Risk Assessment by Forensic Psychologist

seanrx

My brother suffers from severe depression and was abusing alcohol for many years. He is not violent and has no criminal record but was estranged from his family due to his own choice.

Having left work due to stress/depression/alcohol abuse, he went on illness benefit and talked to his GP about getting help. He was referred to HSE mental health services where he was initially assessed by a psychiatric nurse. The nurse referred him to a psychiatrist and addiction counsellor.

During a meeting with psychiatrist, my brother requested talking to a psychologist which the doctor agreed to and said in the mean time, he should continue talking to addiction counselor as there was a lengthy waiting list.

The addiction counsellor asked my brother if he would like one on one counselling and since my brother really needed to talk with someone, he agreed.

However, a week later, the psychiatrist sent him a letter stating that he would cancel referral to psychologist and instead, my brother would continue seeing addiction counselor.

My brother was deeply unhappy with this and told the doctor but the doctor didn't initially listen. The addiction counselor also feigned ignorance but apparently she was part of that decision to not refer for psychologist as they had weekly meetings about patients.

At the next meeting, my brother insisted on either psychologist or CBT and so the doctor again agreed to refer but that it would take 5-6 months.

In the mean time, my brother would continue to talk with addiction counselor believing that there was nothing else available due to waiting lists and shortage of staff.

5 months later, his appointment for what he believed would be CBT arrived but when he attended the day hospital, he met with another psychiatric nurse who said that he was not specialized in CBT but did use some CBT principles.

My brother was again upset because he believed he was going to see a proper CBT specialist after waiting 5 months. He complained about the addiction counselor as she had reassured him on several occasions that he would receive CBT at the day hospital.

In response to this, the nurse claimed the only reason he complained was because he had a problem with women and that he was paranoid with some borderline delusions. He asserted he was simply angry with HSE because of his poor treatment.

What happened over the proceeding months turned into a nightmare. The nurse had written down in her notes that my brother should not be left alone with a woman and as a result of this, he could not be referred for CBT or a psychologist now as the only male psychologist handled criminal cases. These statements made him feel terrible and his drinking became much worse.

He made a complaint with HSE consumer services who met and discussed his treatment, promising to have a investigation and report back their findings. Of course, after 6 weeks, they reported they could find nothing wrong with the treatment he received. They claimed it was his fault because he continued to see the counselor but they completely ignored the fact he was on a waiting list for CBT. They didn't explain or acknowledge any of the complaints he made regarding his treatment.

13 months after engaging with HSE, he was now worse than ever, absolutely gutted and suicidal from the poor treatment, he had too much to drink over the christmas holidays. In frustration and despair, he sent abusive messages to the psychiatric nurse on the internet. He deeply regrets what he did and has never done anything like this before.

He was subsequently arrested and interviewed for 6 hours by the gardai for harassment and expects to be prosecuted.

Since then, he was sent to a forensic psychologist who performed a risk assessment for violent and homicidal behaviours despite having no history of violence in his life. The psychologist also performed a clinical assessment since nobody in the HSE had performed one in the 18 months he was talking to them. The psychologist has stated that my brother needs treatment and that if he didn't get it, he was likely to reoffend.

What they refuse to acknowledge is the innumerable mistakes leading up to this incident.

Is is not unethical for the psychologist to be performing a clinical and forensic role simultaneously when my brother is under investigation for the harassment? Bear in mind the psychologist has stated anything said between them could be used by the prosecution in court. He has not been charged with anything yet but it appears the HSE are gathering evidence to use against him.

Are the HSE negligent here? Behaving unethically? Breaching any laws?

My brother would never hurt a soul but the HSE are attempting to portray him as a psychopath simply because he was upset at the poor treatment he received. It's not right what is happening to him and I am angry and upset too at how the HSE are treating him.

Any advice?

Little CuChulainn

Get a solicitor is all anyone can tell you here. At the very least he can give you the view of an outsider. You are most likely going off your brothers side alone. Have you considered that he may actually be lying about things to you?

seanrx

Little CuChulainn wrote: »

Get a solicitor is all anyone can tell you here. At the very least he can give you the view of an outsider. You are most likely going off your brothers side alone. Have you considered that he may actually be lying about things to you?

