she could not do this because of having autism. This evidences that Elizabeth does not understand all the options available to allow her to participate ***************** No this evidences that you the Dr do not understand!

Elizabeth stated that she could not be involved in court proceedings because “my back is broken and I have got autism”.

That is not conclusive or even persuasive evidence of a lack of capacity.  Elizabeth’s erroneous belief in her condition is not indicative of an inability to choose ******** or a failure to understand the questions put to her.  As for the injury to her back, she has been subjected to numerous physical restraints including pinning her face down on the floor according to witnesses .  It is entirely understandable that she may use hyperbole to describe her pain from injuries sustained by this restraint. That is not evidence of a lack of capacity.

2. RETENTION: Can the person retain the relevant information

long enough for the decision to be made?

Answer: No

Elizabeth has demonstrated that she does retain some information relating to ***********

I can see there have been occasions when she has been emotionally distressed that she has expressed anger about **************without prompting and has stated that LFPT does not have a right to stop her mother ************ She was also able to recall today that her mother is her **********

Although there is clearly a level of retention regarding this decision, I do not consider that Elizabeth is able to retain all the pertinent information required to be able to *********

After I finished my discussion with Elizabeth, deputy ward manager KS went to speak to her

independently in her bedspace to see if she was willing to discuss this decision in more detail without me being present. Elizabeth asked KS if I was going to be going to ******* Elizabeth had asked me the same question approx. 10 mins earlier when I was talking to her and I explained to her that I was not a solicitor and was not going to be in the ******* but that I would be writing about our discussion today and the *********. As Elizabeth had asked KS the same question 10 minutes after I had given her this information, this evidences difficulties with retaining all relevant information relating to ************ I see there have been occasions when she has been emotionally distressed that she has expressed anger about the *********************** without prompting and has stated that LFPT does not have a right to stop her mother being her ************** She was also able to recall today that her mother is her ********

All of that is indicative of a functioning capacity to understand the issues, not only at that point but on reflection of earlier events.  This is fully supportive of her ability not only to recall but to maintain a position on the ********* In the light of this is cannot be stated that “on the balance of probabilities” Elizabeth lacks capacity.  The MCA 2005 principles found at are at section 1  quite explicit that the capacity assessor should work on the basis that a patient has capacity ‘on the balance of probabilities”  Those principles are as follows:

• 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.

Violations of principle 1:El;izabeth is presumed in the negative contrary to the principle of presumed capacity.  Clear evidence in Elizabeth’s answers and  attitude to the capacity assessment indicates a presumption of capacity and not the contrary.

Violation of Principle 2:Elizabeth has received no support to make her own decisions and was not supported at this capacity interview by an independent advocate.  The clinical staff are seen by Elizabeth as intimidatory.  Her responses to these capacity interviews show clear evidence of resistance to the questions and objections to the purposes of it.

Violations of Principle 3:  Section 1 of the MCA 2005 and the Code of Practice are quite explicit that unwise decisions cannot be used as evidence of lack of capacity.  Emphasis is placed in the interviews on irrelevant interpretations of Elizabeth’s mistaken beliefs in her diagnosis.  It is very often that case, probably more often than not that a psychiatric patient will deny their illness.  This is not evidence in itself of either delusion or lack of capacity.  Elizabeth’s complaints about the back injury are quite explainable since she has been subjected to maximum physical restraint on several occasions.  The use of restraint has been described as a method of dealing with “distressed” patients at Ash Villa and that is quite disturbing.

Violation of Principle 4:  It was in Elizabeth’s best interest that this interview was conducted in the presence of an independent advocate or her *******  Neither was present and Elizabeth had no support.  Elizabeth is used to being physically restrained and in the light of that far better safeguarding of her best interest should have been applied at these interviews.    

Violation of Principle 5. Elizabeth is currently being held under a regime of restraint and it is difficult to see how she could be subjected to a more restrictive option.  The two on one surveillance that has been employed at Ash Villa and the intrusive surveillance of family visits is more severe than many s.37/41 patients would encounter.  There is every reason to believe that should Elizabeth be given a less institutionalised and restraint based treatment regime that she would display a much better degree of capacity than the current regime allows.   

“I do not consider that Elizabeth is able to retain all the pertinent information required to be able to******* in these ********

Elizabeth is not required to ********* these proceedings she is represented by a ************* and has a right to a *********

“As Elizabeth had asked KS the same question 10 minutes after I had given her this information, this evidences difficulties with retaining all relevant information relating to the ***************”.

