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SSRI Stories summary: As a child, Philip Wayne’s mom drags him to a psychiatrist because she has divorced and the 9-yr-old boy is acting up. When he is 19 he is sent back again. He has a job but low mood and poor appetite. His GP gives him an unspecified antidepressant. Several months later, in Fed 2004, he is back, complaining of feeling threatened and frightened, and believing that his face is distorted. Instead of stopping the antidepressant, the doctor prescribes atypical antipsychotic medication. This makes things dramatically worse and he is diagnosed with psychotic illness, probably schizophrenia. NHS mental health services recommends continuing the medication and his dose is increased to the maximum allowable. A suicide attempt follows.
At some point after this Philip stops taking his neuroleptic (so-called “anti-psychotic“) medication and by September his “psychotic symptoms had significantly lessened, despite not taking antipsychotic medication”. Of course nobody considered the obvious possibility that he was much better again BECAUSE he had stopped the medication, even though his problems worsened significantly when he started it. He complained of low mood and was again prescribed an unnamed antidepressant. Over the next 2 months his behaviour worsened and reportedly caused serious concern to his mother and stepfather. He went missing, took the car without permission, was rude and unpredictible. His parents wanted to have him committed to a psych facility which did not happen. Clearly they believed he was becoming seriously worse, but did not think it was an emergency. They got an appointment for Nov 25 to have him seen. On Nov 23 he stabbed his mother to death. The news articles do mot mention medication and refer to Philip as a paranoid schizophrenic.
By Richard Alleyne
12:01AM BST 24 May 2005
Philip Wayne:‘I felt absolutely nothing’
A mentally ill man stabbed his mother to death just hours after she and her husband begged doctors to take him into care.
Maxine Penfold, 49, and her husband Stuart, 58, repeatedly pleaded with psychiatrists to section her 20-year-old son Philip Wayne, a paranoid schizophrenic, because he was becoming increasingly irrational and violent.
Yesterday, Mr Penfold blamed mental health services for failing to stop an “absolutely preventable tragedy” after his stepson pleaded guilty to manslaughter on the grounds of diminished responsibility.
He said: “Maxine and I both struggled as hard as we could to get someone to do something about Philip, especially his mother.
“I feel totally let down. Maxine was doing her utmost to help Philip. This was a preventable tragedy.”
Wayne had become increasingly unstable in the 18 months before the killing and was under the care of the psychiatric service after an overdose in April last year, Exeter Crown Court was told. Sarah Munro, QC, prosecuting, said three psychiatrists agreed that he was suffering from paranoid schizophrenia.
His relationship with his family deteriorated in the eight months before the killing. “His mother and stepfather were regularly informing the medical profession that the defendant was severely mentally ill,” said Miss Munro. “The response was to prescribe yet stronger tablets.”
In November last year Wayne took his mother’s car to Cumbria, where he was arrested and bailed by the police, returning home on
Nov 20. “In those three days he was rude to his family, particularly his mother,” said the prosecutor.
On Nov 21 Mr Penfold called a GP asking if Wayne could be sectioned to be detained under the Mental Health Act. He was told not unless he was a danger to himself or others, said Miss Munro.
She said Philip stabbed his mother from the back, headbutted her and then stabbed her nine more times, eventually cutting her throat. Her body was found by neighbours when she failed to turn up for her job as a financial consultant in Exeter. Miss Munro said Wayne told police: “I felt absolutely nothing. It was like a dead dog. She was just something to be killed.”
The college drop-out was ordered to be detained indefinitely at a mental hospital by Judge Graham Cottle, who described the incident as a “tragic act”.
After the case, Mr Penfold, who works for the Department of Work and Pensions, said: “Philip was a loner who did not want help. He was allocated a psychiatrist but in my view, and Maxine’s view, he was not seen often enough and not monitored properly. They gave him drugs but each time he stopped taking them they just gave him stronger pills. We were never told he was a paranoid schizophrenic although we had both guessed it.
“He was never taken into a mental hospital although we tried on at least six occasions to get more help for him. We could see his moods were changing but no one would listen. I was told they could not section him because there was no actual physical violence.
“I do not totally blame Philip for what happened. I believe the mental health service must take a lot of the blame. Maxine was a lovely woman… I felt increasingly sorry for her because she was getting more and more depressed about not being able to help Philip.”
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REPORT OF THE INQUIRY INTO THE CARE AND TREATMENT OF A PATIENT KNOWN AS J
Commissioned by: The South West Peninsula Strategic Health Authority
(Page 7) Brief biography and family background
March 1984: J was born in the South East. A move to Wales followed not long after his birth. When he was aged three, the family moved to Devon. At the age of five his parents separated. He has a younger sister and stepsiblings.
There is no evidence or family history of mental illness, criminality, or drug or alcohol abuse.
Summary of events
17th August 1993, J aged nine: At the request of his mother, J’s GP (who was also a family friend) referred him to a child and family clinic. His mother was concerned that two years after her divorce, discipline and behaviour were becoming a problem. An appointment was offered in November 1993, but by the time of the appointment J’s mother believed that matters had improved, and cancelled the arrangement.
