Kent and Medway Mental Health NHS Trust

3. Miss K complains the Trust failed to provide appropriate care and treatment between 17 September 2024 and 5 April 2025. Specifically, it failed to: • adequately assess her mental health symptoms • provide her with a diagnosis appropriate to her mental health symptoms.

4. Miss K says as a result of the Trust’s failings, she has been unable to access appropriate treatment for her mental health condition. As a result, she continues to experience flashbacks to previous trauma, suicidal ideations, feeling fear and anxiety when she leaves the house, and sleeplessness. Her mental health condition prevents her from finding stable employment and makes her feel isolated and vulnerable. The Trust’s treatment of her has made her feel invalidated, isolated, and desperate, has caused her stress and made her feel she is bothering it.

5. Miss K seeks acknowledgment and an apology from the Trust, service improvements, a proper assessment, and financial compensation.

6. Miss K presented at the Trust in September 2024 in crisis with her mental health.

7. In October 2024 she was referred for specialist psychiatric assessment at the Trust. She was not offered appropriate treatment following the assessment.

8. Miss K had saw a private clinician in October 2024 and was informed she had symptoms related to Complex Post Traumatic Stress Disorder (cPTSD).

9. In November 2024 Miss K was assessed by the Trust and diagnosed with Emotionally Unstable Personality Disorder (EUPD), anxiety and low mood.

10. In November 2024 Miss K complained about the assessment and had in person meeting to discuss her assessment.

11. In February 2025 Miss K attended a follow up appointment where her diagnosis was Emotionally Unstable Personality Disorder (EUPD) and anxiety disorder.

12. Miss K continued to question her diagnosis and why she was not assessed for cPTSD and offered appropriate treatment.

13. Throughout the time she was being treated by the Trust, Miss K continued to access the Mental Health Crisis line and attend the Emergency Department due to her deteriorating mental health.

17. To decide if we should conduct a detailed investigation into a complaint, we first consider whether there are any indications something went wrong with the service provided by the organisation. If so, we then explore if the organisation would be willing to take further steps to put this right and resolve the complaint.

18. Miss K contacted the Trust during September 2024, attending A&E and calling the Urgent Mental Health Helpline. Miss K had experienced a traumatic event and was struggling with suicidal thoughts and negative thoughts about herself.

19. Miss K was assessed on 11 October 2024. The Trust diagnosed EUPD and anxiety disorder and recorded Miss K had a history of complex trauma. It recorded Miss K did not meet the full criteria for active EUPD, and it did not feel she met the criteria for a specific PTSD diagnosis.

20. In the outpatient letter on 11 October 2024, the Trust stated Miss K did not meet the criteria for PTSD but did not state what the diagnostic criteria for PTSD are.

21. Miss K was unhappy with the diagnosis she received. She saw a private clinician later that month and received a diagnosis of cPTSD, EUPD and anxiety.

22. Miss K complained to the Trust and had follow up appointments in November 2024 and February 2025, where she received a diagnosis of EUPD and anxiety.

23. Miss K says she was not assessed properly at these appointments and the private diagnosis of cPTSD was not addressed. She says the Trust did not provide a satisfactory explanation of why it didn’t think she had cPTSD.

24. Medical records show Miss K was assessed 11 October 2024. The assessment recorded her having constant negative thoughts about a recent traumatic event, the accidental death of a pet, a history of complex trauma from an alleged sexual abuse at the age of 14, and an alleged sexual assault at the age of 23.

25. In the outpatient letter, the Trust recorded a history of complex trauma and a past diagnosis of cPTSD by a private clinician. A diagnosis of anxiety disorder was provided. The letter stated Miss K was ‘not currently meeting the full criteria for active EUPD’ and stated Miss K ‘does not currently meet the criteria for specific PTSD diagnosis’. There was no explanation of what the diagnostic criteria for cPTSD are.

26. Medical records show Miss K was assessed on 4 November 2024. In the assessment the Trust recorded Miss K’s past trauma events and a recent event where her pet was accidentally killed. The assessment recorded Miss K was having negative thoughts about herself, anger and low moods.

27. In the outpatient letter, the Trust stated Miss K had; “no convincing evidence of acute mental illness”, recording she was able to engage well, was coherent and able to explain her current circumstances. The letter recorded a diagnosis of EUPD, anxiety and low mood. There is no record of whether cPTSD had been considered.

