risk – Investigative Psychiatry

We Need to do Something about Smoking and Mental Health

November 30, 2024November 9, 2024 by TheEditor

This article is brazenly one-sided because it is about an addictive killing substance sold legally. The author is unapologetically anti-smoking because tobacco is the only killing substance sold legally for …

Article 2 in Psychiatry – Savage and beyond

October 14, 2024October 14, 2024 by TheEditor

The Right to Life, enshrined in Article 2 of the European Convention on Human Rights (ECHR), holds profound implications for the care and treatment of individuals within mental health services. …

Decision-making in forensic psychiatry

November 13, 2024October 10, 2024 by TheEditor

Decision-making in forensic psychiatry is a multifaceted process that goes beyond mere discussion of facts. It involves a deliberate, analytical approach to weighing various factors and arriving at plans, outcomes …

The Barrett Inquiry

November 1, 2024October 3, 2024 by TheEditor

John Barrett, a 41-year-old man with a history of schizophrenia and violence, was conditionally discharged from a medium secure forensic psychiatric unit in October 2003 following his conviction for a …

What is forensic psychiatry?

November 14, 2024September 28, 2024 by TheEditor

Forensic psychiatry in the UK is a specialised branch of psychiatry that interfaces with the legal system. It focuses on the assessment and treatment of individuals with mental health disorders …

Core list of key standards and knowledge

October 25, 2024September 4, 2024 by TheEditor

Standards is a big issue in medical practice. Standards therefore apply in psychiatry as a medical discipline. Psychiatrists are medical doctors; *not psychologists. This article is an aggregate of the …

The Impact of Patient Dishonesty in Psychiatric Practice

August 29, 2024 by TheEditor

In psychiatric care, the issue of patient dishonesty presents a significant challenge for mental health professionals. Definition It is important to set the ground about what ‘lying’ means. Ekman’s definition …

Challenges of the Modern Psychiatric Consultation

September 2, 2024June 19, 2024 by TheEditor

For the last 30-plus years, UK psychiatry has operated on certain tried and tested models that have shaped the practice and delivery of mental health care. These models have provided …

Pain in psychiatric disorders

June 19, 2024June 16, 2024 by TheEditor

Understanding pain in psychiatric presentations is crucial due to the profound and multifaceted impact pain can have on mental health. Pain, whether acute or chronic, often serves as both a …

No new lessons here: Retired consultant killed by son who suffered with schizophrenia.

November 4, 2024June 2, 2024 by TheEditor

The case of Daniel Harrison, who was convicted of manslaughter by diminished responsibility after killing his father, Dr Nicholas Kim Harrison, highlights significant failings in mental health care management. The …

Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences