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Case ref:202007186
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Date:March 2022
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Body:Borders NHS Board
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Sector:Health
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Outcome:Upheld, recommendations
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Subject:Clinical treatment / diagnosis
Summary
C complained about the care and treatment that they received from the board. C said that they had been incorrectly diagnosed with Avoidant Personality Disorder (APD). C said that the board had failed to carry out a proper assessment of their presenting symptoms and incorrectly relied on historic information in reaching their diagnosis. They complained that the board's diagnosis had prevented them from accessing appropriate supports and treatment for other comorbidities.
According to NHS Inform, based on statistical information from England, personality disorders can affect one in 20 people and can be very difficult to live with.
In this case, we took independent advice from an adult psychiatry adviser. We considered that the board's diagnosis had been reasonable, however the possibility of a depressive disorder co-existing with this disorder's traits, and a physical disorder contributing to mood change, had not been adequately investigated. We also found that the board did not have an appropriate care pathway for APD, that staff had been unaware of it and that there was a lack of continuity in the board's procedures for requesting both internal and external opinions. Therefore, on balance we upheld this complaint.
Recommendations
What we asked the organisation to do in this case:
- Apologise to C for failing to carry out a reasonable assessment of their symptoms. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
What we said should change to put things right in future:
- The arrangements for requesting second opinions within the organisation, and external opinions, should be clarified.
- The care pathways for Personality Disorder should be clarified, and in particular the treatment options of Cluster C disorders such as Avoidant (Anxious) Personality Disorder.
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.