Tragic tale of a mentally disturbed woman now facing jail for misusing and over using the NHS

Judge Rebecca Brown’s wig on display at Milton Keynes Museum

A very poignant hearing for contempt by a mentally disturbed woman was held at Milton Keynes County Court last week presided over by Her Honour Judge Rebecca Brown.

Gillian Marriott was facing a committal hearing brought by Thames Valley Police for breaching a court order made two years ago which banned her from contacting the emergency services or attending Stoke Mandeville Hospital in Aylesbury except in a genuine medical emergency. She is now facing two six month prison sentences and the possibility of a much longer prison sentence if she breaches the order for the next two years. She had already been remanded in custody before the hearing.

The judge took the decision in her absence and without any statement by her in her defence but she was represented by a lawyer.

I am highlighting this story because it neatly encapsulates in one episode what is going wrong with mental health treatment, what is happening to a pressurised NHS in the current crisis and the desperation of public authorities to deal with disturbed people by deciding that incarceration in a prison is the only solution. I don’t know the woman concerned but her situation is very well summed up by the judge in her ruling.

114 calls to 999 and 217 calls to the 111 services

Thames Valley Police who brought the case say she “has made 114, 999 calls and 217, 111 calls reporting various medical episodes. These
have all been triaged and checked causing demand on the service unnecessarily” and had attended ” Stoke Mandeville Hospital on occasions which were not for genuine medical need. It is alleged that the defendant attended Stoke Mandeville Hospital on the 23rd of March 2022 claiming an overdose but all her vitals we checked and found to be normal.”

Stoke Mandeville Hospital Pic credit: BBC

The court were told she turned up at Stoke Mandeville claiming to have taken an overdose on “7th of April 2022 , 11th of April 2022 , 13th of April 2022 , 15th of April 2022 , 21st of April 2022 , 26th of April 2022 , 22nd of May 2022 and 3rd of June 2022.”

She also turned up at the accident and emergency department claiming she had taken an overdose on the 15th , 19th , 21st 27th , 28th and 29th of June 2022 and the 18th of July 2022.

She admitted turning up but claimed she had genuinely thought she was ill and needed treatment

Her psychiatrist, Dr Srikanth Nimmagaddam said in a statement to the court that she had ” a history of being brought up in an overprotective environment in the context of the death of her brother. She also feels that she suffered from emotional abuse, as her parents regularly adversely compared her with her deceased brother. She gives a history of problems at school and being sent to a special school. She gives a history of being severely bullied and discriminated at school, as she went to a special school. She gives a history that at the age of 11, she was raped by a person, who later blackmailed to harm her father. She had to withdraw the case and that resulted in being accused by the police of wasting their time. All this seems to have been extremely traumatic for her given her young age. She did some farm jobs
until the age of 25, when she was married. One of her daughters was taken into care.”

He said “I believe there is clear evidence to suggest that she has a personality disorder – an emotionally unstable personality disorder of borderline type. The features of her personality disorder include impulsivity, including acting impulsively without considering the consequences; severe mood swings; chronic feelings of emptiness; uncertainty about her aims, objectives and goals in life; chronic low self-esteem; difficulties in sustaining relationships with a constant fear of rejection and abandonment; maladaptive coping mechanisms in the form of numerous acts of deliberate self-harm and of substance abuse.”

He ruled she was fit to plead and recommended a treatment programme that would not require a hospital admission but would require residential accommodation.

Some of the care plan unavailable because of resources

But Leanne Manning, Community Psychiatric Nurse, told the court: ” Some of the suggested aspects of the care plan are not available in terms of resources such as a residential placement. Ms. Manning thought supported accommodation would assist Ms. Marriott because it she may feel more supported and less isolated.
Ms. Manning informed the court that Ms. Marriott could attend a number of courses at the Whiteleaf centre such as mindfulness classes, managing mood classes and managing and understanding your diagnosis classes. Ms. Manning also told the court that instead of telephoning 999 or 111, Ms. Marriott should first try to consider whether she really needs medical assistance by going through a checklist that she has. She can then telephone the Whiteleaf centre to speak to Ms. Manning or another worker or telephone a “social prescriber” who is based at the GP.”

The police’s lawyer took a hard line against her. Mr Garnett said: “the breaches were a deliberate flouting of the order and the breaches were serious and egregious.”

He argued that there was a high degree of culpability. No real mitigation has been put before the court because there is no evidence from Ms. Marriott. The evidence is that Ms. Marriott has refused to engage with any treatment plan which would
assist her in her impulse control which would stop this conduct.”

Ms Marriott’s Lawyer, Mr Killen, said she would agree to go on the course but not move into residential accommodation.

He said” she values her independence too much and has lived in her current accommodation for a long time.”