28. Miss K contacted the Trust several times during December 2024 and January 2025. The records state Miss K presented with suicidal ideation, low mood and was struggling to overcome the trauma of losing her pet and how this had triggered previous trauma she had experienced in her life.

29. Medical records show Miss K was assessed on 11 February 2025. The outpatient letter records Miss K saying the last four months had been very difficult for her and she had been experiencing mental health problems since the death of her pet. The letter records previous traumatic events at 14 years, at 23 years and an incident in 2023.

30. In the medical records the Trust state Miss K’s presentation “strongly suggests a diagnosis of EUPD”. The Trust record a number of symptoms to provide a justification for a diagnosis of EUPD. It also noted Miss K had been assessed by a private clinician who had suggested a diagnosis of cPTSD. The Trust disagreed with this diagnosis saying it would ‘rather stick with a robustly supported diagnosis of EUPD’. In the outpatient letter the Trust did not explain why Miss K did not meet the criteria for a diagnosis of cPTSD and they did not list any of the criteria being considered.

31. The ICD-10 criteria is the diagnostic classification system used in the UK for the diagnosis of a mental disorder. Our adviser explains good and safe clinical practice would be for a medical practitioner to consult with and refer to the ICD-10 criteria when diagnosing any mental health disorder.

32. ICD-10 says EUPD is characterized by a definite tendency to act impulsively and without consideration of the consequences. There are two recognised types, the impulsive; characterized predominantly by emotional instability and lack of impulse control, and the borderline type; characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts.

33. Our adviser informs us the use of the ICD-10 criteria and referring to such criteria when diagnosing any mental disorder and documenting this in an assessment letter would be in keeping with GMP which states, ‘you must provide a good standard of practice and care’ and, ‘you must make good use of the resources available to you’.

34. NICE guidance says the Trust should ‘explain and give written material in an accessible format about any diagnosis given’.

35. GMP states ‘all patients have the right to be involved in decisions about their treatment and care, and be supported to make informed decisions if they are able to’ and; ‘You must listen to patients and encourage an open dialogue about their health, asking questions to allow them to express what matters to them, and responding honestly to their questions’.

36. Our adviser informs us it is good clinical practice to offer to provide written information about a diagnosis or to point out the ICD-10 criteria for such a diagnosis.

37. NICE PTSD guidance provides information on the recognition of PTSD symptoms, including cPTSD. People may present with a range of symptoms associated with functional impairment including: • re-experiencing • avoidance • hyperarousal (including hypervigilance, anger and irritability) • negative alterations in mood and thinking • emotional numbing • dissociation • emotional dysregulation • interpersonal difficulties or problems in relationships • negative self-perception (including feeling diminished, defeated or worthless)

38. Our adviser says there is a difficulty in making a diagnosis of PTSD as it not a mental disorder. The PTSD UK website says individuals can have both EUPD and complex PTSD, with the two diagnoses sharing many of the same symptoms, such as suicidal thinking and low self-worth.

39. Our adviser tells us a PTSD diagnosis must be based on an assessment of the patient and consideration of their difficulties, and by excluding other appropriate mental disorder diagnoses.

40. In the three assessments made on Miss K, the Trust recorded Miss K’s history of trauma, suggesting it considered this. Our adviser informs us this should have prompted the Trust to consider whether a diagnosis of PTSD or complex PTSD was appropriate in line with GMP guidance.

41. In the October assessment of Miss K, the Trust noted impulsive behaviours such as overspending, difficulties in establishing relationships and low self-esteem. The clinician reached a diagnosis of anxiety disorder and EUPD. The clinician has also stated Miss K did not meet the criteria for PTSD diagnosis.

42. The Trust did not refer to the ICD-10 criteria when documenting its observations and rationale for Miss K’s mental health diagnosis. Miss K was unable to understand whether any of the criteria for a diagnosis of cPTSD had been considered from the documentation she received.

43. In the assessment of Miss K in November 2024, the Trust did not state in the outpatient letter whether it agreed or disagreed with the diagnosis of EUPD. Nor did the Trust mention anything about a comorbid diagnosis of cPTSD. Miss K was unable to understand whether a diagnosis of cPTSD had been considered.

44. The Trust’s assessment of Miss K in February 2025 gave a justification of the diagnosis of EUPD by listing symptoms which are characteristic of the condition. However, these symptoms also overlap with cPTSD. The Trust recorded there had been a diagnosis of cPTSD by a private clinician and it disagreed with this diagnosis, but it did not provide any explanation or justification for disagreeing with the diagnosis of cPTSD. Miss K was unable to understand why the diagnosis of cPTSD had been ruled out.

