I’m a psychiatry trainee interested in deprescribing psychiatric medication.
Something that prevents many clinicians from wanting to deprescribe a medication, is the threat that a subsequent bad outcome (ie suicide etc) following a dose reduction, could leave them open to litigation, if it was decided that the dose reduction was unsafe.
So, I wondered if there is likely to be any case law of a situation whereby reducing medication doses or stopping medication would been seen as unacceptable and causative to a bad outcome.
I would start with the NHS Ombudsman. Maintaining momentum: driving improvements in mental health care | Parliamentary and Health Service Ombudsman (PHSO)
Then look into NHS Redress Scheme, though you may struggle to find any cases available to the public.
I’m not aware of any case law as such, but I do know of very many cases when stopping or ceasing medication has led to patient homicides - detailed in many of the NHS England independent investigations. (Most of these investigations are available on our website)
From the families I’ve supported this has led to very uncomfortable experiences for doctors under close examination in Coroners Inquests justifying their decision making, sometimes years later.
I’m aware other professionals have faced professional standards investigations and have moved jobs as a result of the decision to support stopping medication.
It appears that most of the problems occur when clinicians haven’t seen full case notes, have relied on the patient’s self-report only without any corroboration, have not listened to or been aware of family and friends concerns; have failed to assess risk properly, and have been unaware of their own optimism bias (It’ll be alright).
The recent report into the care of Eltiona Skana, (who killed 7-year-old Emily Jones) is instructive (as well as short) as it called out too much reliance on how the patient appeared on any given day (‘the weather’) with insufficient regard for ‘the climate’ - what had happened when the patient was unwell in the past and whether the assessment of risk fully accounted for that.
It’s unusual in our experience for affected and bereaved families to pursue claims against individual psychiatrists (often they don’t have the means to do so) - but some have made complaints to the GMC about their fitness to practice which can be a lengthy procedure.
Each case is obviously different, but I suggest you make sure you 're aware of all the background history, effectively safeguard all those potentially at risk should the patient become unwell again, and document everything clearly and contemporaneously - and it would probably help to imagine having your decision come under rigorous questioning in a coroners court.
Thank you both so much for your replies and links, very informative!
I reckon deprescribing guidelines will become evermore present in psychiatry. So, in some ways its reassuring that reducing the dose requires additional thought and care, as this will no doubt only improve the quality of deprescribing.
But I am merely a trainee, so I won’t be doing this anytime soon haha.