The Judge said she had considerable sympathy and compassion for Ms Marriott but ruled that her actions amounted to a criminal standard that Ms. Marriott knew that she was making unnecessary calls and as such continued to add unnecessary burdens to the NHS whether it be A and E, ambulance drivers and other medical staff. But she said she had not done it out of malice more because of her vulnerability.

People may die because ambulances are being diverted to Ms Marriott – judge

There is immense pressure on the NHS and emergency services and people may die because an ambulance is not available because it
has been diverted to Ms. Marriott. I am satisfied that Ms. Marriott understands the terms of the injunction and knows that the number of callouts is unacceptable.”

Her judgement concluded: “The court therefore orders that Ms. Marriott serves a term of six months for the 999 and 111 calls and a further sentence of 6 months for the visits to Stoke Mandeville, each sentence to run concurrently and be suspended for two years until 22.8.2024. This court specifically warned Ms. Marriott that if she appears back before this court, has made no sustained attempt at engaging with work to address her behaviour and has carried on breaching the order, she is likely to receive a significant custodial sentence as well as serve the activated suspended sentence.”

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A psychiatrist’s damning indictment of 500 years of racism – now revived by Trump and 9/11

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Suman Fernando. Pic credit: http://www.sumanfernando.com

CROSS POSTED ON BYLINE.COM

Suman Fernando is a gentle soft spoken  consultant psychiatrist, lecturer and honorary professor at the London Metropolitan University.    The 85 year old is not the sort of person at first sight to produce such a searing critique of racism in the UK and the US and the baleful role psychiatrists have had in treating ethnic minorities in both countries.

His book released at  the end of last year and launched by ROTA – Race on the Agenda – looks at both the history of racism which he dates from 1492 when the Spanish finally  removed the Moors from Europe and the role of psychiatry in treating ” mentally ill”  black and brown patients over a very long period.

The book is particularly relevant as Theresa May has  quietly decided to review the UK’s mental health laws  which cover some of these issues – signalling her intent by  holding a meeting of psychiatrists at Number Ten Downing Street.

It also comes at a time when the election of Donald Trump, the rise of Islamophobia in the wake of 9/11 and to an extent, the worst excesses of some people supporting Brexit, has seen a revival of popular nationalism and in the US, white supremacists.

He traces racism from the bloody Inquisition in Spain through the development of the slave trade, the rise of eugenics leading to Nazism,  the Imperialist destruction of other cultures by colonisation to the ” rivers of blood” speech of Enoch Powell as Britain faced an immigration wave in the 1960s and 1970s.

His  thesis is that – mainly because of the 1970s race relations legislation in Britain – overt racism has until recently been replaced with a form of institutional racism and psychiatry is no exception to the rule.

Indeed some of the worse psychiatric theories to treat people as seen by superior whites as ” the other” came from this profession. This was the profession that applied the concept of  ‘Drapetomania’  to slaves in the USA, the primary symptom being a persistent urge to run away.  The implication was Black Afro-Caribbeans were supposed to be happy and content as slaves  and had mental problems if they wanted their freedom.

In Britain the book provides numerous examples of how different ways of dealing what is an obvious imbalance in the number of Afro-Caribbeans being sectioned compared to white Britons. Attempts to change treatment or properly research the issue by black psychiatrists were undermined in a typical British way – their work was subsumed by more conventional psychiatrists or their findings were ignored.

He also reveals  how attempts to change matters politically were undermined. Tony Blair  appointed Paul Boateng – now Lord Boateng- as the first minister for mental health in 1997. At the time he was known to be  strident in wanting to change the treatment of black Afro Caribbeans like himself- but within months he was squashed.

Since 9/11 the danger is that racism is on the rise with Muslims rather than Afro Caribbeans as the main target. That is why the timing of this book is relevant in the context that the mental health legislation is being revised. Already psychological research is being used as a basis in the Prevent programme to decide whether teachers or NHS staff, their pupils and their patients, should be reported to the authorities if they show signs of radicalism.

The next slippery step would be to decide that these people are insane – and should be sectioned rather than prosecuted. This is not as fanciful as it sounds. Under  Labour there was a move to classify stalkers of VIPs as a mental illness and Jack Straw when he was home secretary is said to have considered whether paedophiles should be classified as insane rather than criminals.

That is why this book is so interesting because it tells how deep seated racism is among white Europeans  and how insidious the present system is in dealing with the ” other” – from stop and search to sectioning.

The one sad thing is that the book itself has been “Ghettoised” – it has been pigeon holed by the publisher  as part of ” contemporary black history ” when it is much more of an account of how contemporary British and US society has reached such a view on black and brown people.

The German publisher has created another ghetto by price – Palgrave Macmillan have priced it at a ridiculous £67.99 or £53.99 as an e-book. Amazon have a Kindle version at £45.19. So I suggest you try and get it in a public library or if you are a student make sure your university library has got one.

Institutional Racism in Psychiatry and Clinical Psychology. Suman Fernando