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SSRI Stories Summary: Chauffer TK has been married for 30 yrs to his 5th wife, Myrna. He has reported being depressed before; in 1990, when his son died, and again in 2008. In 2008 his GP prescribed him Fluoxetine and Diazepam for one month without following up. Myrna finds him difficult and controlling and is considering leaving him. Upset over this, and feeling mildly suicidal, he goes to his GP in Nov 2012, and in late November his GP prescribes Prozac (fluoxetine) again. On 10 December he is back, GP advises re: alcohol use and blood pressure. On 16 December he presents with active suicidal thoughts and plans. On Dec 17 he is admitted to a mental health service for older people, on 17 December 2012. Dec 24 2012 TK is discharged and transferred to the care of the South East Crisis Assessment and Treatment Team (CATT). On January 4 2013 spoke to him on the phone. On Jan 11 his son finds his parents dead at their home; TK has suffocated his wife and hanged himself. The BBC reports the murder-suicide but Prozac is not mentioned. Similarly, the independent review notes the medication without considering that it was a potential contributing factor.
16:32, 27 Aug 2014
Chauffeur Terence Kirby and his wife Myrna had been married for 30 years but lived apart for two as their marriage floundered.
A pensioner with a string of failed marriages killed his fifth wife then hanged himself because he couldn’t face another divorce, an inquest heard.
Chauffeur Terence Kirby, 70, and his wife Myrna, 57, had been married for 30 years but lived apart for two as their marriage floundered.
They were both found dead on January 11, 2013, when Mrs. Kirby’s son Frederick called at his stepdad’s home in Cheshunt, Herts.
She was in her nightclothes with a pillow over her face having been suffocated, while her husband was found hanging from the bungalow’s loft.
Happier Times: Terry Kirby killed his fifth wife Myrna and then took his own life, the inquest heard
Philippines-born Mrs Kirby had filed for divorce in December 2010 and moved out and her husband developed a drink problem and depression as he struggled to cope.
He was admitted to hospital in December 2012 but then released for Christmas and was visited by his wife who returned to stay with him.
An inquest heard she told her husband there was a chance she might take him back despite finding him ‘controlling’ and being scared of him.
Mr Kirby told healthcare workers ‘life would be perfect if the divorce was not going ahead’ but continued to drink and was plagued by insomnia.
Controlling Husband: Mrs Kirby was afraid of her husband, the court was told but had filed for divorce.
His wife, a carer and regular churchgoer, called social workers on Boxing Day when she resisted his demands for alcohol, which she had hidden.
The inquest heard Frederick last heard from his mother on January 7 and the coroner said it was possible they could have died around two days apart.
Tests found Mr Kirby had 75mgs of alcohol in his blood – just below the legal limit of 80mgs.
His children had questioned whether he should have been released from hospital and if there was enough contact from community workers.
But Edward Thomas, the coroner for Hertfordshire, said Mr. Kirby had gone to hospital voluntarily and not been detained under the Mental Health Act and his wife had agreed to move back in over the Christmas period.
Gruesome Disovery: Police officers arrive at the property of Mr and Mrs Kirby, Great Cambridge Road, Cheshunt, at the time of the murder suicide.
He told the inquest at Hatfield that the killing of Mrs. Kirby had been ‘an impulsive act’ and said the presence of two mugs in the kitchen suggested there had not been an argument.
He said: “She explained there had been ups and downs and he had been abusive and had called her names. But he was never physically violent toward her. He was controlling.
“Her injuries show she was for example smothered with a pillow or a duvet.”
“What is indicated is he didn’t want a divorce. Clearly the impact of the divorce affected him and so did being described as controlling.
“We’ll never know what actually happened on the day she died. His homicide and suicide was not predictable, there was no sign saying ‘get me out of here’.”
Mr Thomas ruled Mr Kirby’s death was a suicide while Mrs Kirby’s was an unlawful killing.
In a joint statement at the time of the couple’s deaths their children said: “Our parents always wanted the best for us and were incredibly dedicated and loving.”
The children all refused to comment after the inquest.
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An independent investigation into the care and treatment of a mental health service user (T) in Hertfordshire
Chronology created from excerpts extracted directly from different sections of the report:
4.18 A referral was made by T’s GP to a psychiatrist at Chase Farm Hospital in September 1989. M had asked the GP to visit as an emergency, and T was described as ‘agitated, rather incoherent and uncommunicative’ and talked of financial problems. This letter notes he has ‘no past psychiatric history’. The GP reported prescribing Diazepam13 5mg three times a day for three days. The notes do not record any response to the referral.
4.7 T…had been in a relationship with M since 1984, and they married in 1989. This was T’s fifth marriage. M came from the Philippines, and she and T had a son and a daughter. Their son lived nearby in Hatfield and they saw him regularly. Their daughter lives in Canada, and T had visited her in 2012.
4.19 In October 2008 T presented to his GP as ‘very very low’, he said he had a similar episode 18 years earlier when his son died. At the time no obvious triggers were identified though he reported not sleeping since his mother in law died a month before. He said he was not close to her though. At this consultation T reported that he had low moods on and off throughout his life, and masked this with smoking and drinking at times. He said his mother had similar episodes.
