SSWAHS – Dr Victor Storm – Deaths in Mental Health Custody – by Socrates

Socrates notes the sentiment expressed by Dr Victor Storm about the death of a young woman in the UK mental health system. In this article published widely by the National Times last year, Dr Storm moralises on the dilemma faced by his colleagues in the UK: “There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny.”

He also then states in the same article: “To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death.”

Then comes the extraordinary denial of responsibility: “Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.

“Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.

“Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable.”

Socrates has to say: “Who should be held accountable in this case when death occurs? The medical staff who control the patient’s treatment – or the patient whose mental state is deemed to be sufficiently impaired that they are involuntarily admitted to a psychiatric facility by doctors who then, presumably, accept a duty of care for the patient? In my book the very act of detaining a person under the Mental Health Act places the responsibility for the care and protection of that patient clearly and squarely in the hands of the treating doctors.

Perhaps Dr Storm, instead of pointing the accusatory finger at the flaw in the UK Mental Health Act that allowed this death to occur, should look at his actions and those of other medical staff in his SSWAHS Clinical Division, that have led to more than one unnessary death: “Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat – even if our treatment is sometimes controversial.”

Victor Storm

October 4, 2009
National Times Newspaper

A young Englishwoman was allowed to commit suicide in hospital over four days. Kerrie Wooltorton had a history of mental illness and had made multiple attempts on her life. Yet it was deemed she had the mental capacity to refuse treatment.

That refusal was legally binding on hospital doctors under the provisions of the British Mental Capacity Act.

The coroner, William Armstrong, found that the doctors involved with her care had acted lawfully by not trying to save her life. Otherwise they may have faced sanction under the Medical Practice Act, been liable to deregistration and charged with assault.

”She had capacity to consent to treatment which, it is more likely than not, would have prevented her death,” Armstrong said. ”She refused such treatment in full knowledge of the consequences and died as a result.”

Wooltorton was 26.

It is an invidious situation for health professionals to find themselves in. The matters surrounding Wooltorton’s death and the coronial inquiry are disturbing. The death by self-poisoning of a disturbed and depressed young woman was sanctioned – a situation that I hope is never repeated.

Medical practice laws in Britain and NSW have many similarities, but we are fortunate that under current legislation in this state a similar situation would not receive legal sanction.

Mental capacity assessments here do not include a legal right to commit suicide in the way Wooltorton chose. If such a clinical situation were to arise in a NSW hospital, the Mental Health Act should usually be invoked and resuscitative treatment given.

Is this a draconian denial of an individual’s rights? I think not. There are important reasons for us to reject the legalistic argument used in Britain.

I am a psychiatrist who has worked in mental health for 30 years. I have treated people with complex disorders who have made multiple attempts at suicide, recovered and been grateful for the ongoing care that allowed them another chance to lead a satisfying life. This experience is common for most clinicians.

To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death.

We are faced regularly with individuals who suffer significant depression and despair for extended periods. People may express a wish to die, and some might make multiple attempts on their lives, but most clinicians will try as hard and as long as they can to help ease a person’s suffering and bring on recovery.

In most instances, clinical intervention is successful. Most people who seek the support of our services recover and get on with their lives. It is important for the wider community to understand that even those who suffer serious depression associated with other mental health problems generally get better, even if it takes some years.

Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.

Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.

Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable.

Families and friends suffer enormously when people commit suicide – and society as a whole is diminished. There is a place for compulsory treatment. There is a need for persistent attempts to involve depressed and disturbed individuals in some form of ongoing psychological and psychiatric care. Temporary deprivation of liberty under a mental health act may be required.

There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny.

Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat – even if our treatment is sometimes controversial.

Even if Wooltorton had no current sense of hope, there would have been good grounds for us to work towards her recovery.

Her suicide is quite different from people who decide to cease active treatment when their lives are ending due to general debility or failure of bodily systems and there is no feasible possibility of recovery.

