Decision report 201005359

Summary

A consultant psychologist working for the board diagnosed Ms C with a histrionic personality disorder (a condition in which people act in a very emotional and dramatic way that draws attention to them). Ms C was known to frequently appear at the local accident and emergency (A&E) department and at her medical practice, and the consultant wrote to those services advising that they should manage her behaviour carefully and that they should not entertain threats of self-harm or suicide.

In his letters, the consultant noted that Ms C might become aggressive toward staff and suggested that the police could be called should this happen. Ms C complained that the consultant's advice to these services meant that she was prevented from receiving treatment for other conditions, in particular, for nerve pain in her legs. She also complained that the consultant did not make her aware of her diagnosis or of the fact that he had written to other healthcare services about her behaviour.

We found that it was reasonable for the consultant to send letters to the medical practice and A&E, as both services had an ongoing involvement with Ms C. Generally we were satisfied that the content of his letters was appropriate and represented advice rather than instruction. However, in one of his letters to Ms C's GP, the consultant made what we felt was a clear instruction that threats of suicide should not be tolerated. As good practice guidance says that all threats of suicide should be taken seriously and investigated, we did not find this instruction to be appropriate. Comments from the board and our mental health adviser suggested that it was likely that Ms C would have been told her diagnosis. However, there was no written record of such a discussion and nothing to suggest that she was made aware of the letters that were being sent to other healthcare services. It is an underpinning principle of mental health care that patients are involved in decisions about their care and treatment. We considered that the board had failed to involve Ms C in her care or to record her involvement, and upheld her complaints.

Recommendations

We recommended that the board:

• apologise to Ms C for the issues highlighted; and
• draw the consultant's attention to our adviser's comments about the letter.