Sent: 12 July 2012 12:38
RE: Update
Sent: 12 July 2012 12:38
To: Garrett, Helen [
Elizabeth [
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 Harris 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 in 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 – should not be shared publicly.

LH has appealed against his detention under section 3 of the Mental Health Act.

Redacted By Author – “The Thing”

I am on annual leave between 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.

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 Redacted – “The Thing” 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 psychosexual disorder. This is not a “simple matter” of “sexual orientation” and legitimate choice. LH’s auto-homo-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 Author Comment “Are they on about this?? Somebody I used to know. – A Story About Losing a Friend During My Mental Health Struggles. (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