That presumption is fallacious.  Elizabeth could just as likely have been seeking verification from someone she was more familiar with and it does not necessarily indicate she did not understand or retain the information.  It is also indicative of a lack of trust, especially in the light of the stated reason for KS wanting to speak to Elizabeth independently.    The suggestion that the capacity assessor was being mistaken for a solicitor is not made out.  Elizabeth’s question regarding whether the capacity assessor was going to be ********* is perfectly sensible since this person was discussing the ********** with her.  

“Elizabeth demonstrates an ability to communicate her views to the extent that she chooses and is able to do so. She did offer a view regarding her involvement in the current **************”I don’t want any part in it”. Further to this, she has at times of distress spontaneously expressed her unhappiness that LPFT have instigated these *************** Additionally, when deputy ward manager KS went to speak to Elizabeth alone 10 minutes after my assessment with her, she was able to express to KS that she did not want me (meaning KF) to have anything to do with the **********”.

Although Elizabeth is guarded and refused to discuss her capacity to ******** in any great detail with me, I do not consider that a refusal to communicate a decision equates to an inability to do so and therefore on the balance of probabilities, I consider that KS does have the ability to communicate in relation to this aspect of the capacity assessment”.

This element of the statement is riddled with contradictions when considered against the principles defined in section 1 of the MCA 2005.  Elizabeth appears to have a full appreciation of the nature and purpose of the litigation and expresses strong and clear views on it and the *************process as currently conducted by LCC Adult Social Care.  As stated a refusal to communicate is hardly any evidence of an ability to do so and is in realty much more likely to indicate a good range of capacity.  Once again concluding otherwise falls foul of principle one of the Mental Capacity Act 2005.  The entire process seems faulty and as such should not be admissible as evidence in these **************

As for the capacity assessment the best interests assessor will undoubtedly insist on certain conditions in order to carry this out effectively.  I would consider it unlikely that they would think having nurses with Elizabeth while this happened was at all appropriate.  The assessment of course is entirely reliant on Elizabeth co-operating.  It can be done remotely but it would have to be by Zoom or Teams so Elizabeth and the assessor could see each other.   

It is of course very likely that the AMPHs will not approve of this and put pressure on Ash Villa to prevent it.  Complete failure by the so called professionals involved in my daughter’s case. Complete lack of understanding and complete ignorance towards autism. I am apalled so much by hearing some of the heart-breaking messages from my daughter. This needs exposing.

What is manifestly obvious it that neither the LPFT or LCC will countenance Elizabeth moving into the annex full time.  Everyone at the LCC from the unregulated Legal Services Dept through the two AMPHs are opposing this strongly but what they failed in most of all is to take away my daughter’s capacity even with the massive increase in medication for this purpose she still says “i want to come home”. So the question is how very often does Elizabeth have to go into seclusion and be injected? From other patients I gathered it happened more than once a week. No doubt LPFT would have records of this but the CQC accused me of inundating them with complaints when in fact the complaints came from other sources.  

Because of severe neglect and bullying under ENFIELD we moved to Lincolnshire and now have built a separate living accommodation namely the annex.

It is clear Elizabeth wants to come home and has even on her own accord posted a prayer on Lincoln Cathedral’s wall.

I am saddened by having to write this blog even as we wanted to start afresh and hoped so much that we would be treated fairly in another area but sadly this proves that NHS Trusts and Council’s working together can be dishonest and corrupt and severely neglect a vulnerable person and I see this as abuse that needs exposing in order that improvements can be made and lessons learnt by both.

“It is looking more and more likely that Elizabeth will be given trial leave to supported accommodation.  She is entitled to this under section 117 having been on section 3. I will fight any such decision in court! hopefully a transparent hearing.

The leave can be between 3 months and two years and is contingent on the patient residing at the determined placement. 

The recent changes allowing Elizabeth short periods of unsupervised visits and trips out of Ash Villa suggest this is what they are moving to and they may already have a placement in mind.  (two have turned her down thankfully) – we just need a few adaptions to the annex which has already been built.

The patient is not discharged or on a CTO but is on extended leave under s.17.  This is subject to controls imposed by the clinical treatment team and the AMPH. A CTO, a disgusting weapon of abuse whereby; so called professionals can make threats and bully to their hearts content and I have all the paperwork to prove this fact which I can feature in my next blog. “I do now strongly suspect they have this in mind.  It is the best of both worlds for them.  They allow Elizabeth to leave Ash Villa and retain control over medication and supervision.” of which certain so called professionals such as AMHPs know absolutely nothing about.  

MotiVilla – multiply abused – all possessions of value missing.  14 year old drug dealer on site.Supposed to offer 24 hr care.

Phoenix House Northampton no food at the weekend yet rated good by CQC

Premier Inn Enfield Island Village –  moved from room to room – had to keep paying and then had to visit your department  to get the money back

Mays Cottage – Priory Craegmoor group –  broken lock to door of room- told to sleep on settee all night.  Resident drug dealer, resident bringing prostitutes in.  No supervision or care overnight.  Faced eviction because of another resident staying over from a related scheme.