No, he isn't lying because we have correspondence from services and also the notes collected by the psychiatric nurse through FOI request who we feel was negligent.

Consumer services also didn't explain why he was referred for CBT and then didn't receive it. There were obvious mistakes made but the services are denying any wrong doing which seems common enough for any large organization.

It appears the psychiatric nurse was acting like a psychologist but it isn't clear if it's common practice to use psychiatric nurses for psychological assessments.

Something stinks here and it looks like they're trying to pin the blame entirely on my brother.

234

seanrx wrote: »

Something stinks here and it looks like they're trying to pin the blame entirely on my brother.

Blame for what? If you are talking about the harassment charge then this is naturally separate from his previous interaction with the HSE, much as it may take place against that background.

Zambia

seanrx wrote: »

No, he isn't lying because we have correspondence from services and also the notes collected by the psychiatric nurse through FOI request who we feel was negligent.

Consumer services also didn't explain why he was referred for CBT and then didn't receive it. There were obvious mistakes made but the services are denying any wrong doing which seems common enough for any large organization.

It appears the psychiatric nurse was acting like a psychologist but it isn't clear if it's common practice to use psychiatric nurses for psychological assessments.

Something stinks here and it looks like they're trying to pin the blame entirely on my brother.

The harassment charge would be based on his texts.

All the rest of the treatment history appears a civil matter.

Your brother needs a lawyer.

Little CuChulainn

seanrx wrote: »

No, he isn't lying because we have correspondence from services and also the notes collected by the psychiatric nurse through FOI request who we feel was negligent.

Consumer services also didn't explain why he was referred for CBT and then didn't receive it. There were obvious mistakes made but the services are denying any wrong doing which seems common enough for any large organization.

It appears the psychiatric nurse was acting like a psychologist but it isn't clear if it's common practice to use psychiatric nurses for psychological assessments.

Something stinks here and it looks like they're trying to pin the blame entirely on my brother.

I'm referring to what has occurred between him and the people treating him. For example, you claim they only labelled him a danger to women because he made a complaint against a nurse. But are you not merely basing this on what he has told you?

seanrx

Little CuChulainn wrote: »

I'm referring to what has occurred between him and the people treating him. For example, you claim they only labelled him a danger to women because he made a complaint against a nurse. But are you not merely basing this on what he has told you?

He has never assaulted or threatened a woman in his life and was engaged with this counselor for 6+ months before she made this statement. No woman has ever said anything like this before and since it was noted AFTER he made the complaints and on the day before she discharged him, it looks suspicious. As a result of the statement, he was unable to see any other female staff and ended up being sent to a forensic psychologist.

Seems more like a case of retaliation for complaining than anything else.

His treatment is absolutely disgraceful but the HSE remain defiant and obviously deny any misconduct occurred.

There is confirmation in notes of referral for CBT 5+ months prior to meeting with another nurse so they clearly did make some errors which they won't acknowledge or explain.

I wouldn't say my family are looking to take a civil case against the HSE but they do seem reluctant to accept responsibility for anything that goes wrong with patients. I think the recent reports by HIQA and the threat of legal action by HSE against them prove that.

Zambia

seanrx wrote: »

I wouldn't say my family are looking to take a civil case against the HSE but they do seem reluctant to accept responsibility for anything that goes wrong with patients. I think the recent reports by HIQA and the threat of legal action by HSE against them prove that.

Are you saying it's the HSE fault your brother sent those texts and harassed the staff member.

By the way how did he send her messages "on the Internet" ?

Little CuChulainn

seanrx wrote: »

He has never assaulted or threatened a woman in his life and was engaged with this counselor for 6+ months before she made this statement. No woman has ever said anything like this before and since it was noted AFTER he made the complaints and on the day before she discharged him, it looks suspicious. As a result of the statement, he was unable to see any other female staff and ended up being sent to a forensic psychologist.

Seems more like a case of retaliation for complaining than anything else.

His treatment is absolutely disgraceful but the HSE remain defiant and obviously deny any misconduct occurred.

There is confirmation in notes of referral for CBT 5+ months prior to meeting with another nurse so they clearly did make some errors which they won't acknowledge or explain.

