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Care But No Control
The Birmingham and Solihull NHS Trust have recently given an apology to the family of Janice Smith who was killed by her son Kaysley over 5 years ago. This tragic incident was the subject of a domestic homicide review by the Birmingham Community Safety Partnership as long ago as 2013. I went back to look at this review which contains a number of recommendations about listening to families.
Very briefly Kaysley Smith was a young man with a paranoid illness who was very inconsistent in taking medication. He was seen regularly by mental health professionals but the failure to obtain a hospital bed for him meant he was left at home when in need of care and treatment. He is now subject to a hospital order for an indefinite period of time.
Care and Confidentiality
One of the most difficult issues for his mother was the role of carer to Kaysley. The family felt that information about what Kaysley was thinking and talking about was not communicated to them by mental health professionals because they regarded patient confidentiality as paramount. Even though there was no history of physical aggression, the verbal hostility shown to his mother should have been shared as part of the ongoing management of risk.
The homicide review said that all carers should be informed of the right to a carer’s assessment. This would have provided the opportunity to properly identify and plan to support for Janice in her own right.
One of the other important recommendations is mental health professionals should not assume that family carers are always in control of the situation at home. Janice was not regarded as vulnerable in terms of the need for a safeguarding investigation, but the situation at home was a deteriorating one, with increasing paranoia being displayed by Kaysley. In particular mental health services left medication with Janice to administer to her son, which resulted in the relationship between mother and son worsening.
Another recommendation (and this isn’t the first time that such a recommendation has followed a tragedy in Mental Health Care) is that all relevant information from friends, family carers and others should be gathered as part of any assessment. This applies not just to mental health professionals. There was one incident in the report on Kaysley where he presented himself as homeless. The review said this was an opportunity for housing services to gather information from family members as to why Kaysley had done this. Professional services may only see the person at one point in time. Those whom the person is living with are seeing the person nearly all the time. Even if the person is not living with family members, they may well be in contact and have important information to give.
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