Reservoir House  –  total breach of H&S –  five fumigations failed to stop bed bug problem which spread to all other residents.  Had to sleep on floor with damp sheets because of constant washing of clothes to try to stop the problem which persisted.

Solway Road–  temporary scheme without even a proper kitchen or lounge or garden to sit out in

Purcell House – the very best accommodation.   Independent Council Flat but no care act assessment or any S117 aftercare provided.

“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.” Yes how very true and this is what I have been trying to get in place for many years.

However, that legally invalid capacity report is in part good evidence
in your favour: it quotes Elizabethas saying that when she leaves the
hospital she “will go home to her mum”.

Presumably it is to do with the control of the aftercare.  They want to either discharge Elizabeth to sheltered accommodation or send her there on extended s.17 leave.

The failure to carry out a proper capacity assessment and the refusal to properly investigate potential medical conditions interfering with the treatment is staggeringly unprofessional.  If Elizabeth has an endocrine disorder and she almost certainly does. (as proven)  If she had inflammatory disorders they would interfere with the drug metabolism.  We already know she is a poor metaboliser but they continued nonetheless to treat her with medication that almost certainly would not work.  This should be thoroughly investigated and I suspect they do not want any **that might insist on it.  Like me!

The bottom line on the capacity issue is that while they maintain Elizabeth lacks capacity they will be able to perpetuate the myth that she cannot consent to here case being publicised. I am reading all my blogs to Elizabeth for her approval as I want her to know that she has my backing 100% and I feel that certain staff members are provoking her on the ward.

If Elizabeth does not want the ****** publicised she has that right.  It is the LCC and LPFT that actually want to hide things and they  are using Elizabeth’s erroneous lack of capacity to protect themselves.  That looks like an egregious abuse of process to me. And me too and I have written to those at the top of Trust and Council in this connection.

Clibbery is the authority   

Even where a case is heard in private, documents can be released to non-parties? Clibbery v Allan [2002] EWCA Civ 45, [2002] All ER (D) 281 (Jan) (a case cited extensively by Mostyn J in Appleton) concerned family proceedings heard in private. 

A circuit judge had refused to make an occupation order injunction (under Family Law Act 1996, Pt 4) on Ms Clibbery’s application. 

After the hearing she passed documents in the case to The Daily Mail. Mr Allan sought an injunction to prevent publication. 

How very interesting and notable. I’m all in favour of honesty and transparency especially if taxpayer’s money is involved.

 

I will begin writing what a wonderful time we have had together today in a fantastic place – a therapy centre situated quite some distance from the Ash Villa, Sleaford. I had five hours granted of S17 leave, much of which was spent travelling. I collected Elizabeth at 12.00 pm but was conscious that she would not have eaten anything. She was not even up and dressed when I called and was nervous about going initially. I did not pay much attention to the exact time I picked Elizabeth up to be honest but it is so regimented and strict with discipline that the attitude is you have to be back on the dot. This is what is called Section 17 leave and no flexibility but it depends on the member of staff, one in particular is a male nurse with good communication skills who took into account that Elizabeth wanted once to go to a garden centre some distance away but I was told 1 hour only by other staff members. It takes me 1.5 hours to drive there and another 1.5 hours to drive back. Elizabeth really enjoyed herself today and when we left she said she was hungry. There was nowhere in the area apart from 1 pub that had stopped serving food so I took her to a lovely place even further afield called Woodhall Spa and I showed Elizabeth the “Kinema” in the woods and we walked from there to the high street where they have wonderful shops many of which were closing being Sunday but fortunately I managed to find a place that was open. This is called the Inn at Woodall Spa. Realising that time was getting on I asked if they could provide a takeaway but decided to contact the ward to advise we might be a bit late as we were going to have just starters. The response was “I am going to have to escalate this”. This was a nurse who said this. I then said I felt really threatened by such words and asked was she going to call the police again for the third time? The Inn at Woodall Spa went out of their way to help and I would highly recommend not just the food but service.

We had no time to eat in there and felt obliged to make our way back to the car but at least Elizabeth had nice food to look forward to as all they get in the evenings in a sandwich.

Elizabeth wishes to share her views. I am going to make sure that she is heard loud and clear. “What shall I do about the noisy drawers in the medication room” “I’ve got an ?? idea I could go there and tell them that the drawers make a lot of noise but then again they are the only ones.”. I have promised Elizabeth I will feature such comments as this is not good to make a noise slamming drawers in the medication room.

“I really liked the day out today”. “I cant stand up any more for the injection so they are gonna have to do it lying down!!” “Not that I have an injection tod” I have just sent her photos of our wonderful day out.