45. Our adviser explains it is evident in all three assessments between September 2024 and April 2024, various clinical features of EUPD were considered and present in Miss K’s case. There was justification for the Trust to reach a diagnosis of EUPD. While the diagnosis of EUPD was not necessarily wrong, it would be good clinical practice to refer to the ICD-10 criteria particularly when a patient queries or doubts the stated diagnosis. This is in line with NICE guidance where it says to ‘explain and give written material in an accessible format about any diagnosis given’.

46. We are not able to say whether the Trust should have provided a diagnosis of cPTSD as there is insufficient rationale provided in the documentation to decide on whether such a diagnosis was clinically appropriate. Not providing sufficient detail has left Miss K with uncertainty and with a missed opportunity to resolve her complaint.

47. The Trust response stated a full review of all Miss K’s contact with the mental health services had been conducted and the Trust had tried to work with Miss K to resolve her concerns. The Trust stated it had discussed Miss K’s diagnosis with her at length.

48. The NICE guidance says clinicians should ‘explain and give written material in an accessible format about any diagnosis given’. We can see no evidence the Trust did this and consider it a failing by the Trust to not provide Miss K an explanation of her diagnosis and why such a diagnosis was appropriate to her mental health symptoms in the assessment letters or complaint responses.

49. We have seen evidence which indicates the Trust did not consider Miss K may have had cPTSD and did not document the rationales for its decisions, nor did it communicate the rationales for its decisions clearly enough to Miss K.

Impact on Miss K

50. Miss K told us the failures have exacerbated her mental health significantly. She explained the actions of the Trust made her feel she had not been adequately assessed.

51. She stated the Trust could not explain why ‘they don’t think I have PTSD despite being diagnosed by a private psychiatrist’. She informs us the impact made her distrust the decisions being made by the Trust and she felt she was ‘suffering from more stress because of the lack of attention’ and ‘had been pushed from one service to another, feeling isolated and desperate’.

52. Our adviser explained to us many of the symptoms presented by Miss K were clinical features of EUPD. There was justification for a diagnosis of EUPD but there was a lack of clinical rationale for Miss K to understand why a diagnosis of EUPD had been made and why the diagnosis of PTSD had not been made. This led to confusion and frustration, has caused stress to Miss K and led to a distrust of the Trust’s care and treatment.

53. Ms K may be reassured to know our adviser said in the round, ‘the treatment provided by the Trust to address [her] mental health difficulties were clinically indicated and appropriate. The treatment provided was in keeping with good and safe clinical practice’.

Remedy

54. To resolve her complaint, Miss K wanted an acknowledgement of failings, an apology, service improvements and a financial remedy.

55. We used our severity of injustice scale (our scale) to assist us in considering an appropriate level of financial remedy. We also review similar cases where the person affected experienced a similar injustice to Miss K.

56. Level three on our scale covers instances where ‘the injustice would have a moderate impact (for example, in terms of distress, worry, inconvenience) but has lasted for significant period of time’ and ‘the failings may impact to some extent on the affected person’s ability to live a relatively normal life, for example due to stress, impaired sleep, or high levels of inconvenience or uncertainty’. We consider this appropriately reflects the impact on Miss K.

57. We approached the Trust to ask if it would consider providing a resolution to Miss K; an acknowledgement of its failings, an apology, an assessment in line with guidance, service improvements to reduce the likelihood of the same issue reoccurring and a financial remedy of £1200.

58. The Trust have agreed to our resolution and will write to Miss K by the end of June 2026, within a month of this statement, to acknowledge its failings, providing an apology and informing Miss K of the service improvements it has made/will be making, arrange a date for assessment and financial remedy.

59. We consider the above actions from the Trust are sufficient to resolve Miss K’s complaint.

60. We thank Miss K for bringing her complaint to us and we are sorry to hear of the difficulties she has faced. We hope she can be reassured by our findings and the prompt actions of the Trust to resolve her complaint.

1. We have carefully considered Miss K’s complaint about Kent and Medway Mental Health Trust (the Trust). We have decided not to take further action on her complaint because the Trust have agreed a resolution for Miss K's complaint.

2. We thank Miss K for bringing this complaint to us and telling us about her experience. We are grateful she has been able to share with us the effect this has had upon her, and to explain the ongoing symptoms she is experiencing.