Independent investigation: Lisa Sullivan, Walton on the Naze (2005)

When the psychiatrist, or other member of the mental health services, wishes to review the diagnosis of a service user this should be undertaken with a review of the complete history of that service user and the treatment and care plans which have been used. Any change in plan should be fully recorded with the reasons clearly stated. In addition if there is any consideration of a specific diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) there should be consultation with one of the Trust’s four specialist consultants.

The National Service Framework for Children includes a recommendation that CPA meetings (and their equivalent) should take account of children’s needs and any risk of harm to them. Therefore, when a service user is the parent of a child for whom a child protection/safeguarding conference is called, and the mental health services are asked to attend the conference and to provide a report, this should be treated as a priority. A request for information should trigger a reassessment of the service user and the risks he/she may pose to children and others. The Trust should audit attendances at child protection case conferences.

In situations where a service user is usually seen alone without any family or friends and there is no corroborative information to support the ‘history’ or symptoms described by the service user, any opportunity to speak to another person who knows them should be used. The person may be a carer and be entitled to an assessment of their specific needs as a carer, and may also be able to provide additional information about the service user, subject to issues of consent and confidentiality.

Service users who are only being seen by the psychiatrist should be asked about their family and social circumstances so that they are viewed within an overall context. This is particularly important where the only informant is the service user and there is no other source to corroborate the history given. All mental health professionals should complete the form designed by the Lead Nurse for Safeguarding Children which records information about children with whom the service user has contact.

When a service user is being seen by only one member of the mental health services there should be a review, at least annually, to include: diagnosis, care plan and treatment plan, current risk assessment, social and family circumstances, risk to any children in the household and consideration of their needs. This review should set out how the treatment plan is designed to assist the service user and overcome/alleviate the symptoms being experienced.

Where there is irregular attendance and a number of missed appointments by a service user to outpatient appointments it is particularly important that there is a clear plan, which has been discussed between the medical staff and at least one other member of the CMHT, for either the continuation of appointments or an alternative strategy for engagement or discharge from the service.

In situations where it is difficult to engage service users with a complex personality disorder a needs led approach may be taken. This should be preceded by an assessment of the risk that the patient may pose to others in order to be sure this treatment modality is appropriate. This may include consultation with the specialist personality disorder team.

All health professionals responsible for completing DWP forms relating to a patient’s application for State Benefits, should be reminded of their legal duty only to include information that they know is true, or have good grounds for believing to be true.

The Trust should ensure that when complaints by service users are made and investigated, the process complies with the current Trust Policy and a complete record of that investigation is held corporately by the Trust and is not retained in local managers’ offices.

The Strategic Health Authority should ensure that Independent Investigations following a homicide are conducted promptly. The SHA should ensure where there is also a Serious Case Review being conducted by the Local Safeguarding Children Board, that there is good liaison and joint planning between these reviews, particularly at the stage of drawing up Terms of Reference, to maximise learning and to minimise duplication. The SHA should endeavour to ensure that there is full information sharing between the reviews insofar as this is compatible with data sharing legislation. Thought should also be given to careful liaison between the two reviews in relation to the involvement of children, parents and other family members and to the timing of publication of the two reports.

NHS organisations should be alert to the inherent risks of a long period with a shortage of senior medical staff, or a rapid turnover of such staff. In such circumstances the Human Resources Strategy should ensure that the caseload in psychiatric outpatients is reviewed to make certain that all cases have an appropriate care plan which is being fully implemented, and to address any gaps that the review identifies.

When a homicide occurs there will necessarily be an Independent Investigation. The HPFT should ensure that the clinical records and all relevant documents are held securely, including the records which comprise the archive of the Internal Investigation undertaken by the Trust until the Independent Investigation is complete.