Appropriate treatment for EUPD

Law and practice Mental Health Act
1

I can tell everyone that over the last 5 years across the length and breadth of the UK (not Scotland but not excluding Northern Ireland) the following is my honest experience:

  1. There is a rapid rise in EUPD diagnoses compared to the previous 10 years.
  2. There is almost no effort applied to the many cases I have inherited, to subtype EUPD (as per ICD-10).
  3. Almost every case of EUPD has been prescribed over 3 psychotropic medications with the median number clocking in at 5.
  4. I have seen no documented rationales for exceptions to NICE guidance on medicating such paitents (as per CG78 and related).
  5. Usually there is a basket on other diagnoses e.g. ‘autistic traits’, depressive symptoms, mood instability, with psychotic features, with anxiety… and so on. None of the latter are diagnoses - unless psychiatrists unbeknownst to me have been empowered to make up their own diagnoses.
  6. About 90% of the so-called EUPD cases were inpatients (due to the nature of my work).
  7. Almost all were detained on some sort of Section of the MHA 1983 (Amended 2007) - where the supposed EUPD complicated by other non-diagnoses are reasons related to Statutory detention criteria.
  8. I have never seen documentation of the diagnostic discipline of matching evidence to diagnostic criteria in ICD-10, DSM-V-TR or ICD-11. No evidence of the ‘General Criteria’ for PD met, before subtyping (as a ‘must’ in ICD-10)
  9. For the basket containing EUPD and other non-diagnoses, I have never seen documentation of a rational treatment plan meeting GMC expectations.
  10. I have not seen documentation of assessments of capacity for consent to the truckloads of medications, most of them prescribed outside of product licences. And no specificity of any psychological treatments to match diagnoses - albeit EUPD seemingly plucked out of a hat.

While there are variations and combinations of the above, I have had to ask myself:

  1. How the devil is any of that appropriate treatment in law?
  2. How could SOADs possibly approve such treatments for non-consenting patients?
  3. How could Tribunals let this pass?
  4. Where is the CQC?
  5. Where is the GMC?
  6. Do Trusts care about diagnoses and appropriateness of medical prescribing?
  7. Is the patient incidental?

To 1 & 2 above I’ve come up with the answer: its called ‘spin and twist’. What’s that? It’s where psychiatrists can spin anything they want, twist logic anyway they like - and get away with it!

I’m still scratching my bald head on questions 3 to 7. No worries - no more hair to lose.

But seriously - what on earth is going on! Is anybody going to do anything about any of this stuff? Sure - glaciers do move - it’s just that we don’t normally see them moving.

If some got to this point I expect them to be thinking, “Oh dear - another rant?!” [Prohibited in the Kingdom apparently] Well - I have already heeded:

  1. R (on the application of O’Reilly) v Blenheim Healthcare Ltd [2005] EWHC 241 (Admin): Distinguished between acts carried out for the purpose of treatment and treatment itself, highlighting that monitoring alone may not constitute ‘medical treatment’.

  2. DL-H v Devon Partnership NHS Trust [2010] UKUT 102 (AAC): This case likely provided guidance on the interpretation of ‘appropriate medical treatment’.

    • 6.8 This medical treatment must be appropriate, taking into account the nature and degree of the person’s mental disorder and all their particular circumstances, including cultural, ethnic and religious considerations. By definition, it must be treatment which is for the purpose of alleviating or preventing a worsening of the patient’s mental disorder or its symptoms or manifestations.

    • 6.9 The appropriate medical treatment test requires a judgement about whether an appropriate package of treatment for mental disorder is available for the individual in question. Where the appropriate medical treatment test forms part of the criteria for detention, the medical treatment in question is treatment for mental disorder in the hospital in which the patient is to be detained. Where it is part of the criteria for SCT it refers to the treatment for mental disorder that the person will be offered while on SCT.

    • 6.10 The test requires a judgement about whether, when looked at in the round, appropriate medical treatment is available to the patient, given:

      • the nature and degree of the patient’s mental disorder; and
      • all the other circumstances of the patient’s case.
      • In other words, both the clinical appropriateness of the treatment and its appropriateness more generally must be considered.

  3. DL-H v Partnerships in Care & SoSJ [2014] AACR 16: Similar to the previous case, this likely offered interpretative guidance on ‘appropriate medical treatment’.

  4. SLL v (1) Priory Health Care and (2) Secretary of State for Justice (Mental Health) [2019] UKUT 323 (AAC): Established that medical treatment with no prospect of therapeutic benefit cannot be considered ‘appropriate’, even if it technically falls within the MHA definition.

  5. PM v Midlands Partnership NHS Foundation Trust [2020] UKUT 69 (AAC); [2020] AACR 23: Determined that monitoring, without intervention, does not inherently qualify as ‘medical treatment’ under the MHA.

  6. Rooman v Belgium [2019] ECHR 105: Emphasised the dual function of detention under Article 5(1)(e) of the ECHR, requiring both social protection and a therapeutic purpose with ‘real therapeutic measures’.

Unfortunately for me - I lag behind my esteemed colleagues’ skill and competence - so I beg for any assistance that can be offered from this forum.

3 Likes
2

Thank you Russell … skimmed but in response to 7. Is the patient incidental … I would say, in my experience, “yes”, one does often get the impression that patients seem to be there to justify the careers and academic kudos of psychiatrists

1 Like
3
  1. There is a rapid rise in EUPD diagnoses compared to the previous 10 years.

And my personal experience as a Psychiatrist is that most are misdiagnosed as EUPD. It’s a label queried for almost (if not every) in-patient with challenging or disruptive behaviours, often not by a Psychiatrist - often an add on that someone queries in the clinical notes. Once added to clinical notes, usually as a query, it’s almost impossible to remove.

1 Like
4

That’s much of my experience too. However psychiatrists are ‘validating’ such diagnoses in reports consequent to appeals against detention.

I obviously don’t understand. :sob::disappointed:

5

… and it satisfies the big money churning machine. Yuh know… ‘We provide high quality care.’ :roll_eyes:

Row row row your boat… etc

Mark my words, “National scandal ahead.”

1 Like
6

Completely agree. And I’m retaining my audit trail … in this day and age what reaches my ears and experience will meet the same wall of disbelief as those poor postmasters in the Horizon scandal :cry: :disappointed:

1 Like