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SSRI Stories Summary: A young woman, Louise Giles, gets involved with NHS mental health services at the age of 18 because of self-harm tendencies. At that time, the report is clear that nobody noticed any thought disturbance, and she is diagnosed with borderline personality disorder. She is prescribed neuroleptics and venlafaxine (Effexor), and she starts to report hearing voices and to exhibit more serious self-hamring incidents and incidents that threaten others. In late October 2003 she is prescribed Seroxat (paroxetine, or Paxil) and Lorezepam. After that things deteriorate. In 2004 she is assessed with “unpredictable behaviour and [a] potential risk to others”. In late May 2004 she holds two mental health workers hostage with a knife. She reports symptoms consistent with delusions. On July 8, 2004, she stabs and kills another young woman outside a nightclub and is sent to prison. There, a diagnosis of paranoid schizophrenia is pronounced. She commits suicide. All the NHS workers insist she was sane because she never exhibited symptoms of a delusional state while in their care. Nobody considered the potential role of her medications as a causal factor in the onset of her self-reported delusions, and the attendant violence and suicide. The press reports that she was a paranoid schizophrenic and her medications are not mentioned.
Last Updated: Friday, 27 May, 2005, 13:43 GMT 14:43 UK
Louise Giles claimed to be a paranoid schizophrenic
A woman who stabbed a clubber to death with a kitchen knife has been sentenced to life in prison.
Louise Giles, 20, stabbed 23-year-old Helen Hay at least six times in the back and chest outside a Sheffield nightclub in July last year.
After the verdict Miss Hay’s parents called for laws against carrying knives to hold the same sentence as for carrying a gun.
A judge at Sheffield Crown Court said Giles should serve at least 14 years.
She had been given a community rehabilitation order for holding two mental health workers at knifepoint six weeks before the murder occured.
We would like the carrying of knives to be recognised as a lethal possession and hold the same sentence as carrying a gun
Helen Hay’s parents
The court heard Giles, of no fixed address, suffered from paranoid schizophrenia.
She had denied a charge of murder and her defence had said she heard voices in her head and could not control her actions.
Prosecutors had said she had a lesser personality disorder and knew what she was doing.
Judge Alan Goldsack QC said her offence had led to a dreadful waste of a young life and Giles had tried to evade responsibility for her actions.
Ms Hay, an assistant manager at Sheffield’s Powerleague football centre, was attacked outside Flares nightclub in Carver Street.
After the verdict her parents urged for laws to be changed.
In a statement they said: “We hope what has happened can be used as an example as to how cross words on a dance floor or a minor altercation could turn into a much more serious incident.
“In our circumstances it has led to Helen’s death.
“We would like the carrying of knives to be recognised as a lethal possession and hold the same sentence as carrying a gun.”
Helen always had a smile on her face and would unselfishly give her love to and personalilty to her family and friends, they added.
“We are glad justice has been done but as a family no sentence would justify the loss of Helen or ease our pain.”
Ms Hay had been out with friends from work when the incident happened and work colleagues said they could not comprehend how a lovely evening could have ended in a tragic way.
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Prison service ‘failed’ woman who killed herself — (The Independent)
By Nigel Morris, Home Affairs Correspondent
Friday 7 December 2007
The grim pattern to Louise Giles’s short life was set at the age of 13 when she took her first overdose. She tried to kill herself throughout her teens, both inside prison, where staff struggled to cope with her acute psychiatric problems, and in the outside world. Three months after being sent to Durham prison, she was found dead in her cell with a ligature around her neck. She was just 20.
Recording a verdict of accidental death on Giles, an inquest jury directed a string of devastating criticisms at the Durham regime.
In the week that ministers announced a massive expansion of prison capacity and delayed a decision on reforming women’s jails, the jury’s conclusions have raised fresh question-marks over whether too many people with severe mental health problems were being failed by the penal system.
No one involved in the Giles case she had been jailed for life after stabbing a woman to death in a nightclub brawl doubted that she needed to be locked up in the public interest.
But penal reformers argued last night that the prison authorities contributed to her early death by ignoring all the warnings about her history of paranoid schizophrenia and self-harm.
Between the ages of 13 and 19, Giles had taken 20 overdoses and attempted suicide or self-harm a further 40 times in New Hall prison, near Wakefield.
After her conviction for murder in May 2005 she was sent to the women’s unit at Durham, where she tried to harm herself 23 times in the three months before her death.
