Decision Report 201706553

Summary

Mrs C, who works for an advocacy and support agency, complained about the care and treatment that her client (Mrs B)'s adult son (Mr A) received from the board's mental health services. Mrs B and Mr A had been told that Mr A had an assumed borderline personality disorder and that, as part of his treatment, he would attend a specified cognitive behaviour therapy programme. However, the decision was taken that Mr A should attend another course which caused Mr A and his family great distress and they felt that the staff had not diagnosed his condition appropriately. Subsequently, Mr A was reassessed by a consultant psychiatrist as having an Emotionally Unstable Personality Disorder (EUPD) and was placed on the original specified cognitive behaviour therapy programme. The family felt that there was an undue delay in the diagnosis of EUPD.

We took independent advice from two mental health advisers and found that Mr A had been seen by a number of clinicians in mental health over an extended period of three years. We found that, although Mr A had displayed some traits of EUPD, no formal structured assessments had been completed which would have led to an earlier diagnosis of EUPD. We found that this was contrary to national and local guidance. The assessments which were carried out during the period lacked detail and consistency. They concentrated on current symptoms, rather than someone taking on collective responsibility and arriving at a diagnosis of EUPD by carrying out a structured assessment using recognised tools. We also found that there was a failure by the board in arranging for Mr A to receive a second medical opinion which had been requested by one of the consultant psychiatrists. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B and his family for the unreasonable delay in reaching a diagnosis of EUPD and for not arranging a second medical opinion. The apology should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• Staff should familiarise them themselves with relevant guidance for personality disorders.
• Staff should ensure that requests for a second medical opinion are actioned.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.