LH aged 15 . (Li Harris)
Nairac Bertrand (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION
TRUST)
Sent: 12 July 2012 13:09
To: anathanson@tavi-port
Attachments:12.07.12 attachment to ana~1.doc (39 KB)
Dear Mr Nathanson
Tam grateful to your secretary-receptionist who helped me on the telephone this morning.
This is not (yet) a referral, but a notification. I understand from her that you are the
Consultant C&A Psychotherapist i in charge of co-ordination at the Portman, and I thought I
would pass the attached by you. It is self-explanatory, and of course confidential.
Yours sincerely
Dr BL Nairat MRCPsych
Consultant Psychiatrist
[12.07.12 attachment= the 11.07.12 09:00 email of Dr G & Dr Nairac’s
12.07.12 12:38 response — see below]
FW: Update
Nairac Bertrand (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION
TRUST)
Sent: 12 July 2012 12:51
To: Johnson Niall (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST)
Importance: High
From: Nairac Bertrand (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST)
Sent: 12 July 2012 12:38
RE: Update
Nairac Bertrand (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION
TRUST)
Sent: 12 July 2012 12:38
Jo: Garrett, Helen [Helen.Garrett@]
Cc: Bennett Wayne (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST);
* wayne. bennett@ Marlow, Elizabeth [Elizabeth.Marlow@]
Importance: High
Dear Dr Garrett
Re: LH
I shall not be able to attend the CPA this afternoon.
Issues to think about:-
As. above. (I.shall,not.be.able.to.attend. the,CPA this afternoon).
i have not been able to visit since the first CPA.
I have not spoken to Li since one telephone call soon after that visit.
On one level I had to put my foot down against LH trying to engage in
parallel discussions with me on the phone. The points at issue here are the
need which he has of evolving a clearer sense of the differences between the
concrete and the symbolic, and associated differences between feelings,
impulses and actions; and simple boundaries of time, place and person – a
confusion into which some staff, dare I say, got sucked.
On another level, ideally I would have liked to initiate some further contact in
order to concretise the fact that I do think (and indeed correspond about)
him, which he needs to know, for the sake of his dynamics of abandonment
and rejection. Equally, it would help the professionals to know (as far as
possible) whether this dynamic is anyway featured at the material times of
his repeated attempts to get me to speak to him on the telephone; or
whether his motive was that somehow I would rescue him from a restrictive
situation – in which case it was a case of him trying to use me rather than of
me being missed. )
LH is on a Full care Order to Kent Local Authority.
LH is currently of No Fixed Abode, since he will not be allowed back at the
foster carers because they also have an 11 year old other foster child (male)
and also because they have realised that it was their guilt that had kept them
from giving notice sooner than they did – not exactly (if in any way) the same
as LH’s needs (especially of boundaries to better contain his harmful
behaviours).
*Redacted by Author – False and Damaging Information”
LH has appealed against his detention under section 3 of the Mental Health
Act. LH apparently requires operations to repair self-inflicted damage “Redacted by author “The Thing””
I am on annual leave betwe’en Friday 20th July 2012 and back on
Wednesday 8th August 2012
My advice:-
It is obviously not appropriate to discharge LH unless he has another
roof over his head. As part of any placement choice, the Safeguarding/Criminal issues raised
above must surely be borne in mind. It would be for Police & SSD to inform
us of where they are at.
Regarding LH’s physical safety, it is necessary to be clear about the
surgical treatment plan following his recent surgical examination. I have not
seen any documentation from our surgical colleagues. I understand from Dr
Garrett that his injuries are apparently extensive and that he will require
several operations. I would like to receive copies of the surgical
correspondence.
On the basis that he has been injuring his“Redacted by author “The Thing”” for several
years during which he refused to talk about it and to be examined, the risks
of further self-harm+ future self-neglect are non-negligible, to say the
least.
Associated personal and other male YP psychological risks are a
major concern. I would consider the potential benefit to treatment
planning of a discussion with a Consultant at the Portman Clinic. This
is the only pro-active advice which I feel able to give – or repeat, as the case
might be. LH will be 16 at the end of November 2012. I am sure that the
Portman colleagues would understand the implications. It is necessary to face
the fact that LH has a chronic, perverse psycho-sexual disorder. This is not a
“simple matter” of “sexual orientation” and legitimate choice. LH’s auto-horno-
erotic (homo)sexuality has had, amongst its concrete objects, a younger boy,
whose Safeguarding requirements may not have been met, and have
remained out of my hands. LH has been identified with him (hence “auto-
_ homo-erotic”). LH has been an assiduous user of Blackberry etc. He was very
worried about losing this on admission. “It’s my life” he told me…
At the origin of all this there is a broken home with severe parental (and
sibling) dysfunctions on both sides, and contacts on the maternal side; none
of which is likely to assist in minimising the attachment insecurities, the hurt
and the effective loneliness and inevitable narcissism of this very damaged
adolescent.
Yours sincerely
Dr BL Nairac MRCPsych
Consultant Psychiatrist
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