The inquest heard she was one of just six women held in high-security conditions on Durham’s I wing, which had been recommended for closure the previous year.
Julie Patterson, a cellmate, described her as a “young, blonde small girl who was quite bubbly and had a problem with serious self-harming”.
In a statement she complained that many prison officers were new and inexperienced and “sat around doing sudoku, crosswords and reading Take a Break”.
She also suggested that Giles may have been “pushed over the edge” by not having any tobacco or an officer slamming her cell door.
Another prisoner, Deborah Taylor, claimed staff used to taunt Giles and nicknamed her “smelly” because of her poor hygiene.
Her television and radio were taken away a week before she died, although these were considered a distraction from “voices” in her head telling to harm herself. The jury at Chester-le-Street, Co Durham, denounced conditions on the wing as unsuitable for such a highly disturbed inmate.
It protested that staff were not properly trained in mental mental health problems, and condemned the failure to act on warnings to close the wing.
The jury concluded: “We believe that on the nights leading up to and including the night of Louise’s death, she was not appropriately cared for. Signs of emotional distress were overlooked.”
Deborah Coles, co-director of the campaign group Inquest, said: “Louise Giles died as a direct result of the failure of Prison Service officials and ministers to act on the clear warnings that there was a real risk of suicide unless action was taken. Their complacency and inaction is a clear case of corporate manslaughter for which the Prison Service should be brought to account.
“Punishing women with severe mental problems by incarcerating them in such alienating conditions was cruel, inhuman and degrading treatment.”
The unit closed a month after Giles became the seventh woman in a three-year period to take her life on I-wing.
But the tragic toll continues elsewhere seven women prisoners have killed themselves so far this year.
Yorks and Humberside: Independent Investigation Report Reference SUI 2004/1964
To be presented to the NHS Yorkshire and the Humber Board 1 December 2006
(Page 4) EXECUTIVE SUMMARY
This report sets out the Investigation Team’s findings and recommendations
following its analysis of the care and management of Patient S3 (S3) between October 2002 and July 2004. S3 was convicted of murder on the 27th May 2005.
(Page 6) INTRODUCTION
On the 8th July 2004 S3 was involved in a disturbance outside a nightclub in Liverpool. During this disturbance she attacked another young woman who subsequently died of her injuries.
S3 had been in contact with mental health services since October 2002. The main precipitators for her contact with the service were acts of self-harm. Following a period of assessment her diagnosis was determined as Borderline Personality Disorder. At no time were there any convincing signs of delusion or psychosis.
(Page 7)… S3 was arrested for the imprisonment of two health workers on the 21 August 2003. She was detained on remand in Newhall Prison pending her court appearance in January 2004. This resulted in an interim hospital order under Section 38 of the Mental Health Act (1983) and S3’s admission to a private low secure facility in Liverpool. S3 was subsequently discharged from the hospital order on the 6th May 2004 and discharged to her Stepfather’s address on the 7th May 2005.
(Page 7)Between this time (May 7, 2005) and the date of the incident there was good effort made by her Care Coordinator (CC2) to make, and maintain, contact with her. The final contact was on the 7th July. During this time there were concerns about S3’s risk status, and all staff recognised that S3 may offend again and that she continued to pose a risk to herself and others by virtue of her unpredictability. However there was nothing that the mental healthcare professionals could have done that could have averted the events of the 8th July.
(Page 13) Between October 2002 and July 2003 both Consultant Psychiatrists who were involved with S3 made clear their expectations regarding her behaviour and the acceptable boundaries to this. Consultant C1 in particular is robust and consistent in her treatment of S3.
When it became clear that S3 hoarded her medications to fuel her over dose attempts the Mental Health Service advised her GP to stop prescribing medications. Furthermore the GP was advised that there is no clinical reason for S3 to be on Venaflaxine [sic] as the sleep and appetite disturbances she reports are more likely to be a bereavement response to the death of her boyfriend. Subsequent to this there is evidence to show responsible prescribing practice for S3 and appropriate response by her Care Coordinator in 2003 to concerns raised by the GP’s regarding her medication review.
During S3’s attendances at hospital following Deliberate Self Harm (DSH) attempts the clinical records show that all professionals who came into contact with S3 undertook detailed and careful assessments, including appropriate exploration of the voices and images S3 claimed to see and hear. On no occasion were any signs of psychosis identified. The Investigation Team found no evidence that S3’s assessments were compromised in any way by virtue of her diagnosis of Borderline Personality Disorder.
