Safeguards for vulnerable questioned

Safeguards to protect some of society's most vulnerable people are "not fit for purpose", leading mental health experts have told the BBC.

Deprivation of Liberty Safeguards (DoLS) should give people deemed not to have mental capacity the right to challenge their detention by the state.

But a Mental Health Alliance report will say the arrangements are bureaucratic and wasteful.

The government has said it will look carefully at the report's findings.

The Deprivation of Liberty Safeguards (DoLS) were brought into English and Welsh law in April 2009 and apply to people over the age of 18 who are in care homes or hospitals.

Those institutions have to apply for an independent assessment of anybody in their care who lacks mental capacity and is thought to be at risk of harm if they are not deprived of their liberty.

The safeguards include giving those detained, or their families, the right to challenge the restrictions, first locally by means of a review, and ultimately in the Court of Protection.

Robust deprivation of liberty safeguards are an essential protection for vulnerable people”

End Quote Paul Burstow Care Minister But the report from the Mental Health Alliance, which represents a number of charities working in this field, will warn the scheme is "incredibly bureaucratic, wasteful, and the burdensome paperwork itself discourages many local authorities from using the legislation".

Speaking to BBC Radio 4's The Report, the author of the Mental Health Alliance study Roger Hargreaves warns of massive variation in the number of DoLS taken out by local councils across the country.

In the two years since they were introduced, West Sussex, for instance, made 206 authorisations whilst Hull made none.

Mr Hargreaves is calling for a radical rethink:

"If there are such variations, it raises questions about whether those safeguards are not being applied where the activity rates are very low, and alternatively [whether] they may be being overused in areas where they are very high."

'Complex issues'

The damning report follows controversial cases like that of Steven Neary, a 21-year-old autistic man who was kept in a care unit for a year against his and his father's wishes.

Over the course of 2010, Hillingdon Council issued a number of standard authorisations for a Deprivation of Liberty on Steven Neary, even though, importantly, there was a less restrictive option for his care available at home.

The legislation is not meant to be used as a power by a local authority to detain someone against their wishes when other options are available.

Instead, it is meant to authorise restrictions in someone's care plan that are both necessary and in that person's best interests.

Crucially, the legislation is meant to offer safeguards so that the person can challenge their situation.

In Steven Neary's case, a High Court judge ruled that Hillingdon had unlawfully deprived him of his liberty and had not followed the correct procedures.

In a statement, Hillingdon's director of social care, Linda Sanders, said: "Cases such as Steven's are hugely complex... As the judge said in his findings, at all times my staff were genuinely committed to ensuring that they did the right thing for Steven and had his best interests at heart.

"Before the court hearing, we recognised the need to improve our processes and had already made significant changes relevant to this case, including reviewing our training for those staff dealing with the complex issues relating to the Mental Capacity Act and Deprivation of Liberty Safeguards."

'Thoughtful analysis'

While the Court of Protection is very effective in dealing with the cases it hears, the Mental Health Alliance suggests it is unsuitable as the avenue for appeal, as it is too slow, very expensive and hearings mainly take place in London.

Mr Justice Charles, a senior judge at the Court of Protection, said there were plans to have more hearings in district courts.

But he conceded that the legislation was hard to understand.

"It's complicated. What is deprivation of liberty? [If] you ask three people, you probably get four answers," he said.

Care Minister Paul Burstow told the BBC that he would look very carefully at the Mental Health Alliance report to see what lessons could be learned.

"Robust deprivation of liberty safeguards are an essential protection for vulnerable people. The Mental Health Alliance has offered us a thoughtful analysis of the problems some have encountered with the DoLS regime," he said.

The minister added that he looked forward to seeing the group's proposals to improve the system.

Shakespeare 'could help doctors'

  Romeo and Juliet was one of Shakespeare's works that could help doctors, it was argued Reading William Shakespeare could give physicians a fresh insight into the links between emotion and illness, a retired doctor and scholar believes.

Dr Kenneth Heaton says many doctors fail to connect psychological problems with physical symptoms - and argues the playwright could help them do it.

He listed dozens of examples in which Shakespeare described these phenomena in his works.

"They could learn to be better doctors by studying Shakespeare," he said.

While traditional medical school training never strays far from the science of diagnosis and treatment, there has been growing interest in recent years in including courses on health-related art, history or literature as part of the curriculum.

Dr Heaton, from North Somerset, who studied Shakespeare after retiring from his post as a gastroenterologist, believes that a broader perspective could make it easier to understand the viewpoint and needs of a patient, particularly in general practice.

'Reluctance'

His latest research, published in the journal Medical Humanities, focuses on real symptoms such as dizziness, fatigue, fainting, and disturbed hearing, produced by underlying emotional distress, which can sometimes confuse doctors as they have no obvious physical cause.

The frequency of these psychological illnesses in Shakespeare should be a mark not only of his "body-conscious" approach, but also of their importance to doctors, he believes.