“it is totally unacceptable” – her response to my comments that it would appear our battles are far from over yet.

On the way back home Elizabeth came out with random but interesting comments.

Elizabeth is on guard at the moment and it is no wonder way. There is a lot going on behind our backs right now. What is going on is a Care Act Assessment. From what I have heard is the former local area are involved but it has been sprung on Elizabeth very recently and she did not want to participate. That shows mistrust because after all the very many recent flawed capacity assessments on something I cannot talk about as I would end up in prison otherwise, it is no wonder Elizabeth does not trust anyone. It is a good job that she tells me what is going on and I immediately contacted Voiceability. They were advised by me that a care coordinator from Enfield who is well known to us wishes to carry out such tick boxing assessment. Looking back to 2014 “Deprival of Medication Community Care” case – Irwin Mitchell. This same person who wrote nastily for court purposes now is the care coordinator and the same person which according to my files recommended this assessment under MHA leading to 19 months imprisonment.

The other thing Elizabeth told me is that she has been told by the Deputy Ward Manager “You are Not Going Home”. So decided to put this title on my blog to inform the world especially as this is a very topical subject right now as Elizabeth is one of thousands incarcerated under the MHA in the most unsuitable environment of a locked ward which is far from therapeutic.

Elizabeth has also informed that the “Clopixol Depot” has recently been reduced by 100mg. That is an incredibly high drop. I am not a doctor but I am going to copy in Dr Moncrieff and others to check on this and I am not having it said that there is a relapse of so called “illness” when I have read up on the subject that any decrease or increase in medication can affect behaviour. We are still waiting for the MRI scan appointment and the Endocrinologist appointment and dentist after 19 months.

I feel in the mood for writing right now as I want to get the truth out there to as many people as possible. I know the team are reading my blog and feel honoured by this. I wish to advise the Government ministers what changes need to be made to the MHA – the system is not fit for purpose and as said at the CTR in Enfield “the whole thing stinks!” I am now looking at the response from CEO, SC of LPFT who has commented on concerns re Panorama and Dispatches “we are an open and transparent organisation and following these programmes we did contact families and carers of those on our wards to acknowledge how upsetting the documentaries were and provide an opportunity for them to speak to a service manager. Well I am speechless! Why haven’t I been contacted in this connection in that case? Then it is mentioned about “positive progress”. In 19 months of incarceration you would expect to see such positive progress – we have seen none except resilience from Elizabeth despite the mountain of drugs given at one time which led to several patients approaching in the grounds outside voicing their concerns and telling me they were doing the safeguarding. I still cant believe the enormous increase from 300mg fortnightly to 400mg every single week plus 10mg on top and all the frequent rapid tranquilisations. That sounds more like torture to me. Now with a new doctor appointed he had started to give leave unlike any of the following doctors:

Dr Shahpasandy

Dr Ismail

Dr Kumar

Dr Islam

Dr Suleman

I will not name the new doctor because he is being fairer but that does not mean I am at all happy. I am also on the receiving end of heart-breaking messages from Elizabeth which, in accordance with her wishes, I will be openly sharing.

I am glad that Ms Connery mentions “we understand and appreciate that Elizabeth would like to be at home and we are working hard on making preparations for this to happen. This is very contradictory to what the Deputy Ward Manager has just said to Elizabeth and I will not have it said that Elizabeth has got this wrong.

As for “escalation” for being 22 minutes late do you think I am over-reacting?

I would love to hear the comments of my readers after all how comes Police were called twice on me by Ash Villa staff whilst I stood alone under CCTV and then I was accused of assaulting a member of staff. What a lie! Quite rightly I have asked for all the footage so I can share this with my readers. For this I have had to contact the Police themselves and of course there is nothing to show or even the recordings of my alleged threatening behaviour. I find it quite amusing as this reminds me of Cygnet accusing me of “impersonating another mother” via their solicitors. Then I got a threatening letter from the Police. The letter was dated a year prior to when it was posted lol! I never heard anything back from these solicitors about the recordings and this is something I am also awaiting from Lincolnshire Partnership Trust. “Thank you for sharing your constituent’s concerns. I would like to assure you that the Trust is working closely with our NHS colleagues and are continually reviewing Elizabeth’s care to provide her with the most appropriate support and treatment. Like now? Where is the psychologist??? Why is there such staff shortages? Why do you use caged vehicles? Why has my daughter been treated like a restricted prisoner and me like a criminal. Now as someone who is involved in reviewing services myself I can say that I have seen high quality in care but what has clearly been going on here is abuse of power and breach of human rights.

It is not just down to the psychiatrist but a team of 29 and the only positive thing is that they are supporting the former area.

I will keep you informed.