(Page 41) 23/10/03 – CC2 successfully liaises with Consultant Psychiatrist C2. Her advice is that S3 should not be prescribed Diazepam. Temazepam to be prescribed instead. Also in view of some features of depression S3 could have Seroxat and 1mg of Rispiridone. The consultant was to write to S3’s new GP.
(Page 14) In October 2003 S3’s new Care Coordinator (Care Coordinator 2) made a good effort to try and engage with S3. In-spite of the information provided to him about her history he agreed to support her in obtaining a medical re-examination for Psychosis and seemed to try and communicate to S3 that he was taking her reported experiences of voices and delusions seriously even though the likelihood of her actually experiencing these was unlikely. He also acknowledged to her, her distress. Throughout his contact with S3 this Care Coordinator showed diligence and sensitivity towards S3 responding appropriately to concerns raised by her and others and seeking appropriate advice from colleagues.
(Page 41) 27/10 – 3/11/03 – There is an escalation in S3’s anger about the lack of support being offered to her. The Care Coordinator’s notes evidence good efforts to try and find out what type of help S3 feels she needs. Her focus is on practical issues and she refuses to talk about anything personal. The impression is that S3 is confrontational. No progress is made. This episode culminates in S3 being arrested at a Night Club and subsequently re- arrested in A&E where she had been allowed to attend because of injuries sustained to her leg. Psychiatric assessment revealed that she was not thought to be suffering from thought disorder or psychosis. S3 currently prescribed Seroxat and Lorazepam.
(Page 15) On the 8th June 2004 Consultant Psychiatrist C1 wrote a very detailed report about S3 that was widely circulated including copies to S3’s Care Coordinator (CC2), S3’s GP, S3’s Probation Officer and the Court Liaison and Diversion Team. This report made explicit the risks associated with S3, in particular her unpredictable behaviour and her potential risk to others evidenced by this behaviour and the fact that she had held two health workers hostage while in possession of a weapon. Consultant C1 highlights her advice in bold that S3 is not to be seen at home but in a public place with appropriate security. Consultant C1 also states that S3 “is responsible and there is certainly no evidence from past history of her criminal offences that these were in any way conducted whilst she was either psychotic or in a dissociative state.” Consultant C1 goes on to emphasise this by saying that if S3 commits a serious offence “a custodial sentence should be considered albeit on the hospital wing”. The Investigation Team found the report to be of an excellent standard.
(Page 42) March 2004 – 06/05/04 – S3 is admitted to a Private Low Secure Facility in Liverpool under Section 38 of the Mental Health Act. The purpose of this admission was to enable a full assessment of S3.
Her end diagnosis was Borderline Personality and Schizophrenia. (The Investigation Team’s interview with her Consultant Psychiatrist at this hospital revealed that no signs and symptoms of Schizophrenia were identified during S3’s nine week admission. However he felt that he could not discount it as a diagnosis because another Forensic Consultant Psychiatrist had reported some evidence of this in his assessment of S3 in prison.
During the nine weeks S3 was an in-patient at this facility there were 10 reported incidents of self-harm ranging from head banging to the swallowing of a battery and insertion of a pen into her arm on the 6th May (2004), the date of her discharge from Section 38 of the Mental Health Act).
(Page 45) 01/07/04 – CMHT – Team Meeting. CC2 requested assistance/joint allocation from a female team member on the basis of S3’s request and Consultant Psychiatrist 1’s recommendation that S3 should be seen by two professionals. There was no female CPN with the capacity to provide the support required. S3’s previous Care Coordinator, SW1, therefore agreed to assist. A meeting was agreed with S3 for the 7th July.
07/07/04 – CC2 and S3’s previous Care Coordinator CC1 meet with S3 at the Limbrick Centre. This meeting lasted an hour and generated six pages of notes. Owing to the length of the meeting and the range of issues discussed with S3 they agreed to meet again on the 25th July. In the interim period SW1 and CC2 were to undertake the actions they had agreed.
The impressions of SW1 and CC2 at the end of the meeting were:
- Good engagement by S3 in the conversation.
- S3 not distracted by hallucinations or dissociation.
- S3 sometimes tearful and frustrated – especially when not wanting to accept Consultant Psychiatrist 2’s assessment
- No signs of overt anger, no direct aggression and no direct threatening comments or behaviour from S3.
08/07/04 – CC2 advised by CID that S3 had been arrested on suspicion of stabbing another girl in the early hours of the morning.