4.20 The GP prescribed Fluoxetine14 20mg and Diazepam 2 mg three times a day. The GP notes state for ‘review in two weeks’. There is no note of follow up by either the GP or T and only one months’ prescription of Fluoxetine and Diazepam was issued.
4.9 The notes record that M said their marriage had its ‘ups and downs’ and she had left T on previous occasions due to his behaviour. She had separated from him about two years earlier [late 2010/early 2011], and was living in her own flat. A year later she had instigated divorce proceedings, which were due to be completed a few weeks after November 2012, when his mental health deteriorated.
1.7 T had a self-reported history of depression dating back over several years, but had no contact with secondary mental health services until November 2012. His GP made an urgent referral on 27 November 2012 to mental health services at Hertfordshire Partnership NHS Foundation Trust (HPFT). T presented with suicidal thoughts and a plan to use a rope to hang himself.
4.22 On 27 November 2012 T attended his GP again, and an urgent referral was made to the Hertfordshire Partnership NHS Foundation Trust mental health service single point of access (SPA). T completed a Patient Health Questionnaire (PHQ-9)15 with a score of 25. This would indicate a severe depression. Question 9 on this scale is ‘Thoughts that you would be better off dead, or of hurting yourself in some way’ screens for the presence and duration of suicidal thoughts. T has scored ‘for several days’ on this question, all other answers are nearly every day, for example for Question 2 ‘feeling down, depressed, hopeless’. The results of the PHQ-9 were conveyed in the GPs referral letter, and he was described as having ‘marked depression’ and ‘suicidal thoughts’.
1.8 He was initially assessed on 5 December 2012 by a community psychiatric nurse (CPN) from the mental health services for older people. At this assessment the CPN recommended that he be seen by a psychiatrist at outpatient clinic, and be referred to psychology. At this time he had suicidal thoughts but no plan. The plan of care was not actioned. [NOTE: FROM THE DEC 17 note it is clear that fluoxetine, or Prozac) was prescribed at this visit. He had taken Prozac before, in 2008, for at least one month.]
1.9 T presented on 10 and 16 December 2012 to the emergency department at Chase Farm Hospital Enfield, intoxicated and complaining of chest pain. He was discharged to the care of his GP on 10 December with advice to monitor alcohol use and blood pressure. On 16 December he presented with active suicidal thoughts and plans, and a mental health assessment recommended informal admission.
(Report page 42-43) December 17, 2012 ENFIELD ACUTE ASSESSMENT CENTRE (MH) LAMBOURN GROVE (bolding added):
Chase farm A&E notes: 11.50: Assessment by Enfield Acute Assessment Centre – part of Barnet, Enfield and Haringey Mental Health Trust: Mental health assessment carried out by CPN, thought to be at risk of suicide therefore decision taken to admit to Lambourn Grove – referral to HPFT CATT for admission.
Chlordiazepoxide 40mg Admitted to Lambourn Grove as an informal service user accompanied by his wife. Presented as:
- Low in mood, no eye contact…
- Poor coping strategies and if wife leaves again then risk could again become high. Wife also disclosed to doctor (but did not want T to know): Separated from T for about a year and lives on income support , Has been staying with T over the past two weeks and helping him with food and washing due to mental illness, She was scared of him because of his shouting at her if she did not get him a drink, She has told him she will probably get back with him – she still loves him, Marriage had ups and downs and he was verbally abusive to her on occasions, Left him many times and one went to a refuge and also went to the police in 2007 because she was fearful for her life. Always went back to him because of children and because she loved him Never physically violent towards her but very controlling and forceful. Finally decided to leave him for good, got a flat and filed for divorce. T told her that second wife ‘put him in prison’ and wife said this is probably true as it is on his CRB form.
- Observations reduced to ten minutes, with plan to increase if necessary. Px Fluoxetine 20mg (started 2 weeks ago) Tamsulosin Diazepam alcohol withdrawal reducing regime Simvastatin Amlopidine Dispersible Aspirin Thiamine 19/12
1.10 T was admitted to Lambourn Grove, a mental health service for older people, on 17 December 2012, and went home on leave on 22 December 2012. He was transferred on 24 December 2012 to the care of the South East Crisis Assessment and Treatment Team (CATT), following discharge from the inpatient unit and a period of weekend leave. T had not returned for the planned review meeting and did not want to return to hospital.
1.11 CATT team contact was made by phone and home visits. T was seen on 5 occasions, and spoken to by phone on 3 occasions. There was more frequent contact by phone with M, who was staying with him.
1.12 T’s last contact was with a CATT community support worker by phone on 4 January 2013, when he declined a home visit. CATT staff made phone calls on 6, 7, 8 and 9 January; and a cold call to the house on 11 January 2013; none of these elicited a response.
1.13 A police welfare check was requested, and on 11 January 2013 Hertfordshire police attended the property. T & M’s son had already entered the property, and found his parents deceased.
1.14 Both were deceased. M was found in bed apparently suffocated, and T was found hanging from the loft hatch.