Hello Dr G
Following our dialogue I note your statement "I am curious now too about this diagnosis."
As mentioned in my second post, I was in the process of asking "how the diagnosis was reached" and arranged a meeting with the Trust to discuss this; which I attended on 12 September. I recieved a written response from the Trust on 19 October.
To bring you fully into the picture I paste the initial diagnosis report, my letter requesting a meeting to discuss the diagnosis and the Trust's response post meeting date.
I would appreciate it if you could review the report/letter and let me know if they are justified.The initial diagnosis report (dated 21 April 2010) is as follows;
I reviewed Mr Stanmore in my clinic at the Donold Winnicott Centre on 25th
August 2010, although he was thirty minutes late. Fortunately, my preceding
patient failed to attend so I was able to assess him myself.
You will be aware that he had previously been assessed by Dr Holland and has
had an assessment for CBT. Mr Stanmore informed me that he had been
offered a course of CBT, but had rejected this because he does not believe
he is unwell or would indeed benefit from this intervention. He continues to
harbour delusional beliefs of persecution relating to the police. He believes
he is being monitored by them for reasons he cannot understand and he
believes that this monitoring has extended to his neighbours and general
community. He feels watched and looked upon in a peculiar way, not
consistent with people's normal behaviour. He believes that shop keepers
have been informed about him by the police and observe him from a
distance attending the shop and give him close scrutiny while he is in the
shop, such as looking at his hands in a way which distresses him. He connot
account for this and informs me that his family and friends do not believe him,
although he is unwllling to accept a psychological explanation such aspsychosis
It is my belief that Mr Stanmore is clearly suffering from a Paranoid Psychosis,
which is untreated. His symptoms may be consistent with a diagnosis of
Persistent Delusional Disorder or Paranoid Schizophrenia
. I have no doubt that
he would benefit from a trial of treatment with an antipsychotic, although he
is not willing to accept this. You will be aware that he also suffers from
significant symptoms of anxiety, possibly as a result of his psychotic
phenomena and I understand that he has been considered appropriate for
Cognitive Behavioural Therapy, but would prefer not to engage either.
He does not believe that we at the Mental Health Team are involved in the
conspiracy, although he informed me that you have told him he may have
Schizophrenia. I myself told him today that I think that you may be right,
but he is unwilling to accept this possibility.
I asked him if he wished to followed up in the clinic and he said that he would
not; so reluctantly l will discharge him from care. Although he is distressed by
his symptomotology the risks are low and he does not feel the need to act
upon his beliefs in a way which would cause concern. There are no grounds
for compulsory treating him under The Mental Health Act, although I have
asked him to consider what both you and I have said to him and I would
accept his re-referral should he be willing to engage or should circumstances
change, such that we would be able to act.
Consultant PsychiatristMy letter requesting a local resolution meeting (dated 25 July 2011) is as follows;
Local Resolution Meeting
Following my letter of 27 June, which I note was not adequately addressed; I write to request a local resolution meeting with Dr Sherrin as per Dr Curran's letter of 13 July to discuss my outstanding concerns which are outlined below.
- How was the diagnosis reached?
- On what grounds does the diagnosis remain?
The aim of this meeting is to get oral reasons to the above questions as I do not believe my outstanding concern regarding Dr Barnett’s diagnosis has been adequately addressed.
I believe the hospital/psychiatrist must provide both oral and written reasons at the time of the decision of mental health assessments. I do not believe Dr Barnett provided any reasons for his diagnosis both at the assessment and in his report dated 21 April 2010. [Please note, I realised after sending this letter that my police complaint could be used as a reason for the diagnosis; although I was coerced into talking about it and I believe the Trust were aware of what was going on. And, I am not sure if my complaint is adequate to diagnose me with paranoid schizophrenia.]
I am also requesting the reasons for Dr Barnett’s diagnosis in writing post meeting date.
I understand that the Trust may need to contact me prior to the meeting and confirm I have no objections to this. My contact number is XXXXX(NNN) NNN-NNNN
I would like to make it clear that this meeting is not to discuss inaccurate or false statements written about me throughout the assessment. Dr Fisher has given me an opportunity to discuss this in his letter of 12 April, but I wish to address this at a later date.
I would appreciate it if a meeting could be arranged as soon as possible and to that end I look forward to hearing from you by close of business on 1 August 2011.
Local Resolution Meeting held 12 September 2011...
The Trust's response (date 11 October 2011) post meeting date is as follows;
I am very sorry for the delay in responding but unfortunately the tape that I dictated my letter on went missing.
This is just to remind you that we discussed queries regarding how Dr Barnett's team reached a diagnosis. We had a discussion about diagnostic criteria as set forth by the World Health Organisation (WHO) and that we used the operationalised criteria as in the latest edition of the International Classification of Disease Chapter 5 which is the chapter for mental health. I gave an overview about how we reached diagnoses and that there are usually symptoms and signs as reported by you that would fulfil the criteria for the diagnosis reached.
I gave you a print-out about the relevant chapter on the International Classification of Disease for you and you were quite happy about that. Since that time Dr Barnett was on special leave and the SHO in your case is no longer working for us, we could not have any of them in person at the meeting to explain in more detail how the diagnoses was reached by them at that time. You made me aware of your concerns that there was a diagnosis of a paranoid schizophrenia in the GP notes which, in your view, predated the meetings with Dr Price's team at our surgery. Since the GPs have their own filing system and are not part of our Trust, I can not comment on that. You would need to go into your GP practice to discuss it yourself or ask the Primary Care Trust for City & Hackney if they would want to start an investigation for that. Since you are also no longer a patient of our CMHT I would suggest going with any further queries to your GP practice.
I hope this is helpful.
Associate Clinical Director
I would like to know;
1. Are the above letters justified?
2. My GP made an entry of paranoid psychosis and delusional disorder in my medical records on 21 April 2010; although I was not diagnosed until 25 August 2010. Is this right?