3. Ms L complains about care and treatment given to her while an inpatient at West London NHS Trust. She complains she was injected with medication against her will and she complains that staff accused her of medical fraud, and accused her of being violent.
4. Ms L tells us that this experience has left her traumatised and she has lost trust in the West London Mental Health NHS trust.
5. Ms L would like the Trust to listen to her concerns so that she is able to move on.
6. Ms L was admitted on 23 January 2020 under section 2 of the Mental Health Act following an assessment in the community as she had stopped taking her medication.
Medication against her will
10. Ms L complains that she was injected with medications against her will.
11. The Trust said Ms L was admitted on 23 January 2020 under Section 2 of the Mental Health Act following an assessment in the community. The SpeciLst Registrar prescribed Zuclopenthixol (an antipsychotic medication) tablets and requested Ms L was observed every 15 minutes.
12. The Trust said that Ms L disagreed with her detention and did not believe she needed to take medication. The Trust also said Ms L lacked insight into her condition and did not have capacity to make decisions regarding her medication. The Trust also notes that Ms L was refusing to take the oral medications.
13. The Trust said it felt it was necessary to start Zuclopenthixol Decanoate depot injection (an antipsychotic medication in the form of an injection). The Trust states it informed Ms L of the plan and she refused to discuss medication options. The Trust administered the dose at 1.50pm on 24 January 2020.
14. The records show Ms L was prescribed Zuclopenthixol tablets 10mg twice daily after an initial assessment, when she was admitted to the Trust.
15. The records also show the medical staff thought at the time Ms L’s likely diagnosis was paranoid schizophrenia.
16. NICE guidelines for the management of psychosis and schizophrenia therefore apply. These guidelines state ‘for people with an acute exacerbation or recurrence of psychosis or schizophrenia, offer oral antipsychotic medication or review existing medication’.
17. The British National Formulary (BNF) states Zuclopenthixol is a medication for use in the treatment of schizophrenia and other psychoses. The BNF also states that the starting dose should be 20-30mg daily in divided doses. The prescription given to Ms L, of 10mg twice a day, is in line with guidance.
18. The records show that Ms L was reviewed on the ward on 24 January 2020. This review notes that Ms L did not agree with her diagnosis. This review also notes the consultant discussed the initiation of the depot injection due to her refusal of the oral medication, and that Ms L lacked capacity to consent to treatment as she was not able to understand the nature, purpose or effects of the medication prescribed.
19. Our adviser has said that the records show a clear rationale and clinical justification for Ms L to be given antipsychotic treatment.
20. Ms L was detained under Section 2 of the Mental Health Act 1983. A person detained as such can be provided with compulsory treatment against their will and without consent, if they lack capacity to make a decision on treatment for their mental health.
21. The treatment given to Ms L, specifically, the antipsychotic in depot form, was in line with guidance.
22. We understand that being given medication you do not want, or believe you need would be very distressing for Ms L. We have not seen an indication of a failing in the actions of the Trust.
Staff Attitude
23. Ms L complains that the ward staff accused her of medical fraud, and also made her out to be a violent person.
24. The Trust said that it has contacted the staff who have said they did not accuse Ms L of being a fraud. The staff have said they attempted to reinforce the idea they did not believe Ms L to be a fraud or a criminal.
25. The Trust has said the incident Ms L has referred to where she felt she was being made out to be violent was a misunderstanding. It has said that the door to the MDT room did not have a closer, and the staff asked her to mind the door when entering the room for this reason. Ms L may have perceived this as an indication she was violent. The staff involved have apologised if this was how Ms L felt in this interaction.
26. The Trust has apologised for her experience during the care received and for any distress it caused. The Trust has also said the complaint will be shared with the team so that it can be learned from.
27. Our Complaint Standards state that organisations should actively listen and demonstrate a clear understanding of the main issues for the complainant and the outcomes sought. Our Complaint Standards also say an organisation should recognise the impact what happened had on a complainant and look to provide a remedy to address that impact. The Complaint Standards say this might include a meaningful apology and an acceptance of responsibility.
28. We consider the Trust’s apology to Ms L is sufficient to resolve this issue and in line with our complaint standards.
29. We understand that the concerns Ms L brought to us have caused her a great deal of stress and we thank her for raising her concerns with us.
1. We have carefully considered Ms L’s complaint about West London NHS Trust (the Trust). We have not seen an indication of a failing in the Trust administering medication. We consider the Trust’s apology to be sufficient to resolve the issue of the staff attitudes towards Ms L.
2. We are sorry to hear of the events in Ms L’s complaint and the distress this has caused her. We hope the information in this report helps to put her mind at rest.