August 1994, J aged ten: J’s mother contacted the child and family clinic directly, stating that J was being defiant with both families, and was presenting with discipline and behavioural problems. Ongoing appointments were offered and arrangements made to see a child and adolescent psychiatrist. Appointments then took place on a regular basis, and it was observed that J was reluctant to separate from his mother and would not be seen alone. Nevertheless, the child and adolescent psychiatrist recorded that the meetings were useful, and J’s mother stated that the home and school situation had much improved.
February 2000, J aged 15: A community psychiactric nurse (CPN) specialising in child and adolescent mental health saw J. After attending, accompanied by his mother, J failed to follow up on further appointments and, despite great efforts on his part, the CPN was not able to engage any further with J. J’s mother subsequently contacted the service stating that J no longer needed or desired further contact.
(Page 8) August 2003, J aged 19: J was referred by his GP to the adult community mental health team (CMHT) following a discussion with his mother. He complained of a lack of interest, poor appetite, low mood and poor sleep pattern. By now he was employed at a local store but was off sick from work. The GP felt that J might have been unwell for many years. There is a record of intrusive and recurring thoughts, and visual hallucinations at night. J was prescribed an anti-depressant, but failed to attend for his appointment with the CMHT.
February 2004, J aged 19: J was referred for a second time by his GP to the CMHT. This followed an emergency home visit at night by the GP. It is recorded that J was feeling threatened and frightened, believed his face to be distorted, and was seeing things in front of his eyes. J stated that this had been happening for about three weeks and was getting worse. There followed a discussion between the GP and the duty psychiatrist, who recommended treatment with an atypical antipsychotic medication.
12th February 2004: J had an outpatient appointment to see the senior house officer (SHO). J did not attend this appointment but his mother did, and she was able to give *SHO1 a detailed account of J’s medical and personal history, and of her concerns regarding his increasingly ‘strange’ behaviour during the previous twelve months.
A probable diagnosis of psychotic illness was made and explained to J’s mother. It was recommended that he continue with the medication.
24th March 2004: J was seen again by SHO1. Auditory hallucinations had reduced, particularly over the previous week. However, he continued to experience visual hallucinations, had poor concentration and felt detached and remote. He reported that he was not thinking of suicide. Possible diagnoses were considered, the most likely being schizophrenia. An electroencephalogram (EEG) was organised to eliminate an organic basis for his symptoms. A further outpatient appointment was offered for two to three weeks’ time, and his medication was increased to the maximum dose according to British National Formulary3 (BNF) guidelines.
27th March 2004: Just after midnight J took an overdose of prescribed medication and alcohol, and his mother found him the following morning. She called for an ambulance, and he was taken to the local acute hospital (LAH), and admitted…
(Page 11) 18th August 2004: J was seen in the psychiatric outpatient clinic by the consultant psychiatrist. Psychotic symptoms were much less in evidence, despite him not having taken antipsychotic medication for some time, by his choice. Depressive symptoms were noted, and an antidepressant prescribed.
5th September 2004: J’s mother telephoned the consultant psychiatrist’s secretary expressing her concerns about side effects to J’s medication, namely, being ‘spaced out and giggling’. The consultant arranged an urgent appointment for J with his senior house officer (*SHO2), with instructions to look for specific side effects and depressive features.
8th September 2004: J was seen in the outpatient clinic by SHO2. J reported that his sleep and appetite had improved. He complained of periodic low moods, but this was considerably improved following the taking of antidepressant medication.
Psychotic symptoms had significantly lessened, despite not taking antipsychotic medication, although he described episodes when he felt ‘spaced out’. It was recommended that he continue with the antidepressant at the current dose and with no increase. A further outpatient appointment was made for October 2004. J and his mother were told to make contact with the consultant’s secretary if they had any further questions, or wanted an earlier appointment.
21st October 2004: J did not attend his outpatient appointment. Another appointment with the consultant psychiatrist was offered for 5th November 2004. 4th November 2004: J went absent from home for several days, taking his mother’s car without her consent and driving to Cumbria, where the police apprehended him. He then returned to Devon, staying in motels and guesthouses,before returning home over the weekend.
The second SHO to see J 5th November 2004: J’s mother informed the consultant psychiatrist at the outpatient clinic that he had absconded with her car. The outpatient clinic offered J another appointment on 17th November 2004.
17th November 2004: J did not attend the outpatient appointment with SHO2.
22nd November 2004: At 13:10 the team manager of the CMHT received a telephone call from J’s GP. The GP had received a telephone call at home the previous evening from J’s mother and stepfather, expressing concern at his behaviour. J’s mother and stepfather had not conveyed any great sense of urgency, or of aggressive or threatening behaviour, during their conversation with the GP. The GP requested that the CC telephone the mother to offer support.
At approximately 13:15, following a call to the team leader, the CC rang J’s mother. The situation was discussed and the CC asked J’s mother about his mental state. An immediate appointment was offered for that afternoon, which J’s mother declined, as she did not consider the situation was an emergency and it was not convenient for her or J. She was offered appointments for the 23rd, 24th and 25th November. J’s mother opted for the appointment on the 25th, agreeing to try to get J to attend as well.
23rd November 2004: During the early morning J stabbed his mother at the family home, which resulted in her death.