A SEVERELY depressed patient who died after throwing himself under a lorry on Hogmanay was handed a copy of the Yellow Pages and told to find a hostel because psychiatric staff believed he was “faking” his symptoms, a damning report reveals today.
The man, who is known only as Mr QR, killed himself less than 48 hours after being discharged from an unnamed psychiatric ward in Scotland because his consultant psychiatrist was due to go on holiday and had told the man’s family that prescribing anti-anxiety medication and a care package “would only validate the behaviour”.
An investigation published today by the Mental Welfare Commission for Scotland reveals that the patient and his family were given just 24 hours notice that he would be discharged on December 29 2014 and that he was "given an copy of the Yellow Pages to find accommodation" because his wife did not want him back in the family home. He was also warned that the police would escort him from the facility if he refused to leave voluntarily.
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The patient, a former professional with no previous history of mental health problems, entered a downward mental spiral shortly after taking early retirement in December 2013 - a decision he regretted. He first complained to his GP about suicidal thoughts on August 16 2014, but was dead less than five months later.
The report also reveals that his psychiatrist, who is still practising, misled the man's family by repeatedly telling them that two other psychiatrists agreed with his diagnosis that Mr QR was suffering from personality disorder and factitious disorder – an extremely rare psychological condition, also known as Munchausen's syndrome, where patients feign illness – when in fact this was “completely at odds” with the second psychiatrist, who recommended a course of antidepressants to treat agitated depression. This second opinion was “disregarded”.
The watchdog said the case exposed “serious flaws” in care which all health boards in Scotland should learn from. It said the advice of clinical directors must be sought in future “in cases where the doctor is making an unusual diagnosis which does not correspond with a second opinion”.
The MWC said it believed that the man's suicide on December 31 2014 "could have been foreseen and prevented", but that the "misguided" diagnosis stood in the way of him receiving potentially therapeutic drug and counselling regimens and meant that staff in the psychiatric ward did not take his distress seriously.
The MWC report states: "The Commission does not doubt that Mr QR's consultant believed that he was diagnosing Mr QR correctly. Furthermore, the Commission accepts that he had the best interest of Mr QR's wife as a focus of his attention. However, it seems the clinical focus of Mr QR's consultant was fixed in its perspective, to the exclusion of other more plausible diagnoses for Mr QR. This led to a firmly placed diagnosis of personality disorder and then factitious disorder which the Commission considered to have been misguided."
Mr QR had been happily married, had a successful career and many long-standing friendships, whereas patients with personality disorders struggle maintain personal relationships or hold down a job. He was described as "a spiritual person" who meditated daily and was well-known and respected in his local community.
However, the report reveals that while the psychiatrist now "regretted" the timing of Mr QR's discharge from hospital, he stands by his original diagnosis.
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On the morning Mr QR committed suicide he was picked up by police walking towards a bridge after leaving the hostel where he was staying. He was taken to the local psychiatric hospital where an on-call doctor - based on the diagnoses of factitious disorder and personality disorder in his medical records - judged that "there was no indication that admission would be of benefit" and discharged him. Two hours later Mr QR was struck and killed by a lorry.
Copies of the report have been sent to both the Crown Office - who can consider whether to pursue a Fatal Accident Inquiry - and to the General Medical Council (GMC), the body which enforces professional standards among medics.
Mike Diamond, executive director at MWCS, said MR QR was "not rigorously treated, and the manner of his discharge was completely unacceptable".
He added: "We question the diagnosis given to Mr QR, and we believe the diagnosis - of personality disorder and factitious disorder - affected the way in which Mr QR was treated. Every patient, no matter what their diagnosis, should be treated with dignity and respect and we do not believe that happened in this case."
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