I wouldn't say my family are looking to take a civil case against the HSE but they do seem reluctant to accept responsibility for anything that goes wrong with patients. I think the recent reports by HIQA and the threat of legal action by HSE against them prove that.

Are claims against the HSE not dealt with by the state claims agency?

Anyway, like I said, go to a solicitor. But don't be shocked if you get full disclosure from the HSE and it isn't what you expected. You are completely relying on your brothers account and accusing psychiatric healthcare workers of making stuff up about him rather than accept the more likely scenario that they were able to see a side of him you don't. You say he never had an issue with women yet he is facing a charge of harassment. You claim they failed him by not giving him proper care but you are ignoring the possibility that they, being experts on psychiatric care, may not have felt he needed the care he demanded.

You could be right, they may have messed up, but you could be very wrong too so you should be prepared for that.

seanrx

Zambia wrote: »

Are you saying it's the HSE fault your brother sent those texts and harassed the staff member.

No, he's guilty of the harassment and he did it because of the slanderous statements made by this nurse who has obviously been given more responsibilities than she's capable of undertaking.

He hasn't denied sending insulting messages but HSE are obviously guilty of negligence. What the HSE do best is avoid taking responsibility for mistakes, that's my problem with them. They would prefer to punish a man who simply asked for assistance over health problems than admit they made some errors. They are like children.

First of all, nurses are not psychologists so it's bizarre to me why when he requests a psychologist they send him to a nurse, maybe you can enlighten me on that one?

Second, if you're going to depend on nurses for psychological evaluations, perhaps the patient should be aware of that? Matter of fact, the public in general should be aware of such shoddy practices so that people know in advance they will be receiving poor health care.

I understand HSE are in a crisis right now with funding (because 70% is spent on wages) but they can't keep blaming patients for negligence.

A more constructive approach would be to ensure something like this doesn't occur again but HSE policy is to simply blame the patient and hope the problem goes away.

seanrx

Little CuChulainn wrote: »

Are claims against the HSE not dealt with by the state claims agency?

Anyway, like I said, go to a solicitor. But don't be shocked if you get full disclosure from the HSE and it isn't what you expected. You are completely relying on your brothers account and accusing psychiatric healthcare workers of making stuff up about him rather than accept the more likely scenario that they were able to see a side of him you don't. You say he never had an issue with women yet he is facing a charge of harassment. You claim they failed him by not giving him proper care but you are ignoring the possibility that they, being experts on psychiatric care, may not have felt he needed the care he demanded.

You could be right, they may have messed up, but you could be very wrong too so you should be prepared for that.

I wouldn't take the word of an incompetent nurse expected by the HSE to carry out psychological evaluations. I suppose we'll just have to wait and see what a jury says since it's likely to end up in a circuit court.

Zambia

seanrx wrote: »

No, he's guilty of the harassment and he did it because of the slanderous statements made by this nurse who has obviously been given more responsibilities than she's capable of undertaking.

He hasn't denied sending insulting messages but HSE are obviously guilty of negligence. What the HSE do best is avoid taking responsibility for mistakes, that's my problem with them. They would prefer to punish a man who simply asked for assistance over health problems than admit they made some errors. They are like children.

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So he is guilty and using provocation as a defence ( sort of) . Anyway he needs a criminal solicitor to answer questions on that defence.

Your omission to answer the Internet question is concerning.

The lack of funding in relation to mental health is a world wide issue. In relation to that you have my every sympathy.

seanrx

Zambia wrote: »

So he is guilty and using provocation as a defence ( sort of) . Anyway he needs a criminal solicitor to answer questions on that defence.

Your omission to answer the Internet question is concerning.

The lack of funding in relation to mental health is a world wide issue. In relation to that you have my every sympathy.

Well, not defending his actions but it probably wouldn't have happened if he had been sent to a professional psychologist instead of a nurse expected to perform psychological evaluations.

Little CuChulainn

seanrx wrote: »

Well, not defending his actions but it probably wouldn't have happened if he had been sent to a professional psychologist instead of a nurse expected to perform psychological evaluations.

You can't possibly know that.