Notable examples include the fatigue suffered by Hamlet, grief-stricken for his murdered father, who complains of his "weary, stale, flat and unprofitable" existence, and the headache suffered by the cuckolded Othello.

In King Lear, when Gloucester is led to the point of attempting suicide, his son Edgar notes that his "senses grow imperfect" because of his anguish.

In Romeo and Juliet, feelings of both coldness and faintness are used to convey shock. In all Dr Heaton found at least 43 references to physical problems caused by psychological stress in Shakespeare's works - far more than in other authors of the same period.

He said that the reluctance of modern doctors to attribute physical symptoms to emotional disturbance could cause delayed diagnoses, and unnecessary tests and treatment.

"Shakespeare had an extraordinary insight into the psychology of human beings, extending to the emotional effects on the body.

"Some medical schools have more in the way of humanities teaching than others, but many doctors would be able to learn something from Shakespeare."

Dr Paul Lazarus, a senior clinical educator from the University of Leicester, is one of those advocating a broader curriculum at medical schools, possibly including subjects such as the history of medicine, its depiction in literature and art, and even the architecture of hospitals.

He said: "While it isn't for everyone, it can help make students more capable of being able to view problems from a wider range of perspectives."

Slow paracetamol overdose warning

 Taking slightly more than is recommended can cause significant damage over time Taking slightly too much paracetamol day after day can be fatal, experts have warned.

A dangerous dose might just be a few pills too many taken regularly over days, weeks or months, they said.

Researchers at Edinburgh University saw 161 cases of "staggered overdose" at its hospital over a 16-year period.

People taking tablets for chronic pain might not realise they were taking too many or recognise symptoms of overdose and liver injury, they said.

The researchers told the British Journal of Clinical Pharmacology that this life-threatening condition could be easily missed by doctors and patients.

Doctors may not initially spot the problem because blood tests will not show the staggeringly high levels of paracetamol seen with a conventional overdose, where someone may have swallowed several packets of the drug.

Patients who have taken a staggered overdose tend to fare worse than those who have taken a large overdose, the study suggests.

Dr Kenneth Simpson and colleagues looked at the medical records of 663 patients who had been referred with paracetamol-induced liver injury to the Scottish Liver Transplantation Unit at the university hospital.

The 161 who had taken a staggered overdose were more likely to develop liver and brain problems and need kidney dialysis or help with their breathing. They were also more likely to die of their complications.

Dr Simpson said: "They haven't taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal."

Professor Roger Knaggs of the Royal Pharmaceutical Society said patients should heed the warning.

Continue reading the main story Take paracetamol as directed on the packet or patient information leaflet that comes with the medicineEach tablet usually contains 500mgAdults can take 1-2 tablets of paracetamol 4-6 hourly, up to four times a day This means you should not take more than 8 tablets (4g) in a 24-hour periodIf you accidentally take an extra dose of paracetamol, you should miss out the next dose so that you do not take more than the recommended maximum dose for a 24-hour period. If you are concerned or you feel unwell, contact your GP or call NHS Direct on 0845 4647"If people experience pain and paracetamol doesn't help, rather than thinking a 'top up' dose may work, they should consult their pharmacist for alternative pain control or referral to someone who can help with the cause of the pain.

"The message is clear: if you take more paracetamol than is recommended, you won't improve your pain control but you may seriously damage your health.

"At this time of year people should also take care with combination cold and flu products which may have paracetamol as one of the ingredients. It's easy to take more than intended, so if in doubt consult your pharmacist."

Meanwhile, researchers at King's College London and Lund University in Sweden say they have discovered precisely how paracetamol works in the body. It is via a protein on nerve cells called TRPA1, says Nature Communications.

Now that they understand this principal mechanism, scientists can start to look for molecules that work in the same way to effectively relieve pain, but are less toxic and will not lead to serious complications following overdose.

Software shows patient biography

 Carers can access the information about the patient using a touchscreen A Dundee PhD student has developed a computer program that helps dementia sufferers communicate with their carer.

Dr Gemma Webster, 25, created software that holds a "multimedia biography" of the patient which carers can access through a touchscreeen.

The computing researcher said it would help busy care staff learn about the people they were looking after.

Research Councils UK has awarded Dr Webster £10,000 to help promote her "Portrait" project.

The software holds a digital timeline of key events in a patient's life, along with a family tree and other personal information.

Dr Webster, who completed her PhD at Dundee in September, said her software would act as a "communications bridge", enabling carers to learn about patients' lives in a relatively short time.

"Establishing some form of communication between carers and people with dementia can have vital implications for their health and well-being," she said.

"Learning about a person's past may help the care-giver by providing interesting and important information from which to stimulate discussion and communication.

"This information can be difficult to obtain through patient records or discussions with family especially when the health or medical situation often takes priority, and that's where Portrait comes in."

Dr Webster, who has just taken up a post-doctoral position at Lancaster University, hopes the Research Council's funding will lead to care and nursing homes using the Portrait software.