Her death leaves a nagging doubt: that in spite of what she said verbally and in writing, she took measures of self-harm that were not immediately fatal. She asked to be in hospital, where she could have received treatment and another chance at life.

Perhaps her non-verbal cues were missed. Her father has expressed a wish that the mental capacity law be changed. I support his wish. I am grateful no such law exists in NSW.

Associate Professor Victor Storm is clinical director of mental health at the Sydney South West Area Health Service. For help, call Lifeline on 13 11 14.

Perhaps Dr Storm would like to give another article to the National Times in which he would like to give the number of patients, actively in the care of the SSWAHS Mental Health Service, who have died in one of his mental health facilities, or while on approved leave from one, or in the care of his community mental health teams after they have returned home.

Let us see if it is only the UK mental health system that misses “the non-verbal cues” of their patients. Then, I would like to see how much soul-searching by SSWAHS clinicians takes place, and what explanation has been given to the families of those who have died while in the care of SSWAHS.

SSWAHS – Dr Victor Storm and those problems of files lost in the public domain! – by Socrates

Socrates’s internet trawl to find even more evidence of the stumbling efforts of SSWAHS to manage even the simplest tasks came up with this gripping expose by “The Age” newspaper about the time when Dr Storm was doing his best to organise the transfer of the Rozelle “asylum” to his new Concord “asylum” – the one that he thought the Liberal Party should not build in 2002!

Private files put on street for all to read

Matthew Moore “The Age”
Freedom of Information Editor
May 6, 2008

PLASTIC wheelie bins full of confidential documents were left outside Rozelle Hospital in a last-minute rush to move the hospital to its new site at Concord.

Staff records, including details of criminal convictions and personal medical histories, were jammed into the bins along with minutes of meetings and disciplinary proceedings.

A letter lying at the top of one of the bins details an altercation in January 1991 between a cleaner and his supervisor, who had asked him to clean some windows.

“Mr A [name deleted] … threw a garbage tin of rubbish on the ground and also said he would kill Mr S … [name deleted],” an exasperated manager notes.

Other documents detail the property staff members have failed to return over decades.

Records from the Child Support Agency detailing maintenance deductions the hospital was required to make for individual employees are also included in the thousand of pages of personal documents.

Anyone wandering through the open hospital grounds, popular with dog walkers, was free to leaf through decades of documents left in the driveway of the administrative and information building, which closed its doors at the site last week.

Half a dozen wheelie bins left in the driveway of the administration block were locked but six others were open or secured only with adhesive tape applied by desperate staff members unable to get enough bins to secure documents they knew to be confidential. Two of those bins carried notes headed “Confidential documents”.

The notes, written by a staff doctor, Graeme Halliday, said: “To Whom It May Concern, Ive been requesting confidential paper bins for at least a week before the hospital closed but could not get any. Transport kindly delivered these on Thursday May 1st, but I didnt realise until I had filled them – they are in fact not for the disposal of confidential documents. Quite happy to return to help transfer these to confidential bins if someone can help me obtain these.”

Yesterday Dr Halliday was furious the bins had been left outside the building and said he had done his best to ensure their contents were properly disposed of.

He said he had worked until midnight on Saturday trying to dispose of documents he had no time to finish packing as he had had a full patient load during preparations for the move.

He had left all the bins locked inside the building on Saturday night and was uncertain who had moved them outside.

Dr Halliday drove immediately to Rozelle Hospital when he heard the documents were outside to ensure they were secured.

In other parts of the hospital grounds staff record cards spilled from torn plastic bags before a compactor truck arrived yesterday afternoon.

The director of mental health for the Sydney South West Area Health Service, Dr Victor Storm, said only two normal bins had been used for confidential waste. The bins had been put outside by accident yesterday morning.

“Both the secure and general waste bins have since been locked away, and a collection is now expected later this week.”
I suppose we should be grateful that “only two normal bins had been used for confidential waste.”

There, doesn’t that make us all feel better? Obviously, Dr Storm and SSWAHS seem to think so.